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Sample records for england cohort study

  1. Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study

    NARCIS (Netherlands)

    Jaarsveld, C.H.M. van; Gulliford, M.C.

    2015-01-01

    OBJECTIVE: This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. DESIGN: Cohort study of primary care electronic health records. SETTING: 375 general

  2. Explaining the excess mortality in Scotland compared with England: pooling of 18 cohort studies.

    Science.gov (United States)

    McCartney, Gerry; Russ, Tom C; Walsh, David; Lewsey, Jim; Smith, Michael; Smith, George Davey; Stamatakis, Emmanuel; Batty, G David

    2015-01-01

    Mortality in Scotland is higher than in the rest of west and central Europe and is improving more slowly. Relative to England and Wales, the excess is only partially explained by area deprivation. We tested the extent to which sociodemographic, behavioural, anthropometric and biological factors explain the higher mortality in Scotland compared with England. Pooled data from 18 nationally representative cohort studies comprising the Health Surveys for England (HSE) and the Scottish Health Survey (SHS). Cox regression analysis was used to quantify the excess mortality risk in Scotland relative to England with adjustment for baseline characteristics. A total of 193,873 participants with a mean of 9.6 years follow-up gave rise to 21,345 deaths. The age-adjusted and sex-adjusted all-cause mortality HR for Scottish respondents compared with English respondents was 1.40 (95% CI 1.34 to 1.47), which attenuated to 1.29 (95% CI 1.23 to 1.36) with the addition of the baseline socioeconomic and behavioural characteristics. Cause-specific mortality HRs attenuated only marginally to 1.43 (95% 1.28 to 1.60) for ischaemic heart disease, 1.37 (95% CI 1.15 to 1.63) for stroke, 1.41 (95% CI 1.30 to 1.53) for all cancers, 3.43 (95% CI 1.85 to 6.36) for illicit drug-related poisoning and 4.64 (95% CI 3.55 to 6.05) for alcohol-related mortality. The excess was greatest among young adults (16-44 years) and was observed across all occupational social classes with the greatest excess in the unskilled group. Only a quarter of the excess mortality among Scottish respondents could be explained by the available baseline risk factors. Greater understanding is required on the lived experience of poverty, the role of social support, and the historical, environmental, cultural and political influences on health in Scotland. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Why do males in Scotland die younger than those in England? Evidence from three prospective cohort studies.

    Directory of Open Access Journals (Sweden)

    Gerry McCartney

    Full Text Available BACKGROUND: To examine explanations for the higher rates of male mortality in two Scottish cohorts compared with a cohort in south-east England for which similar data were collected. METHODOLOGY/PRINCIPAL FINDINGS: We compared three cohort studies which recruited participants in the late 1960s and early 1970s. A total of 13,884 men aged 45-64 years at recruitment in the Whitehall occupational cohort (south-east England, 3,956 men in the Collaborative occupational cohort and 6,813 men in the Renfrew & Paisley population-based study (both central Scotland were included in analyses of all-cause and cause-specific mortality. All-cause mortality was 25% (age-adjusted hazard ratio 1.25, 95% confidence interval (CI1.21 to 1.30 and 41% (hazard ratio 1.41 (95% CI 1.36 to 1.45 higher in the Collaborative and Renfrew & Paisley cohorts respectively compared to the Whitehall cohort. The higher mortality rates were substantially attenuated by social class (to 8% and 17% higher respectively, and were effectively eliminated upon the further addition of the other baseline risk factors, such as smoking habit, lung function and pre-existing self-reported morbidity. Despite this, coronary heart disease mortality remained 11% and 16% higher, stroke mortality 45% and 37% higher, mortality from accidents and suicide 51% and 70% higher, and alcohol-related mortality 46% and 73% higher in the Collaborative and Renfrew & Paisley cohorts respectively compared with the Whitehall cohort in the fully adjusted model. CONCLUSIONS/SIGNIFICANCE: The higher all-cause, respiratory, and lung cancer male mortality in the Scottish cohorts was almost entirely explained by social class differences and higher prevalence of known risk factors, but reasons for the excess mortality from stroke, alcohol-related causes, accidents and suicide remained unknown.

  4. Malignancy in scleroderma patients from south west England: a population-based cohort study.

    LENUS (Irish Health Repository)

    Siau, Keith

    2010-01-08

    The pathophysiological relationship between scleroderma and malignancy remains poorly understood. Although some previous studies have demonstrated an increased malignancy risk in patients with scleroderma, others have been inconclusive. We aimed to determine if patients with scleroderma had an increased risk of malignancy compared to an age- and sex-matched local South West England population, and if there were any important differences between scleroderma patients with and without malignancy. Methods of this study are as follows. Notes were obtained on all local scleroderma patients (n = 68) locally, and those diagnosed with malignancy verified by contacting each patient\\'s general practitioner. Expected malignancy figures were obtained from age- and sex-stratified regional prevalence data provided by the South West Cancer Intelligence Service registry. Among the patients, 22.1% with scleroderma were identified with concurrent malignancy. Affected sites were of the breast (n = 5), haematological system (n = 5), skin (n = 4), and unknown primary (n = 1). Overall, malignancy risk was found to be increased in scleroderma (RR = 3.15, 95% CI 1.77-5.20, p = 0.01). In particular, this risk was the highest for haematological malignancies (RR = 18.5, 95% CI 6-43, p = 0.03), especially for non-Hodgkin\\'s lymphoma (RR = 25.8, 95% CI 5-75, p = 0.10). The majority of patients (86.7%) developed malignancy after the onset of scleroderma (mean = 6.9 years). Age of >70 and patients with limited scleroderma were significant risk factors for a patient with scleroderma to have a concurrent malignancy; however, no increased risk was found in patients with any particular pattern of organ involvement, cytotoxic usage or serology. To conclude, in this small patient cohort, we have found that scleroderma is associated with an increased risk of malignancy. This risk is statistically significant in patients with limited scleroderma. Patients who are elderly and those with limited disease

  5. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study.

    OpenAIRE

    Murray, J.; Bottle, A.; Sharland, M; Modi, N; Aylin, P; Majeed, A; Saxena, S.; Medicines for Neonates Investigator Group,

    2014-01-01

    OBJECTIVE: To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission.\\ud \\ud DESIGN: A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database. SETTING: 71 hospitals across England.\\ud \\ud PARTICIPANTS: We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first...

  6. Risk Factors for Hospital Admission with RSV Bronchiolitis in England: A Population-Based Birth Cohort Study

    OpenAIRE

    Joanna Murray; Alex Bottle; Mike Sharland; Neena Modi; Paul Aylin; Azeem Majeed; Sonia Saxena

    2014-01-01

    OBJECTIVE: To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission. DESIGN: A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database. SETTING: 71 hospitals across England. PARTICIPANTS: We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life....

  7. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    NARCIS (Netherlands)

    Brocklehurst, P.; Kwee, A.; Birthplace in England Collaborative Group

    2011-01-01

    Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home,

  8. Specialist treatment of chronic fatigue syndrome/ME: a cohort study among adult patients in England.

    Science.gov (United States)

    Collin, Simon M; Crawley, Esther

    2017-07-14

    NHS specialist chronic fatigue syndrome (CFS/ME) services in England treat approximately 8000 adult patients each year. Variation in therapy programmes and treatment outcomes across services has not been described. We described treatments provided by 11 CFS/ME specialist services and we measured changes in patient-reported fatigue (Chalder, Checklist Individual Strength), function (SF-36 physical subscale, Work & Social Adjustment Scale), anxiety and depression (Hospital Anxiety & Depression Scale), pain (visual analogue rating), sleep (Epworth, Jenkins), and overall health (Clinical Global Impression) 1 year after the start of treatment, plus questions about impact of CFS/ME on employment, education/training and domestic tasks/unpaid work. A subset of these outcome measures was collected from former patients 2-5 years after assessment at 7 of the 11 specialist services. Baseline data at clinical assessment were available for 952 patients, of whom 440 (46.2%) provided 1-year follow-up data. Treatment data were available for 435/440 (98.9%) of these patients, of whom 175 (40.2%) had been discharged at time of follow-up. Therapy programmes varied substantially in mode of delivery (individual or group) and number of sessions. Overall change in health 1 year after first attending specialist services was 'very much' or 'much better' for 27.5% (115/418) of patients, 'a little better' for 36.6% (153/418), 'no change' for 15.8% (66/418), 'a little worse' for 12.2% (51/418), and 'worse' or 'very much worse' for 7.9% (33/418). Among former patients who provided 2- to 5-year follow-up (30.4% (385/1265)), these proportions were 30.4% (117/385), 27.5% (106/385), 11.4% (44/385), 13.5% (52/385), and 17.1% (66/385), respectively. 85.4% (327/383) of former patients responded "Yes" to "Do you think that you are still suffering from CFS/ME?" 8.9% (34/383) were "Uncertain", and 5.7% (22/383) responded "No". This multi-centre NHS study has shown that, although one third of patients

  9. Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study.

    Science.gov (United States)

    Wilcox, M Elizabeth; Harrison, David A; Short, Alasdair; Jonas, Max; Rowan, Kathryn M

    2014-08-14

    Research has demonstrated that intensivist-led care of the critically ill is associated with reduced intensive care unit (ICU) and hospital mortality. The objective of this study was to evaluate whether a relation exists between intensivist cover pattern (for example, number of days of continuous cover) and patient outcomes among adult general ICUs in England. We conducted a retrospective cohort study by using data from a pooled case mix and outcome database of adult general critical care units participating in the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. Consecutive admissions to participating units for the years 2010 to 2011 were linked to a survey of intensivist cover practices. Our primary outcome of interest was mortality at ultimate discharge from acute-care hospital. The analysis included 80,122 patients admitted to 130 ICUs in 128 hospitals. Multivariable logistic regression analysis was used to assess the relation between intensivist cover patterns (days of continuous cover, grade of physician staffing at nighttime, and frequency of daily handovers) and acute hospital mortality, adjusting for patient case mix. No relation was seen between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and acute hospital mortality. Acute hospital mortality and ICU length of stay were not associated with intensivist characteristics, intensivist full-time equivalents per bed, or years of clinical experience. Intensivist participation in handover was associated with increased mortality (odds ratio, 1.27; 95% confidence interval, 1.04 to 1.55); however, only nine units reported no intensivist participation. We found no relation between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and patient outcomes in adult, general ICUs in England. Intensivist participation in handover was associated with increased mortality; further research to confirm or refute

  10. Nationwide bowel cancer screening programme in England: cohort study of lifestyle factors affecting participation and outcomes in women.

    Science.gov (United States)

    Blanks, R G; Benson, V S; Alison, R; Brown, A; Reeves, G K; Beral, V; Patnick, J; Green, J

    2015-04-28

    In 2006, the National Health Service Bowel Cancer Screening Programme in England (NHSBCSP) began offering routine population-based biennial faecal occult blood testing (FOBt) at ages 60-69. There is, however, limited information on how characteristics of individuals affect participation and outcomes of screening, and we studied this association by linking NHSBCSP data to a large prospective cohort of women. Electronic linkage of the NHSBCSP and Million Women Study records identified 899 166 women in the study cohort with at least one invitation for screening. NHSBCSP provided information on screening acceptance, FOBt results, screen-detected colorectal cancer and other outcomes. The Million Women Study provided prospectively collected information on personal and lifestyle factors. Multiple regression was used to estimate relative risks (RRs) of factors associated with acceptance and outcomes of screening. Overall, 70% of women (628 976/899 166) accepted their first invitation for bowel cancer screening, of whom 9133 (1.5%) were FOBt-positive, 743 (0.1%) had screen-detected colorectal cancer and 3056 (0.5%) had screen-detected colorectal adenoma. Acceptance was lower in women from the most than the least deprived tertile, in South Asians and in Blacks than in Whites, in current than in never smokers and in obese than in normal weight women: adjusted RRs (95% confidence interval) for acceptance vs not, 0.90 (0.90-0.90); 0.77 (0.75-79); 0.94 (0.92-0.96); 0.78 (0.77-0.78); and 0.88 (0.88-0.89), respectively: Plifestyle factors strongly affect participation in routine bowel cancer screening, risk of being FOBt-positive and risk of having screen-detected colorectal adenoma. However, screen-detected colorectal cancer risk is not strongly related to these factors.

  11. Safety of Atrovent(®) CFC-free inhaler: respiratory events reported from an observational cohort study in England.

    Science.gov (United States)

    Osborne, Vicki; Layton, Deborah; Fogg, Carole; Tong, Edward; Shakir, Saad A W

    2017-10-09

    The aim of the study was to identify any unexpected clinical events associated with starting the new CFC-free formulation of Atrovent(®) MDI in general practice in England. An active surveillance cohort study was conducted with a focus on selected clinical events, including respiratory symptoms, in past users of Atrovent(®) CFC MDI ('switchers') and Atrovent(®) naïve users. Incidence density rate ratios (with 99% confidence intervals) for events occurring in the first 3 months of exposure (risk period-ID1-3 ) compared to 3 months prior to starting treatment (reference period-IDR ) were calculated. The cohort consisted of 13 211 patients (median age 70 years, 50.1% female; 63.5% prior users of Atrovent(®) CFC MDI ('switchers')). Common respiratory events occurred at higher rates after starting treatment than before for switchers, for example lower respiratory tract infection (LRTI) [ID1 /IDR = 1.45 (99% CI: 1.17, 1.81)] and worsening asthma [ID1 /IDR = 1.58 (99% CI: 1.00, 2.51)]. Of these events only LRTI was significant for Atrovent(®) naïve patients [ID1 /IDR = 1.42 (99% CI: 1.04, 1.95)]. The results of this study suggest effect modification of risk as a result of prior Atrovent(®) CFC MDI use. Overall, Atrovent(®) CFC-free MDI appeared to be reasonably well tolerated in the immediate postmarketing period and the safety profile appeared similar to that of the CFC formulation. © 2017 Royal Pharmaceutical Society.

  12. Does public transport use prevent declines in walking speed among older adults living in England? A prospective cohort study.

    Science.gov (United States)

    Rouxel, Patrick; Webb, Elizabeth; Chandola, Tarani

    2017-09-28

    Although there is some evidence that public transport use confers public health benefits, the evidence is limited by cross-sectional study designs and health-related confounding factors. This study examines the effect of public transport use on changes in walking speed among older adults living in England, comparing frequent users of public transport to their peers who did not use public transport because of structural barriers (poor public transport infrastructure) or through choice. Prospective cohort study. England, UK. Older adults aged ≥60 years eligible for the walking speed test. 6246 individuals at wave 2 (2004-2005); 5909 individuals at wave 3 (2006-2007); 7321 individuals at wave 4 (2008-2009); 7535 individuals at wave 5 (2010-2011) and 7664 individuals at wave 6 (2012-2013) of the English Longitudinal Study of Ageing. The walking speed was estimated from the time taken to walk 2.4 m. Fixed effects models and growth curve models were used to examine the associations between public transport use and walking speed. Older adults who did not use public transport through choice or because of structural reasons had slower walking speeds (-0.02 m/s (95% CI -0.03 to -0.003) and -0.02 m/s (95% CI -0.03 to -0.01), respectively) and took an extra 0.07 s to walk 2.4 m compared with their peers who used public transport frequently. The age-related trajectories of decline in walking speed were slower for frequent users of public transport compared with non-users. Frequent use of public transport may prevent age-related decline in physical capability by promoting physical activity and lower limb muscle strength among older adults. The association between public transport use and slower decline in walking speed among older adults is unlikely to be confounded by health-related selection factors. Improving access to good quality public transport could improve the health of older adults. © Article author(s) (or their employer(s) unless otherwise stated in the text

  13. Risk Factors for Hospital Admission with RSV Bronchiolitis in England: A Population-Based Birth Cohort Study

    Science.gov (United States)

    Murray, Joanna; Bottle, Alex; Sharland, Mike; Modi, Neena; Aylin, Paul; Majeed, Azeem; Saxena, Sonia

    2014-01-01

    Objective To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission. Design A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database. Setting 71 hospitals across England. Participants We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life. Results In our cohort there were 7189 hospital admissions with a diagnosis of bronchiolitis, 24.2 admissions per 1000 infants under 1 year (95%CI 23.7–24.8), of which 15% (1050/7189) were born preterm (47.3 bronchiolitis admissions per 1000 preterm infants (95% CI 44.4–50.2)). The peak age group for bronchiolitis admissions was infants aged 1 month and the median was age 120 days (IQR = 61–209 days). The median length of stay was 1 day (IQR = 0–3). The relative risk (RR) of a bronchiolitis admission was higher among infants with known risk factors for severe RSV infection, including those born preterm (RR = 1.9, 95% CI 1.8–2.0) compared with infants born at term. Other conditions also significantly increased risk of bronchiolitis admission, including Down's syndrome (RR = 2.5, 95% CI 1.7–3.7) and cerebral palsy (RR = 2.4, 95% CI 1.5–4.0). Conclusions Most (85%) of the infants who are admitted to hospital with bronchiolitis in England are born at term, with no known predisposing risk factors for severe RSV infection, although risk of admission is higher in known risk groups. The early age of bronchiolitis admissions has important implications for the potential impact and timing of future active and passive immunisations. More research is needed to explain why babies born with Down's syndrome and cerebral palsy are also at higher risk of hospital admission with RSV bronchiolitis. PMID:24586581

  14. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study.

    Directory of Open Access Journals (Sweden)

    Joanna Murray

    Full Text Available To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission.A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database.71 hospitals across England.We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life.In our cohort there were 7189 hospital admissions with a diagnosis of bronchiolitis, 24.2 admissions per 1000 infants under 1 year (95%CI 23.7-24.8, of which 15% (1050/7189 were born preterm (47.3 bronchiolitis admissions per 1000 preterm infants (95% CI 44.4-50.2. The peak age group for bronchiolitis admissions was infants aged 1 month and the median was age 120 days (IQR = 61-209 days. The median length of stay was 1 day (IQR = 0-3. The relative risk (RR of a bronchiolitis admission was higher among infants with known risk factors for severe RSV infection, including those born preterm (RR = 1.9, 95% CI 1.8-2.0 compared with infants born at term. Other conditions also significantly increased risk of bronchiolitis admission, including Down's syndrome (RR = 2.5, 95% CI 1.7-3.7 and cerebral palsy (RR = 2.4, 95% CI 1.5-4.0.Most (85% of the infants who are admitted to hospital with bronchiolitis in England are born at term, with no known predisposing risk factors for severe RSV infection, although risk of admission is higher in known risk groups. The early age of bronchiolitis admissions has important implications for the potential impact and timing of future active and passive immunisations. More research is needed to explain why babies born with Down's syndrome and cerebral palsy are also at higher risk of hospital admission with RSV bronchiolitis.

  15. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study.

    Science.gov (United States)

    Murray, Joanna; Bottle, Alex; Sharland, Mike; Modi, Neena; Aylin, Paul; Majeed, Azeem; Saxena, Sonia

    2014-01-01

    To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission. A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database. 71 hospitals across England. We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life. In our cohort there were 7189 hospital admissions with a diagnosis of bronchiolitis, 24.2 admissions per 1000 infants under 1 year (95%CI 23.7-24.8), of which 15% (1050/7189) were born preterm (47.3 bronchiolitis admissions per 1000 preterm infants (95% CI 44.4-50.2)). The peak age group for bronchiolitis admissions was infants aged 1 month and the median was age 120 days (IQR = 61-209 days). The median length of stay was 1 day (IQR = 0-3). The relative risk (RR) of a bronchiolitis admission was higher among infants with known risk factors for severe RSV infection, including those born preterm (RR = 1.9, 95% CI 1.8-2.0) compared with infants born at term. Other conditions also significantly increased risk of bronchiolitis admission, including Down's syndrome (RR = 2.5, 95% CI 1.7-3.7) and cerebral palsy (RR = 2.4, 95% CI 1.5-4.0). Most (85%) of the infants who are admitted to hospital with bronchiolitis in England are born at term, with no known predisposing risk factors for severe RSV infection, although risk of admission is higher in known risk groups. The early age of bronchiolitis admissions has important implications for the potential impact and timing of future active and passive immunisations. More research is needed to explain why babies born with Down's syndrome and cerebral palsy are also at higher risk of hospital admission with RSV bronchiolitis.

  16. Mental health improves after transition from comprehensive school to vocational education or employment in England: A national cohort study.

    Science.gov (United States)

    Symonds, Jennifer; Dietrich, Julia; Chow, Angela; Salmela-Aro, Katariina

    2016-04-01

    Underpinned by stage-environment fit and job demands-resources theories, this study examined how adolescents' anxiety, depressive symptoms, and positive functioning developed as they transferred from comprehensive school to further education, employment or training, or became NEET (not in education, employment, or training), at age 16 years, in the longitudinal English national cohort study Next Steps (N = 13,342). Controlling for childhood achievement, socioeconomic status, ethnicity, and gender, we found that NEET adolescents had the largest losses in mental health. This pattern was similar to adolescents staying on at school who had increased anxiety and depression, and decreased positive functioning, after transition. In comparison, adolescents transferring to full-time work, apprenticeships, or vocational college experienced gains in mental health. (c) 2016 APA, all rights reserved).

  17. Vitamin D status in chronic fatigue syndrome/myalgic encephalomyelitis: a cohort study from the North-West of England.

    Science.gov (United States)

    Earl, Kate E; Sakellariou, Giorgos K; Sinclair, Melanie; Fenech, Manuel; Croden, Fiona; Owens, Daniel J; Tang, Jonathan; Miller, Alastair; Lawton, Clare; Dye, Louise; Close, Graeme L; Fraser, William D; McArdle, Anne; Beadsworth, Michael B J

    2017-11-08

    Severe vitamin D deficiency is a recognised cause of skeletal muscle fatigue and myopathy. The aim of this study was to examine whether chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with altered circulating vitamin D metabolites. Cohort study. UK university hospital, recruiting from April 2014 to April 2015. Ninety-two patients with CFS/ME and 94 age-matched healthy controls (HCs). The presence of a significant association between CFS/ME, fatigue and vitamin D measures. No evidence of a deficiency in serum total 25(OH) vitamin D (25(OH)D 2 and 25(OH)D 3 metabolites) was evident in individuals with CFS/ME. Liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis revealed that total 25(OH)D was significantly higher (p=0.001) in serum of patients with CFS/ME compared with HCs (60.2 and 47.3 nmol/L, respectively). Analysis of food/supplement diaries with WinDiets revealed that the higher total 25(OH) vitamin D concentrations observed in the CFS/ME group were associated with increased vitamin D intake through use of supplements compared with the control group. Analysis of Chalder Fatigue Questionnaire data revealed no association between perceived fatigue and vitamin D levels. Low serum concentrations of total 25(OH)D do not appear to be a contributing factor to the level of fatigue of CFS/ME. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Is treatment for alcohol use disorder associated with reductions in criminal offending? A national data linkage cohort study in England.

    Science.gov (United States)

    Willey, Helen; Eastwood, Brian; Gee, Ivan L; Marsden, John

    2016-04-01

    This is the first English national study of change in criminal offending following treatment for alcohol use disorder (AUD). All adults treated for AUD by all publicly funded treatment services during April 2008-March 2009 (n=53,017), with data linked to the Police National Computer (April 2006-November 2011). Pre-treatment offender sub-populations were identified by Latent Profile Analysis. The outcome measure was the count of recordable criminal offences during two-year follow-up after admission. A mixed-effects, Poisson regression modelled outcome, adjusting for demographics and clinical information, the latent classes, and treatment exposure covariates. Twenty-two percent of the cohort committed one or more offences in the two years pre-treatment (n=11,742; crude rate, 221.5 offenders per 1000). During follow-up, the number of offenders and offences fell by 23.5% and 24.0%, respectively (crude rate, 69.4 offenders per 1000). During follow-up, a lower number of offences was associated with: completing treatment (adjusted incident rate ratio [IRR] 0.82; 95% confidence interval [CI] 0.79-0.85); receiving inpatient detoxification (IRR 0.84; CI 0.80-0.89); or community pharmacological therapy (IRR 0.89; CI 0.84-0.96). Reconviction was reduced in the sub-population characterised by driving offences (n=1,140; 11.7%), but was relatively high amongst acquisitive (n=768; 58.3% reconvicted) and violent offending sub-populations (n=602; 77.6% reconvicted). Reduced offending was associated with successful completion of AUD treatment and receiving inpatient and pharmacological therapy, but not enrolment in psychological and residential interventions. Treatment services (particularly those providing psychological therapy and residential care) should be alert to offending, especially violent and acquisitive crime, and enhance crime reduction interventions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the Birthplace national prospective cohort study

    Science.gov (United States)

    2013-01-01

    Background In England, there is a policy of offering healthy women with straightforward pregnancies a choice of birth setting. Options may include home or a freestanding midwifery unit (FMU). Transfer rates from these settings are around 20%, and higher for nulliparous women. The duration of transfer is of interest because of the potential for delay in access to specialist care and is also of concern to women. We aimed to estimate the duration of transfer in births planned at home and in FMUs and explore the effects of distance and urgency on duration. Methods This was a secondary analysis of data collected in a national prospective cohort study including 27,842 ‘low risk’ women with singleton, term, ‘booked’ pregnancies, planning birth in FMUs or at home in England from April 2008 to April 2010. We described transfer duration using the median and interquartile range, for all transfers and those for reasons defined as potentially urgent or non-urgent, and used cumulative distribution curves to compare transfer duration by urgency. We explored the effect of distance for transfers from FMUs and described outcomes in women giving birth within 60 minutes of transfer. Results The median overall transfer time, from decision to transfer to first OU assessment, was shorter in transfers from home compared with transfers from FMUs (49 vs 60 minutes; p < 0.001). The median duration of transfers before birth for potentially urgent reasons (home 42 minutes, FMU 50 minutes) was 8–10 minutes shorter compared with transfers for non-urgent reasons. In transfers for potentially urgent reasons, the median overall transfer time from FMUs within 20 km of an OU was 47 minutes, increasing to 55 minutes from FMUs 20-40 km away and 61 minutes in more remote FMUs. In women who gave birth within 60 minutes after transfer, adverse neonatal outcomes occurred in 1-2% of transfers. Conclusions Transfers from home or FMU commonly take up to 60 minutes from decision to

  20. Vitamin D status of White pregnant women and infants at birth and 4 months in North West England: A cohort study.

    Science.gov (United States)

    Emmerson, A J B; Dockery, K; Mughal, M Z; Roberts, S A; Tower, C L; Berry, J L

    2017-04-18

    The prevalence of vitamin D deficiency in pregnant white-skinned women (WSW) and their infants has not been investigated at northern latitudes in a developed county. A 2-year observational cohort study was undertaken in the North West of England to determine 25-hydroxyvitamin D (25OHD) levels in WSW and their infants during pregnancy and 4 months postdelivery and to explore factors associated with these levels. Nutritional and lifestyle questionnaires were completed and 25OHD levels measured at 28 weeks and 4 months postdelivery. Twenty-seven percent and 7% of WSW had insufficient and deficient levels of 25OHD during pregnancy and 48% and 11% four months postdelivery. WSW with Fitzpatrick skin-type I (FST I) have significantly lower 25OHD than other skin types after controlling for time spent outside and vitamin D intake. Twenty-four percent and 13% of infants had insufficient and deficient 25OHD levels at 4 months. Unsupplemented breast-fed infants have the highest level of insufficiency (67%) compared with formula-fed infants (2%). Factors associated with infant serum 25OHD levels at 4 months included breast feeding, supplementation, and time outside. WSW have a high prevalence of insufficiency and deficiency during pregnancy which doubles 4 months after birth. Breast-fed infants of WSW are rarely considered at risk of vitamin D insufficiency but have high rates compared with formula-fed infants. This is the first study to show the finding that FST I WSW have significantly lower levels of 25OHD than those with FST II-IV (difference adjusted for diet and time outside 14 (95%CI 7-21) nmol/L). © 2017 John Wiley & Sons Ltd.

  1. Mental Health Improves after Transition from Comprehensive School to Vocational Education or Employment in England: A National Cohort Study

    Science.gov (United States)

    Symonds, Jennifer; Dietrich, Julia; Chow, Angela; Salmela-Aro, Katariina

    2016-01-01

    Underpinned by stage-environment fit and job demands-resources theories, this study examined how adolescents' anxiety, depressive symptoms, and positive functioning developed as they transferred from comprehensive school to further education, employment or training, or became NEET (not in education, employment, or training), at age 16 years, in…

  2. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

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    Simon S Jameson

    Full Text Available Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing; the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs, costs and risk of repeat (revision surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index (9159 linked episodes and competing risks modelling of implant survival (79,775 procedures. Cost of implants and ancillary equipment were obtained from National Health Service procurement data.EQ5D score improvements (at 6 months were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001, when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001 for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003 and resurfacing implants, HR = 3.46, p<0.001, with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524 and highest with cementless implants (£1928 to £4285. Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the

  3. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales

    Science.gov (United States)

    Jameson, Simon S.; Mason, James; Baker, Paul N.; Gregg, Paul J.; Deehan, David J.; Reed, Mike R.

    2015-01-01

    Background Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis. Methods and Findings Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing); the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs), costs and risk of repeat (revision) surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index) (9159 linked episodes) and competing risks modelling of implant survival (79,775 procedures). Cost of implants and ancillary equipment were obtained from National Health Service procurement data. Results EQ5D score improvements (at 6 months) were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001), when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001) for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003) and resurfacing implants, HR = 3.46, p<0.001), with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524) and highest with cementless implants (£1928 to £4285). Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long

  4. Impaired glucose metabolism among those with and without diagnosed diabetes and mortality: a cohort study using Health Survey for England data.

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    Vanessa L Z Gordon-Dseagu

    Full Text Available The extent that controlled diabetes impacts upon mortality, compared with uncontrolled diabetes, and how pre-diabetes alters mortality risk remain issues requiring clarification.We carried out a cohort study of 22,106 Health Survey for England participants with a HbA1C measurement linked with UK mortality records. We estimated hazard ratios (HRs of all-cause, cancer and cardiovascular disease (CVD mortality and 95% confidence intervals (CI using Cox regression.Average follow-up time was seven years and there were 1,509 deaths within the sample. Compared with the non-diabetic and normoglycaemic group (HbA1C <5.7% [<39 mmol/mol] and did not indicate diabetes, undiagnosed diabetes (HbA1C ≥6.5% [≥48 mmol/mol] and did not indicate diabetes inferred an increased risk of mortality for all-causes (HR 1.40, 1.09-1.80 and CVD (1.99, 1.35-2.94, as did uncontrolled diabetes (diagnosed diabetes and HbA1C ≥6.5% [≥48 mmol/mol] and diabetes with moderately raised HbA1C (diagnosed diabetes and HbA1C 5.7-<6.5% [39-<48 mmol/mol]. Those with controlled diabetes (diagnosed diabetes and HbA<5.7% [<39 mmol/mol] had an increased HR in relation to mortality from CVD only. Pre-diabetes (those who did not indicate diagnosed diabetes and HbA1C 5.7-<6.5% [39-<48 mmol/mol] was not associated with increased mortality, and raised HbA1C did not appear to have a statistically significant impact upon cancer mortality. Adjustment for BMI and socioeconomic status had a limited impact upon our results. We also found women had a higher all-cause and CVD mortality risk compared with men.We found higher rates of all-cause and CVD mortality among those with raised HbA1C, but not for those with pre-diabetes, compared with those without diabetes. This excess differed by sex and diabetes status. The large number of deaths from cancer and CVD globally suggests that controlling blood glucose levels and policies to prevent hyperglycaemia should be considered public health priorities.

  5. 1970 British Cohort Study

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    Matt Brown

    2014-10-01

    Full Text Available The 1970 British Cohort Study (BCS70 is one of Britain’s world famous national longitudinal birth cohort studies, three of which are run by the Centre for Longitudinal Studies at the Institute of Education, University of London.  BCS70 follows the lives of more than 17,000 people born in England, Scotland and Wales in a single week of 1970. Over the course of cohort members lives, the BCS70 has collected information on health, physical, educational and social development, and economic circumstances among other factors. Since the birth survey in 1970, there have been nine ‘sweeps’ of all cohort members at ages 5, 10, 16, 26, 30, 34, 38 and most recently at 42. Data has been collected from a number of different sources (the midwife present at birth, parents of the cohort members, head and class teachers, school health service personnel and the cohort members themselves. The data has been collected in a variety of ways including via paper and electronic questionnaires, clinical records, medical examinations, physical measurements, tests of ability, educational assessments and diaries. The majority of BCS70 survey data can be accessed by bona fide researchers through the UK Data Service at the University of Essex.

  6. Effects of seasonal and pandemic influenza on health-related quality of life, work and school absence in England: results from the Flu Watch cohort study.

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    Fragaszy, Ellen B; Warren-Gash, Charlotte; White, Peter J; Zambon, Maria; Edmunds, W John; Nguyen-Van-Tam, Jonathan S; Hayward, Andrew C

    2017-10-09

    Estimates of health-related quality of life (HRQoL) and work/school absences for influenza are typically based on medically-attended cases or those meeting influenza-like-illness (ILI) case definitions, and thus biased towards severe disease. Although community influenza cases are more common, estimates of their effects on HRQoL and absences are limited. To measure Quality-Adjusted Life Days and Years (QALDs and QALYs) lost and work/school absences among community cases of acute respiratory infections (ARI), ILI and influenza A and B and to estimate community burden of QALY loss and absences from influenza. Flu Watch was a community cohort in England from 2006-2011. Participants were followed-up weekly. During respiratory illness they prospectively recorded daily symptoms, work/school absences and EQ-5D-3L data and submitted nasal swabs for RT-PCR influenza testing. Average QALD lost was 0.26, 0.93, 1.61 and 1.84 for ARI, ILI, H1N1pdm09 and influenza B cases respectively. 40% of influenza A cases and 24% of influenza B cases took time off work/school with an average duration of 3.6 days and 2.4 days respectively. In England, community influenza cases lost 24,300 QALYs in 2010/11 and had an estimated 2.9 million absences per season based on data from 2006/07 - 2009/10. Our QALDs and QALYs lost and work and school absence estimates are lower than previous estimates because we focus on community cases, most of which are mild, may not meet ILI definitions and do not result in healthcare consultations. Nevertheless, they contribute a substantial loss of HRQoL on a population level. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  7. Rates and determinants of uptake and use of an internet physical activity and weight management program in office and manufacturing work sites in England: cohort study.

    Science.gov (United States)

    Ware, Lisa J; Hurling, Robert; Bataveljic, Ogi; Fairley, Bruce W; Hurst, Tina L; Murray, Peter; Rennie, Kirsten L; Tomkins, Chris E; Finn, Anne; Cobain, Mark R; Pearson, Dympna A; Foreyt, John P

    2008-12-31

    Internet-based physical activity (PA) and weight management programs have the potential to improve employees' health in large occupational health settings. To be successful, the program must engage a wide range of employees, especially those at risk of weight gain or ill health. The aim of the study was to assess the use and nonuse (user attrition) of a Web-based and monitoring device-based PA and weight management program in a range of employees and to determine if engagement with the program was related to the employees' baseline characteristics or measured outcomes. Longitudinal observational study of a cohort of employees having access to the MiLife Web-based automated behavior change system. Employees were recruited from manufacturing and office sites in the North West and the South of England. Baseline health data were collected, and participants were given devices to monitor their weight and PA via data upload to the website. Website use, PA, and weight data were collected throughout the 12-week program. Overall, 12% of employees at the four sites (265/2302) agreed to participate in the program, with 130 men (49%) and 135 women (51%), and of these, 233 went on to start the program. During the program, the dropout rate was 5% (11/233). Of the remaining 222 Web program users, 173 (78%) were using the program at the end of the 12 weeks, with 69% (153/222) continuing after this period. Engagement with the program varied by site but was not significantly different between the office and factory sites. During the first 2 weeks, participants used the website, on average, 6 times per week, suggesting an initial learning period after which the frequency of website log-in was typically 2 visits per week and 7 minutes per visit. Employees who uploaded weight data had a significant reduction in weight (-2.6 kg, SD 3.2, Pweight was largest for employees using the program's weight loss mode (-3.4 kg, SD 3.5). Mean PA level recorded throughout the program was 173 minutes

  8. Rates and Determinants of Uptake and Use of an Internet Physical Activity and Weight Management Program in Office and Manufacturing Work Sites in England: Cohort Study

    Science.gov (United States)

    Hurling, Robert; Bataveljic, Ogi; Fairley, Bruce W; Hurst, Tina L; Murray, Peter; Rennie, Kirsten L; Tomkins, Chris E; Finn, Anne; Cobain, Mark R; Pearson, Dympna A; Foreyt, John P

    2008-01-01

    Background Internet-based physical activity (PA) and weight management programs have the potential to improve employees’ health in large occupational health settings. To be successful, the program must engage a wide range of employees, especially those at risk of weight gain or ill health. Objective The aim of the study was to assess the use and nonuse (user attrition) of a Web-based and monitoring device–based PA and weight management program in a range of employees and to determine if engagement with the program was related to the employees’ baseline characteristics or measured outcomes. Methods Longitudinal observational study of a cohort of employees having access to the MiLife Web-based automated behavior change system. Employees were recruited from manufacturing and office sites in the North West and the South of England. Baseline health data were collected, and participants were given devices to monitor their weight and PA via data upload to the website. Website use, PA, and weight data were collected throughout the 12-week program. Results Overall, 12% of employees at the four sites (265/2302) agreed to participate in the program, with 130 men (49%) and 135 women (51%), and of these, 233 went on to start the program. During the program, the dropout rate was 5% (11/233). Of the remaining 222 Web program users, 173 (78%) were using the program at the end of the 12 weeks, with 69% (153/222) continuing after this period. Engagement with the program varied by site but was not significantly different between the office and factory sites. During the first 2 weeks, participants used the website, on average, 6 times per week, suggesting an initial learning period after which the frequency of website log-in was typically 2 visits per week and 7 minutes per visit. Employees who uploaded weight data had a significant reduction in weight (−2.6 kg, SD 3.2, Pemployees using the program’s weight loss mode (−3.4 kg, SD 3.5). Mean PA level recorded throughout the

  9. Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study.

    Science.gov (United States)

    Johns, Louise E; Coleman, Derek A; Swerdlow, Anthony J; Moss, Susan M

    2017-01-17

    Population breast screening has been implemented in the UK for over 25 years, but the size of benefit attributable to such programmes remains controversial. We have conducted the first individual-based cohort evaluation of population breast screening in the UK, to estimate the impact of the NHS breast screening programme (NHSBSP) on breast cancer mortality. We followed 988 090 women aged 49-64 years in 1991 resident in England and Wales, who because of the staggered implementation of the NHSBSP, included both invited subjects and an uninvited control group. Individual-level breast screening histories were linked to individual-level mortality and breast cancer incidence data from national registers. Risk of death from breast cancer was investigated by incidence-based mortality analyses in relation to intention to screen and first round attendance. Overdiagnosis of breast cancer following a single screening round was also investigated. Invitation to NHSBSP screening was associated with a reduction in breast cancer mortality in 1991-2005 of 21% (RR=0.79, 95% CI: 0.73-0.84, PBreast cancer deaths among first invitation attenders were 46% lower than among non-attenders (RR=0.54, 95% CI: 0.51-0·57, Pscreen. The results indicate a substantial, statistically significant reduction in breast cancer mortality between 1991 and 2005 associated with NHSBSP activity. This is important in public health terms.

  10. Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study.

    Science.gov (United States)

    Waight, Pauline A; Andrews, Nicholas J; Ladhani, Shamez N; Sheppard, Carmen L; Slack, Mary P E; Miller, Elizabeth

    2015-05-01

    The 13-valent pneumococcal conjugate vaccine (PCV13) protects against key serotypes that increased after routine immunisation with the seven-valent vaccine (PCV7), but its potential for herd protection and serotype replacement is uncertain. The aim of this study was to analyse the effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction. We used a national dataset of electronically reported and serotyped invasive pneumococcal disease cases in England and Wales to estimate incidence rate ratios (IRRs) for vaccine and non-vaccine type invasive pneumococcal disease between July, 2013, and June, 2014, versus the pre-PCV13 and pre-PCV7 baseline. Incidence rates were corrected for missing serotype data and changes in surveillance sensitivity over time. An over-dispersed Poisson model was used to estimate IRRs and confidence intervals. Incidence of invasive pneumococcal disease in the epidemiological year 2013/14 decreased by 32% compared with the pre-PCV13 baseline (incidence 10·14 per 100,000 in 2008-10 vs 6·85 per 100,000 in 2013/14; IRR 0·68, 95% CI 0·64-0·72). This was due to an 86% reduction of the serotypes covered by PCV7 (1·46 vs 0·20 per 100,000; IRR 0·14, 0·10-0·18) and a 69% reduction of the additional six serotypes covered by PCV13 (4·48 vs 1·40 per 100,000; IRR 0·31, 0·28-0·35). When compared with the pre-PCV7 baseline, there was a 56% overall reduction in invasive pneumococcal disease (15·63 vs 6·85 per 100,000; IRR 0·44, 95% CI 0·43-0·47). Compared with the pre-PCV13 baseline, the incidence of non-PCV13 serotypes increased (incidence all ages 4·19 vs 5·25 per 100,000; IRR 1·25, 95% CI 1·17-1·35) due to increases across a broad range of serotypes in children younger than 5 years and in people aged 45 years or more. In children younger than 5 years, incidence of non-PCV13 serotypes in 2013/14 was higher than in 2012/13 (age Wales has reduced the

  11. Recent household transmission of tuberculosis in England, 2010-2012: retrospective national cohort study combining epidemiological and molecular strain typing data.

    Science.gov (United States)

    Lalor, Maeve K; Anderson, Laura F; Hamblion, Esther L; Burkitt, Andy; Davidson, Jennifer A; Maguire, Helen; Abubakar, Ibrahim; Thomas, H Lucy

    2017-06-13

    We estimate the proportion of tuberculosis (TB) in England due to recent household transmission, identify factors associated with being a household transmitter, and investigate the impact that identification of a case has on time to treatment of subsequent cases. TB cases notified between 2010 and 2012 in England in the same household as another case were identified; 24 locus MIRU-VNTR strain typing (ST) was used to identify household cases with likely recent transmission. Treatment delay in index and subsequent cases was compared. Risk factors for being a household transmitter were identified in univariable and multivariable analyses. Overall, 7.7% (1849/24,060) of TB cases lived in a household with another case. We estimate that 3.9% were due to recent household transmission. ST data was unavailable for 67% (1242) of household pairs. For those with ST data, 64% (386) had confirmed, 11% probable (66) and 25% (155) refuted household transmission. The median treatment delay was 65 days for index cases and 37 days for subsequent asymptomatic cases. Risk factors for being a household transmitter included being under 25 years old, UK-born with Black African, Indian or Pakistani ethnicity, or born in Somalia or Romania. This study has a number of implications for household TB contact tracing in low incidence countries, including the potential to reduce the diagnostic delay for subsequent household cases and the benefit of using ST to identify when to conduct source contact tracing outside the household. As 25% of TB cases in households had discordant strains, households with multiple TB cases do not necessarily represent household transmission. The additional fact that 25% of index cases within households only had extra-pulmonary TB demonstrates that, if household contact tracing is limited to pulmonary TB cases (as recently recommended in UK guidelines), additional cases of active TB in households will be missed. Our finding that no lineage of TB was associated with

  12. Patient-orientated longitudinal study of multiple sclerosis in south west England (The South West Impact of Multiple Sclerosis Project, SWIMS 1: protocol and baseline characteristics of cohort

    Directory of Open Access Journals (Sweden)

    Wright Dave E

    2010-10-01

    Full Text Available Abstract Background There is a need for greater understanding of the impact of multiple sclerosis (MS from the perspective of individuals with the condition. The South West Impact of MS Project (SWIMS has been designed to improve understanding of disease impact using a patient-centred approach. The purpose is to (1 develop improved measurement instruments for clinical trials, (2 evaluate longitudinal performance of a variety of patient-reported outcome measures, (3 develop prognostic predictors for use in individualising drug treatment for patients, particularly early on in the disease course. Methods This is a patient-centred, prospective, longitudinal study of multiple sclerosis and clinically isolated syndrome (CIS in south west England. The study area comprises two counties with a population of approximately 1.7 million and an estimated 1,800 cases of MS. Self-completion questionnaires are administered to participants every six months (for people with MS or 12 months (CIS. Here we present descriptive statistics of the baseline data provided by 967 participants with MS. Results Seventy-five percent of those approached consented to participate. The male:female ratio was 1.00:3.01 (n = 967. Average (standard deviation age at time of entry to SWIMS was 51.6 (11.5 years (n = 961 and median (interquartile range time since first symptom was 13.3 (6.8 to 24.5 years (n = 934. Fatigue was the most commonly reported symptom, with 80% of participants experiencing fatigue at baseline. Although medication use for symptom control was common, there was little evidence of effectiveness, particularly for fatigue. Nineteen percent of participants were unable to classify their subtype of MS. When patient-reported subtype was compared to neurologist assessment for a sample of participants (n = 396, agreement in disease sub-type was achieved in 63% of cases. There were 836 relapses, reported by 931 participants, in the twelve months prior to baseline. Twenty

  13. A cohort study of post-weaning multisystemic wasting syndrome and PCV2 in 178 pigs from birth to 14 weeks on a single farm in England.

    Science.gov (United States)

    Woodbine, K A; Turner, M J; Medley, G F; Scott, P D; Easton, A J; Slevin, J; Brown, J C; Francis, L; Green, L E

    2010-11-01

    Our hypothesis was that pigs that develop post-weaning multisystemic wasting syndrome (PMWS) are detectable from an early age with signs of weight loss and other clinical and serological abnormalities. Therefore, the objective of this study was to investigate the temporally varying and fixed events linked with the clinical incidence of PMWS by comparing affected and unaffected pigs in a cohort of 178 male piglets. Piglets were enrolled at birth and examined each week. Samples of blood were collected at regular intervals. The exposures measured were porcine circovirus type 2 (PCV2) antibody titres in all 178 and PCV2 antigen in a subset of 75 piglets. We also observed piglet health and measured their weight, and a post-mortem examination was performed by an external laboratory on all pigs between 6 and 14 weeks of age that died. From the cohort, 14 (8%) pigs died from PMWS and 4% from other causes. A further 37 pigs between 6 and 14 weeks of age died from PMWS (30) and ileitis and other causes (7). PMWS was only apparent in pigs from 1 to 2 weeks before death when they wasted rapidly. There were no other characteristic clinical signs and no obvious gross clinical lesions post-mortem. There was no strong link with PCV2 antibody throughout life but PCV2 antigen level was higher from 4 to 6 weeks of age in pigs that died from PMWS compared with pigs that died from other causes. Copyright © 2010 Elsevier B.V. All rights reserved.

  14. Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland.

    Science.gov (United States)

    Aldridge, Robert W; Zenner, Dominik; White, Peter J; Williamson, Elizabeth J; Muzyamba, Morris C; Dhavan, Poonam; Mosca, Davide; Thomas, H Lucy; Lalor, Maeve K; Abubakar, Ibrahim; Hayward, Andrew C

    2016-11-19

    Tuberculosis elimination in countries with a low incidence of the disease necessitates multiple interventions, including innovations in migrant screening. We examined a cohort of migrants screened for tuberculosis before entry to England, Wales, and Northern Ireland and tracked the development of disease in this group after arrival. As part of a pilot pre-entry screening programme for tuberculosis in 15 countries with a high incidence of the disease, the International Organization for Migration screened all applicants for UK visas aged 11 years or older who intended to stay for more than 6 months. Applicants underwent a chest radiograph, and any with results suggestive of tuberculosis underwent sputum testing and culture testing (when available). We tracked the development of tuberculosis in those who tested negative for the disease and subsequently migrated to England, Wales, and Northern Ireland with the Enhanced Tuberculosis Surveillance system. Primary outcomes were cases of all forms of tuberculosis (including clinically diagnosed cases), and bacteriologically confirmed pulmonary tuberculosis. Our study cohort was 519 955 migrants who were screened for tuberculosis before entry to the UK between Jan 1, 2006, and Dec 31, 2012. Cases notified on the Enhanced Tuberculosis Surveillance system between Jan 1, 2006, and Dec 31, 2013, were included. 1873 incident cases of all forms of tuberculosis were identified, and, on the basis of data for England, Wales, and Northern Ireland, the estimated incidence of all forms of tuberculosis in migrants screened before entry was 147 per 100 000 person-years (95% CI 140-154). The estimated incidence of bacteriologically confirmed pulmonary tuberculosis in migrants screened before entry was 49 per 100 000 person-years (95% CI 45-53). Migrants whose chest radiographs were compatible with active tuberculosis but with negative pre-entry microbiological results were at increased risk of tuberculosis compared with those with no

  15. The mental health of adolescents with and without mild/moderate intellectual disabilities in England: Secondary analysis of a longitudinal cohort study.

    Science.gov (United States)

    Hatton, Chris; Emerson, Eric; Robertson, Janet; Baines, Susannah

    2017-11-24

    Children with mild/moderate intellectual disabilities are at greater risk for mental health problems, with socio-economic factors and adversity partly accounting for this. Fewer data are available for adolescents. Secondary analysis was undertaken of the Next Steps annual panel study following a cohort through adolescence into adulthood containing self-report mental health data up to age 16/17. Participants with mild/moderate intellectual disabilities were identified through data linkage with educational records. Adolescents with mild/moderate intellectual disabilities were more likely than non-disabled peers to experience socio-economic disadvantage and bullying. Incidence rates of mental health problems were generally not significantly different between adolescents with and without intellectual disabilities. These findings are consistent with higher rates of persistent mental health problems beginning earlier among children with intellectual disabilities. Greater attention needs to be paid to the timecourse of mental health problems, and the impact of socio-economic factors, family and peers on mental health. © 2017 John Wiley & Sons Ltd.

  16. Differing patterns in intentional and unintentional poisonings among young people in England, 1998-2014: a population-based cohort study.

    Science.gov (United States)

    Tyrrell, Edward G; Orton, Elizabeth; Sayal, Kapil; Baker, Ruth; Kendrick, Denise

    2017-06-01

    Accurate and up to date data on changes in poisoning incidence among young people are lacking. Recent linkage of UK primary care, hospital and mortality data allows these to be quantified to inform service delivery. An open cohort study of 1 736 527 young people aged 10-24 between 1998 and 2014 was conducted using linked data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics deaths. Incidence rates (IRs) by poisoning intent were calculated by age, sex, deprivation and year. Total poisoning IRs increased by 25% from 1998/99 to 2013/14 [adjusted incidence rate ratio (aIRR) 1.25, 95% CI: 1.20-1.30]. Patterns differed markedly by intent. Intentional poisoning rates increased by 52% while unintentional rates remained unchanged. Intentional rates increased almost exclusively among females, gradually between 1998/99 and 2013/14 among 16-18 (88% increase) and 19-24 (36% increase) year olds but only increased among 10-15 year olds in the last 2 years (79% increase). A 2-fold increased risk of poisoning for the most compared to least deprived quintile existed (aIRR 2.21, 95% CI: 2.02-2.23) and remained over time. Commissioning of primary and secondary prevention services needs to address the growing problem of intentional poisonings among young people.

  17. Self-reported school experience as a predictor of self-harm during adolescence: a prospective cohort study in the South West of England (ALSPAC).

    Science.gov (United States)

    Kidger, Judi; Heron, Jon; Leon, David A; Tilling, Kate; Lewis, Glyn; Gunnell, David

    2015-03-01

    Several aspects of school life are thought to be associated with increased risk of self-harm in adolescence, but these have rarely been investigated in prospective studies. Members of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort completed postal surveys of school experiences aged 14, and self-harm behaviour aged 16 (n=3939). Associations between school experiences (feeling connected to school, enjoyment of school and perception of teachers as fair) and subsequent self-harm were examined using multivariable logistic regression models. Self-harm aged 16 was associated with earlier perceptions of school, specifically not getting on well with or feeling accepted by others (OR=2.43 [1.76, 3.35] and OR=2.69 [2.16, 3.35] respectively), not liking school or the work done in class (OR=1.40 [1.17, 1.69] and OR=1.36 [1.10, 1.67]), and feeling that teachers are not clear about behaviour or fail to address misbehaviour consistently (OR=1.59 [1.20, 2.12] OR=1.89 [1.51, 2.37]). These associations were partially attenuated in models controlling for mental health concurrent with the outcome. Poor school experiences were related to both suicidal and non-suicidal self-harm, with slightly stronger associations visible for the former. (i) There was some loss to follow up, (ii) experience of bullying was not measured, and (iii) exposure and outcome measures were self-report. Students who feel unconnected to school, unhappy at school, or feel that teachers are unfair are more likely to self-harm in the future. Assessing students' perceptions of school may serve to identify those at risk of self-harm who would benefit from preventative interventions. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  18. Quality of life and associated socio-clinical factors after encephalitis in children and adults in England: a population-based, prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Parashar Pravin Ramanuj

    Full Text Available We sought to measure HRQoL in all-cause encephalitis survivors and assess the impact of various socio-clinical factors on outcome.We used a prospective cohort study design, using the short-form 36 (SF-36 to measure the HRQoL in patients 15 years and older, and the short-form 10 (SF-10 for patients less than 15 years old. We posted questionnaires to individuals six months after discharge from hospital. All scores were normalised to the age- and sex-matched general population. We used multivariate statistical analysis to assess the relative association of clinical and socio-demographic variables on HRQoL in adults.Of 109 individuals followed-up, we received 61 SF-36 and twenty SF-10 questionnaires (response rate 74%. Patients scored consistently worse than the general population in all domains of the SF-36 and SF-10, although there was variation in individual scores. Infectious encephalitis was associated with the worst HRQoL in those aged 15 years and over, scoring on average 5.64 points less than immune-mediated encephalitis (95% CI -8.77- -2.89. In those aged less than 15 years the worst quality of life followed encephalitis of unknown cause. Immuno compromise, unemployment, and the 35-44 age group all had an independent negative association with HRQoL. A poor Glasgow Outcome Score was most strongly associated with a poor HRQoL. Less than half of those who had made a 'good' recovery on the score reported a HRQoL equivalent to the general population.Encephalitis has adverse effects on the majority of survivors' wellbeing and quality of life. Many of these adverse consequences could be minimised by prompt identification and treatment, and with better rehabilitation and support for survivors.

  19. Incidence and Trends in Hypoglycemia Hospitalization in Adults With Type 1 and Type 2 Diabetes in England, 1998-2013: A Retrospective Cohort Study.

    Science.gov (United States)

    Zhong, Victor W; Juhaeri, Juhaeri; Cole, Stephen R; Kontopantelis, Evangelos; Shay, Christina M; Gordon-Larsen, Penny; Mayer-Davis, Elizabeth J

    2017-07-17

    To determine trends in hospitalization for hypoglycemia in adults with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in England. Adults with T1DM or T2DM were identified from 398 of the 684 practices within the Clinical Practice Research Datalink, for which linkage to the Hospital Episode Statistics was possible. Hypoglycemia as primary reason for hospitalization between 1998 and 2013 was extracted. Trends were estimated using joinpoint regression models for adults with T1DM, young and middle-aged adults with T2DM (18-64 years), and elderly adults with T2DM (≥65 years), respectively. Among 23,246 adults with T1DM, 1,591 hypoglycemia hospitalizations occurred during 121,262 person-years. Among 241,441 adults with T2DM, 3,738 hypoglycemia hospitalizations occurred during 1,344,818 person-years. In adults with T1DM, the incidence increased 3.74% (95% CI 1.70-5.83) annually from 1998 to 2013. In young and middle-aged adults with T2DM, the annual incidence increase was 4.12% (0.61-7.75) from 1998 to 2013. In elderly adults with T2DM, the incidence increased 8.59% (5.76-11.50) annually from 1998 to 2009, and decreased 8.05% (-14.48 to -1.13) annually from 2009 to 2013, but the incidence was still higher in 2013 than 1998 (adjusted rate ratio 3.01 [1.76-5.14]). Trends in HbA1c level did not parallel trends of hypoglycemia hospitalization for both diabetes types. A possible reason for declined hypoglycemia trend in 2009-2013 in elderly adults with T2DM may be continuously decreased sulfonylurea use after 2009, which was not seen in young and middle-aged adults with T2DM. Hypoglycemia requiring hospitalization has been an increasing burden in adults with T1DM and T2DM in England in the previous two decades, with the exception of the decline in elderly adults with T2DM starting in 2009. © 2017 by the American Diabetes Association.

  20. Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England.

    Science.gov (United States)

    Bouras, George; Burns, Elaine Marie; Howell, Ann-Marie; Bottle, Alex; Athanasiou, Thanos; Darzi, Ara

    2015-01-01

    Trends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE) may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay. This was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD), hospital administrative (Hospital Episodes Statistics, HES), population statistics (Office of National Statistics, ONS) and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records. There were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years). Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710) when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in haemorrhoidectomy to 118

  1. Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England

    Directory of Open Access Journals (Sweden)

    McVeigh Jim

    2006-08-01

    Full Text Available Abstract Background Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ led. No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF, since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. Methods A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415 was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and re-presentations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent re-presentation versus no re-presentation. Results The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P Conclusion Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration.

  2. Effect of severity of disability on survival in north east England cerebral palsy cohort

    OpenAIRE

    Hutton, J; Colver, A; Mackie, P; ROSENBLOOM, L.

    2000-01-01

    AIMS—To investigate the effect of motor and cognitive disabilities on the survival of people on the North of England Collaborative Cerebral Palsy Survey, and compare this with other published results.
METHODS—The cerebral palsy cohort consists of 1960-1990 births in Northumberland, Newcastle, and North Tyneside health districts. Survival and cause of death were analysed in relation to data on birth, disabilities, and a unique measure of the impact of disability.
RESULTS—D...

  3. Effect of severity of disability on survival in north east England cerebral palsy cohort.

    Science.gov (United States)

    Hutton, J L; Colver, A F; Mackie, P C

    2000-12-01

    To investigate the effect of motor and cognitive disabilities on the survival of people on the North of England Collaborative Cerebral Palsy Survey, and compare this with other published results. The cerebral palsy cohort consists of 1960-1990 births in Northumberland, Newcastle, and North Tyneside health districts. Survival and cause of death were analysed in relation to data on birth, disabilities, and a unique measure of the impact of disability. Disability strongly influences survival. More than a third of those with a severe disability die before age 30. Fewer than a third of deaths are attributed to cerebral palsy on death certificates. Of those with severe cognitive disability, 63% live to age 35 (58% with severe ambulatory disability and 53% with severe manual disability), whereas at least 98% without severe disabilities live to age 35. The Lifestyle Assessment Score (LAS) allows a finer categorisation of impact of disability, and is strongly associated with survival: a ten point increase in LAS is associated with a doubling of the hazard rate. People who had LAS of at least 70, and had survived to age 5 have a 39% chance of dying before age 35. The majority of people with cerebral palsy attain adulthood. There appears to be more variation in survival rates associated with severe disability between regions of England, than between north east England, British Columbia, and California. Instantaneous risks of dying vary widely between England and California. This variation is not obviously attributable to differing rates of severe disability.

  4. Disadvantaged children at greater relative risk of thinness (as well as obesity): a secondary data analysis of the England National Child Measurement Programme and the UK Millennium Cohort Study.

    Science.gov (United States)

    Pearce, Anna; Rougeaux, Emeline; Law, Catherine

    2015-08-05

    Young children living in more disadvantaged socio-economic circumstances (SECs) are at an increased risk of overweight and obesity. However, there is scant research examining the prevalence and social distribution of thinness in early childhood, despite potential negative consequences for health and development across the life-course. We examined the social gradient in thinness (and overweight and obesity for comparison) for 2,620,422 four-to-five year olds attending state maintained primary schools from 2007/8 to 2011/12, in the England National Child Measurement Programme (NCMP), and 16,715 children from the UK Millennium Cohort Study (MCS), born in 2000-2002, and measured at ages of three, five and seven. Children were classified as being thin, healthy weight (and, for completeness, overweight or obese) using international age and sex adjusted cut-offs for body mass index (BMI). Prevalences (and 95% confidence intervals (CIs)) were estimated, overall, and according to SECs: area deprivation (NCMP, MCS); household income, and maternal social class and education (MCS only). Relative Risk Ratios (RRRs) and CIs for thinness, overweight and obesity were estimated in multinomial models by SECs (baseline healthy weight). In the MCS, standard errors were estimated using clustered sandwich estimators to account for repeated measures, and, for thinness, RRRs by SECs were also estimated adjusting for a range of early life characteristics. In 2007/8 to 2011/12, 5.20% of four-to-five year old girls (n = 66,584) and 5.88% of boys (78,934) in the NCMP were thin. In the MCS, the prevalence of thinness was 4.59% (693) at three, 4.21% (702) at five, and 5.84% (804) at seven years. In both studies, and for all measures of SECs, children from the most disadvantaged groups were more likely to be thin than those from the most advantaged groups. For example, MCS children whose mothers had no educational qualifications were fifty percent more likely to be thin (RRR 1.5 (CI: 1.24, 1

  5. Cancer-related outcomes in kidney allograft recipients in England versus New York State: a comparative population-cohort analysis between 2003 and 2013.

    Science.gov (United States)

    Jackson-Spence, Francesca; Gillott, Holly; Tahir, Sanna; Nath, Jay; Mytton, Jemma; Evison, Felicity; Sharif, Adnan

    2017-03-01

    It is unclear whether cancer-related epidemiology after kidney transplantation is translatable between countries. In this population-cohort study, we compared cancer incidence and all-cause mortality after extracting data for every kidney-alone transplant procedure performed in England and New York State (NYS) between 2003 and 2013. Data were analyzed for 18,493 and 11,602 adult recipients from England and NYS respectively, with median follow up 6.3 years and 5.5 years respectively (up to December 2014). English patients were more likely to have previous cancer at time of transplantation compared to NYS patients (5.6% vs. 3.5%, P Kidney allograft recipients in England versus NYS had increased cancer incidence (12.3% vs. 5.9%, P cancer were equivalent between the two countries. During the first year of follow up, if patients had an admission with a cancer diagnosis, they were more likely to die in both England (Odds Ratio 4.28 [95% CI: 3.09-5.93], P Kidney allograft recipients in NYS demonstrated higher hazard ratios for developing kidney transplant rejection/failure compared to England on Cox regression analysis. Our analysis demonstrates significant differences in cancer-related epidemiology between kidney allograft recipients in England versus NYS, suggesting caution in translating post-transplant cancer epidemiology between countries. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  6. Internet-based cohort study of HIV testing over 1 year among men who have sex with men living in England and exposed to a social marketing intervention promoting testing.

    Science.gov (United States)

    Hickson, Ford; Tomlin, Keith; Hargreaves, James; Bonell, Chris; Reid, David; Weatherburn, Peter

    2015-02-01

    Increasing HIV testing among men who have sex with men (MSM) is a major policy goal in the UK. Social marketing is a common intervention to increase testing uptake. We used an online panel of MSM to examine rates of HIV testing behaviour and the impact of a social marketing intervention on them. MSM in England were recruited to a longitudinal internet panel through community websites and a previous survey. Following an enrolment survey, respondents were invited to self-complete 13 surveys at monthly intervals throughout 2011. A unique alphanumeric code linked surveys for individuals. Rates of HIV testing were compared relative to prompted recognition of a multi-part media campaign aiming to normalise HIV testing. Of 3386 unique enrolments, 2047 respondents were included in the analysis, between them submitting 15,353 monthly surveys (equivalent to 1279 years of follow-up), and recording 1517 HIV tests taken, giving an annual rate of tests per participant of 1.19 (95% CI 1.13 to 1.25). Tests were highly clustered in individuals (61% reported no test during the study). Testing rates were higher in London, single men and those aged 25-34 years. Only 7.6% recognised the intervention when prompted. After controlling for sociodemographic characteristics and exposure to other health promotion campaigns, intervention recognition was not associated with increased likelihood of testing. Higher rates of testing were strongly associated with higher number of casual sexual partners and how recently men had HIV tested before study enrolment. This social marketing intervention was not associated with increased rates of HIV testing. More effective promotion of HIV testing is needed among MSM in England to reduce the average duration of undiagnosed infection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. Mortality of people with chronic fatigue syndrome: a retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register.

    Science.gov (United States)

    Roberts, Emmert; Wessely, Simon; Chalder, Trudie; Chang, Chin-Kuo; Hotopf, Matthew

    2016-04-16

    Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) register. We calculated standardised mortality ratios (SMRs) for all-cause, suicide-specific, and cancer-specific mortality for a 7-year observation period using the number of deaths observed in SLaM records compared with age-specific and sex-specific mortality statistics for England and Wales. Study participants were included if they had had contact with the chronic fatigue service (referral, discharge, or case note entry) and received a diagnosis of chronic fatigue syndrome. We identified 2147 cases of chronic fatigue syndrome from CRIS and 17 deaths from Jan 1, 2007, to Dec 31, 2013. 1533 patients were women of whom 11 died, and 614 were men of whom six died. There was no significant difference in age-standardised and sex-standardised mortality ratios (SMRs) for all-cause mortality (SMR 1·14, 95% CI 0·65-1·85; p=0·67) or cancer-specific mortality (1·39, 0·60-2·73; p=0·45) in patients with chronic fatigue syndrome when compared with the general population in England and Wales. This remained the case when deaths from suicide were removed from the analysis. There was a significant increase in suicide-specific mortality (SMR 6·85, 95% CI 2·22-15·98; p=0·002). We did not note increased all-cause mortality in people with chronic fatigue syndrome, but our findings show a substantial increase in mortality from suicide. This highlights the need for clinicians to be aware of the increased risk of completed suicide and to assess suicidality adequately in patients with chronic fatigue syndrome. National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London

  8. An ethnographic study of career aspirations amongst students studying level 3 sports courses at a further education college in England

    OpenAIRE

    Connolly, Daniel J.; Evans, Adam B.; Allen-Collinson, Jacquelyn

    2013-01-01

    There is currently a dearth of research into how sports students’ career aspirations are formed during their post-compulsory education. This paper is based on an ethnographic study of sport students’ habitus and career aspirations. Two first-year cohorts on two different courses at a Further Education College in England were selected to participate in the in-depth study. The paper provides an analysis of the contrasting subcultures emergent within these groups, and how specific cultural pract...

  9. The New England travel market: changes in generational travel patterns

    Science.gov (United States)

    Rodney B. Warnick

    1995-01-01

    The purpose of this study was to examine and explore the New England domestic travel market trends, from 1979 through 1991 within the context of generations. The existing travel markets, who travel to New England, are changing by age cohorts and specifically within different generations. The New England changes in generational travel patterns do not reflect national...

  10. HIV incidence in an open national cohort of men who have sex with men attending sexually transmitted infection clinics in England.

    Science.gov (United States)

    Desai, S; Nardone, A; Hughes, G; Delpech, V; Burns, F; Hart, G; Gill, O N

    2017-10-01

    The aim of the study was to determine HIV incidence among men who have sex with men (MSM) who repeat test for HIV at sexually transmitted infection (STI) clinics in England, and identify associated factors. Annual HIV incidence and 95% confidence interval (CI) were calculated for a national cohort of MSM who tested HIV negative at any STI clinic in England in 2012 and had a follow-up test within 1 year using routinely collected data. Cox regression analyses were performed to identify predictors of HIV acquisition and population attributable risk for HIV infection was calculated for predictors. In 2012, 85 500 MSM not known to be HIV positive attended any STI clinic in England, and 31% tested for HIV at least twice within 1 year at the same clinic. HIV incidence was 2.0 per 100 person-years (PY; 95% CI 1.8-2.2) among repeat testers. Incidence was higher among MSM of black ethnicity (3.2 per 100 PY) and those with a bacterial STI diagnosis at the initial attendance (3.2 per 100 PY). MSM with a previous syphilis or gonorrhoea infection were at significantly greater risk of acquiring HIV in the subsequent year [adjusted hazard ratio 4.1 (95% CI 2.0-8.3) and 2.1 (95% CI 1.4-3.2), respectively]. The predictors accounted for 37% of HIV infections. Annual HIV incidence among MSM attending STI clinics in England is high. Previous STIs were predictors of HIV acquisition but only accounted for one in five infections. More discriminatory behavioural predictors of HIV acquisition could provide better triaging of HIV prevention services for MSM attending STI clinics. © 2017 British HIV Association.

  11. Nonresident Suicides in England: A National Study

    Science.gov (United States)

    Windfuhr, Kirsten; Bickley, Harriet; While, David; Williams, Alyson; Hunt, Isabelle M.; Appleby, Louis; Kapur, Navneet

    2010-01-01

    Little is known about the numbers and characteristics of people who travel away from home before dying by suicide. Therefore, this studied attempts to identify the sociodemographic characteristics, location, and method of suicide in people who died distant from home, in a national sample. Data were collected on all English suicides and a patient…

  12. Period and cohort trends for mortality and cigarette consumption in England and Wales, 1946 to 1980, with emphasis on sex ratios.

    Science.gov (United States)

    Burch, P R

    1988-01-01

    In an earlier paper (Burch P. R. J. J Chron Dis 1981; 34: 87-103) changes in sex- and age-specific mortality from all causes of death in England and Wales were studied in relation to changes in sex- and age-specific cigarette consumption. The absence of a consistent correlation between the two variables, and the general characteristics of the data, suggested that studies of sex ratios might provide a better test of the hypothesis that the association between smoking and mortality has a causal basis. In this paper temporal changes in the sex ratio of cumulative cigarette consumption by cohort, and of smoking rates by age, are considered in relation to changes in the sex ratio of mortality. Again, no consistent correlations emerge and it is evident that factors other than smoking have played a dominant part in determining recent changes in the sex ratio of mortality in all age groups from 35-39 to 80-84 years. Among these "other factors" are birth cohort effects that can be attributed, in part, to birth cohort changes in the sex ratio of mortality from bronchitis and emphysema. The present results, together with other evidence (vide supra; and Burch P. R. J. J Chron Dis 1984; 37: 148-156), show that great care needs to be exercised when attempts are made to deduce causation from epidemiologic surveys.

  13. A qualitative study of uptake of free vitamins in England

    Science.gov (United States)

    Jessiman, Tricia; Cameron, Ailsa; Wiggins, Meg; Lucas, Patricia J

    2013-01-01

    Objective To identify reasons why eligible families are not accessing free ‘Healthy Start’ vitamin supplementation (providing vitamins A, C and D) in England. Design Qualitative study using in-depth interviews. Setting 13 primary care trusts in England. Participants Purposive sample of 15 Healthy Start coordinators, 50 frontline health and children's professionals and 107 parents. Results Vitamin take-up was low across all research sites, reported as below 10% of eligible beneficiaries for free vitamins. Reasons identified by both parents and professionals included (1) poor accessibility of vitamins, (2) low promotion of the scheme by health professionals, (3) a lack of awareness among eligible families, and (4) low motivation among mothers to take vitamins for themselves during pregnancy or for children under 4 years old. Conclusions Low uptake rates can be explained by poor accessibility of vitamins and lack of awareness and motivation to take vitamin supplements among eligible families. Universal provision (at least for pregnant women) and better training for health professionals are identified as potential solutions worthy of further research and evaluation. PMID:23702436

  14. A qualitative study of uptake of free vitamins in England.

    Science.gov (United States)

    Jessiman, Tricia; Cameron, Ailsa; Wiggins, Meg; Lucas, Patricia J

    2013-08-01

    To identify reasons why eligible families are not accessing free 'Healthy Start' vitamin supplementation (providing vitamins A, C and D) in England. Qualitative study using in-depth interviews. 13 primary care trusts in England. Purposive sample of 15 Healthy Start coordinators, 50 frontline health and children's professionals and 107 parents. Vitamin take-up was low across all research sites, reported as below 10% of eligible beneficiaries for free vitamins. Reasons identified by both parents and professionals included (1) poor accessibility of vitamins, (2) low promotion of the scheme by health professionals, (3) a lack of awareness among eligible families, and (4) low motivation among mothers to take vitamins for themselves during pregnancy or for children under 4 years old. Low uptake rates can be explained by poor accessibility of vitamins and lack of awareness and motivation to take vitamin supplements among eligible families. Universal provision (at least for pregnant women) and better training for health professionals are identified as potential solutions worthy of further research and evaluation.

  15. Cohort Studies: Prospective versus Retrospective

    NARCIS (Netherlands)

    Euser, Anne M.; Zoccali, Carmine; Jager, Kitty J.; Dekker, Friedo W.

    2009-01-01

    Cohort studies form a suitable study design to assess associations between multiple exposures on the one hand and multiple outcomes on the other hand. They are especially appropriate to study rare exposures or exposures for which randomization is not possible for practical or ethical reasons.

  16. a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    RP Lystad

    2015-09-01

    Full Text Available The objectives of this study were to estimate the incidence and describe the pattern and severity of training injuries in taekwondo, and to compare pattern and severity of training injuries with competition injuries. One hundred and fifty-two active Australian amateur taekwondo athletes, aged 12 years or over, completed an online survey comprising questions on training exposure and injury history over the preceding 12 months. The main outcome measures were: overall injury incidence rate per athlete-year; training injury incidence rate per athlete-year, per 1000 athlete-training-sessions, and per 1000 athlete-hours of training; injury severity; and injury proportions by anatomical region and by type of injury. Injury incidence rates were calculated with 95% confidence intervals using standard methods, while injury proportions were compared using Fisher’s exact test. The vast majority (81.5% of taekwondo injuries in an average athlete-year occurred during training. The training injury incidence rate was estimated to be 1.6 (95% CI: 1.4, 1.9 per athlete-year, 11.8 (95% CI: 10.4, 13.4 per 1000 athlete-training-sessions, and 7.0 (95% CI: 6.1, 7.9 per 1000 athlete-hours of training. Among athletes with five or fewer injuries, the severity and injury pattern of training injuries were, by and large, the same as for competition injuries. Approximately sixty percent (60.3% of training injuries required treatment by a health professional. Considering the burden of training injuries exceeds that of competition injuries, taekwondo governing bodies and stakeholders are encouraged to devote more efforts towards the identification of risk factors for, and prevention of, training injuries in the sport of taekwondo.

  17. Challenges to dental access - England as a case study.

    Science.gov (United States)

    Bedi, Raman

    2006-06-01

    Access to dental services because of an insufficient workforce is a historic challenge faced by many developing countries. In recent years, however, it has become a major issue for many industrialized countries. The growing demand for cosmetic dentistry, an increase in patients' willingness to pay for dental treatment, and growing numbers of older dentate patients have all put pressure on dental systems. Ways of meeting these challenges and ensuring reasonable dental access will vary from country to country, but the solutions often lie in how the dental workforce is regulated. This case study of the dental reforms currently being implemented in England highlights progress at a particular point in time (Summer 2005). It is clear that it will take a number of years to find a new national dental payment system (the National Health Service) to replace the system which has changed little since 1948. However, the political pressure to address poor access to state-funded dental services calls for more immediate actions. The initial approach was to increase the dental workforce via international recruitment, and in the medium term to increase the number of dental students in training and to expand the numbers of other members of the dental team. An additional stratagem is to retain those already providing dental care under the National Health Service by the introduction of a new method of remuneration. England is trying to improve both access to care and the oral health of the population by creating a workforce more suitable to public demands and changing oral health needs.

  18. Cohort profile update: the Danish HIV Cohort Study (DHCS).

    Science.gov (United States)

    Omland, Lars Haukali; Ahlström, Magnus Glindvad; Obel, Niels

    2014-12-01

    The DHCS is a cohort of all HIV-infected individuals seen in one of the eight Danish HIV centres after 31 December 1994. Here we update the 2009 cohort profile emphasizing the development of the cohort. Every 12-24 months, DHCS is linked with the Danish Civil Registration System (CRS) in order to extract an age- and sex-matched comparison cohort from the general population, as well as cohorts of family members of the HIV-infected patients and of the comparison cohort. The combined cohort is linked with CRS, the Danish Cancer Registry, the Danish National Hospital Registry, the Danish Registry of Causes of Death, the Danish National Prescription Registry, the Attainment Register and the Integrated Database for Labour Market Research to get information on vital status, migration, cancer, hospital contacts, causes of death, dispensed prescriptions, education and employment. Using this design, rates of a range of outcomes have been compared between HIV-infected patients and the comparison cohort, as well as between families of these two cohorts in order to disaggregate the effects of HIV infection and familial/environmental factors. Data can be shared with foreign institutions following approval from the Danish Data Protection Agency. Potential collaborators can contact the study director, Niels Obel (e-mail: niels.obel@regionh.dk). © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  19. Prostate Cancer Biospecimen Cohort Study

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-15-2-0062 TITLE: Prostate Cancer Biospecimen Cohort Study PRINCIPAL INVESTIGATOR: Bettina F. Drake, MPH, PhD CONTRACTING...ADDRESS. 1. REPORT DATE October 2017 2. REPORT TYPE Annual 3. DATES COVERED 30 Sep 2016 - 29 Sep 2017 4. TITLE AND SUBTITLE Prostate Cancer Biospecimen...14. ABSTRACT The goal of the study is development of a Prostate Cancer Biorepository Network (PCBN) resource site with high quality and well

  20. Methodology Series Module 1: Cohort Studies.

    Science.gov (United States)

    Setia, Maninder Singh

    2016-01-01

    Cohort design is a type of nonexperimental or observational study design. In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. They are then followed over time to evaluate for the occurrence of the outcome of interest. Some examples of cohort studies are (1) Framingham Cohort study, (2) Swiss HIV Cohort study, and (3) The Danish Cohort study of psoriasis and depression. These studies may be prospective, retrospective, or a combination of both of these types. Since at the time of entry into the cohort study, the individuals do not have outcome, the temporality between exposure and outcome is well defined in a cohort design. If the exposure is rare, then a cohort design is an efficient method to study the relation between exposure and outcomes. A retrospective cohort study can be completed fast and is relatively inexpensive compared with a prospective cohort study. Follow-up of the study participants is very important in a cohort study, and losses are an important source of bias in these types of studies. These studies are used to estimate the cumulative incidence and incidence rate. One of the main strengths of a cohort study is the longitudinal nature of the data. Some of the variables in the data will be time-varying and some may be time independent. Thus, advanced modeling techniques (such as fixed and random effects models) are useful in analysis of these studies.

  1. Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study

    National Research Council Canada - National Science Library

    Matheson, Lauren; Asherson, Philip; Wong, Ian Chi Kei; Hodgkins, Paul; Setyawan, Juliana; Sasane, Rahul; Clifford, Sarah

    2013-01-01

    ...) in the published scientific literature. This study aimed to explore the experiences of adults in England with ADHD regarding access to diagnostic and treatment services, ADHD-related impairment and to compare experiences between patients...

  2. GPs' perceptions of workload in England: a qualitative interview study.

    Science.gov (United States)

    Croxson, Caroline Hd; Ashdown, Helen F; Hobbs, Fd Richard

    2017-02-01

    GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable. To gather an in-depth understanding of GPs' perceptions and attitudes towards workload. All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached. Semi-structured, qualitative interviews were conducted. Data were analysed thematically. In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload. This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved. © British Journal of General Practice 2017.

  3. Recognition and enforcement of foreign judgments in the Law of Iran and England: a comparative study

    Directory of Open Access Journals (Sweden)

    Abasat Pour Mohammad

    2017-07-01

    Full Text Available The aim of this study was to Recognition and Enforcement of Foreign Judgments in the Law of Iran and England: A Comparative Study. There are a lot of similarities and commonalities between the legal system of Iran and England in the field of recognition and enforcement of the foreign judgments including public discipline and conflicting judgments. Public discipline in England Law is more specific than that of Iran. Being a civil case of the judgment, impossibility of recognition, enforcement of tax and criminal judgments are among the similarities of the two systems. On the other hand, reciprocity, precise of the foreign court, and the jurisdiction governing the nature of the claim are among instances which are different in Iran and England legal systems on the recognizing of the enforcement of foreign judgments.

  4. Cohort profile: the ages 2003 cohort study in Aichi, Japan.

    Science.gov (United States)

    Nishi, Akihiro; Kondo, Katsunori; Hirai, Hiroshi; Kawachi, Ichiro

    2011-01-01

    The longevity of Japanese is thought to be associated with psychosocial factors such as sense of coherence, social support, and social capital. However, the actual factors responsible and the extent of their contribution to individual health status are not known. The Aichi Gerontological Evaluation Study (AGES) 2003 Cohort Study is a prospective cohort study of community-dwelling, activities of daily living-independent people aged 65 or older living in 6 municipalities in Chita peninsula, Aichi Prefecture, Japan. Information on psychosocial factors and other individual- and community-level factors was collected in the second half of 2003 using a baseline questionnaire. Vital status and physical and cognitive decline have been followed using data derived from long-term care insurance certification. Geographical information on the study participants was also obtained. A total of 13 310 (6508 men; 6802 women) study participants were registered in the study. For an interim report, we followed the cohort for 48 months, yielding 24 753 person-years of observation among men and 26 456 person-years among women. The AGES 2003 Cohort Study provides useful evidence for research in social epidemiology, gerontology, and health services.

  5. Cohort profile: the Social Inequality in Cancer (SIC) cohort study.

    Science.gov (United States)

    Nordahl, Helene; Hvidtfeldt, Ulla Arthur; Diderichsen, Finn; Rod, Naja Hulvej; Osler, Merete; Frederiksen, Birgitte Lidegaard; Prescott, Eva; Tjønneland, Anne; Lange, Theis; Keiding, Niels; Andersen, Per Kragh; Andersen, Ingelise

    2014-12-01

    The Social Inequality in Cancer (SIC) cohort study was established to determine pathways through which socioeconomic position affects morbidity and mortality, in particular common subtypes of cancer. Data from seven well-established cohort studies from Denmark were pooled. Combining these cohorts provided a unique opportunity to generate a large study population with long follow-up and sufficient statistical power to develop and apply new methods for quantification of the two basic mechanisms underlying social inequalities in cancer-mediation and interaction. The SIC cohort included 83 006 participants aged 20-98 years at baseline. A wide range of behavioural and biological risk factors such as smoking, physical inactivity, alcohol intake, hormone replacement therapy, body mass index, blood pressure and serum cholesterol were assessed by self-administered questionnaires, physical examinations and blood samples. All participants were followed up in nationwide demographic and healthcare registries. For those interested in collaboration, further details can be obtained by contacting the Steering Committee at the Department of Public Health, University of Copenhagen, at inan@sund.ku.dk. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  6. [Birth cohort studies in China: a review].

    Science.gov (United States)

    Wang, L; Sun, L; He, X Y; Wang, Y X; Yu, W P

    2017-04-10

    With longer than 100-year experience of development, methods used on birth cohort study have been viewed as having important roles in exploring the probable effects of health and environment exposure both prior to and during the pregnancy in the life circle as infants, children, adolescents, adults, and the elderly. However in China, birth cohort studies started late but with rapid development. Recently, some well-known methods on birth cohort studies were established in mainland China, Hong Kong and Taiwan area. This paper presented an overall review on the progress about birth cohort studies and their prospects, in China.

  7. PROFESSIONALISATION OF NURSING IN ENGLAND AND SPAIN: A Comparative Study

    OpenAIRE

    Camaño-Puig, Ramón

    2005-01-01

    The publication of this book is the result of the close collaboration,both in terms of research as well as in students and faculty exchanges that has existed for a long time between Laurea Polytechnic, in Finland, and the University of Valencia, Spain. Through the initiative of Laurea Polytechnic, the research of Dr. Ramón Camaño-Puig that led to his European Doctorate, is now brought to the public with the title of “Professionalisation of Nursing in England and Spain: A Comparative Study”. W...

  8. Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study

    OpenAIRE

    Helen L Fisher; Terrie E Moffitt; Houts, Renate M.; Belsky, Daniel W.; Arseneault, Louise; Caspi, Avshalom

    2012-01-01

    Objectives To test whether frequent bullying victimisation in childhood increases the likelihood of self harming in early adolescence, and to identify which bullied children are at highest risk of self harm. Design The Environmental Risk (E-Risk) longitudinal study of a nationally representative UK cohort of 1116 twin pairs born in 1994-95 (2232 children). Setting England and Wales, United Kingdom. Participants Children assessed at 5, 7, 10, and 12 years of age. Main outcome measures Relative...

  9. Examining smoking behaviours among parents from the UK Millennium Cohort Study after the smoke-free legislation in Scotland.

    Science.gov (United States)

    Hawkins, Summer Sherburne; Cole, Tim J; Law, Catherine

    2011-03-01

    To investigate parental smoking behaviours between England and Scotland after the smoke-free legislation in Scotland came into effect in 2006 and examine inequalities in maternal smoking behaviours between countries. 5954 white mothers and 3757 fathers resident in England and 1522 white mothers and 904 fathers resident in Scotland who participated in the Millennium Cohort Study (a prospective nationally representative cohort study) when the cohort child was age 9 months (before legislation) and 5 years (after legislation in Scotland but not in England). The main outcome measures were smoking at 9 months and 5 years, quitting smoking by 5 years, starting smoking by 5 years. In England and Scotland approximately 30% of parents reported smoking at 9 months with only a slight decrease in smoking at 5 years. There were no differences between countries in parental smoking after the smoke-free legislation in Scotland came into effect, taking into account prior smoking levels. Light smokers (1-9 cigarettes/day) from Scotland were less likely to quit by 5 years than those from England, but there were no differences between countries among heavy smokers (10+ cigarettes/day). Non-smoking mothers from Scotland (6.2%) were less likely to start smoking by 5 years than mothers from England (7.3%). Mothers from more disadvantaged circumstances in both countries were more likely to report that they smoked or started smoking. In England quitting was also socially patterned, but in Scotland, after the legislation was introduced, the gradients in quitting smoking were flatter across social groups. Smoking behaviours among parents with young children remained relatively stable, highlighting the need for additional tobacco control efforts to support smoking cessation. However, the smoke-free legislation does not appear to widen health inequalities and may even help reduce them by encouraging quitting across socioeconomic groups.

  10. Trends in penile cancer: a comparative study between Australia, England and Wales, and the US.

    Science.gov (United States)

    Sewell, James; Ranasinghe, Weranja; De Silva, Daswin; Ayres, Ben; Ranasinghe, Tamra; Hounsome, Luke; Verne, Julia; Persad, Raj

    2015-01-01

    To investigate and compare the trends in incidence and mortality of penile cancer between Australia, England and Wales, and the US, and provide hypotheses for these trends. Cancer registry data from 1982 to 2005 inclusive were obtained from Australia, England and Wales, and the United States. From these data, age-specific, -standardised and mortality:incidence ratios were calculated, and compared. The overall incidence of penile cancer in England and Wales (1.44 per 100,000 man-years) was higher than in Australia (0.80 per 100,000), and the US (0.66 per 100,000). Incidence of penile cancer in all three countries has remained relatively stable over time. Similarly, although the mortality rates were also higher in England and Wales (0.37 per 100,000 man-years) compared to Australia (0.18 per 100,000) and the US (0.15 per 100,000), the mortality/incidence ratios were similar for all three countries. Penile cancer incidence is low, affecting mainly older men. Rates differ between the three countries, being twice as common in England and Wales as in the other studied regions. Circumcision rates have a potential influence on these rates but are not the sole explanation for the variation.

  11. Three decades of geochronologic studies in the New England Appalachians

    Science.gov (United States)

    Zartman, R.E.

    1988-01-01

    Over the past 30 years, both isotope geochronology and plate tectonics grew from infancy into authoritative disciplines in the geological sciences. The existing geochronlogy is summarized into a map and table emphasizing the temporal construction of the New England Appalachians. By using lithotectonic zones as the building blocks of the orogen, seven such zones are defined in terms of pre-, syn-, and post-assembly geologic history. The boundaries between these zones are faults in most cases, some of which may have had recurring movement to further complicate any plate-tectonic scenario. A delineation of underlying Grenvillian, Chain Lakes, and Avalonian basement is also attempted, which now can make use of isotopes in igneous rocks as petrogenic indicators to supplement the rare occurrences of basement outcrop within mobile zones of the orogen. -from Author

  12. Perceptions and experiences of financial incentives: a qualitative study of dialysis care in England

    NARCIS (Netherlands)

    Abma, I.L.; Jayanti, A.; Bayer, S.; Mitra, S.; Barlow, J.

    2014-01-01

    OBJECTIVE: The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. DESIGN: The study followed a qualitative design. Data collection involved 32 in-depth

  13. Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile.

    Science.gov (United States)

    Wahabi, Hayfaa; Fayed, Amel; Esmaeil, Samia; Alzeidan, Rasmieh; Elawad, Mamoun; Tabassum, Rabeena; Hansoti, Shehnaz; Magzoup, Mohie Edein; Al-Kadri, Hanan; Elsherif, Elham; Al-Mandil, Hazim; Al-Shaikh, Ghadeer; Zakaria, Nasria

    2016-01-01

    To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant. A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated. The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%. Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.

  14. Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile.

    Directory of Open Access Journals (Sweden)

    Hayfaa Wahabi

    Full Text Available To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant.A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated.The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%.Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.

  15. Understanding What Influences the Health-Related Quality of Life of Hemodialysis Patients: A Collaborative Study in England and Ireland.

    Science.gov (United States)

    Lowney, Aoife C; Myles, Helena T; Bristowe, Katherine; Lowney, Eanna L; Shepherd, Katie; Murphy, Marie; O'Brien, Tony; Casserly, Liam; McQuillan, Regina; Plant, William D; Conlon, Peter J; Vinen, Catherine; Eustace, Joseph A; Murtagh, Fliss E M

    2015-12-01

    The international cohort of hemodialysis patients is aging and increasing in number. Nephrologists have a therapeutic relationship with their patients that may span decades. Often overlooked components of chronic disease management include symptom control and assessment of health-related quality of life (HRQoL). This study describes the symptom profile of a large cohort of patients with end-stage renal disease on hemodialysis in England and Ireland and evaluates how symptom burden and other factors influence quality-of-life scores. A prospective cross-sectional observational study of hemodialysis patients was conducted in Ireland and England during 2011 and 2012. Two validated clinical tools were used to determine HRQoL and symptom burden. Demographic and clinical data were examined, and regression analysis was used to determine associations with HRQoL scores. A total of 893 patients on hemodialysis (mean [SD] age 64 [16] years) had a high symptom burden and poor HRQoL compared with population norms. Specifically, 64% of patients reported pain (95% confidence interval 61%-67%) and 79% reported weakness (95% confidence interval 75%-81%). A total of 43 percent of patients reported between six and 10 symptoms in the week preceding the survey. HRQoL was significantly and independently associated with poor mobility and pain and remained significant after adjusting for variations in clinical characteristics. Being listed on a transplant wait-list register was positively associated with HRQoL. These findings illustrate the high symptom burden and poor HRQoL of the hemodialysis population. Emphasis during clinical reviews on pain assessment and on assessing mobility plus interventions, such as pain management and physiotherapy/occupational therapy, are practical ways for renal teams to help improve patients' quality of life. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  16. What Do Geography Textbook Authors in England Consider When They Design Content and Select Case Studies?

    Science.gov (United States)

    Lee, Jongwon; Catling, Simon

    2017-01-01

    This study investigated the perspectives of seven English authors, on aspects of their geography textbook writing for schools in England, through a questionnaire-based enquiry. This investigation asked about the features that geography textbook authors consider to be the most important when designing student activities, and which criteria they…

  17. Joshua Rodda: Public Religious Disputations in England 1558–1626, St Andrews Studies in Reformation History

    Directory of Open Access Journals (Sweden)

    Joachim Schwend

    2015-01-01

    Full Text Available This contribution offers a review of Joshua Rodda's Public Religious Disputations in England 1558–1626, St Andrews Studies in Reformation History. Farnham, Surrey: Ashgate, 2014. 252 pages, regular price £ 70, 234 x 156 mm, ISBN 978–1–4724–1555–4.

  18. A Population-Based Study of Juvenile Perpetrators of Homicide in England and Wales

    Science.gov (United States)

    Rodway, Cathryn; Norrington-Moore, Victoria; While, David; Hunt, Isabelle M.; Flynn, Sandra; Swinson, Nicola; Roscoe, Alison; Appleby, Louis; Shaw, Jenny

    2011-01-01

    This study aimed to describe the social, behavioural and offence characteristics of all convicted perpetrators of homicide aged 17 and under; to examine their previous contact with mental health services, and to discuss strategies for homicide prevention. An eight-year (1996-2004) sample of 363 juvenile homicide perpetrators in England and Wales…

  19. Primary School Physical Education and Sports Coaches: Evidence from a Study of School Sport Partnerships in North-West England

    Science.gov (United States)

    Smith, Andy

    2015-01-01

    Drawing on interview data from a study of one School Sport Partnership (SSP) in north-west England, this paper examines (from the perspective of teachers): (1) some of the ways in which the SSP programme facilitated the increasing use of sports coaches to deliver aspects of physical education (PE) in state primary schools in England and (2) how…

  20. Brain-Science Based Cohort Studies

    Science.gov (United States)

    Koizumi, Hideaki

    2011-01-01

    This article describes a number of human cohort studies based on the concept of brain-science and education. These studies assess the potential effects of new technologies on babies, children and adolescents, and test hypotheses drawn from animal and genetic case studies to see if they apply to people. A flood of information, virtual media,…

  1. Comparison of breast and bowel cancer screening uptake patterns in a common cohort of South Asian women in England

    Directory of Open Access Journals (Sweden)

    Gumber Anil K

    2010-04-01

    Full Text Available Abstract Background Inequalities in uptake of cancer screening by ethnic minority populations are well documented in a number of international studies. However, most studies to date have explored screening uptake for a single cancer only. This paper compares breast and bowel cancer screening uptake for a cohort of South Asian women invited to undertake both, and similarly investigates these women's breast cancer screening behaviour over a period of fifteen years. Methods Screening data for rounds 1, 2 and 5 (1989-2004 of the NHS breast cancer screening programme and for round 1 of the NHS bowel screening pilot (2000-2002 were obtained for women aged 50-69 resident in the English bowel screening pilot site, Coventry and Warwickshire, who had been invited to undertake breast and bowel cancer screening in the period 2000-2002. Breast and bowel cancer screening uptake levels were calculated and compared using the chi-squared test. Results 72,566 women were invited to breast and bowel cancer screening after exclusions. Of these, 3,539 were South Asian and 69,027 non-Asian; 18,730 had been invited to mammography over the previous fifteen years (rounds 1 to 5. South Asian women were significantly less likely to undertake both breast and bowel cancer screening; 29.9% (n = 1,057 compared to 59.4% (n = 40,969 for non-Asians (p Conclusions Culturally appropriate targeted interventions are required to reduce observed disparities in cancer screening uptakes.

  2. How robust is the calculation of health inequality trends by educational attainment in England and Wales using the Longitudinal Study?

    Science.gov (United States)

    Flanagan, L; McCartney, G

    2015-06-01

    Inequalities in mortality by educational attainment are wider in Eastern Europe than in West and Central Europe, but have thus far been largely limited to cross-sectional analyses. This study explored the potential to use the Longitudinal Study to describe trends in mortality inequality by educational attainment in England and Wales from 1971 to 2009 and the limitations in the available data. Comparison of cohort studies. Data from the Office for National Statistics Longitudinal Study were used which takes a sample of respondees from each Census (1971-2001) and links them to death certification. Age-standardized mortality was calculated by educational attainment for those aged 25-69 years as was the Relative Index of Inequality and Slope Index of Inequality for men and women for each time period. Overall mortality declined in all categories of educational attainment for men and women from 1971. Limited data were collected on educational attainment in the Censuses prior to 2001, combined with the high proportion of respondents with missing data or reporting 'no education', meant that estimates of inequalities for the period 1971 to 2000 were very imprecise and likely to be misleading. For 2001-2009, the slope index of inequality was 268 (95% CI 57-478) and relative index of inequality was 0.61 (95% CI 0.13-1.10) for the total population; 354 (95% CI 72-636) and 0.67 (95% CI 0.14-1.21) respectively for men; and 231 (95% CI 72-389) and 0.66 (95% CI 0.21-1.11) respectively for women. Limited educational data in the Censuses prior to 2001 makes calculation of mortality inequalities by educational attainment in England and Wales imprecise and potentially misleading. International comparisons and time trend analyses using these data prior to 2001 should be done with great caution. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  3. Cultivating cohort studies for observational translational research.

    Science.gov (United States)

    Ransohoff, David F

    2013-04-01

    "Discovery" research about molecular markers for diagnosis, prognosis, or prediction of response to therapy has frequently produced results that were not reproducible in subsequent studies. What are the reasons, and can observational cohorts be cultivated to provide strong and reliable answers to those questions? Experimental Selected examples are used to illustrate: (i) what features of research design provide strength and reliability in observational studies about markers of diagnosis, prognosis, and response to therapy? (ii) How can those design features be cultivated in existing observational cohorts, for example, within randomized controlled clinical trial (RCT), other existing observational research studies, or practice settings like health maintenance organization (HMOs)? Examples include a study of RNA expression profiles of tumor tissue to predict prognosis of breast cancer, a study of serum proteomics profiles to diagnose ovarian cancer, and a study of stool-based DNA assays to screen for colon cancer. Strengths and weaknesses of observational study design features are discussed, along with lessons about how features that help assure strength might be "cultivated" in the future. By considering these examples and others, it may be possible to develop a process of "cultivating cohorts" in ongoing RCTs, observational cohort studies, and practice settings like HMOs that have strong features of study design. Such an effort could produce sources of data and specimens to reliably answer questions about the use of molecular markers in diagnosis, prognosis, and response to therapy.

  4. Observed and Expected Mortality in Cohort Studies.

    Science.gov (United States)

    Richardson, David B; Keil, Alexander P; Cole, Stephen R; MacLehose, Richard F

    2017-03-15

    Epidemiologists often compare the observed number of deaths in a cohort with the expected number of deaths, obtained by multiplying person-time accrued in the cohort by mortality rates for a reference population (ideally, a reference that represents the mortality rate in the cohort in the absence of exposure). However, if exposure is hazardous (or salutary), this calculation will not consistently estimate the number of deaths expected in the absence of exposure because exposure will have affected the distribution of person-time observed in the study cohort. While problems with interpretation of this standard calculation of expected counts were discussed more than 2 decades ago, these discussions had little impact on epidemiologic practice. The logic of counterfactuals may help clarify this topic as we revisit these issues. In this paper, we describe a simple way to consistently estimate the expected number of deaths in such settings, and we illustrate the approach using data from a cohort study of mortality among underground miners. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Cohort studies in health sciences librarianship

    Science.gov (United States)

    Eldredge, Jonathan

    2002-01-01

    Question: What are the key characteristics of the cohort study design and its varied applications, and how can this research design be utilized in health sciences librarianship? Data Sources: The health, social, behavioral, biological, library, earth, and management sciences literatures were used as sources. Study Selection: All fields except for health sciences librarianship were scanned topically for either well-known or diverse applications of the cohort design. The health sciences library literature available to the author principally for the years 1990 to 2000, supplemented by papers or posters presented at annual meetings of the Medical Library Association. Data Extraction: A narrative review for the health, social, behavioral, biological, earth, and management sciences literatures and a systematic review for health sciences librarianship literature for the years 1990 to 2000, with three exceptions, were conducted. The author conducted principally a manual search of the health sciences librarianship literature for the years 1990 to 2000 as part of this systematic review. Main Results: The cohort design has been applied to answer a wide array of theoretical or practical research questions in the health, social, behavioral, biological, and management sciences. Health sciences librarianship also offers several major applications of the cohort design. Conclusion: The cohort design has great potential for answering research questions in the field of health sciences librarianship, particularly evidence-based librarianship (EBL), although that potential has not been fully explored. PMID:12398244

  6. Statistical challenges in observational cohort studies

    NARCIS (Netherlands)

    Hof, M.H.P.

    2015-01-01

    For over a century observational cohort studies have been used to study determinants of health and disease. Within a sample from the population, we can determine the relation between health outcomes (e.g. death) and a broad range of factors as genetic markers, environmental exposures, and lifestyle

  7. Cohort studies in health sciences librarianship.

    Science.gov (United States)

    Eldredge, Jonathan

    2002-10-01

    What are the key characteristics of the cohort study design and its varied applications, and how can this research design be utilized in health sciences librarianship? The health, social, behavioral, biological, library, earth, and management sciences literatures were used as sources. All fields except for health sciences librarianship were scanned topically for either well-known or diverse applications of the cohort design. The health sciences library literature available to the author principally for the years 1990 to 2000, supplemented by papers or posters presented at annual meetings of the Medical Library Association. A narrative review for the health, social, behavioral, biological, earth, and management sciences literatures and a systematic review for health sciences librarianship literature for the years 1990 to 2000, with three exceptions, were conducted. The author conducted principally a manual search of the health sciences librarianship literature for the years 1990 to 2000 as part of this systematic review. The cohort design has been applied to answer a wide array of theoretical or practical research questions in the health, social, behavioral, biological, and management sciences. Health sciences librarianship also offers several major applications of the cohort design. The cohort design has great potential for answering research questions in the field of health sciences librarianship, particularly evidence-based librarianship (EBL), although that potential has not been fully explored.

  8. Cohort Profile: LifeLines, a three-generation cohort study and biobank

    National Research Council Canada - National Science Library

    Scholtens, Salome; Smidt, Nynke; Swertz, Morris A; Bakker, Stephan J. L; Dotinga, Aafje; Vonk, Judith M; van Dijk, Freerk; van Zon, Sander K. R; Wijmenga, Cisca; Wolffenbuttel, Bruce H. R; Stolk, Ronald P

    2015-01-01

    The LifeLines Cohort Study is a large population-based cohort study and biobank that was established as a resource for research on complex interactions between environmental, phenotypic and genomic...

  9. Longitudinal cohort survey of women's smoking behaviour and attitudes in pregnancy: study methods and baseline data

    Science.gov (United States)

    Orton, Sophie; Bowker, Katharine; Cooper, Sue; Naughton, Felix; Ussher, Michael; Pickett, Kate E; Leonardi-Bee, Jo; Sutton, Stephen; Dhalwani, Nafeesa N; Coleman, Tim

    2014-01-01

    Objectives To report the methods used to assemble a contemporary pregnancy cohort for investigating influences on smoking behaviour before, during and after pregnancy and to report characteristics of women recruited. Design Longitudinal cohort survey. Setting Two maternity hospitals, Nottingham, England. Participants 3265 women who attended antenatal ultrasound scan clinics were offered cohort enrolment; those who were 8–26 weeks pregnant and were currently smoking or had recently stopped smoking were eligible. Cohort enrollment took place between August 2011 and August 2012. Primary and secondary outcome measures Prevalence of smoking at cohort entry and at two follow-up time points (34–36 weeks gestation and 3 months postnatally); response rate, participants’ sociodemographic characteristics. Results 1101 (33.7%, 95% CI 32.1% to 35.4%) women were eligible for inclusion in the cohort, and of these 850 (77.2%, 95% CI 74.6% to 79.6%) were recruited. Within the cohort, 57.4% (N=488, 95% CI 54.1% to 60.7%) reported to be current smokers. Current smokers were significantly younger than ex-smokers (p<0.05), more likely to have no formal qualifications and to not be in current paid employment compared to recent ex-smokers (p<0.001). Conclusions This contemporary cohort, which seeks very detailed information on smoking in pregnancy and its determinants, includes women with comparable sociodemographic characteristics to those in other UK cross-sectional studies and cohorts. This suggests that future analyses using this cohort and aimed at understanding smoking behaviour in pregnancy may produce findings that are broadly generalisable. PMID:24833689

  10. Dogslife: A cohort study of Labrador Retrievers in the UK.

    Science.gov (United States)

    Pugh, C A; Bronsvoort, B M de C; Handel, I G; Summers, K M; Clements, D N

    2015-12-01

    Studies of animals that visit primary and secondary veterinary centres dominate companion animal epidemiology. Dogslife is a research initiative that collects data directly from owners about the health and lifestyle of Kennel Club (KC) registered Labrador Retrievers (LR) in the UK. The ultimate aim is to seek associations between canine lifestyle and health. A selection of data from Dogslife regarding the height, weight and lifestyle of 4307 LR up to four years of age is reported here. The majority of the dogs were household pets, living with at least one other pet, in families or households with more than one adult. The dogs typically ate diets of dried food and daily meal frequency decreased as the dogs aged. Working dogs spent more time exercising than pets, and dogs in Wales and Scotland were exercised more than their counterparts in England. Dogs in households with children spent less time exercising than dogs in other types of households. There was considerable variation in height and weight measurements indicative of a highly heterogeneous population. The average male height at the shoulders was 2-3cm taller than the UK breed standard. Dog weights continued to increase between one and four years of age. Those with chocolate coloured coats were heavier than their yellow and black counterparts. Greater dog weight was also associated with dogs whose owners reported restricting their dog's exercise due to where they lived. These findings highlight the utility of wide public engagement in the collation of phenotypic measures, providing a unique insight into the physical development and lifestyle of a cohort of LRs. In combination with concurrently collected data on the health of the cohort, phenotypic data from the Dogslife Project will contribute to understanding the relationship between dog lifestyle and health. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Examining the influence of gender, education, social class and birth cohort on MMSE tracking over time: a population-based prospective cohort study.

    Science.gov (United States)

    Matthews, Fiona; Marioni, Riccardo; Brayne, Carol

    2012-08-13

    Whilst many studies have analysed predictors of longitudinal cognitive decline, few have described their impact on population distributions of cognition by age cohort. The aim of this paper was to examine whether gender, education, social class and birth cohort affect how mean population cognition changes with age. The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) is a multi-centre population based longitudinal study of 13,004 individuals in England and Wales. Using ten years of follow-up data, mean Mini-mental State Examination (MMSE) scores were modelled by age and birth cohort adjusting for non-random drop-out. The model included terms to estimate cohort effects. Results are presented for five year age bands between 65-95 years. At a population level, women show greater change in MMSE scores with age than men. Populations with lower education level and manual work also show similar effects. More recent birth cohorts have slightly higher scores. Longitudinal data can allow examination of population patterns by gender, educational level, social class and cohort. Each of these major socio-demographic factors shows some effect on whole population change in MMSE with age.

  12. Maternal engagement with music up to nine months post-birth: Findings from a cross-sectional study in England

    OpenAIRE

    Fancourt, D.; Perkins, R

    2017-01-01

    There is significant evidence of the benefits of music for babies and emerging evidence that music may also benefit mothers’ wellbeing. However, there is a lack of current data documenting maternal engagement with music in England. This cross-sectional survey study used descriptive and inferential statistics to examine how 473 mothers living in England engaged with music between 1–9 months post-birth, and regression models to examine demographic and musical predictors of this engagement. Find...

  13. Sustainability in Secondary Education in England: An Ethnographic Study

    OpenAIRE

    O'Sullivan, Ciaran Francis

    2014-01-01

    This research sets out to establish both the extent to which and the ways in which English Secondary schools have a school culture focusing upon sustainability. I visited three case study schools for six weeks each: these were carefully selected to represent a range of progress towards becoming sustainable schools. I visited two other ‘benchmark’ schools for two days each: these were chosen on the recommendations of school sustainability experts, and visiting them helped me judge the progres...

  14. Reporting of heterogeneity of treatment effect in cohort studies: a review of the literature.

    Science.gov (United States)

    Dahan, Meryl; Scemama, Caroline; Porcher, Raphael; Biau, David J

    2018-01-12

    This article corresponds to a literature review and analyze how heterogeneity of treatment (HTE) is reported and addressed in cohort studies and to evaluate the use of the different measures to HTE analysis. prospective cohort studies, in English language, measuring the effect of a treatment (pharmacological, interventional, or other) published among 119 core clinical journals (defined by the National Library of Medicine) in the last 16 years were selected in the following data source: Medline. One reviewer randomly sampled journal articles with 1: 1 stratification by journal type: high impact journals (the New England Journal of Medicine, JAMA, LANCET, Annals of Internal Medicine, BMJ and Plos Medicine) and low impact journal (the remaining journals) to identify 150 eligible studies. Two reviewers independently and in duplicate used standardized piloted forms to screen study reports for eligibility and to extract data. They also used explicit criteria to determine whether a cohort study reported HTE analysis. Logistic regression was used to examine the association of prespecified study characteristics with reporting versus not reporting of heterogeneity of treatment effect. One hundred fifty cohort studies were included of which 88 (58%) reported HTE analysis. High impact journals (Odds Ratio: 3.5, 95% CI: 1.78-7.5; P studies (Odds Ratio: 0.26, 95% CI: 0.13-0.51; P studies published after 2014 (Odds Ratio: 0.5, 95% CI: 0.25-0.97; P = 0.004) were associated with more frequent reporting of HTE. 27 (31%) studies which reported HTE used an interaction test. More than half cohort studies report some measure of heterogeneity of treatment effect. Prospective cohort studies published in high impact journals, with large sample size, or studying a pharmacological treatment are associated with more frequent HTE reporting. The source of funding was not associated with HTE reporting. There is a need for guidelines on how to perform HTE analyses in cohort studies.

  15. Literature in the Abstract: Althusser and English Studies in England

    Directory of Open Access Journals (Sweden)

    David Margolies

    1994-01-01

    Full Text Available Althusser's work arrived just when the disintegrating liberal consensus was shaking the ivory towers of the university. Students protested the war in Vietnam as well as the policies of the university. Althusser offered an understanding of this corrupt world and its distorted self-image. These theories provided an exciting new totalization in which life had meaning and intellectuals, a vital role. In literary studies, students and lecturers assumed that works of literature were anti-scientific, preservers of the status quo, without genuine knowledge. Disillusioned, these students and lecturers condemned Literature as an institution and ignored the individual work. To stop teaching the dominant ideology, they found redemption through abstraction—general principles, abstract structures. Academics found it attractive to raise barricades in the mind, not the street. Althusserian ideas showed lecturers and students that what was thought to be a purely literary or factual matter of aesthetic appreciation was really ideological and political, but the arrogance of the Althusserians, who recognized no theory before Althusser and no value in empirical experience, offended potential allies.

  16. Awareness and Use of mHealth Apps: A Study from England

    OpenAIRE

    Kayyali, Reem; Peletidi, Aliki; Ismail, Muhammad; Hashim, Zahra; Bandeira, Pedro; Bonnah, Jennifer

    2017-01-01

    Purpose: Mobile health (mHealth) solutions have become an inevitable element of the healthcare landscape. The recommendation and use of mHealth is important, but it is often underutilised. This study was conducted in England. It aimed to determine the use and recommendation of mHealth apps by pharmacists, the public’s perceptions of mHealth apps in general, and the awareness and use of health apps by diabetic patients in particular. Methods: The study used a mixed research approach, utilising...

  17. Green space and physical activity: An observational study using Health Survey for England data

    OpenAIRE

    Mytton, Oliver T; Townsend, Nick; Rutter, Harry; Foster, Charlie

    2012-01-01

    : Past studies have suggested that a link between health outcomes and green space is due to increased levels of physical activity of individuals living in areas with more green space. We found a positive association between green space and physical activity levels. The odds of achieving the recommended amount of physical activity was 1.27 (95% CI: 1.13-1.44) for people living in the greenest quintile in England compared to those living in the least green quintile, after controlling for indivi...

  18. Trends in operation rates for inguinal hernia over five decades in England: database study.

    Science.gov (United States)

    Maisonneuve, J J; Yeates, D; Goldacre, M J

    2015-10-01

    We aimed to study trends over time in operation rates for inguinal hernia with and without obstruction over five decades. Routine hospital statistics were used to analyse trends in National Health Service hospitals in England (1968-2011). All-England admission rates for elective repair of unobstructed inguinal hernia in males were 240.8 episodes per 100,000 population [95 % confidence interval (CI) 234.5-247.2] in 1968 and were relatively stable until 2003 after which they declined to 217.1 (215.4-218.8) by 2011. However, the stability of the all ages rates masked a large decline in admission rates in the young (e.g. 425 per 100,000 in 1968-1970 in males under 1 year of age, down to 155 per 100,000 in 2007-2011) and a large increase in the elderly (e.g. 247 in 1968-1970 per 100,000 males aged 75-84, up to 799 per 100,000 in 2007-2011). All-England admission rates for obstructed inguinal hernia in males almost halved, from 19.3 episodes (17.4-21.2) in 1968 to 10.7 episodes (10.3-11.0) per 100,000 population in 2011. Admission rates for females gradually declined over time for both unobstructed and obstructed inguinal hernia. Hospital admission rates for elective operation on inguinal hernia without obstruction, for all ages combined, have been relatively stable over five decades, but this masked big differences between age groups. Rates of obstructed hernia have declined over time, particularly in the early years covered by the study, and have not shown an increase associated with the recent fall in elective surgery for hernia repair.

  19. An evaluation of pre-registration midwifery education in England. Research design: a case study approach.

    Science.gov (United States)

    Kent, J

    1992-06-01

    In this paper some aspects of research design are described and discussed. A national study to evaluate pre-registration midwifery education in England is currently in progress. As part of that study six case study sites have been selected. How those sites were selected and the theory and method of the case study approach are discussed in this paper. The value of the case study approach is discussed as are methodological issues of the case study method. What is a case? Are case studies representative? How can you generalise from case studies? What is theoretical sampling? What is the difference between statistical and logical inference? These are some of the questions raised and examined. It is suggested that an understanding of these theoretical issues and the research process is important to understand the research findings. By making the research design explicit and describing the research process the study also adopts a reflexive approach.

  20. Establishment of a Korea HPV cohort study

    Science.gov (United States)

    Lee, Won-Chul; Lee, Sae-Young; Koo, Yu Jin; Kim, Tae-Jin; Hur, Soo Young; Hong, Sung Ran; Kim, Sung Soon; Kee, Mee-Kyung; Rhee, Jee Eun; Lee, Joo Shil; Choi, Ho Sun; Cho, Chi Heum; Kim, Ki Tae

    2013-01-01

    We have designed a five-year multicentre prospective cohort study in women who are both human papillomavirus (HPV)-positive with either atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) of cervix. This study aimed to analyze the risk of developing a high-grade squamous intraepithelial lesion (HSIL) from either ASCUS or LSIL in HPV-positive women, so called 'progression' rate, to investigate differences in the progression rates according to HPV type-specific infection, and to evaluate the various factors associated with the persistence or clearance of HPV infection in the Korean population. At present, the study protocol composed of cervical cytology, HPV DNA testing, and questionnaire have been conducted actively since the first participant was enrolled in 2010. This study is the first nationwide Korea HPV cohort study. Our data will provide valuable information about not only the ambiguous cytology results of ASCUS and LSIL but also the effect of the specific HPV type and other various factors on the progression to HSIL. Finally, the results of our study will be helpful and applicable to determine the primary cervical cancer prevention strategies. PMID:23346315

  1. Cohort profile: the lidA Cohort Study-a German Cohort Study on Work, Age, Health and Work Participation.

    Science.gov (United States)

    Hasselhorn, Hans Martin; Peter, Richard; Rauch, Angela; Schröder, Helmut; Swart, Enno; Bender, Stefan; du Prel, Jean-Baptist; Ebener, Melanie; March, Stefanie; Trappmann, Mark; Steinwede, Jacob; Müller, Bernd Hans

    2014-12-01

    The lidA Cohort Study (German Cohort Study on Work, Age, Health and Work Participation) was set up to investigate and follow the effects of work and work context on the physical and psychological health of the ageing workforce in Germany and subsequently on work participation. Cohort participants are initially employed people subject to social security contributions and born in either 1959 (n = 2909) or 1965 (n = 3676). They were personally interviewed in their homes in 2011 and will be visited every 3 years. Data collection comprises socio-demographic data, work and private exposures, work ability, work and work participation attitudes, health, health-related behaviour, personality and attitudinal indicators. Employment biographies are assessed using register data. Subjective health reports and physical strength measures are complemented by health insurance claims data, where permission was given. A conceptual framework has been developed for the lidA Cohort Study within which three confirmatory sub-models assess the interdependencies of work and health considering age, gender and socioeconomic status. The first set of the data will be available to the scientific community by 2015. Access will be given by the Research Data Centre of the German Federal Employment Agency at the Institute for Employment Research (http://fdz.iab.de/en.aspx). © The Author 2014. Published by Oxford University Press on behalf of the International Epidemiological Association.

  2. Community water fluoridation and health outcomes in England: a cross-sectional study.

    Science.gov (United States)

    Young, Nicholas; Newton, John; Morris, John; Morris, Joan; Langford, John; Iloya, Jonathan; Edwards, Diane; Makhani, Semina; Verne, Julia

    2015-12-01

    Six million people in England live in areas where the level of fluoride in water is adjusted to reduce the significant public health burden of dental caries. The dental effects of fluoride are well established, but evidence for suggested adverse health effects is limited, with a lack of rigorous small area population studies that control for confounding. This study aims to test the association between water fluoridation schemes and selected health outcomes using the best available routine data sources. Ecological level exposure to fluoridated water was estimated for standard small areas and administrative districts in England using Geographical Information Systems and digitized boundaries based on known patterns of water supply. The association between fluoridation and dental and nondental health indicators was tested using multivariable regression models including ecological level confounding variables. Health indicator data were obtained from routine sources. There was strong evidence of lower prevalence of dental caries (P fluoridated areas, they also had fewer teeth affected on average (P fluoridation and hip fracture, Down syndrome, all-cancer, all-cause mortality or osteosarcoma. Fluoridation was negatively associated with the incidence of renal stones (7.9% lower; 95% CI-9.6%,-6.2%; P fluoridation is a safe and highly effective public health measure to reduce dental decay. Although lower rates of certain nondental outcomes were found in fluoridated areas, the ecological, observational design prohibits any conclusions being drawn regarding a protective role of fluoridation. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Case and control recruitment, and validation of cases for the MICA case-control study in England, Scotland and Wales.

    Science.gov (United States)

    Dunn, N R; Arscott, A; Thorogood, M; Thomas, S; Davison, H; Richardson, J

    1999-07-01

    To describe the processes involved in the selection of cases and controls, and the validation of case diagnosis, in a large case-control study on the association between myocardial infarction (MI) and oral contraceptives. Community case-control study in England, Scotland and Wales. Cases were women aged 16-44 with a diagnosis of MI. Controls were age and general practice matched women without a diagnosis of MI. The proportion of interviewed cases per number eligible was 19% (95% CI 12-26%) lower in England and Wales than in Scotland. The kappa score for agreement between three cardiologists on diagnostic categories of the potential cases was 0.52 overall ('moderate' agreement). For the 35 cases resubmitted for categorization, the kappa scores for agreement between the first and second classification for the two national committee cardiologists were 0.32 and 0.23 ('fair' agreement). Age matching of controls was better in Scotland than England and Wales, the proportion of the first choice controls being 14% (95% CI 8-19%) higher in Scotland. The mean time to complete a cluster of interviews (one case and four controls) was 36 days in Scotland and 63 days in England and Wales. Very close age-matching was achieved overall, although the process was more efficient in Scotland than in England and Wales. Some suggestions for improvement in the case validation process are made. Copyright 1999 John Wiley & Sons, Ltd.

  4. Religious discrimination and common mental disorders in England: a nationally representative population-based study.

    Science.gov (United States)

    Jordanova, Vesna; Crawford, Mike J; McManus, Sally; Bebbington, Paul; Brugha, Traolach

    2015-11-01

    Although the impact of discrimination on mental health has been increasingly discussed, the effect of religious discrimination has not been examined systematically. We studied the prevalence of perceived religious discrimination and its association with common mental disorders in a nationally representative population-based sample in England. We used data from the Adult Psychiatric Morbidity Survey 2007 that represents all adults age 16 years and over living in private households in England. Common mental disorders were ascertained using the Revised Clinical Interview Schedule. Experience of discrimination was assessed by a computer-assisted self-report questionnaire and potential paranoid traits by the Psychosis Screening Questionnaire. From the total of 7318 participants, 3873 (52.4%) reported adhering to religion. 108 subjects (1.5%) reported being unfairly treated in the past 12 months due to their religion. Non-Christian religious groups were more likely to report perceived religious discrimination compared to Christians (OR 11.44; 95% CI 7.36-17.79). People who experienced religious discrimination had increased prevalence of all common mental disorders. There was a two-fold increase in the risk of common mental disorders among people who reported experience of religious discrimination independent of their ethnicity, skin colour or suspected paranoid traits. The impact of perceived religious discrimination on mental health should be given more consideration in treatment and future preventative policies.

  5. [Lessons from the Hokkaido COPD cohort study].

    Science.gov (United States)

    Nishimura, Masaharu; Makita, Hironi

    2016-05-01

    Hokkaido COPD cohort study is a carefully-designed, well-conducted, prospective observational 10 year-long study, which ended early in 2015. We have obtained a number of clinically-relevant novel findings, some of which are as follows. Severity of emphysema was highly varied even in those individuals whose airflow limitation is comparable. The annual change in forced expiratory volume in 1 second (FEV1) over 5 years was also widely varied with normal distribution among the subjects under appropriate treatment. Some patients maintained their pulmonary function for a long time, and others showed a rapid decline. Emphysema severity, but not pulmonary function, was independently associated with such an inter-subject variation in the annual decline in FEV1. When we explored any biomarkers for predicting the FEV1 decline, a lower leptin/adiponectin ratio alone emerged as an explanatory parameter for the rapid decline, and this was also confirmed in an independent Danish cohort study of different ethnicity. Monitoring of quality of life (QOL), using SGRQ scores, also provided interesting observations. The annual change in total score reflected that of FEV1 decline during the follow-up period. However, activity component in QOL deteriorated in almost all the subjects, while symptom component rather improved in many of the patients under appropriate treatment.

  6. Inter-regional migration and social change: a study of South East England based upon data from the Longitudinal Study.

    Science.gov (United States)

    Fielding, A J

    1989-01-01

    "Data from the [Office of Population Censuses and Surveys] Longitudinal Study are used to trace the social class effects of migration between the South East region and the rest of England and Wales in the period 1971-81. The analysis begins with the migration streams into and out of the South East of those people who were in the labour market (including the unemployed) at both census dates. The paper then proceeds to an analysis of the migration streams of those who entered or left the labour market between 1971 and 1981. Finally, the effects of the migration streams on the social class composition of both the South East and the rest of England and Wales are summarised. The results are interpreted in the light of debates about change in the British urban and regional system." excerpt

  7. How are European birth-cohort studies engaging and consulting with young cohort members?

    Science.gov (United States)

    Lucas, Patricia J; Allnock, Debra; Jessiman, Tricia

    2013-04-11

    Birth cohort studies, where parents consent for their child to be enrolled in a longitudinal study prior to or soon after birth, are a powerful study design in epidemiology and developmental research. Participation often continues into adulthood. Where participants are enrolled as infants, provision should be made for consent, consultation and involvement in study design as they age. This study aims to audit and describe the extent and types of consultation and engagement currently used in birth cohorts in Europe. Seventy study groups (representing 84 cohorts) were contacted to ask about their practice in engaging and involving study members. Information was gathered from study websites and publications, 15 cohorts provided additional information via email and 17 cohorts were interviewed over the phone. The cohorts identified confirm the growth of this study design, with more than half beginning since 1990, and 4 since 2011. Most studies maintain a website open to the general public, although many are written for the scientific community only. Five studies have web pages specifically for young cohort members and one study provides a dedicated page for fathers. Cohorts send newsletters, cards, and summaries of findings to participants to stay in touch. Six cohorts use Facebook for this purpose. Five cohorts provide feedback opportunities for participants after completing a round of data collection. We know of just 8 cohorts who have a mechanism for consulting with parents and 3 a mechanism for consulting with young people themselves, although these were 'one off' consultations for some groups. Barriers to further consultation with cohort members were: concerns about impact on quality of research, ethical constraints, resource limitations, lack of importance, and previous adverse experiences. Although the children in some of the cohorts are still young (born in the last 10 years) many are old enough to include some element of consultation. Barriers to greater

  8. General Practitioners' Concerns About Online Patient Feedback: Findings From a Descriptive Exploratory Qualitative Study in England.

    Science.gov (United States)

    Patel, Salma; Cain, Rebecca; Neailey, Kevin; Hooberman, Lucy

    2015-12-08

    The growth in the volume of online patient feedback, including online patient ratings and comments, suggests that patients are embracing the opportunity to review online their experience of receiving health care. Very little is known about health care professionals' attitudes toward online patient feedback and whether health care professionals are comfortable with the public nature of the feedback. The aim of the overall study was to explore and describe general practitioners' attitudes toward online patient feedback. This paper reports on the findings of one of the aims of the study, which was to explore and understand the concerns that general practitioners (GPs) in England have about online patient feedback. This could then be used to improve online patient feedback platforms and help to increase usage of online patient feedback by GPs and, by extension, their patients. A descriptive qualitative approach using face-to-face semistructured interviews was used in this study. A topic guide was developed following a literature review and discussions with key stakeholders. GPs (N=20) were recruited from Cambridgeshire, London, and Northwest England through probability and snowball sampling. Interviews were transcribed verbatim and analyzed in NVivo using the framework method, a form of thematic analysis. Most participants in this study had concerns about online patient feedback. They questioned the validity of online patient feedback because of data and user biases and lack of representativeness, the usability of online patient feedback due to the feedback being anonymous, the transparency of online patient feedback because of the risk of false allegations and breaching confidentiality, and the resulting impact of all those factors on them, their professional practice, and their relationship with their patients. The majority of GPs interviewed had reservations and concerns about online patient feedback and questioned its validity and usefulness among other things

  9. Cohort Profile : LifeLines, a three-generation cohort study and biobank

    NARCIS (Netherlands)

    Scholtens, Salome; Smidt, Nynke; Swertz, Morris A; Bakker, Stephan Jl; Dotinga, Aafje; Vonk, Judith M; van Dijk, Freerk; van Zon, Sander Kr; Wijmenga, Cisca; Wolffenbuttel, Bruce Hr; Stolk, Ronald P

    2014-01-01

    The LifeLines Cohort Study is a large population-based cohort study and biobank that was established as a resource for research on complex interactions between environmental, phenotypic and genomic factors in the development of chronic diseases and healthy ageing. Between 2006 and 2013, inhabitants

  10. Cohort Profile : LifeLines, a three-generation cohort study and biobank

    NARCIS (Netherlands)

    Scholtens, Salome; Smidt, Nynke; Swertz, Morris A.; Bakker, Stephan J. L.; Dotinga, Aafje; Vonk, Judith M.; van Dijk, Freerk; van Zon, Sander K. R.; Wijmenga, Cisca; Wolffenbuttel, Bruce H. R.; Stolk, Ronald P.

    The LifeLines Cohort Study is a large population-based cohort study and biobank that was established as a resource for research on complex interactions between environmental, phenotypic and genomic factors in the development of chronic diseases and healthy ageing. Between 2006 and 2013, inhabitants

  11. The Danish National Cohort Study (DANCOS)

    DEFF Research Database (Denmark)

    Davidsen, Michael; Kjøller, Mette; Helweg-Larsen, Karin

    2011-01-01

    INTRODUCTION: The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986-2005, to the national Danish registers on health and welfare. It facilitates studies of self......-reported health behaviour and utilisation of healthcare services by subgroups and analysis of non-response bias. RESEARCH TOPICS: DANCOS data are utilised in a variety of analyses presented here by a few examples that emphasise the impact of modifiable risk factors on public health, description of non......-response bias, and the epidemiology of chronic pain and of osteoarthritis. Examples of DANCOS-based results are shown for each of the four topics. Smoking results in 24% of all deaths and, compared to other risk factors for public health, smoking accounts for the highest number of years of life lost. For non...

  12. Essentialism and the expression of social stereotypes: a comparative study of Spain, Brasil and England.

    Science.gov (United States)

    Pereira, Marcos Emanoel; Alvaro Estramiana, José Luis; Schweiger Gallo, Inge

    2010-11-01

    Over the past few years, one of the most productive directions in the study of the activation and application of stereotypes has been provided by the essentialist concept of categorization. The research presented here studied the impact of two dimensions of essentialist beliefs--naturalism and entitativity-by using data collected from Brazil, Spain and England. The aim was to test whether there was a greater degree of essentialization among the naturalizable categories (sex, age and race) than among the entitative categories (economic condition, religion, political orientation, nationality and social condition). The results not only showed that participants hold more essentialist beliefs with regard to naturalistic categories but also showed the differences in the degree of essentialization across the three cultures. A discussion is conducted on the implications of the present findings, and on the heuristic value of the theoretical model (of the bidimensional nature of essentialism) adopted by this research.

  13. An Ethnographic Study of the Friendship Patterns of International Students in England: An Attempt to Recreate Home through Conational Interaction

    Science.gov (United States)

    Brown, Lorraine

    2009-01-01

    This paper reports findings from an ethnographic study into the adjustment experience of a group of postgraduate international students at a university in the South of England. Friendship emerged as a major theme in this study; of particular importance to students was the desire and need to mix with conational friends. This desire was driven by…

  14. Geographical variation in glaucoma prescribing trends in England 2008–2012: an observational ecological study

    Science.gov (United States)

    Wormald, Richard; Khaw, Peng Tee

    2016-01-01

    Objectives To explore (1) the national trend in population-adjusted prescription rates for glaucoma and ocular hypertension (OHT) in England and (2) any geographical variation in glaucoma/OHT prescribing trends and its association with established risk factors for primary open-angle glaucoma (POAG) at the population level. Design Observational ecological study. Setting Primary care in England 2008–2012. Participants All patients who received 1 or more of the 37 778 660 glaucoma/OHT prescription items between 2008 and 2012. Primary and secondary outcome measure methods Glaucoma/OHT prescription statistics for England and its constituent primary care trusts (PCTs) between 2008 and 2012 were divided by annual population estimates to give prescription rates per 100 000 population aged ≥40 years. To examine regional differences, prescription rates and the change in prescription rates between 2008 and 2012 for PCTs were separately entered into multivariable linear regression models with the population proportion aged ≥60 years; the proportion of males; the proportion of West African Diaspora (WAD) ethnicity; PCT funding per capita; Index of Multiple Deprivation 2010 score and its domains. Results Between 2008 and 2012, glaucoma/OHT prescriptions increased from 28 029 to 31 309 items per 100 000 population aged ≥40 years. Between PCTs, nearly a quarter of the variation in prescription rates in 2008 and 2012 could be attributed to age, WAD ethnicity and male gender. The change in prescription rates between 2008 and 2012 was only modestly correlated with age (p=0.003, β=0.234), and income deprivation (p=0.035, β=−0.168). Conclusions Increased population-adjusted glaucoma/OHT prescription rates in the study period were likely due to increased detection of POAG and OHT cases at risk of POAG. Between PCTs, regional variation in overall prescription rates was partly attributable to demographic risk factors for POAG, although the change in

  15. Estimating Water Supply Arsenic Levels in the New England Bladder Cancer Study

    Science.gov (United States)

    Freeman, Laura E. Beane; Lubin, Jay H.; Airola, Matthew S.; Baris, Dalsu; Ayotte, Joseph D.; Taylor, Anne; Paulu, Chris; Karagas, Margaret R.; Colt, Joanne; Ward, Mary H.; Huang, An-Tsun; Bress, William; Cherala, Sai; Silverman, Debra T.; Cantor, Kenneth P.

    2011-01-01

    Background: Ingestion of inorganic arsenic in drinking water is recognized as a cause of bladder cancer when levels are relatively high (≥ 150 µg/L). The epidemiologic evidence is less clear at the low-to-moderate concentrations typically observed in the United States. Accurate retrospective exposure assessment over a long time period is a major challenge in conducting epidemiologic studies of environmental factors and diseases with long latency, such as cancer. Objective: We estimated arsenic concentrations in the water supplies of 2,611 participants in a population-based case–control study in northern New England. Methods: Estimates covered the lifetimes of most study participants and were based on a combination of arsenic measurements at the homes of the participants and statistical modeling of arsenic concentrations in the water supply of both past and current homes. We assigned a residential water supply arsenic concentration for 165,138 (95%) of the total 173,361 lifetime exposure years (EYs) and a workplace water supply arsenic level for 85,195 EYs (86% of reported occupational years). Results: Three methods accounted for 93% of the residential estimates of arsenic concentration: direct measurement of water samples (27%; median, 0.3 µg/L; range, 0.1–11.5), statistical models of water utility measurement data (49%; median, 0.4 µg/L; range, 0.3–3.3), and statistical models of arsenic concentrations in wells using aquifers in New England (17%; median, 1.6 µg/L; range, 0.6–22.4). Conclusions: We used a different validation procedure for each of the three methods, and found our estimated levels to be comparable with available measured concentrations. This methodology allowed us to calculate potential drinking water exposure over long periods. PMID:21421449

  16. Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups

    Science.gov (United States)

    Zachariadis, Markos; Oborn, Eivor; Barrett, Michael; Zollinger-Read, Paul

    2013-01-01

    Objective To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Design Mixed-method, multisite and case study research. Setting Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population. Methods Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis. Main outcome measures Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs. Results Drawing upon innovation network theory provides unique insights of the CCG leaders’ activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with

  17. A retrospective study of the impact of the doctors’ strike in England on 21 June 2012

    Science.gov (United States)

    Ruiz, Milagros; Bottle, Alex; Aylin, Paul

    2013-01-01

    Objective To examine the effect of the 24-h doctors’ strike on 21 June 2012 on hospital activity in English NHS hospitals. Design Retrospective descriptive study of inpatient, outpatient and Accident and Emergency (A&E) activity in NHS hospitals over the strike period. Setting All English NHS hospitals. Participants Patients admitted to hospital, patients with outpatient appointments and A&E attendances over a three-week period (from 11 to 29 June 2012), excluding weekends and spanning the strike day. Main outcome measures Numbers and percentage change of inpatient admissions (elective and emergency), day surgery cases, outpatient appointments cancellations, A&E attendances and in-hospital deaths on the day of the strike compared with patient activity on the Thursday before and the Thursday after the strike week. Results There were a total of 795,267 admissions, 5,602,971 outpatient appointments, 356,645 outpatient cancellations (by NHS provider), 4,470,208 outpatients seen by medical staff, 986,322 A&E attendances and 13,857 in-hospital deaths over the three-week period. Compared with the non-strike period, on the day of the strike, emergency admissions fell by 2.4% while the elective admissions decreased by 12.8%. There was a 7.8% drop in the number of outpatients seen by medical staff on the day of the strike and a 45.5% increase in the number of cancelled appointments by NHS hospitals, while A&E attendances dropped by 4.7%. The impact of the strike across regional Health Authorities in England was varied. The North West Health Authority was affected the most while the least affected Health Authorities were the South West, East of England and South Central. Conclusions The 24-h doctors’ strike in England on 21 June 2012 significantly affected the provision of healthcare by NHS hospitals. We observed regional variations on NHS service levels on the day of the strike. PMID:23759894

  18. Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups.

    Science.gov (United States)

    Zachariadis, Markos; Oborn, Eivor; Barrett, Michael; Zollinger-Read, Paul

    2013-01-01

    To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Mixed-method, multisite and case study research. Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population. Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis. Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs. Drawing upon innovation network theory provides unique insights of the CCG leaders' activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with patient needs and brought the leaders closer to frontline stakeholders

  19. Green space and physical activity: an observational study using Health Survey for England data.

    Science.gov (United States)

    Mytton, Oliver T; Townsend, Nick; Rutter, Harry; Foster, Charlie

    2012-09-01

    Past studies have suggested that a link between health outcomes and green space is due to increased levels of physical activity of individuals living in areas with more green space. We found a positive association between green space and physical activity levels. The odds of achieving the recommended amount of physical activity was 1.27 (95% CI: 1.13-1.44) for people living in the greenest quintile in England compared to those living in the least green quintile, after controlling for individual and environmental factors. However, no association was found between green space and types of physical activity normally associated with green space. An association was found with other types of physical activity (gardening and do-it-yourself, and occupational physical activity). These findings suggest that although there is a positive association between physical activity and green space it may not be explained by individuals using green space for recreation. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Understanding welfare conditionality in the context of a generational habitus: A qualitative study of older citizens in England.

    Science.gov (United States)

    Milton, Sarah; Buckner, Stefanie; Salway, Sarah; Powell, Katie; Moffatt, Suzanne; Green, Judith

    2015-08-01

    In many welfare states, 'austerity' policies have ignited debates about the fairness and cost-effectiveness of universal welfare benefits, with benefits received by older citizens a particular topic of concern. Empirical studies suggest that conditionality generates problems of access and uptake but, to date, there has been little research on how different conditions of entitlement are understood by older citizens. This study drew on interviews with 29 older citizens from three areas of England to explore how eligibility for and uptake of different kinds of welfare benefits were understood. In interviews, current entitlement was understood in relation to a generational habitus, in which 'our generation' was framed as sharing cohort experiences, and moral orientations to self-reliance, hard work and struggle. Entitlement to some welfare benefits was taken for granted as a reward owed by the state to its citizens for hard-earned lives. State transfers such as pensions, free travel and fuel subsidies were congruent with a nationalised generational habitus, and fostered recognition, self-worth and the sense of a generation as a collective. In contrast, transfers contingent on economic or need-based conditionality were more explicitly framed as 'benefits', and negatively associated with vulnerability and moral contestation. Uptake was therefore often incompatible with their generational habitus. Calls for introducing further conditionality to benefits for older adults are often based on claims that this will increase fairness and equality. Our analysis suggests, however, that introducing conditionality has the potential to promote inequality and foster differentiation and division, within the older population and between generations. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Youth, alcohol and place-based leisure behaviours: a study of two locations in England.

    Science.gov (United States)

    Townshend, Tim G

    2013-08-01

    Excessive alcohol consumption among young people in England regularly features in national media and has been a focus of recent academic research and government policy. Though the majority of young people do not regularly drink excessively, heavy sessional drinking - 'binge' drinking - is associated with negative health and social consequences for those who do. Alcohol-related health problems in young people are not spread consistently across England, however, and while there are significant intra-regional differences, northern regions fare worse overall than those in the south. This paper draws on an 18-month project which explored differences in the physical, social and regulatory environments (highlighted by previous research as influential) in two locations with contrasting alcohol harm profiles. The paper focuses on the lives of 15-16 year olds and examines potential differences that influence behaviour at this crucial age; and in particular issues that might presage risky and/or harmful drinking in young adulthood. The study examines evidence from young people themselves (activity diaries and interviews); stakeholder interviews; and observation analysis. The study finds social practices in the two areas to be largely similar; moreover, the collectivised and social nature of alcohol consumption suggests sources of influence from a wider context, beyond immediate family and friendship groups. However these social practices were acted out in locations with very different physical characteristics, in particular these related to the availability of non-alcohol focused leisure activities and the spatial arrangement/visibility of adult drinking culture. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. A Comparative Study of Cybercrime in Criminal Law: China, US, England, Singapore and the Council of Europe

    NARCIS (Netherlands)

    Q. Wang (Qianyun)

    2016-01-01

    markdownabstractThis research intends to unveil problems in the criminal law when dealing with cybercrime and explore possible solutions through comparative study of China, US, England, Singapore and the Council of Europe. Criminals have abused the convenience brought by information technology. When

  3. Changing Land Use: The Fens of England. A Case Study in Land Reclamation [And] Student Work Book.

    Science.gov (United States)

    Laws, Kevin

    A social studies unit and student workbook explore changes in land use that have occurred in the Fenlands of England since the time it was first inhabited. Fens are lowlying land which is partially or completely covered with water. The English Fens are located on the eastern side of the British Isles and cover a total area of about 2,000 square…

  4. Children's Judgment of the Legitimacy of Group Decision-Making about Individual Concerns: A Comparative Study between England and Japan

    Science.gov (United States)

    Kinoshita, Yoshiko

    2006-01-01

    This study aimed to examine when children come to distinguish between the private affairs of an individual and the group's matter in relation to group decision making and whether there are any differences between Japan and England in learning the distinction. In total 217 children aged 8, 11, and 13 years, and undergraduates participated in the…

  5. Why does education matter to employers in different institutional contexts? A vignette study in England and the Netherlands

    NARCIS (Netherlands)

    Di Stasio, V.; van de Werfhorst, H.G.

    We study the process by which employers evaluate and interpret information related to the educational background of job applicants in simulated hiring contexts. We focus on England and the Netherlands, countries with very different education systems and labor-market institutions. Using a vignette

  6. English Teachers in the Digital Age--A Case Study of Policy and Expert Practice from England

    Science.gov (United States)

    Goodwyn, Andy

    2011-01-01

    This article is a case study of how English teachers in England have coped with the paradigm shift from print to digital literacy. It reviews a large scale national initiative that was intended to upskill all teachers, considers its weak impact and explores the author's involvement in the evaluation of the project's direct value to English…

  7. Attitudes to Diversity: A Cross-Cultural Study of Education Students in Spain, England and the United States

    Science.gov (United States)

    Molto, M. Cristina Cardona; Florian, Lani; Rouse, Martyn; Stough, Laura M.

    2010-01-01

    This study explores the beliefs and attitudes that university students enrolled in teacher education programmes in Spain, England and the US (Texas) hold about individuals who differ. A beliefs and attitudes toward difference scale (BATD) was constructed using nine dimensions of diversity; culture, language, socioeconomic status/social class,…

  8. A qualitative study exploring pupil and school staff perceptions of school meal provision in England.

    Science.gov (United States)

    Day, Rhiannon E; Sahota, Pinki; Christian, Meaghan S; Cocks, Kim

    2015-11-14

    Despite recent attempts to improve the quality of school meals in England through the introduction of school meal standards, uptake remains low. Since the introduction of the universal infant free school meal (UIFSM) scheme in September 2014 all pupils in Reception, Year 1 and Year 2 in English state-funded primary schools are eligible to receive a free lunch. This study aimed to explore the perceptions of pupils, catering managers and head teachers concerning school meal provision in eight primary schools in North England and provides a unique insight into each school's preparation for implementation of UIFSM. A total of thirty-two focus groups were conducted with sixty-four pupils aged 7-8 years (Year 3) and sixty-four pupils aged 9-10 years (Year 5) in June-July 2014, to explore perceptions of school meals. Interviews were carried out with six catering managers and five head teachers concerning catering and the impending implementation of UIFSM. Increasing acceptance of school meals could lead to improved uptake. Pupils desired increased choice and menu variety, including greater variety of vegetables and fruit. Caterers can influence the quantity and types of foods offered to pupils, and there are opportunities for them to promote healthy eating behaviours in the dining room. The important roles of school meal providers, caterers, pupils and parents need to be recognised to improve delivery and acceptability of school meals and ultimately school meal uptake. There were practical challenges to implementation of UIFSM, with some concerns expressed over its feasibility. Head teachers were mainly positive about the potential beneficial impacts of the scheme.

  9. Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics.

    Science.gov (United States)

    Jeevan, R; Cromwell, D A; Trivella, M; Lawrence, G; Kearins, O; Pereira, J; Sheppard, C; Caddy, C M; van der Meulen, J H P

    2012-07-12

    To examine whether rate of reoperation after breast conserving surgery is associated with patients' characteristics and investigate whether reoperation rates vary among English NHS trusts. Cohort study using patient level data from hospital episode statistics. English NHS trusts. Adult women who had breast conserving surgery between 1 April 2005 and 31 March 2008. Reoperation rates after primary breast conserving surgery within 3 months, adjusted using logistic regression for tumour type, age, comorbidity, and socioeconomic deprivation. Tumours were grouped by whether a carcinoma in situ component was coded at the time of the primary breast conserving surgery. 55,297 women had primary breast conserving surgery in 156 NHS trusts during the three year period. 11,032 (20.0%, 95% confidence interval 19.6% to 20.3%) women had at least one reoperation. 10,212 (18.5%, 18.2% to 18.8%) had one reoperation only; of these, 5943 (10.7%, 10.5% to 11.0%) had another breast conserving procedure and 4269 (7.7%, 7.5% to 7.9%) had a mastectomy. Of the 45,793 women with isolated invasive disease, 8229 (18.0%) had at least one reoperation. In comparison, 2803 (29.5%) of the 9504 women with carcinoma in situ had at least one reoperation (adjusted odds ratio 1.9, 95% confidence interval 1.8 to 2.0). Substantial differences were found in the adjusted reoperation rates among the NHS trusts (10th and 90th centiles 12.2% and 30.2%). One in five women who had breast conserving surgery in England had a reoperation. Reoperation was nearly twice as likely when the tumour had a carcinoma in situ component coded. Women should be informed of this reoperation risk when deciding on the type of surgical treatment of their breast cancer.

  10. Clinical disorders in a post war British cohort reaching retirement: evidence from the First National Birth Cohort study.

    Directory of Open Access Journals (Sweden)

    Mary B Pierce

    Full Text Available The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood.The data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60-64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0-9; only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%-56.7%, obesity (31.1%, 28.8%-33.5%, raised cholesterol (25.6%, 23.1-28.26%, and diabetes or impaired fasting glucose (25.0%, 22.6-27.5%. A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used.Most British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the individual's ability to adapt to and self manage

  11. Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Costantini Massimo

    2002-03-01

    Full Text Available Abstract Background Prognosis estimates are used to access services, but are often inaccurate. This study aimed to determine the accuracy of giving a prognosis range. Methods and measurements A prospective cohort study in four multi-professional palliative care teams in England collected data on 275 consecutive cancer referrals who died. Prognosis estimates (minimum – maximum at referral, patient characteristics, were recorded by staff, and later compared with actual survival. Results Minimum survival estimates ranged Conclusions Offering a prognosis range has higher levels of accuracy (about double than traditional estimates, but is still very often inaccurate, except very close to death. Where possible clinicians should discuss scenarios with patients, rather than giving a prognosis range.

  12. Breast cancer mortality trends in England and the assessment of the effectiveness of mammography screening: population-based study.

    Science.gov (United States)

    Mukhtar, Toqir K; Yeates, David Rg; Goldacre, Michael J

    2013-06-01

    To investigate whether mortality statistics show an effect of mammographic screening on population-based breast cancer mortality in England. Joinpoint regression analyses, and other analyses, of population-based mortality data. Analysis of mortality rates in the Oxford region, UK (1979-2009) because, unlike the rest of England, all causes of death mentioned on each death certificate for its residents (not just the underlying cause) are available prior to commencement of the English National Breast Screening Programme (NHSBSP). In addition, analysis of English national breast cancer mortality rates (1971-2009). Women who died from breast cancer in the Oxford region (1979--2009) and England (1971--2009) MAIN OUTCOME MEASURES: Age-specific mortality rates, and age-standardized mortality rates. Joinpoint regression analysis was used to estimate years ('joinpoints') in which trends changed, and annual percentage change between joinpoints, with confidence intervals. In the Oxford region, trends for breast cancer mortality based on underlying cause and on mentions were very similar. For all ages combined, mortality rates peaked for both underlying cause and mentions in 1985 and then started to decline, prior to the introduction of the NHSBSP in 1988. Between 1979 and 2009, for mortality measured as underlying cause, rates declined by -2.1% (95% CI -2.7 to -1.4) per year for women aged 40-49 years (unscreened), and by the same percentage per year (-2.1% [-2.4 to -1.7]) for women aged 50-64 years (screened). In England, the first estimated changes in trend occurred prior to the introduction of screening, or before screening was likely to have had an effect (between 1982 and 1989). Thereafter, the downward trend was greatest in women aged under 40 years: -2.0% per year (-2.8 to -1.2) in 1988-2001 and -5.0% per year (-6.7 to -3.3) in 2001-2009. There was no evidence that declines in mortality rates were consistently greater in women in age groups and cohorts that had been

  13. Assessment of sleep and circadian rhythm disorders in the very old: the Newcastle 85+ Cohort Study.

    Science.gov (United States)

    Anderson, Kirstie N; Catt, Michael; Collerton, Joanna; Davies, Karen; von Zglinicki, Thomas; Kirkwood, Thomas B L; Jagger, Carol

    2014-01-01

    to examine the association between subjective and objective measures of sleep and wake and other health parameters in a cohort of the very old. a population-based cohort study. primary care, North East England. four hundred and twenty-one men and women, aged 87-89, recruited to the Newcastle 85+ Study cohort. sleep questionnaires were administered and sleep-wake patterns were assessed over 5-7 days with a novel wrist triaxial accelerometer. Associations between sleep measures and various health parameters, including mortality at 24 months, were examined. only 16% of participants perceived their sleep as severely disturbed as assessed with questionnaire responses. Wrist accelerometry showed marked variation between normal and abnormal sleep-wake cycles that did not correlate with the participants' perception of sleep. Impaired sleep-wake cycles were significantly associated with cognitive impairment, disability, depression, increased falls, body mass index and arthritis but not with any other specific disease markers and with decreased survival. commonly used sleep questionnaires do not differentiate well between those with objectively determined disturbance of sleep-wake cycles and those with normal cycles. Abnormal sleep-wake patterns are associated with institutionalisation, cognitive impairment, disability, depression and arthritis but not with other diseases; there is also an association with reduced survival.

  14. Odontogenic sinus tracts: a cohort study.

    Science.gov (United States)

    Slutzky-Goldberg, Iris; Tsesis, Igor; Slutzky, Hagay; Heling, Ilana

    2009-01-01

    To determine the prevalence,location, and distribution of sinus tracts in patients referred for endodontic consultation. This cohort study included 1,119 subjects referred for endodontic consultation, 108 of whom presented with sinus tracts. Following clinical and radiographic examination, the diameter of the rarifying osteitis lesion on the radiograph was measured and the path and origin of the sinus tracts determined. Signs and symptoms, tooth site,buccal/lingual location, and diameter were recorded. Data were statistically analyzed using Pearson chi-square test. Sinus tracts originated mainly from maxillary teeth (63.1%); only 38.9% originated from mandibular teeth. Chronic periapical abscess was the most prevalent diagnosed origin (71.0%). Broken restorations were highly associated with the presence of sinus tracts (53.0%). The most frequent site of orifices was buccal(82.4%), followed by lingual or palatal (12.0%). Orifices on the lingual aspect of the gingiva were observed in mandibularmolars. There was an 86.8% correlation between the occurrence of an apically located sinus tract and apical rarifying osteitis(P<.01). Sinus tract in the lingual or palatal aspect of the gingiva is relatively common. Practitioners should look for signs of sinus tract during routine examination

  15. Retrospective Cohort Study of Hydrotherapy in Labor.

    Science.gov (United States)

    Vanderlaan, Jennifer

    To describe the use of hydrotherapy for pain management in labor. This was a retrospective cohort study. Hospital labor and delivery unit in the Northwestern United States, 2006 through 2013. Women in a nurse-midwifery-managed practice who were eligible to use hydrotherapy during labor. Descriptive statistics were used to report the proportion of participants who initiated and discontinued hydrotherapy and duration of hydrotherapy use. Logistic regression was used to provide adjusted odds ratios for characteristics associated with hydrotherapy use. Of the 327 participants included, 268 (82%) initiated hydrotherapy. Of those, 80 (29.9%) were removed from the water because they met medical exclusion criteria, and 24 (9%) progressed to pharmacologic pain management. The mean duration of tub use was 156.3 minutes (standard deviation = 122.7). Induction of labor was associated with declining the offer of hydrotherapy, and nulliparity was associated with medical removal from hydrotherapy. In a hospital that promoted hydrotherapy for pain management in labor, most women who were eligible initiated hydrotherapy. Hospital staff can estimate demand for hydrotherapy by being aware that hydrotherapy use is associated with nulliparity. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  16. Global teaching and training initiatives for emerging cohort studies.

    Science.gov (United States)

    Paulus, Jessica K; Santoyo-Vistrain, Rocío; Havelick, David; Cohen, Amy; Kalyesubula, Robert; Ajayi, Ikeoluwapo O; Mattsson, Jens G; Adami, Hans-Olov; Dalal, Shona

    2012-09-01

    A striking disparity exists across the globe, with essentially no large-scale longitudinal studies ongoing in regions that will be significantly affected by the oncoming non-communicable disease epidemic. The successful implementation of cohort studies in most low-resource research environments presents unique challenges that may be aided by coordinated training programs. Leaders of emerging cohort studies attending the First World Cohort Integration Workshop were surveyed about training priorities, unmet needs and potential cross-cohort solutions to these barriers through an electronic pre-workshop questionnaire and focus groups. Cohort studies representing India, Mexico, Nigeria, South Africa, Sweden, Tanzania and Uganda described similar training needs, including on-the-job training, data analysis software instruction, and database and bio-bank management. A lack of funding and protected time for training activities were commonly identified constraints. Proposed solutions include a collaborative cross-cohort teaching platform with web-based content and interactive teaching methods for a range of research personnel. An international network for research mentorship and idea exchange, and modifying the graduate thesis structure were also identified as key initiatives. Cross-cohort integrated educational initiatives will efficiently meet shared needs, catalyze the development of emerging cohorts, speed closure of the global disparity in cohort research, and may fortify scientific capacity development in low-resource settings. Copyright © 2012 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  17. Global teaching and training initiatives for emerging cohort studies

    Science.gov (United States)

    Paulus, Jessica K.; Santoyo-Vistrain, Rocío; Havelick, David; Cohen, Amy; Kalyesubula, Robert; Ajayi, Ikeoluwapo O.; Mattsson, Jens G.; Adami, Hans-Olov; Dalal, Shona

    2015-01-01

    A striking disparity exists across the globe, with essentially no large-scale longitudinal studies ongoing in regions that will be significantly affected by the oncoming non-communicable disease epidemic. The successful implementation of cohort studies in most low-resource research environments presents unique challenges that may be aided by coordinated training programs. Leaders of emerging cohort studies attending the First World Cohort Integration Workshop were surveyed about training priorities, unmet needs and potential cross-cohort solutions to these barriers through an electronic pre-workshop questionnaire and focus groups. Cohort studies representing India, Mexico, Nigeria, South Africa, Sweden, Tanzania and Uganda described similar training needs, including on-the-job training, data analysis software instruction, and database and bio-bank management. A lack of funding and protected time for training activities were commonly identified constraints. Proposed solutions include a collaborative cross-cohort teaching platform with web-based content and interactive teaching methods for a range of research personnel. An international network for research mentorship and idea exchange, and modifying the graduate thesis structure were also identified as key initiatives. Cross-cohort integrated educational initiatives will efficiently meet shared needs, catalyze the development of emerging cohorts, speed closure of the global disparity in cohort research, and may fortify scientific capacity development in low-resource settings. PMID:23856451

  18. Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study.

    Science.gov (United States)

    Amirthalingam, Gayatri; Andrews, Nick; Keel, Philip; Mullett, David; Correa, Ana; de Lusignan, Simon; Ramsay, Mary

    2018-02-01

    In 2013, a herpes zoster vaccination programme was introduced in England for adults aged 70 years with a phased catch-up programme for those aged 71-79 years. We aimed to evaluate the effect of the first 3 years of the vaccination programme on incidence of herpes zoster and postherpetic neuralgia in this population. In this population-based study, we extracted data from the Royal College of General Practitioners sentinel primary care network on consultations with patients aged 60-89 years for herpes zoster and postherpetic neuralgia occurring between Oct 1, 2005, and Sept 30, 2016, obtaining data from 164 practices. We identified individual data on herpes zoster vaccinations administered and consultations for herpes zoster and postherpetic neuralgia, and aggregated these data to estimate vaccine coverage and incidence of herpes zoster and postherpetic neuralgia consultations. We defined age cohorts to identify participants targeted in each year of the programme, and as part of the routine or catch-up programme. We modelled incidence according to age, region, gender, time period, and vaccine eligibility using multivariable Poisson regression with an offset for person-years. Our analysis included 3·36 million person-years of data, corresponding to an average of 310 001 patients aged 60-89 years who were registered at an RCGP practice each year. By Aug 31, 2016, uptake of the vaccine varied between 58% for the recently targeted cohorts and 72% for the first routine cohort. Across the first 3 years of vaccination for the three routine cohorts, incidence of herpes zoster fell by 35% (incidence rate ratio 0·65 [95% 0·60-0·72]) and of postherpetic neuralgia fell by 50% (0·50 [0·38-0·67]). The equivalent reduction for the four catch-up cohorts was 33% for herpes zoster (incidence rate ratio 0·67 [0·61-0·74]) and 38% for postherpetic neuralgia (0·62 [0·50-0·79]). These reductions are consistent with a vaccine effectiveness of about 62% against herpes zoster

  19. Thiazolidinediones and Parkinson Disease: A Cohort Study.

    Science.gov (United States)

    Connolly, John G; Bykov, Katsiaryna; Gagne, Joshua J

    2015-12-01

    Thiazolidinediones, a class of medications indicated for the treatment of type 2 diabetes mellitus, reduce inflammation and have been shown to provide a therapeutic benefit in animal models of Parkinson disease. We examined the association between treatment with thiazolidinediones and the onset of Parkinson disease in older individuals. We performed a cohort study of 29,397 Medicare patients enrolled in state pharmaceutical benefits programs who initiated treatment with thiazolidinediones or sulfonylureas during the years 1997 through 2005 and had no prior diagnosis of Parkinson disease. New users of thiazolidinediones were propensity score matched to new users of sulfonylureas and followed to determine whether they were diagnosed with Parkinson disease. We used Cox proportional hazards models to compare time to diagnosis of Parkinson disease in the propensity score-matched populations. To assess the association with duration of use, we performed several analyses that required longer continuous use of medications. In the primary analysis, thiazolidinedione users had a hazard ratio for a diagnosis of Parkinson disease of 1.09 (95% confidence interval: 0.71, 1.66) when compared with sulfonylurea users. Increasing the duration-of-use requirements to 10 months did not substantially change the association; the hazard ratios ranged from 1.00 (95% confidence interval: 0.49, 2.05) to 1.17 (95% confidence interval: 0.60, 2.25). Thiazolidinedione use was not associated with a longer time to diagnosis of Parkinson disease than was sulfonylurea use, regardless of duration of exposure. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Bullying and parasomnias: a longitudinal cohort study.

    Science.gov (United States)

    Wolke, Dieter; Lereya, Suzet Tanya

    2014-10-01

    Environmental factors such as serious trauma or abuse and related stress can lead to nightmares or night terrors. Being bullied can be very distressing for children, and victims display long-term social, psychological, and health consequences. Unknown is whether being bullied by peers may increase the risk for experiencing parasomnias such as nightmares, night terrors, or sleepwalking. A total of 6796 children of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were interviewed at elementary school age (8 and 10 years) about bullying experiences with a previously validated bullying interview and at secondary school age (12.9 years) about parasomnias such as nightmares, night terrors and sleepwalking by trained postgraduate psychologists. Even after adjusting for pre-existing factors related to bullying and parasomnias, being bullied predicted having nightmares (8 years odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05-1.44; 10 years OR, 1.62; 95% CI, 1.35-1.94) or night terrors (8 years OR, 1.39; 95% CI, 1.10-1.75; 10 years OR, 1.53; 95% CI, 1.18-1.98) at age 12 to 13 years. Especially being a chronic victim was associated with both nightmares (OR, 1.82; 95% CI, 1.46-2.27) and night terrors (OR, 2.01; 95% CI, 1.48-2.74). Being a bully/victim also increased the risk for any parasomnia at ages 8 or 10 years (8 years OR, 1.42; 95% CI, 1.08-1.88; 10 years OR, 1.75; 95% CI, 1.30-2.36). In contrast, bullies had no increased risk for any parasomnias. Being bullied increases the risk for having parasomnias. Hence, parents, teachers, school counselors, and clinicians may consider asking about bullying experiences if a child is having parasomnias. Copyright © 2014 by the American Academy of Pediatrics.

  1. Who cares in England and Wales? The Positive Care Law: cross-sectional study.

    Science.gov (United States)

    Shaw, Mary; Dorling, Danny

    2004-12-01

    The inverse care law proposing that medical services are distributed inversely to population health needs, and that this law operates more completely where medical care is most exposed to market forces, was first suggested by Tudor Hart in 1971. This paper considers whether an inverse care law can be observed for the provision of informal care as well as for medical care. Using data from the 2001 census we sought to investigate the contemporary relevance of the inverse care law. Cross-sectional study. England and Wales. Data from the 2001 census for the population of England and Wales were analysed at the county, unitary, or former metropolitan authority level. The prevalence of the conjunction of general health status and limiting long-term illness was correlated with the percentage of the local population who were working as qualified healthcare workers (nurses, qualified medical practitioners, dentists, and other health professionals and therapists) and with the percentage of the population providing 50 or more hours of unpaid care per week. In 2001, 7.6% of people reported that their health was not good and that they had a limiting long-term illness (the need for care). Over one million people reported providing 50 or more hours of unpaid care per week. An inverse care law was found at the ecological level between the need for care and the proportion of the population who were working as qualified medical practitioners, dentists, and other health professionals. Informal care was almost perfectly positively correlated with the need for care (r = 0.97). These relationships were more marked for areas in the north of the country compared with the south. In the north more people provide unpaid care as more people need that care and because there are fewer working qualified medical professionals, other than nurses, providing such care per head. Medical care is distributed inversely to need, whereas the provision of informal care is positively related to need

  2. Constructions of ‘the Polish’ in Northern England: Findings From a Qualitative Interview Study

    Directory of Open Access Journals (Sweden)

    Stephen Gibson

    2015-10-01

    Full Text Available The enlargement of the European Union in 2004 gave rise to moral panics concerning the likelihood of mass migration from the new eastern European member states to established member states in the west. A great deal of social and political science research has examined the ongoing impact of the enlargement, but there remains a gap in the literature regarding the ways in which members of ‘receiving’ populations reacted to these changes. The present paper reports findings from a qualitative interview study of 14-16 year-olds conducted in northern England. It focuses on how migrants from one particular country – Poland – were constructed by participants. Drawing on previous analyses of immigration and racist discourse, the study points to some ways in which Polish migrants and migration were constructed, and how complaints against ‘the Polish’ were formulated. The analysis focusses on four key issues: employment and the economy; language and culture; threat and intimidation; and physical stereotyping. It is suggested that constructions of ‘the Polish’ draw on the tropes of both ‘old’ and ‘new’ racism, and that attention to the use of deixical ingroup referents (‘us’, ‘we’, ‘our’ in contrast to the explicit labelling of the outgroup (‘the Polish’ can be understood in terms of the requirement to present complaints concerning migrant groups via appeals to assumed universal standards of behaviour and civility.

  3. Couple-based Intervention for Depression: An Effectiveness Study in the National Health Service in England.

    Science.gov (United States)

    Baucom, Donald H; Fischer, Melanie S; Worrell, Michael; Corrie, Sarah; Belus, Jennifer M; Molyva, Efthymia; Boeding, Sara E

    2017-12-04

    This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple-based treatment for depression (BCT-D) provided in London services that are part of the "Improving Access to Psychological Therapies" (IAPT) program in England. Twenty-three therapists in community clinics were trained in BCT-D during a 5-day workshop, followed by monthly group supervision for 1 year. The BCT-D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT-D. Eighty-five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT-D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT-D, although they were not the focus of treatment. BCT-D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT-D in routine clinical settings. © 2017 Family Process Institute.

  4. Fingermark visualisation on uncirculated £5 (Bank of England) polymer notes: Initial process comparison studies.

    Science.gov (United States)

    Downham, Rory P; Brewer, Eleigh R; King, Roberto S P; Luscombe, Aoife M; Sears, Vaughn G

    2017-06-01

    Experiments were conducted to investigate the effectiveness of a range of fingermark visualisation processes on brand new, uncirculated, £5 polymer banknotes (and their test note predecessors), as produced by the Bank of England (BoE). In the main study of this paper, a total of 14 individual processes were investigated on BoE £5 polymer banknotes, which included both 'Category A' processes (as recommended in the Home Office Fingermark Visualisation Manual) as well as recently developed processes, including fpNatural(®) 2 powder (cuprorivaite) from Foster+Freeman and a vacuum metal deposition sequence that evaporates silver followed by zinc. Results from this preliminary investigation indicate that fpNatural(®) 2, multimetal deposition, Wet Powder(™) Black, iron oxide powder suspension and black magnetic powder are the most effective processes on these uncirculated £5 BoE polymer banknotes, when viewed under "primary viewing" conditions (white light or fluorescence). Additional fingermarks were visualised on the polymer banknotes following the subsequent use of reflected infrared imaging and lifting techniques, and with the benefit of these techniques taken into consideration, the aforementioned processes remained amongst the most effective overall. This work provides initial insight into fingermark visualisation strategies for BoE £5 polymer banknotes, and the need for further studies in order to generate mature operational guidance is emphasised. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Place and cause of death in centenarians: a population-based observational study in England, 2001 to 2010.

    Directory of Open Access Journals (Sweden)

    Catherine J Evans

    2014-06-01

    Full Text Available Centenarians are a rapidly growing demographic group worldwide, yet their health and social care needs are seldom considered. This study aims to examine trends in place of death and associations for centenarians in England over 10 years to consider policy implications of extreme longevity.This is a population-based observational study using death registration data linked with area-level indices of multiple deprivations for people aged ≥100 years who died 2001 to 2010 in England, compared with those dying at ages 80-99. We used linear regression to examine the time trends in number of deaths and place of death, and Poisson regression to evaluate factors associated with centenarians' place of death. The cohort totalled 35,867 people with a median age at death of 101 years (range: 100-115 years. Centenarian deaths increased 56% (95% CI 53.8%-57.4% in 10 years. Most died in a care home with (26.7%, 95% CI 26.3%-27.2% or without nursing (34.5%, 95% CI 34.0%-35.0% or in hospital (27.2%, 95% CI 26.7%-27.6%. The proportion of deaths in nursing homes decreased over 10 years (-0.36% annually, 95% CI -0.63% to -0.09%, p = 0.014, while hospital deaths changed little (0.25% annually, 95% CI -0.06% to 0.57%, p = 0.09. Dying with frailty was common with "old age" stated in 75.6% of death certifications. Centenarians were more likely to die of pneumonia (e.g., 17.7% [95% CI 17.3%-18.1%] versus 6.0% [5.9%-6.0%] for those aged 80-84 years and old age/frailty (28.1% [27.6%-28.5%] versus 0.9% [0.9%-0.9%] for those aged 80-84 years and less likely to die of cancer (4.4% [4.2%-4.6%] versus 24.5% [24.6%-25.4%] for those aged 80-84 years and ischemic heart disease (8.6% [8.3%-8.9%] versus 19.0% [18.9%-19.0%] for those aged 80-84 years than were younger elderly patients. More care home beds available per 1,000 population were associated with fewer deaths in hospital (PR 0.98, 95% CI 0.98-0.99, p<0.001.Centenarians are more likely to have causes of death certified as

  6. Identifying dietary differences between Scotland and England: a rapid review of the literature.

    Science.gov (United States)

    Chambers, Stephanie; Barton, Karen L; Albani, Viviana; Anderson, Annie S; Wrieden, Wendy L

    2017-10-01

    Rates of premature mortality have been higher in Scotland than in England since the 1970s. Given the known association of diet with chronic disease, the study objective was to identify and synthesise evidence on current and historical differences in food and nutrient intakes in Scotland and England. A rapid review of the peer-reviewed and grey literature was carried out. After an initial scoping search, Medline, CINAHL, Embase and Web of Science were searched. Relevant grey literature was also included. Inclusion criteria were: any date; measures of dietary intake; representative populations; cross-sectional or observational cohort studies; and English-language publications. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A narrative synthesis of extracted information was conducted. Fifty publications and reports were included in the review. Results indicated that children and adults in Scotland had lower intakes of vegetables and vitamins compared with those living in England. Higher intakes of salt in Scotland were also identified. Data were limited by small Scottish samples, difficulty in finding England-level data, lack of statistical testing and adjustment for key confounders. Further investigation of adequately powered and analysed surveys is required to examine more fully dietary differences between Scotland and England. This would provide greater insight into potential causes of excess mortality in Scotland compared with England and suitable policy recommendations to address these inequalities.

  7. Ecological assessments of surface water bodies at the river basin level: a case study from England.

    Science.gov (United States)

    Collins, Alexandra; Voulvoulis, Nikolaos

    2014-12-01

    Ecological assessments of surface water bodies are essential in order to evaluate the level of degradation in freshwater ecosystems and to address the subsequent decline in services they provide. These assessments cover multiple aspects of the aquatic environment, particularly biological elements due to their ability to respond to all pressures within an ecosystem. Such assessments can enable the identification of the multiple pressures which threaten water bodies, facilitating sustainable decisions regarding their management to be identified. Here, the design requirements of the networks which facilitate ecological assessments are presented. A river basin district in England is used as a case study to investigate the number of elements monitored, the number of failing elements and the relationship between failing elements. Findings demonstrate the value of ensuring that monitoring networks are risk based and appropriately designed to meet their objectives. This therefore requires that monitoring is not only for the communicating of compliance but also for use iteratively so that the design of monitoring networks and ultimately management can be continually improved.

  8. Breast Density Legislation in New England: A Survey Study of Practicing Radiologists.

    Science.gov (United States)

    Lourenco, Ana P; DiFlorio-Alexander, Roberta M; Slanetz, Priscilla J

    2017-10-01

    This study aimed to assess radiologists' knowledge about breast density legislation as well as perceived practice changes resulting from the enactment of breast density legislation. This is an institutional review board-exempt anonymous email survey of 523 members of the New England Roentgen Ray Society. In addition to radiologist demographics, survey questions addressed radiologist knowledge of breast density legislation, knowledge of breast density as a risk factor for breast cancer, recommendations for supplemental screening, and perceived practice changes resulting from density notification legislation. Of the 523 members, 96 responded, yielding an 18% response rate. Seventy-three percent of respondents practiced in a state with breast density legislation. Sixty-nine percent felt that breast density notification increased patient anxiety about breast cancer, but also increased patient (74%) and provider (66%) understanding of the effect of breast density on mammographic sensitivity. Radiologist knowledge of the relative risk of breast cancer when comparing breasts of different density was variable. Considerable confusion and controversy regarding breast density persists, even among practicing radiologists. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  9. Access to yellow fever travel vaccination centres in England, Wales, and Northern Ireland: A geographical study.

    Science.gov (United States)

    Petersen, Jakob; Simons, Hilary; Patel, Dipti

    More than 700,000 trips were made by residents in England, Wales, and Northern Ireland (EWNI) in 2015 to tropical countries endemic for yellow fever, a potentially deadly, yet vaccine-preventable disease transmitted by mosquitoes. The aim of this study was to map the geographical accessibility of yellow fever vaccination centres (YFVC) in EWNI. The location of 3208 YFVC were geocoded and the average geodetic distance to nearest YFVC was calculated for each population unit. Data on trips abroad and centres were obtained regionally for EWNI and nationally for the World Top20 countries in terms of travel. The mean distance to nearest YFVC was 2.4 km and only 1% of the population had to travel more than 16.1 km to their nearest centre. The number of vaccines administered regionally in EWNI was found correlated with the number of trips to yellow fever countries. The number of centres per 100,000 trips was 6.1 in EWNI, which was below United States (12.1) and above the rest of Top20 countries. The service availability was in line with demand regionally. With the exception of remote, rural areas, yellow fever vaccination services were widely available with only short distances to cover for the travelling public. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  10. Hyponatremic hypertensive syndrome - a retrospective cohort study

    OpenAIRE

    Mukherjee, Devdeep; Sinha, Rajiv,; Akhtar, Md Shakil; Saha, Agni Sekhar

    2017-01-01

    AIM To ascertain the frequency of hyponatremic hypertensive syndrome (HHS) in a cohort of children with hypertensive emergency in a tertiary pediatric hospital. METHODS A retrospective review was undertaken among children with hypertensive emergency admitted in our tertiary children hospital between June 2014 and December 2015 with an aim to identify any children with HHS. Three children with HHS were identified during this period. RESULTS The 3 patients with HHS presented with hypertensive e...

  11. Global, Yet Incomplete Overview of Cohort Studies in Parkinson's disease.

    Science.gov (United States)

    Heinzel, Sebastian; Lerche, Stefanie; Maetzler, Walter; Berg, Daniela

    2017-01-01

    Parkinson's disease (PD) is characterized by heterogeneity and multifactorial longitudinal changes. To identify PD subtypes and factors influencing the disease course, multiple cohort studies have been designed globally. Knowledge about existing cohorts is pivotal to foster collaboration, which may help to advance the understanding of PD. To raise the awareness about PD cohorts and potential global collaboration opportunities. Observational cohort studies in clinical PD were identified by a European working group (JPND BioLoC-PD) and through literature search. Using a structured survey investigators of 44 cohorts provided basic information on cohorts and assessments performed. For the 44 cohorts (32% on early/de-novo PD), 14.666 participants (cohorts' median: 138; range: 23-3.090), a median 1.5-year follow-up interval (0.5-4 years) and a median (planned) observational period of 5 years (1-20 years) were indicated. All studies have assessed motor functions often using rating scales (UPDRS-III; 93% of studies) and less frequently quantitative gait/balance (25%) or fine motor assessments (27%). Cognitive (100%), neuropsychiatric (91%), daily living (78%), sleep (70%), sensory (63%), and gastrointestinal/autonomic (55%) assessments were common and often comparable. Neuroimaging data (82%) and biomaterial (69%) have been collected in many studies. Surprisingly, possible disease modifiers, such as sport/physical activity (11%), have rarely been assessed. Existing data of PD cohorts provide vast collaboration opportunities. We propose to establish a comprehensive, up-to-date, open-access internet platform with easy-to-use search tools of PD cohort descriptions and potentially available data. Bringing researchers together to enable collaborative joint, meta- and replication analyses is timely and necessary to advance PD research ultimately required for an understanding of PD that can be translated into more effective therapies.

  12. Complexity in the new NHS: longitudinal case studies of CCGs in England.

    Science.gov (United States)

    Checkland, Katherine; McDermott, Imelda; Coleman, Anna; Perkins, Neil

    2016-01-07

    The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be 'bottom up' with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged. Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures. In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings. Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs. The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a 'membership' organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of 'membership' raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  13. Positive Associations of Dispositional Mindfulness with Cardiovascular Health: the New England Family Study.

    Science.gov (United States)

    Loucks, Eric B; Britton, Willoughby B; Howe, Chanelle J; Eaton, Charles B; Buka, Stephen L

    2015-08-01

    Mindfulness (the ability to attend nonjudgmentally to one's own physical and mental processes) is receiving substantial interest as a potential determinant of health. However, little is known whether mindfulness is associated with cardiovascular health. The aim of this study is to evaluate whether dispositional mindfulness is associated with cardiovascular health. Study participants (n = 382) were from the New England Family Study, born in Providence, RI, USA, with mean age 47 years. Dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS). Cardiovascular health was assessed based on American Heart Association criteria. Cross-sectional multivariable-adjusted log binomial regression analyses were performed. Analyses demonstrated that those with high vs. low MAAS had prevalence ratio (PR) for good cardiovascular health of 1.83 (95 % confidence interval (CI) 1.07, 3.13), adjusted for age, gender, and race/ethnicity. There were significant associations of high vs. low mindfulness with nonsmoking (PR = 1.37, 95 % CI 1.06, 1.76), body mass index physical activity (PR = 1.56, 95 % CI 1.04, 2.35), but not blood pressure, total cholesterol, or fruit/vegetable consumption. Exploratory mediation analyses suggested that sense of control and depressive symptomatology may be mediators. This study demonstrated preliminary cross-sectional evidence that dispositional mindfulness is positively associated with cardiovascular health, with the associations particularly driven by smoking, body mass index, fasting glucose, and physical activity. If in future research mindfulness-based practices are found to consistently improve cardiovascular disease risk factors, such interventions may have potential to strengthen effects of cardiovascular health promotion programs.

  14. The Hokkaido Birth Cohort Study on Environment and Children's Health: cohort profile-updated 2017.

    Science.gov (United States)

    Kishi, Reiko; Araki, Atsuko; Minatoya, Machiko; Hanaoka, Tomoyuki; Miyashita, Chihiro; Itoh, Sachiko; Kobayashi, Sumitaka; Ait Bamai, Yu; Yamazaki, Keiko; Miura, Ryu; Tamura, Naomi; Ito, Kumiko; Goudarzi, Houman

    2017-05-18

    The Hokkaido Study on Environment and Children's Health is an ongoing study consisting of two birth cohorts of different population sizes: the Sapporo cohort and the Hokkaido cohort. Our primary study goals are (1) to examine the effects of low-level environmental chemical exposures on birth outcomes, including birth defects and growth retardation; (2) to follow the development of allergies, infectious diseases, and neurobehavioral developmental disorders and perform a longitudinal observation of child development; (3) to identify high-risk groups based on genetic susceptibility to environmental chemicals; and (4) to identify the additive effects of various chemicals, including tobacco smoking. The purpose of this report is to update the progress of the Hokkaido Study, to summarize the recent results, and to suggest future directions. In particular, this report provides the basic characteristics of the cohort populations, discusses the population remaining in the cohorts and those who were lost to follow-up at birth, and introduces the newly added follow-up studies and case-cohort study design. In the Sapporo cohort of 514 enrolled pregnant women, various specimens, including maternal and cord blood, maternal hair, and breast milk, were collected for the assessment of exposures to dioxins, polychlorinated biphenyls, organochlorine pesticides, perfluoroalkyl substances, phthalates, bisphenol A, and methylmercury. As follow-ups, face-to-face neurobehavioral developmental tests were conducted at several different ages. In the Hokkaido cohort of 20,926 enrolled pregnant women, the prevalence of complicated pregnancies and birth outcomes, such as miscarriage, stillbirth, low birth weight, preterm birth, and small for gestational age were examined. The levels of exposure to environmental chemicals were relatively low in these study populations compared to those reported previously. We also studied environmental chemical exposure in association with health outcomes

  15. How Technicians Can Lead Science Improvements in Any School: A Small-Scale Study in England

    Science.gov (United States)

    Jones, Beth; Quinnell, Simon

    2015-01-01

    This article describes how seven schools in England improved their science provision by focusing on the professional development of their science technicians. In September 2013, the Gatsby Charitable Foundation funded the National Science Learning Centre to lead a project connecting secondary schools with experienced senior science technicians…

  16. Redesign and commissioning of sexual health services in England - a qualitative study.

    Science.gov (United States)

    Walker, I F; Leigh-Hunt, N; Lee, A C K

    2016-10-01

    Responsibility for the commissioning of sexual and reproductive health (SRH) services transferred from the National Health Service to local authorities in England in 2013. This transfer prompted many local authorities to undertake new procurements of these SRH services. This study was undertaken to capture some of the lessons learnt in order to inform future commissioning and system redesign. A qualitative study was carried out involving semi-structured interviews. Interviews were conducted with 13 local authority sexual health commissioners in Yorkshire and the Humber from 11 interviews. Thematic analysis was used to identify themes from transcripts of the interviews with the 13 participants. Key themes identified were as follows: the challenge and complexity to those new to clinical commissioning; the prerequisites of robust infrastructural inputs to undertake the process, including technical expertise, a dependable project team, with clarity over the timescales and the budget; the requirement for good governance, stakeholder engagement and successful management of relationships with the latter; and the need to focus on the outcomes, aiming for value for money and improved system performance. Several key issues emerged from our study that significantly influenced the outcome of the redesign and commissioning process for sexual health services. An adapted model of the Donabedian evaluation framework was developed to provide a tool to inform future system redesign. Our model helps identify the key determinants for successful redesign in this context which is essential to both mitigate potential risks and maximize the likelihood of successful outcomes. Our model may have wider applications. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  17. Tubal ligation, hysterectomy and epithelial ovarian cancer in the New England Case-Control Study.

    Science.gov (United States)

    Rice, Megan S; Murphy, Megan A; Vitonis, Allison F; Cramer, Daniel W; Titus, Linda J; Tworoger, Shelley S; Terry, Kathryn L

    2013-11-15

    Previous studies have observed that tubal ligation and hysterectomy are associated with a decreased risk of ovarian cancer; however, little is known about whether these associations vary by surgical characteristics, individual characteristics or tumor histology. We used logistic regression to examine tubal ligation, simple hysterectomy and hysterectomy with unilateral oophorectomy in relation to risk of epithelial ovarian cancer in the New England Case-Control Study. Our primary analysis included 2,265 cases and 2,333 controls. Overall, tubal ligation was associated with a lower risk of epithelial ovarian cancer [odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.68-0.97], especially for endometrioid tumors (OR = 0.45, 95% CI: 0.29-0.69). The inverse association between tubal ligation and ovarian cancer risk was stronger for women who had undergone the procedure at the time of last delivery (OR = 0.60, 95% CI: 0.42-0.84) rather than at a later time (OR = 0.93, 95% CI: 0.75-1.15). Overall, simple hysterectomy was not associated with ovarian cancer risk (OR: 1.09, 95% CI: 0.83-1.42), although it was associated with a nonsignificant decreased risk of ovarian cancer among women who underwent the procedure at age 45 or older (RR: 0.64, 95% CI: 0.40-1.02) or within the last 10 years (OR = 0.65, 95% CI: 0.38-1.13). Overall, women who had a hysterectomy with a unilateral oophorectomy had significantly lower risk of ovarian cancer (OR = 0.65, 95% CI: 0.45-0.94). In summary, tubal ligation and hysterectomy with unilateral oophorectomy were inversely associated with ovarian cancer risk in a large population-based case-control study. Additional research is necessary to understand the potential biologic mechanisms by which these procedures may reduce ovarian cancer risk. Copyright © 2013 UICC.

  18. Overview of ongoing cohort and dietary studies in the Arctic

    Directory of Open Access Journals (Sweden)

    Pál Weihe

    2016-12-01

    Full Text Available This article gives an overview of the ongoing cohort and dietary studies underlying the assessment of population health in the Arctic. The emphasis here is on a description of the material, methods and results or preliminary results for each study. Detailed exposure information is available in an article in this journal, whereas another paper describes the effects associated with contaminant exposure in the Arctic. The cohort descriptions have been arranged geographically, beginning in Norway and moving east to Finland, Sweden, Russia and the other Arctic countries and ultimately to the Faroe Islands. No cohort studies have been reported for Alaska or Iceland.

  19. What can cohort studies in the dog tell us?

    Science.gov (United States)

    Pugh, Carys A; Bronsvoort, Barend M de C; Handel, Ian G; Summers, Kim M; Clements, Dylan N

    2014-01-01

    This paper addresses the use of cohort studies in canine medicine to date and highlights the benefits of wider use of such studies in the future. Uniquely amongst observational studies, cohort studies offer the investigator an opportunity to assess the temporal relationship between hypothesised risk factors and diseases. In human medicine cohort studies were initially used to investigate specific exposures but there has been a movement in recent years to more broadly assess the impact of complex lifestyles on morbidity and mortality. Such studies do not focus on narrow prior hypotheses but rather generate new theories about the impact of environmental and genetic risk factors on disease. Unfortunately cohort studies are expensive both in terms of initial investment and on-going costs. There is inevitably a delay between set up and the reporting of meaningful results. Expense and time constraints are likely why this study design has been used sparingly in the field of canine health studies. Despite their rather limited numbers, canine cohort studies have made a valuable contribution to the understanding of dog health, in areas such as the dynamics of infectious disease. Individual exposures such as neutering and dietary restriction have also been directly investigated. More recently, following the trend in human health, large cohort studies have been set up to assess the wider impact of dog lifestyle on their health. Such studies have the potential to develop and test hypotheses and stimulate new theories regarding the maintenance of life-long health in canine populations.

  20. Estimation of Error Components in Cohort Studies: A Cross-Cohort Analysis of Dutch Mathematics Achievement

    Science.gov (United States)

    Keuning, Jos; Hemker, Bas

    2014-01-01

    The data collection of a cohort study requires making many decisions. Each decision may introduce error in the statistical analyses conducted later on. In the present study, a procedure was developed for estimation of the error made due to the composition of the sample, the item selection procedure, and the test equating process. The math results…

  1. A geographical study of thyroid cancer incidence in north-west England following the Windscale nuclear reactor fire of 1957.

    Science.gov (United States)

    McNally, Richard J Q; Wakeford, Richard; James, Peter W; Basta, Nermine O; Alston, Robert D; Pearce, Mark S; Elliott, Alex T

    2016-12-01

    The Windscale nuclear reactor fire at Sellafield, United Kingdom, in October 1957 led to an uncontrolled release of iodine-131 (radioactive half-life, 8 d) into the atmosphere. Contamination from the accident was most pronounced in the counties of Cumbria and Lancashire, north-west England. Radioiodine concentrates in the thyroid gland producing an excess risk of thyroid cancer, notably among those exposed as children, which persists into later life. For an initial investigation of thyroid cancer incidence in north-west England, data were obtained on cases of thyroid cancer among people born during 1929-1973 and diagnosed during 1974-2012 while resident in England, together with corresponding populations. Incidence rate ratios (IRRs), with Poisson 95% confidence intervals (CIs), compared thyroid cancer incidence rates in Cumbria and in Lancashire with those in the rest of England. For those aged  <20 years in 1958, a statistically significantly increased IRR was found for those diagnosed during 1974-2012 while living in Cumbria (IRR  =  1.29; 95% CI 1.09-1.52), but the equivalent IRR for Lancashire was marginally non-significantly decreased (IRR  =  0.91; 95% CI 0.80-1.04). This pattern of IRRs was also apparent for earlier births, and the significantly increased IRR in Cumbria extended to individuals born in 1959-1963, who would not have been exposed to iodine-131 from the Windscale accident. Moreover, significant overdispersion was present in the temporal distributions of the IRRs, so that Poisson CIs substantially underestimate statistical uncertainties. Consequently, although further investigations are required to properly understand the unusual patterns of thyroid cancer IRRs in Cumbria and Lancashire, the results of this preliminary study are not consistent with an effect of exposure to iodine-131 from the Windscale accident.

  2. Effectiveness of tobacco control television advertising in changing tobacco use in England: a population-based cross-sectional study.

    Science.gov (United States)

    Sims, Michelle; Salway, Ruth; Langley, Tessa; Lewis, Sarah; McNeill, Ann; Szatkowski, Lisa; Gilmore, Anna B

    2014-06-01

    To examine whether government-funded tobacco control television advertising shown in England between 2002 and 2010 reduced adult smoking prevalence and cigarette consumption. Analysis of monthly cross-sectional surveys using generalised additive models. England. More than 80 000 adults aged 18 years or over living in England and interviewed in the Opinions and Lifestyle Survey. Current smoking status, smokers' daily cigarette consumption, tobacco control gross rating points (GRPs-a measure of per capita advertising exposure combining reach and frequency), cigarette costliness, tobacco control activity, socio-demographic variables. After adjusting for other tobacco control policies, cigarette costliness and individual characteristics, we found that a 400-point increase in tobacco control GRPs per month, equivalent to all adults in the population seeing four advertisements per month (although actual individual-level exposure varies according to TV exposure), was associated with 3% lower odds of smoking 2 months later [odds ratio (OR) = 0.97, 95% confidence interval (CI) = 0.95, 0.999] and accounted for 13.5% of the decline in smoking prevalence seen over this period. In smokers, a 400-point increase in GRPs was associated with a 1.80% (95%CI = 0.47, 3.11) reduction in average cigarette consumption in the following month and accounted for 11.2% of the total decline in consumption over the period 2002-09. Government-funded tobacco control television advertising shown in England between 2002 and 2010 was associated with reductions in smoking prevalence and smokers' cigarette consumption. © 2014 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

  3. Awareness and Use of mHealth Apps: A Study from England

    Directory of Open Access Journals (Sweden)

    Reem Kayyali

    2017-06-01

    Full Text Available Purpose: Mobile health (mHealth solutions have become an inevitable element of the healthcare landscape. The recommendation and use of mHealth is important, but it is often underutilised. This study was conducted in England. It aimed to determine the use and recommendation of mHealth apps by pharmacists, the public’s perceptions of mHealth apps in general, and the awareness and use of health apps by diabetic patients in particular. Methods: The study used a mixed research approach, utilising a sequence of survey-based questionnaires with pharmacists and the general public, followed by semi-structured interviews with diabetic patients. Results: Pharmacists’ questionnaires revealed that 56% of the respondents were aware of health apps, 60% of which recommended them to patients. Over 76% of the individuals owned a smartphone. The types of applications that saw the most use from the general public were health and lifestyle apps (24%, social apps (19%, followed by news (18%. Although eight out of nine diabetic patients owned a smartphone, only three used diabetes apps. Diabetic patients also suggested an interest in using diabetes apps to aid in optimising care via the utilisation of visual aids, reminders, recording patient data, social coaching, and remote collaboration with healthcare professionals (HCPs, but time was seen as the biggest obstacle to using a diabetes mHealth application. Conclusion: Despite the growing number of mHealth apps, the level of awareness and usability of such apps by patients and pharmacists was still relatively low. Nevertheless, the majority who used health apps found them to be beneficial, and the public agreed that it helped them to live a healthier lifestyle. Therefore, health apps have great potential in health promotion. Pharmacists are ideally placed to promote them and make patients more aware of them. To increase the use of these apps, it is necessary to first increase awareness and knowledge of these apps

  4. Awareness and Use of mHealth Apps: A Study from England.

    Science.gov (United States)

    Kayyali, Reem; Peletidi, Aliki; Ismail, Muhammad; Hashim, Zahra; Bandeira, Pedro; Bonnah, Jennifer

    2017-06-14

    Purpose: Mobile health (mHealth) solutions have become an inevitable element of the healthcare landscape. The recommendation and use of mHealth is important, but it is often underutilised. This study was conducted in England. It aimed to determine the use and recommendation of mHealth apps by pharmacists, the public's perceptions of mHealth apps in general, and the awareness and use of health apps by diabetic patients in particular. Methods: The study used a mixed research approach, utilising a sequence of survey-based questionnaires with pharmacists and the general public, followed by semi-structured interviews with diabetic patients. Results: Pharmacists' questionnaires revealed that 56% of the respondents were aware of health apps, 60% of which recommended them to patients. Over 76% of the individuals owned a smartphone. The types of applications that saw the most use from the general public were health and lifestyle apps (24%), social apps (19%), followed by news (18%). Although eight out of nine diabetic patients owned a smartphone, only three used diabetes apps. Diabetic patients also suggested an interest in using diabetes apps to aid in optimising care via the utilisation of visual aids, reminders, recording patient data, social coaching, and remote collaboration with healthcare professionals (HCPs), but time was seen as the biggest obstacle to using a diabetes mHealth application. Conclusion: Despite the growing number of mHealth apps, the level of awareness and usability of such apps by patients and pharmacists was still relatively low. Nevertheless, the majority who used health apps found them to be beneficial, and the public agreed that it helped them to live a healthier lifestyle. Therefore, health apps have great potential in health promotion. Pharmacists are ideally placed to promote them and make patients more aware of them. To increase the use of these apps, it is necessary to first increase awareness and knowledge of these apps, both to the public

  5. Characteristics that define high risk in carotid endarterectomy from the Vascular Study Group of New England

    Science.gov (United States)

    Gates, Lindsay; Botta, Robert; Schlosser, Felix; Goodney, Philip; Fokkema, Margriet; Schermerhorn, Marc; Sarac, Timur; Indes, Jeffrey

    2017-01-01

    Objective The Stenting with Angioplasty and Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial compared carotid endarterectomy (CEA) to carotid artery stenting (CAS) among high-risk patients using a model of risk that has not been validated by previous publications. The objective of our study was to determine the accuracy of this high-risk model and to determine the true risk factors that result in patients being at high risk for CEA. Methods Prospectively collected data for 3098 CEAs between 2003 and 2011 at 20 Vascular Surgery Group of New England (VSGNE) centers were used. SAPPHIRE general inclusion criteria and primary outcomes were assessed. Factors that were associated with the primary outcome by analysis of variance (P carotid artery stenosis (95% CI, 1.0–1.2; P = .001). Three of the SAPPHIRE high-risk criteria—abnormal stress test, recurrent stenosis after CEA, and previous radiotherapy to the neck—were not independently associated with an adverse outcome. Independently significant risk factors not included in the SAPPHIRE criteria are inclusion of ages carotid stenosis, and any previous cerebrovascular accident. The risk index predictors are age in years (40–49: 0 points; 50–59: 2 points; 60–69: 4 points; 70–79: 6 points; 80–89: 8 points), living in a nursing home (4 points), any cardiovascular disease (2 points), congestive heart failure (5 points), chronic obstructive pulmonary disease (3 points), DM (2 points), degree of contralateral stenosis (13 points, representing adverse outcome rate of 22.5%. Conclusions SAPPHIRE and other previously reported high-risk CAS inclusion criteria do not include all of the factors found to be independently associated with outcomes. Further studies are required to determine whether CAS is inferior to CEA in high-risk patients using a validated model of risk. In addition, this preoperative assessment includes novel criteria that can be used to stratify risks. PMID:26054590

  6. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study.

    Directory of Open Access Journals (Sweden)

    Thomas E Cowling

    Full Text Available BACKGROUND: The number of visits to hospital emergency departments (EDs in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS. Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. METHODS: A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001. Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

  7. Language barriers in health and social care consultations in the community: a comparative study of responses in Ireland and England.

    Science.gov (United States)

    Macfarlane, Anne; Singleton, Carrie; Green, Eileen

    2009-10-01

    This paper focuses on the implications of migration for host health and social care systems in terms of linguistic diversity, language barriers and language supports. The objective is to compare Ireland, as a context responding to the new challenge of language barriers in healthcare, and England, as a context in which the management of language barriers is being re-assessed. Empirical data from two action research studies in Ireland and England are compared. The combined data set is 146 data collection episodes with service users with limited English and their health and social care providers. Key findings are that the same range of formal and informal responses to language barriers occurs in practice in both contexts but proportions of knowledge and use of these responses differ. English service providers have more awareness about the use of formal responses than Irish service providers but uptake of formal responses remains low in both contexts. Data from service users confirms these findings. There is a need for more attention to the implementation of policies for language barriers in both Ireland and England, further research about the normalization processes associated with these consultations and knowledge transfer networks to facilitate on-going dialogue between all key stakeholders with an emphasis on supporting service users' involvement and participation.

  8. European birth cohort studies on asthma and atopic diseases I

    DEFF Research Database (Denmark)

    Keil, T; Kulig, M; Simpson, A

    2006-01-01

    BACKGROUND: The reasons for the rise in asthma and allergies remain unclear. To identify risk or protective factors, it is essential to carry out longitudinal epidemiological studies, preferably birth cohort studies. In Europe, several birth cohort studies on asthma and atopic diseases have been...... initiated over the last two decades. AIM: One of the work packages within the Global Allergy and Asthma European Network (GA(2)LEN) project was designed to identify and compare European birth cohorts on asthma and atopic diseases. The present review (part I) describes their objectives, study settings......, recruitment process and follow-up rates. A subsequent review (part II) will compare outcome and exposure parameters. METHODS: For each birth cohort, we collected detailed information regarding recruitment process, study setting, baseline data (pregnancy, birth, parents/siblings) as well as follow-up rates...

  9. A high resolution temporal study of phytoplankton bloom dynamics in the eutrophic Taw Estuary (SW England).

    Science.gov (United States)

    Maier, Gerald; Glegg, Gillian A; Tappin, Alan D; Worsfold, Paul J

    2012-09-15

    The Taw Estuary (SW England) is eutrophic as a result of enhanced nutrient inputs from its catchment. However, factors influencing the timing and extent of phytoplankton bloom formation are not fully understood in this system. In this study, high resolution chemical and biological sampling was undertaken in late-winter/spring and summer 2008 in order to gain further insights into bloom dynamics in the Taw Estuary. Temporal variations in chlorophyll a maxima in the upper and middle estuary during summer were controlled by river flow and tidal amplitude, with nutrient limitation probably less important. Concentrations of chlorophyll a were highest during low river flow and neap tides. Increased river flows advected the chlorophyll maximum to the outer estuary, and under highest river discharges, chlorophyll a concentrations were further reduced. This feature was even more pronounced when spring tides coincided with high flows. The main bloom species were the diatoms Asterionellopsis glacialis and Thalassiosira guillardii. Using two multivariate statistical techniques in combination, five distinct physical and biogeochemical states in the Taw estuarine waters were identified. These states can be summarised as: A(1), high chlorophyll a, high temperature, long residence times, nutrient depletion; A(2), strong coastal water influence; B(1), decreasing chlorophyll a, increasing river flow and/or spring tides; B(2), transitional between states A(1) and B(3); B(3), high river flow. It was thus possible to differentiate between contrasting environmental conditions that were either beneficial or detrimental for the development of algal blooms. A conceptual model of diatom - dominated primary production for the Taw Estuary is proposed which describes how physical controls (river flow, tidal state) moderate plankton biomass production in the upper and mid - estuarine regions. Copyright © 2011 Elsevier B.V. All rights reserved.

  10. Adverse Pregnancy Outcomes Among Women with Inflammatory Bowel Disease: A Population-Based Study from England.

    Science.gov (United States)

    Abdul Sultan, Alyshah; West, Joe; Ban, Lu; Humes, David; Tata, Laila J; Fleming, Kate M; Nelson-Piercy, Catherine; Card, Timothy

    2016-07-01

    There is limited contemporary population-based evidence on adverse birth outcomes and pregnancy-related complications for women with inflammatory bowel disease (IBD). This study provides such estimates of these risks and assesses variation by IBD type and surgical interventions. We calculated the proportion of pregnancies in women with and without IBD between 1997 and 2012 throughout England using linked primary (Clinical Practice Research Datalink) and secondary care (Hospital Episode Statistics) data. Risk of pregnancy-related complications and adverse birth outcomes in women with Crohn's disease and ulcerative colitis were compared with risks in women without IBD using odds ratios (ORs). Of 364,363 singleton pregnancies resulting in live or stillbirths, 1969 (0.5%) were in women with IBD. Women with Crohn's disease were more likely to have preterm births (OR = 1.42; 95% confidence interval, 1.12-1.79), babies with low birth weights (OR = 1.39; 95% confidence interval, 1.05-1.83), and postpartum hemorrhage (OR = 1.27; 95% confidence interval, 1.04-1.55), whereas women with ulcerative colitis were only at increased risk of preterm births with an absolute risk difference of pregnancy-related complications compared with cases without surgery, however, women with IBD were more likely to have an elective caesarean section. Women with Crohn's disease have increased risks of some specific pregnancy-related complications and adverse birth outcomes which are independent of caesarean section, however, the absolute risk differences are small, indicating that most women with IBD will have an uncomplicated pregnancy.

  11. Clinical Disorders in a Post War British Cohort Reaching Retirement: Evidence from the First National Birth Cohort Study

    Science.gov (United States)

    Pierce, Mary B.; Silverwood, Richard J.; Nitsch, Dorothea; Adams, Judith E.; Stephen, Alison M.; Nip, Wing; Macfarlane, Peter; Wong, Andrew; Richards, Marcus; Hardy, Rebecca; Kuh, Diana

    2012-01-01

    Background The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood. Methods and Findings The data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60–64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0–9); only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%–56.7%), obesity (31.1%, 28.8%–33.5%), raised cholesterol (25.6%, 23.1–28.26%), and diabetes or impaired fasting glucose (25.0%, 22.6–27.5%). A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used. Conclusions Most British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the

  12. Does Low Participation in Cohort Studies Induce Bias?

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard; Frydenberg, Morten; Henriksen, Tine Brink

    2006-01-01

    Background: Participation rates in large cohort studies have dropped during the last two decades. The consequences of this trend for relative risk estimation are unknown. Methods: The impact of a low participation rate (30%) on the Danish National Birth Cohort was examined among 49,751 women from...... the source population, including 15,373 participants in the cohort study. Based on independent data collection, we estimated odds ratios (ORs) in the source population and among participants for three exposure-risk associations: a) in vitro fertilization and preterm birth, b) smoking during pregnancy...... intervals gave very similar results and a small simulation study showed that the coverage probabilities were close to the 95% nominal level Conclusion: For the three chosen associations the odds ratios were not biased by non-participation. The results are reassuring for studies based on the Danish cohort...

  13. Hyponatremic hypertensive syndrome - a retrospective cohort study.

    Science.gov (United States)

    Mukherjee, Devdeep; Sinha, Rajiv; Akhtar, Md Shakil; Saha, Agni Sekhar

    2017-01-06

    To ascertain the frequency of hyponatremic hypertensive syndrome (HHS) in a cohort of children with hypertensive emergency in a tertiary pediatric hospital. A retrospective review was undertaken among children with hypertensive emergency admitted in our tertiary children hospital between June 2014 and December 2015 with an aim to identify any children with HHS. Three children with HHS were identified during this period. The 3 patients with HHS presented with hypertensive emergency. They were initially managed with Labetalol infusion and thereafter switched to oral anti-hypertensives (combination of Nifedipine sustained release, Hydralazine and Beta Blocker). All 3 were diagnosed to have unilateral renal artery stenosis. One child was lost to follow up, whereas the other 2 underwent renal angioplasty which was followed with normalization of blood pressure. Despite activation of renin angiotensin axis secondary to renal artery stenosis, these groups of children have significant hyponatremia. Renal re-vascularisation produces excellent results in most of them.

  14. Cohort profile: LIFEWORK, a prospective cohort study on occupational and environmental risk factors and health in the Netherlands.

    NARCIS (Netherlands)

    Reedijk, M.; Lenters, V.; Slottje, P.; Pijpe, A.; Peeters, P.H.; Korevaar, J.C.; Bueno-de-Mesquita, B.; Verschuren, W.M.M.; Verheij, R.A.; Pieterson, I.; Leeuwen, F.E. van; Rookus, M.A.; Kromhout, H.; Vermeulen, R.C.H.

    2017-01-01

    Purpose LIFEWORK is a large federated prospective cohort established in the Netherlands to quantify the health effects of occupational and environmental exposures. This cohort is also the Dutch contribution to the international Cohort Study of Mobile Phone Use and Health (COSMOS). In this paper, we

  15. Childhood psychological distress and youth unemployment: evidence from two British cohort studies.

    Science.gov (United States)

    Egan, Mark; Daly, Michael; Delaney, Liam

    2015-01-01

    The effect of childhood mental health on later unemployment has not yet been established. In this article we assess whether childhood psychological distress places young people at high risk of subsequent unemployment and whether the presence of economic recession strengthens this relationship. This study was based on 19,217 individuals drawn from two nationally-representative British prospective cohort studies; the Longitudinal Study of Young People in England (LSYPE) and the National Child Development Study (NCDS). Both cohorts contain rich contemporaneous information detailing the participants' early life socioeconomic background, household characteristics, and physical health. In adjusted analyses in the LSYPE sample (N = 10,232) those who reported high levels of distress at age 14 were 2 percentage points more likely than those with low distress to be unemployed between ages 16 and 21. In adjusted analyses of the NCDS sample (N = 8985) children rated as having high distress levels by their teachers at age 7 and 11 were 3 percentage points more likely than those with low distress to be unemployed between ages 16 and 23. Our examination of the 1980 UK recession in the NCDS cohort found the difference in average unemployment level between those with high versus low distress rose from 2.6 pct points in the pre-recession period to 3.9 points in the post-recession period. These findings point to a previously neglected contribution of childhood mental health to youth unemployment, which may be particularly pronounced during times of economic recession. Our findings also suggest a further economic benefit to enhancing the provision of mental health services early in life. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Socioeconomic impacts of nuclear power plant siting: a case study of two New England communities

    Energy Technology Data Exchange (ETDEWEB)

    Purdy, B. J.

    1976-01-01

    An examination is presented of the social, economic and political/institutional impacts of two operating nuclear power complexes on two New England communities. The work is one of a series planned to broaden knowledge of the effects of large energy-generating facilities upon the social structure of local communities. Its primary objectives are to investigate and assess social and economic impacts resulting from construction and operation of nuclear power plants and to generate hypotheses about such impacts for future testing.

  17. Lyme disease and Bell's palsy: an epidemiological study of diagnosis and risk in England.

    Science.gov (United States)

    Cooper, Lilli; Branagan-Harris, Michael; Tuson, Richard; Nduka, Charles

    2017-05-01

    Lyme disease is caused by a tick-borne spirochaete of the Borrelia species. It is associated with facial palsy, is increasingly common in England, and may be misdiagnosed as Bell's palsy. To produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy, to enable prevention, early diagnosis, and effective treatment. Hospital episode statistics (HES) data in England from the Health and Social Care Information Centre were interrogated from April 2011 to March 2015 for International Classification of Diseases 10th revision (ICD-10) codes A69.2 (Lyme disease) and G51.0 (Bell's palsy) in isolation, and as a combination. Patients' age, sex, postcode, month of diagnosis, and socioeconomic groups as defined according to the English Indices of Deprivation (2004) were also collected. Lyme disease hospital diagnosis increased by 42% per year from 2011 to 2015 in England. Higher incidence areas, largely rural, were mapped. A trend towards socioeconomic privilege and the months of July to September was observed. Facial palsy in combination with Lyme disease is also increasing, particularly in younger patients, with a mean age of 41.7 years, compared with 59.6 years for Bell's palsy and 45.9 years for Lyme disease (P = 0.05, analysis of variance [ANOVA]). Healthcare practitioners should have a high index of suspicion for Lyme disease following travel in the areas shown, particularly in the summer months. The authors suggest that patients presenting with facial palsy should be tested for Lyme disease. © British Journal of General Practice 2017.

  18. Familial aggregation of hypospadias: a cohort study

    DEFF Research Database (Denmark)

    Schnack, Tine H; Zdravkovic, Slobodan; Myrup, Charlotte

    2008-01-01

    Hypospadias is one of the most common birth defects. However, its etiology remains largely unknown. The authors investigated the contribution of genetic and environmental factors to familial aggregation of hypospadias. Using Danish health registers, they identified 5,380 boys diagnosed...... with hypospadias in a cohort of 1,201,790 boys born in 1973-2005. Using binomial log-linear regression, they estimated recurrence risk ratios of hypospadias for male twin pairs and first-, second-, and third-degree relatives of a hypospadias case, which were 50.8 (95% confidence interval [CI]: 34.2, 75.5), 11.......6 (95% CI: 9.75, 13.7), 3.27 (95% CI: 2.47, 4.34), and 1.33 (95% CI: 0.94, 1.88), respectively. Recurrence risk ratios did not differ for family members of a hypospadias case related to the same degree. In addition, the authors found no difference in the recurrence risk ratio for maternal compared...

  19. A non-participant observational study of health and social care waste disposal behaviour in the South West of England.

    Science.gov (United States)

    Manzi, Sean; Nichols, Andrew; Richardson, Janet

    2014-10-01

    The National Health Service in England has a large carbon footprint. Waste production and disposal contributes to this carbon footprint and costs the National Health Service England over £82 million per annum. This study builds on existing work regarding health care waste management in the United Kingdom where the potential for recycling has begun to be studied. The study focuses on a private hospital and social care organizations, and provides a more detailed study of the behaviour of individuals across a variety of waste management systems. The study was an overt observational study at four health and social care sites in the South West of England. Systematic observations were made of the waste disposed of by employees in which the observer recorded: a description of the waste item; the bin into which the waste was placed; the type of employee who disposed of the waste; the material the waste comprised and the appropriateness of the disposal behaviour. The domestic waste bin was found to be most commonly used by employees to dispose of waste (51%), and the materials observed being disposed of most often were paper (26%), organic wastes (19%) and plastic (19%). There were significant differences between the four sites indicating that the activities performed at each site may have been influencing the waste being disposed of. It was concluded that the transfer of waste from the domestic waste stream to the recycling waste stream should be a central focus for the design of new health and social care waste management systems. Employees will require guidance and training in identifying and classifying waste materials for recycling. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Effects of fully-established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational study.

    Science.gov (United States)

    Melhuish, Edward; Belsky, Jay; Leyland, Alastair H; Barnes, Jacqueline

    2008-11-08

    Sure Start Local Programmes (SSLPs) are area-based interventions to improve services for young children and their families in deprived communities, promote health and development, and reduce inequalities. We therefore investigated whether SSLPs affect the wellbeing of 3-year-old children and their families. In a quasi-experimental observational study, we compared 5883 3-year-old children and their families from 93 disadvantaged SSLP areas with 1879 3-year-old children and their families from 72 similarly deprived areas in England who took part in the Millennium Cohort Study. We studied 14 outcomes-children's immunisations, accidents, language development, positive and negative social behaviours, and independence; parenting risk; home-learning environment; father's involvement; maternal smoking, body-mass index, and life satisfaction; family's service use; and mother's rating of area. After we controlled for background factors, we noted beneficial effects associated with the programmes for five of 14 outcomes. Children in the SSLP areas showed better social development than those in the non-SSLP areas, with more positive social behaviour (mean difference 0.45, 95% CI 0.09 to 0.80, p=0.01) and greater independence (0.32, 0.18 to 0.47, phome-learning environment (1.30, 0.75 to 1.86, pchild and family development than those not living in SSLP areas (0.98, 0.86 to 1.09, plife chances of young children living in deprived areas.

  1. The Korea Nurses' Health Study: A Prospective Cohort Study.

    Science.gov (United States)

    Kim, Oksoo; Ahn, Younjhin; Lee, Hea-Young; Jang, Hee Jung; Kim, Sue; Lee, Jung Eun; Jung, Heeja; Cho, Eunyoung; Lim, Joong-Yeon; Kim, Min-Ju; Willett, Walter C; Chavarro, Jorge E; Park, Hyun-Young

    2017-08-01

    The Korea Nurses' Health Study (KNHS) is a prospective cohort study of female nurses, focusing on the effects of occupational, environmental, and lifestyle risk factors on the health of Korean women. Female registered nurses aged 20-45 years and living in the Republic of Korea were invited to join the study, which began in July 2013. They were asked to complete a web-based baseline survey. The study protocols and questionnaires related to the KNHS are based on the Nurses' Health Study 3 (NHS3) in the United States, although they were modified to reflect the Korean lifestyle. Participants were asked about demographic, lifestyle factors, disease history, occupational exposure, reproductive factors, and dietary habits during their adolescence: Follow-up questionnaires were/will be completed at 6-8 month intervals after the baseline survey. If a participant became pregnant, she answered additional questionnaires containing pregnancy-related information. Among 157,569 eligible female nurses, 20,613 (13.1%) completed the web-based baseline questionnaire. The mean age of the participants was 29.4 ± 5.9 years, and more than half of them were in their 20s. Eighty-eight percent of the participants had worked night shifts as a nurse (mean, 5.3 ± 4.3 nights per month). Approximately 80% of the participants had a body mass index below 23 kg/m2. Gastrointestinal diseases were the most prevalent health issues (25.9%). The findings from this prospective cohort study will help to identify the effects of lifestyle-related and occupational factors on reproductive health and development of chronic diseases in Korean women.

  2. A multilevel study of the environmental determinants of swine ascariasis in England.

    Science.gov (United States)

    Mendes, Ângelo Joel; Ribeiro, Ana Isabel; Severo, Milton; Niza-Ribeiro, João

    2017-12-01

    Ascariasis is considered a common parasitosis of swine worldwide. The disease causes significant economic losses due to its effect on feed conversion ratio and liver condemnations at slaughter (liver milk spots). This study aimed to characterise the between-farm and spatial variance in porcine ascariasis in England and to assess the association between the percentage of infected animals and potential environmental risk factors, including production system, socioeconomic deprivation, soil characteristics (pH, topsoil bulk density, topsoil organic matter, topsoil texture class, soil water regime, topsoil available water capacity, and elevation), and climatic conditions (relative humidity, air temperature, and rainfall) before slaughter. Post-mortem inspection results were provided by the Food Standards Agency and comprised information about the number of rejected livers, the number of animals sent to slaughter and the production system. All farms were georeferenced based on the postcode, which allowed the assessment of the area index of socioeconomic deprivation and the extraction of soil and climatic characteristics available in different online databases. Under a multilevel framework with adjustment for spatial autocorrelation, a standard linear mixed model was fitted to estimate the association between these determinants and the percentage of infected animals. From 2,513,973 English farmed pigs included in the study, 4.3% had their livers rejected due to milk spots. The percentage of infected pigs per batch ranged from 0% to 100%. The highest percentages were found in Surrey, East and West Sussex (8.9%) and lowest in Leicestershire, Rutland and Northamptonshire (2.0%). Significant associations were found at multivariable analysis between the proportion of infection and the number of animals sent to slaughter (β=-0.005; 95%CI=-0.005, -0.004), soil texture (peat compared to coarse textured soils; β=-0.516; 95%CI=-1.010, -0.063), relative humidity (β=0.011; 95%CI

  3. Cross-Sectional Study of Toxoplasma gondii Infection in Pig Farms in England.

    Science.gov (United States)

    Limon, Georgina; Beauvais, Wendy; Dadios, Nikolaos; Villena, Isabelle; Cockle, Charlotte; Blaga, Radu; Guitian, Javier

    2017-05-01

    Ingestion of undercooked meat has been proposed as an important source of human Toxoplasma gondii infection. To ascertain the contribution of meat consumption to the risk of human infection, estimates of the prevalence of infection in meat-producing animals are required. A cross-sectional study was conducted to assess T. gondii infection in pigs raised in England, to identify risk factors for infection, and to compare performance of two serological tests: modified agglutination test (MAT) and enzyme-linked immunosorbent assay (ELISA). Blood samples from 2071 slaughter pigs originating from 131 farms were collected and 75 (3.6%) were found to be positive by MAT. Positive pigs originated from 24 farms. A subset of samples (n = 492) were tested using ELISA, and a significant disagreement (p < 0.001) was found between the two tests. An empirical Bayes approach was used to estimate the farm-level prevalence and the probability of each individual farm having at least one positive animal, considering the uncertainty arising from the sampling strategy and the imperfect test performance. The adjusted farm-level prevalence was 11.5% (95% credible interval of positive farms 8.4-16.0%). Two different criteria were used for classifying farms as infected: (1) ≥50% probability of having at least one infected pig (n = 5, 6.8%) and (2) ≥10% probability (n = 15, 20.5%). Data on putative risk factors were obtained for 73 farms. Using a 10% cutoff, the relative risk (RR) of infection was higher in farms where cats have direct access to pigs' food (RR = 2.6; p = 0.04), pigs have outdoor access (RR = 3.0; p = 0.04), and farms keeping ≤200 pigs (RR = 3.9; p = 0.02), with strong collinearity between the three variables. The findings suggest a low level of T. gondii infection in the farms studied, most of which are likely to send to slaughter batches comprising 100% uninfected pigs. These results provide key inputs to quantitatively assess the

  4. Association of Primary Care Characteristics with Variations in Mortality Rates in England: An Observational Study

    Science.gov (United States)

    Levene, Louis S.; Bankart, John; Khunti, Kamlesh; Baker, Richard

    2012-01-01

    Background Wide variations in mortality rates persist between different areas in England, despite an overall steady decline. To evaluate a conceptual model that might explain how population and service characteristics influence population mortality variations, an overall null hypothesis was tested: variations in primary healthcare service do not predict variations in mortality at population level, after adjusting for population characteristics. Methodology/Principal Findings In an observational study of all 152 English primary care trusts (geographical groupings of population and primary care services, total population 52 million), routinely available published data from 2008 and 2009 were modelled using negative binomial regression. Counts for all-cause, coronary heart disease, all cancers, stroke, and chronic obstructive pulmonary disease mortality were analyzed using explanatory variables of relevant population and service-related characteristics, including an age-correction factor. The main predictors of mortality variations were population characteristics, especially age and socio-economic deprivation. For the service characteristics, a 1% increase in the percentage of patients on a primary care hypertension register was associated with decreases in coronary heart disease mortality of 3% (95% CI 1–4%, p = 0.006) and in stroke mortality of 6% (CI 3–9%, p<0.0001); a 1% increase in the percentage of patients recalling being better able to see their preferred doctor was associated with decreases in chronic obstructive pulmonary disease mortality of 0.7% (CI 0.2–2.0%, p = 0.02) and in all cancer mortality of 0.3% (CI 0.1–0.5%, p = 0.009) (continuity of care). The study found no evidence of an association at primary care trust population level between variations in achievement of pay for performance and mortality. Conclusions/Significance Some primary healthcare service characteristics were also associated with variations in mortality at

  5. Responses to concerns about child maltreatment: a qualitative study of GPs in England

    Science.gov (United States)

    Woodman, Jenny; Gilbert, Ruth; Allister, Janice; Glaser, Danya; Brandon, Marian

    2013-01-01

    Objectives To provide a rich description of current responses to concerns related to child maltreatment among a sample of English general practitioners (GPs). Design In-depth, face-to-face interviews (November 2010 to September 2011). Participants selected and discussed families who had prompted ‘maltreatment-related concerns’. Thematic analysis of data. Setting 4 general practices in England. Participants 14 GPs, 2 practice nurses and 2 health visitors from practices with at least 1 ‘expert’ GP (expertise in child safeguarding/protection). Results The concerns about neglect and emotional abuse dominated the interviews. GPs described intense and long-term involvement with families with multiple social and medical problems. Narratives were distilled into seven possible actions that GPs took in response to maltreatment-related concerns. These were orientated towards whole families (monitoring and advocating), the parents (coaching) and children (opportune healthcare), and included referral to or working with other services and recording concerns. Facilitators of the seven actions were: trusting relationships between GPs and parents, good working relationships with health visitors and framing the problem/response as ‘medical’. Narratives indicated significant time and energy spent building facilitating relationships with parents with the aim of improving the child's well-being. Conclusions These GPs used core general practice skills for on-going management of families who prompted concerns about neglect and emotional abuse. Policy and research focus should be broadened to include strategies for direct intervention and on-going involvement by GPs, such as using their core skills during consultations and practice systems for monitoring families and encouraging presentation to general practice. Exemplars of current practice, such as those identified in our study, should be evaluated for feasibility and acceptability in representative general practice settings

  6. Neuropsychological Performance and Family History in Children at Age 7 who Develop Adult Schizophrenia or Bipolar Psychosis in the New England Family Studies

    Science.gov (United States)

    Seidman, Larry J.; Cherkerzian, Sara; Goldstein, Jill M.; Agnew-Blais, Jessica; Tsuang, Ming T.; Buka, Stephen L.

    2013-01-01

    Objective Persons developing schizophrenia (SCZ) manifest various premorbid neuropsychological deficits, studied most often by measures of IQ. Far less is known about premorbid neuropsychological functioning in individuals who later develop bipolar psychoses (BP). We evaluated the specificity and impact of family history (FH) of psychosis on premorbid neuropsychological functioning. Methods We conducted a nested case-control study investigating the associations of neuropsychological data systematically collected at age 7 years for 99 adults with psychotic diagnoses (including 45 SCZ and 35 BP) and 101 controls, drawn from the New England cohort of the Collaborative Perinatal Project. A mixed model approach evaluated Full Scale IQ, four neuropsychological factors derived from principal components analysis, and the profile of 10 intelligence and achievement tests, controlling for maternal education, race, and intrafamilial correlation. We used a deviant responder approach (neuropsychologically impaired. Presence of psychosis in first-degree relatives (FH+) significantly increased the severity of childhood impairment for SCZ but not for BP. Conclusions Premorbid neuropsychological deficits are found in a substantial proportion of children who later develop SCZ, especially in the SCZ FH+ subgroup, but less so in BP, suggesting especially impaired neurodevelopment underlying cognition in pre-SCZ children. Future work should assess genetic and environmental factors that explain this FH effect. PMID:22575089

  7. Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales.

    Science.gov (United States)

    Hughes, David; Allen, Pauline; Doheny, Shane; Petsoulas, Christina; Vincent-Jones, Peter

    2013-01-01

    This paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties and incentives, while Wales was retreating from the 1990 s internal market and emphasising cooperation and flexibility in the contracting process. But there were also cross-border spill-overs involving common contracting technologies and management cultures that meant that differences in on-the-ground contracting practices might be smaller than headline policy differences suggested. The nature of real-world contracting behaviour was investigated by undertaking two qualitative case studies in England and two in Wales, each based on a local purchaser/provider network. The case studies involved ethnographic observations and interviews with staff in primary care trusts (PCTs) or local health boards (LHBs), NHS or Foundation trusts, and the overseeing Strategic Health Authority or NHS Wales regional office, as well as scrutiny of relevant documents. Wider policy differences between the two NHS systems were reflected in differing contracting frameworks, involving regional commissioning in Wales and commissioning by either a PCT, or co-operating pair of PCTs in our English case studies, and also in different oversight arrangements by higher tiers of the service. However, long-term relationships and trust between purchasers and providers had an important role in both systems when the financial viability of organisations was at risk. In England, the study found examples where both PCTs and trusts relaxed contractual requirements to assist partners faced with deficits. In Wales, news of plans to end the purchaser/provider split meant a return to less precisely-specified block contracts and a renewed concern to build cooperation between LHB and trust staff. The interdependency of local

  8. Methodological aspects of the 1993 Pelotas (Brazil) Birth Cohort Study

    Science.gov (United States)

    Victora, Cesar Gomes; Araújo, Cora Luiza Pavin; Menezes, Ana Maria Batista; Hallal, Pedro Curi; Vieira, Maria de Fátima; Neutzling, Marilda Borges; Gonçalves, Helen; Valle, Neiva Cristina; Lima, Rosangela Costa; Anselmi, Luciana; Behague, Dominique; Gigante, Denise Petrucci; Barros, Fernando Celso

    2010-01-01

    This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city’s hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings. PMID:16410981

  9. Inflammatory Bowel Disease Cohort Studies in Korea: Present and Future.

    Science.gov (United States)

    Lee, Jung Won; Im, Jong Pil; Cheon, Jae Hee; Kim, You Sun; Kim, Joo Sung; Han, Dong Soo

    2015-07-01

    Inflammatory bowel disease (IBD) is defined as a chronic and relapsing inflammatory disorder of the intestine. Intestinal inflammation in IBD has been proposed to be attributable to the interplay between microbial, genetic, environmental, and immunological factors. The incidence and prevalence rates of IBD are rapidly increasing apparently in other parts of the world, with dramatic increases especially in East Asia. Generally, cohort studies are useful for estimating the incidence, prevalence, natural course, prognosis, and risk factors of diseases. In particular, cohort studies performed in Western countries have well described the prevalence, risk factors, and natural course of IBD and investigated its genetic pathophysiology. However, the outcomes of IBD cohort studies performed in Korea are not as persuasive as those of Western studies because of the relatively low prevalence of IBD and short follow-up periods of the cohorts in Korea. Despite this critical limitation, members of the Korean Association for the Study of Intestinal Diseases have demonstrated outstanding results. Some unique features of IBD patients in Korea are well demonstrated, such as thiopurine-induced leukopenia or risks of opportunistic tuberculosis infection in patients receiving tumor necrosis factor-α inhibitors. In this review, the present authors summarized the key points of the results of the cohort studies performed in Korea and explored future perspectives.

  10. Partnering for bioregionalism in England: a case study of the Westcountry Rivers Trust

    Directory of Open Access Journals (Sweden)

    Hadrian Cook

    2016-06-01

    Full Text Available The adoption of bioregionalism by institutions that are instrumental in river basin management has significant potential to resolve complex water resource management problems. The Westcountry Rivers Trust (WRT in England provides an example of how localized bioregional institutionalization of adaptive comanagement, consensus decision making, local participation, indigenous technical and social knowledge, and "win-win" outcomes can potentially lead to resilient partnership working. Our analysis of the WRT's effectiveness in confronting nonpoint source water pollution, previously impervious to centralized agency responses, provides scope for lesson-drawing on institutional design, public engagement, and effective operation, although some evident issues remain.

  11. Incorporating global warming risks in power sector planning: A case study of the New England region. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Krause, F.; Busch, J.; Koomey, J.

    1992-11-01

    Growing international concern over the threat of global climate change has led to proposals to buy insurance against this threat by reducing emissions of carbon (short for carbon dioxide) and other greenhouse gases below current levels. Concern over these and other, non-climatic environmental effects of electricity generation has led a number of states to adopt or explore new mechanisms for incorporating environmental externalities in utility resource planning. For example, the New York and Massachusetts utility commissions have adopted monetized surcharges (or adders) to induce emission reductions of federally regulated air pollutants (notably, SO{sub 2}, NO{sub x}, and particulates) beyond federally mandated levels. These regulations also include preliminary estimates of the cost of reducing carbon emissions, for which no federal regulations exist at this time. Within New England, regulators and utilities have also held several workshops and meetings to discuss alternative methods of incorporating externalities as well as the feasibility of regional approaches. This study examines the potential for reduced carbon emissions in the New England power sector as well as the cost and rate impacts of two policy approaches: environmental externality surcharges and a target- based approach. We analyze the following questions: Does New England have sufficient low-carbon resources to achieve significant reductions (10% to 20% below current levels) in fossil carbon emissions in its utility sector? What reductions could be achieved at a maximum? What is the expected cost of carbon reductions as a function of the reduction goal? How would carbon reduction strategies affect electricity rates? How effective are environmental externality cost surcharges as an instrument in bringing about carbon reductions? To what extent could the minimization of total electricity costs alone result in carbon reductions relative to conventional resource plans?

  12. Assessing the external validity of model-based estimates of the incidence of heart attack in England: a modelling study

    Directory of Open Access Journals (Sweden)

    Peter Scarborough

    2016-11-01

    Full Text Available Abstract Background The DisMod II model is designed to estimate epidemiological parameters on diseases where measured data are incomplete and has been used to provide estimates of disease incidence for the Global Burden of Disease study. We assessed the external validity of the DisMod II model by comparing modelled estimates of the incidence of first acute myocardial infarction (AMI in England in 2010 with estimates derived from a linked dataset of hospital records and death certificates. Methods Inputs for DisMod II were prevalence rates of ever having had an AMI taken from a population health survey, total mortality rates and AMI mortality rates taken from death certificates. By definition, remission rates were zero. We estimated first AMI incidence in an external dataset from England in 2010 using a linked dataset including all hospital admissions and death certificates since 1998. 95 % confidence intervals were derived around estimates from the external dataset and DisMod II estimates based on sampling variance and reported uncertainty in prevalence estimates respectively. Results Estimates of the incidence rate for the whole population were higher in the DisMod II results than the external dataset (+54 % for men and +26 % for women. Age-specific results showed that the DisMod II results over-estimated incidence for all but the oldest age groups. Confidence intervals for the DisMod II and external dataset estimates did not overlap for most age groups. Conclusion By comparison with AMI incidence rates in England, DisMod II did not achieve external validity for age-specific incidence rates, but did provide global estimates of incidence that are of similar magnitude to measured estimates. The model should be used with caution when estimating age-specific incidence rates.

  13. Work disability after whiplash : a prospective cohort study

    NARCIS (Netherlands)

    Buitenhuis, J.; Jong, Peter J. de; Jaspers, Jan P. C.; Groothoff, Johan W.

    2009-01-01

    Study Design. Prospective cohort study. Objective. To investigate the consequences of neck pain after motor vehicle accidents in terms of disability for work and the relationship this has with symptom and work-related factors. Summary of Background Data. Previous studies on work disability related

  14. Using full-cohort data in nested case-control and case-cohort studies by multiple imputation.

    Science.gov (United States)

    Keogh, Ruth H; White, Ian R

    2013-10-15

    In many large prospective cohorts, expensive exposure measurements cannot be obtained for all individuals. Exposure-disease association studies are therefore often based on nested case-control or case-cohort studies in which complete information is obtained only for sampled individuals. However, in the full cohort, there may be a large amount of information on cheaply available covariates and possibly a surrogate of the main exposure(s), which typically goes unused. We view the nested case-control or case-cohort study plus the remainder of the cohort as a full-cohort study with missing data. Hence, we propose using multiple imputation (MI) to utilise information in the full cohort when data from the sub-studies are analysed. We use the fully observed data to fit the imputation models. We consider using approximate imputation models and also using rejection sampling to draw imputed values from the true distribution of the missing values given the observed data. Simulation studies show that using MI to utilise full-cohort information in the analysis of nested case-control and case-cohort studies can result in important gains in efficiency, particularly when a surrogate of the main exposure is available in the full cohort. In simulations, this method outperforms counter-matching in nested case-control studies and a weighted analysis for case-cohort studies, both of which use some full-cohort information. Approximate imputation models perform well except when there are interactions or non-linear terms in the outcome model, where imputation using rejection sampling works well. Copyright © 2013 John Wiley & Sons, Ltd.

  15. [Quality standards for epidemiologic cohort studies : An evaluated catalogue of requirements for the conduct and preparation of cohort studies].

    Science.gov (United States)

    Schmidt, Carsten Oliver; Krabbe, Christine E M; Schössow, Janka; Berger, Klaus; Enzenbach, Cornelia; Kamtsiuris, Panagiotis; Schöne, Gina; Houben, Robin; Meisinger, Christa; Bamberg, Fabian; Hendel, Thomas; Selder, Sonja; Nonnemacher, Michael; Moebus, Susanne; Stausberg, Jürgen

    2018-01-01

    Cohort studies are a longitudinal observational study type. They are firmly established within epidemiology to assess the course of diseases and risk factors. Yet, standards to describe and evaluate quality characteristics of cohort studies need further development. Within the TMF ("Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V.") project "Quality management standards in cohort studies", a catalogue of requirements was compiled and evaluated, focusing on the preparation and conduct of epidemiologic cohort studies. The catalogue of requirements was established based on a consensus process between representatives of seven German epidemiologic cohort studies. For this purpose, a set of expert meetings (telephone, face-to-face, web-based) was conducted and the importance of each element of the catalogue was assessed as well as its implementation. A catalogue of requirements with 138 requirements was consented. It is structured into ten sections: 1. Study documentation; 2. Selection of instruments; 3. Study implementation, 4. Organizational structure; 5. Qualification and certification; 6. Participant recruitment; 7. Preparation, conduct and follow-up processing of examinations; 8. Study logistics and maintenance, 9. Data capture and data management; 10. Reporting and monitoring. In total, 41 elements were categorized as being essential, 91 as important, and 6 as less important. The catalogue of requirements provides a guideline to improve the preparation and operation of cohort studies. The evaluation of the importance and degree of implementation of requirements depended on the study design. With adaptations, the catalogue might be transferable to other study types.

  16. Changing patterns in place of cancer death in England: a population-based study.

    Directory of Open Access Journals (Sweden)

    Wei Gao

    Full Text Available Most patients with cancer prefer to die at home or in a hospice, but hospitals remain the most common place of death (PoD.This study aims to explore the changing time trends of PoD and the associated factors, which are essential for end-of-life care improvement.The study analysed all cancer deaths in England collected by the Office for National Statistics during 1993-2010 (n = 2,281,223. Time trends of age- and gender-standardised proportion of deaths in individual PoDs were evaluated using weighted piecewise linear regression. Variables associated with PoD (home or hospice versus hospital were determined using proportion ratio (PR derived from the log-binomial regression, adjusting for clustering effects. Hospital remained the most common PoD throughout the study period (48.0%; 95% CI 47.9%-48.0%, followed by home (24.5%; 95% CI 24.4%-24.5%, and hospice (16.4%; 95% CI 16.3%-16.4%. Home and hospice deaths increased since 2005 (0.87%; 95% CI 0.74%-0.99%/year, 0.24%; 95% CI 0.17%-0.32%/year, respectively, p<0.001, while hospital deaths declined (-1.20%; 95% CI -1.41 to -0.99/year, p<0.001. Patients who died from haematological cancer (PRs 0.46-0.52, who were single, widowed, or divorced (PRs 0.75-0.88, and aged over 75 (PRs 0.81-0.84 for 75-84; 0.66-0.72 for 85+ were less likely to die in home or hospice (p<0.001; reference groups: colorectal cancer, married, age 25-54. There was little improvement in patients with lung cancer of dying in home or hospice (PRs 0.87-0.88. Marital status became the second most important factor associated with PoD, after cancer type. Patients from less deprived areas (higher quintile of the deprivation index were more likely to die at home or in a hospice than those from more deprived areas (lower quintile of the deprivation index; PRs 1.02-1.12. The analysis is limited by a lack of data on individual patients' preferences for PoD or a clinical indication of the most appropriate PoD.More efforts are needed to reduce

  17. Handling ethical, legal and social issues in birth cohort studies involving genetic research: responses from studies in six countries

    Directory of Open Access Journals (Sweden)

    LeGrandeur Jane

    2010-03-01

    Full Text Available Abstract Background Research involving minors has been the subject of much ethical debate. The growing number of longitudinal, pediatric studies that involve genetic research present even more complex challenges to ensure appropriate protection of children and families as research participants. Long-term studies with a genetic component involve collection, retention and use of biological samples and personal information over many years. Cohort studies may be established to study specific conditions (e.g. autism, asthma or may have a broad aim to research a range of factors that influence the health and development of children. Studies are increasingly intended to serve as research platforms by providing access to data and biological samples to researchers over many years. This study examines how six birth cohort studies in North America and Europe that involve genetic research handle key ethical, legal and social (ELS issues: recruitment, especially parental authority to include a child in research; initial parental consent and subsequent assent and/or consent from the maturing child; withdrawal; confidentiality and sample/data protection; handling sensitive information; and disclosure of results. Methods Semi-structured telephone interviews were carried out in 2008/09 with investigators involved in six birth cohort studies in Canada, Denmark, England, France, the Netherlands and the United States. Interviewees self-identified as being knowledgeable about ELS aspects of the study. Interviews were conducted in English. Results The studies vary in breadth of initial consent, but none adopt a blanket consent for future use of samples/data. Ethics review of new studies is a common requirement. Studies that follow children past early childhood recognise a need to seek assent/consent as the child matures. All studies limit access to identifiable data and advise participants of the right to withdraw. The clearest differences among studies concern

  18. Associations of pet ownership with biomarkers of ageing: population based cohort study.

    Science.gov (United States)

    Batty, G David; Zaninotto, Paola; Watt, Richard G; Bell, Steven

    2017-12-13

    To examine the prospective relation between animal companionship and biomarkers of ageing in older people. Analyses of data from the English Longitudinal Study of Ageing, an ongoing, open, prospective cohort study initiated in 2002-03. Nationally representative study from England. 8785 adults (55% women) with a mean age of 67 years (SD 9) at pet ownership assessment in 2010-11 (wave 5). Established biomarkers of ageing in the domains of physical, immunological, and psychological function, as assessed in 2012-13 (wave 6). One third of study members reported pet ownership: 1619 (18%) owned a dog, 1077 (12%) a cat, and 274 (3%) another animal. After adjustment for a range of covariates, there was no evidence of a clear association of any type of pet ownership with walking speed, lung function, chair rise time, grip strength, leg raises, balance, three markers of systemic inflammation, memory, or depressive symptoms. In this population of older adults, the companionship of creatures great and small seems to essentially confer no relation with standard ageing phenotypes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Epidemiological study of venous thromboembolism in a big Danish cohort

    DEFF Research Database (Denmark)

    Severinsen, Marianne Tang; Kristensen, Søren Risom; Overvad, Kim

    Introduction: Epidemiological data on venous thromboembolism (VT), i.e. pulmonary emboli (PE) and deep venous thrombosis (DVT) are sparse. We have examined VT-diagnoses registered in a big Danish Cohort study.  Methods: All first-time VT diagnoses in The Danish National Patient Register were...... identified among participants in the Danish cohort study "Diet, Cancer and Health" in which 57,053 50-64 years old persons were included 1993-7. Medical records were retrieved and reviewed by an experienced physician using a detailed standardized form, and information on the diagnostic work-up and presence...

  20. Exploring the potential of refugees and asylum seekers for social care work in England: a qualitative study.

    Science.gov (United States)

    Hussein, Shereen; Manthorpe, Jill; Stevens, Martin

    2011-09-01

    Literature highlights the potential for refugees to contribute to the labour force of receiving countries. Such a contribution may be welcomed in sectors, such as social care, where demand for labour is increasing and high vacancy rates exist. This article reports on empirical data examining the potential of refugee communities to work in social care in England. The analysis is based primarily on 20 interviews with refugees and asylum seekers and five representatives of refugee support groups, conducted in 2008-2009. The findings of this sub-study are set within results obtained from other interviews as part of a multi-methods study examining the contribution of migrants to the English care sector. In-depth interviews were analysed thematically, guided by a theoretical framework linking employment, migration and the nature of care work. The findings highlight a general willingness of refugee participants to join the care workforce. Individual and structural barriers to increased employability were identified, as well as possible strategies to overcome them. Although the findings and discussions presented are based on data collected in England and are specific to the care sector, most are more generalisable and may inform strategies aiming at maximising refugees' employability in other sectors and in other developed states. © 2011 Blackwell Publishing Ltd.

  1. Overview of ongoing cohort and dietary studies in the Arctic

    DEFF Research Database (Denmark)

    Weihe, Pál; Bjerregaard, Peter; Bonefeld-Jørgensen, Eva

    2016-01-01

    This article gives an overview of the ongoing cohort and dietary studies underlying the assessment of population health in the Arctic. The emphasis here is on a description of the material, methods and results or preliminary results for each study. Detailed exposure information is available in an...

  2. Dropout from exercise programs for seniors: A prospective cohort study

    NARCIS (Netherlands)

    Stiggelbout, M.; Hopman-Rock, M.; Tak, E.; Lechner, L.; Mechelen, W. van

    2005-01-01

    This study examines dropout incidence, moment of dropout, and switching behavior in organized exercise programs for seniors in the Netherlands, as determined in a prospective cohort study (with baseline measurements at the start of the exercise program and follow-up after 6 months; N = 1,725,

  3. Social and behavioural outcomes in children diagnosed with autism spectrum disorders: a longitudinal cohort study.

    Science.gov (United States)

    Russell, Ginny; Golding, Jean; Norwich, Brahm; Emond, Alan; Ford, Tamsin; Steer, Colin

    2012-07-01

      To compare social and behavioural outcomes between children formally diagnosed with autism spectrum disorders (ASD) with those of children who displayed autistic traits at preschool age, but remained undiagnosed as teenagers.   A secondary analysis of data from a birth cohort study, the Avon Longitudinal Study of Parents and Children (N = 13,944), in SW England. Children clinically diagnosed with ASD were identified from their medical records (n = 71). A comparison group, who displayed autistic traits at age 3-4, but without ASD diagnosis were also identified (n = 142). Social and behavioural outcomes in adolescence were compared between the two groups.   Children with ASD diagnoses were more impaired as teenagers that those in the comparison group on a range of measures of autistic-like behaviour. The developmental trajectory of prosocial behaviour showed that differences between the case and comparison groups increased dramatically in the preschool and early primary years, but that after 6 years the trajectories were similar.   The divergence of the clinically diagnosed group and the nondiagnosed group in measures of autistic-like behaviour increased with age. This study provides evidence that it may be difficult to distinguish preschool age children who exhibit autistic-like symptoms but improve, from those who go on to develop lifelong impairment. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental Health.

  4. The Danish National Cohort Study (DANCOS)

    DEFF Research Database (Denmark)

    Helweg-Larsen, Karin; Kjøller, Mette; Davidsen, Michael

    2003-01-01

    for a wide range of analysis in a historical prospective design of determinants of morbidity and mortality, of health care utilization and of the social effects of ill health. DANCOS also allows studies of methodological issues, including analyzing the characteristics of non-respondents. Udgivelsesdato: 2003...

  5. Evaluating the effects of mountain resort development on snowmelt and runoff production: a case study from northern New England, USA

    Science.gov (United States)

    del Peral, A.; Wemple, B.

    2012-04-01

    Over the last decade, significant developments at mountain resorts in northern New England, USA have occurred to maintain competitiveness with western (USA) ski resorts. This development has included expansion of trail networks and snowmaking and development of resort base infrastructure, including housing, retail and amenities. Permitting these developments has posed particular challenges for predicting the effects of development on runoff and water quality. In this study, we describe efforts to model the effects of ski area development on snowmelt and runoff using a distributed rainfall-runoff model. Our test cases include a forested control watershed and an adjacent watershed encompassing a premier New England alpine ski resort. Empirical results from these watersheds show substantial differences in spring snowmelt and annual water yield between the watersheds. We are evaluating the performance of the Distributed Soil Hydrology Vegetation Model (DHSVM) to model snowmelt and runoff from these watersheds in order to assess its utility for predicting changes in runoff associated with resort development. We use distributed snow pack measurements to validate model simulations of snow accumulation and melt. Our results replicate observed patterns of runoff production in the watershed and can be used to test the effects of alternate development schemes on spring stream flow and annual water yield.

  6. National outbreak of Salmonella Enteritidis phage type 14b in England, September to December 2009: case-control study.

    Science.gov (United States)

    Janmohamed, K; Zenner, D; Little, C; Lane, C; Wain, J; Charlett, A; Adak, B; Morgan, D

    2011-04-14

    We conducted an unmatched retrospective case–control study to investigate an upsurge of non-travel-related sporadic cases of infection with Salmonella enterica subsp. enterica serotype Enteritidis phage type 14b with antimicrobial resistance to nalidixic acid and partial resistance to ciprofloxacin (S. Enteritidis PT 14b NxCp(L)) that was reported in England from 1 September to 31 December 2009. We analysed data from 63 cases and 108 controls to determine whether cases had the same sources of infection as those found through investigation of 16 concurrent local foodborne outbreaks in England and Wales. Multivariable logistic regression analysis adjusting for age and sex identified food consumption at restaurants serving Chinese or Thai cuisine (odds ratio (OR): 4.4; 95% CI: 1.3–14.8; p=0.02), egg consumed away from home (OR: 5.1; 95% CI: 1.3–21.2; p=0.02) and eating vegetarian foods away from home (OR: 14.6; 95% CI: 2.1–99; p=0.006) as significant risk factors for infection with S. Enteritidis PT 14b NxCp(L). These findings concurred with those from the investigation of the16 outbreaks, which identified the same Salmonella strain in eggs from a specified source outside the United Kingdom. The findings led to a prohibition of imports from this source, in order to control the outbreak.

  7. Understanding middle-aged and older adults' first associations with the word "cancer": A mixed methods study in England.

    Science.gov (United States)

    Agustina, Edelyn; Dodd, Rachael H; Waller, Jo; Vrinten, Charlotte

    2017-10-18

    Cancer is still widely feared and often associated with death. Fatalistic beliefs adversely affect help-seeking for cancer symptoms and engagement in cancer prevention. This study aims to understand middle-aged and older adults' first association with the word "cancer" and their relationship with sociodemographic factors, cancer fear, and cancer information avoidance. We conducted a cross-sectional survey of 1464 community-based adults aged 50 to 70 living in England in April 2015. First associations with cancer were measured qualitatively and analysed using content analysis. We used binary logistic regression to analyse associations between the most common first association of cancer and sociodemographic characteristics, cancer fear, and cancer information avoidance. Cancer was most commonly associated with "death" (26%). Respondents with lower levels of education, living in the Midlands or North of England where cancer mortality is higher, or with close friends or family members with a cancer history, were more likely to associate cancer with death. Cancer fear was significantly associated with death associations, but cancer information avoidance was not. Despite improved cancer outcomes, middle-aged and older adults often associate cancer with death. Further efforts to decrease fatalistic associations in this age group may be needed. © 2017 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

  8. Understanding low colorectal cancer screening uptake in South Asian faith communities in England--a qualitative study.

    Science.gov (United States)

    Palmer, Cecily K; Thomas, Mary C; McGregor, Lesley M; von Wagner, Christian; Raine, Rosalind

    2015-10-01

    Colorectal cancer screening uptake within the South Asian population in England is approximately half that of the general population (33 % vs 61 %), and varies by Muslim (31.9 %), Sikh (34.6 %) and Hindu (43.7 %) faith background. This study sought to explore reasons for low uptake of CRC screening in South Asian communities and for the variability of low uptake between three faith communities; and to identify strategies by which uptake might be improved. We interviewed 16 'key informants' representing communities from the three largest South Asian faith backgrounds (Islam, Hinduism and Sikhism) in London, England. Reasons for low colorectal cancer screening uptake were overwhelmingly shared across South Asian faith groups. These were: limitations posed by written English; limitations posed by any written language; reliance on younger family members; low awareness of colorectal cancer and screening; and difficulties associated with faeces. Non-written information delivered verbally and interactively within faith or community settings was preferred across faith communities. Efforts to increase accessibility to colorectal cancer screening in South Asian communities should use local language broadcasts on ethnic media and face-to-face approaches within community and faith settings to increase awareness of colorectal cancer and screening, and address challenges posed by written materials.

  9. Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England.

    Science.gov (United States)

    Holmes, Richard D; Steele, Jimmy G; Donaldson, Cam; Exley, Catherine

    2015-09-01

    The aim of this research was to explore and synthesise learning from stakeholders (NHS dentists, commissioners and patients) approximately five years on from the introduction of a new NHS dental contract in England. The case study involved a purposive sample of stakeholders associated with a former NHS Primary Care Trust (PCT) in the north of England. Semi-structured interviews were conducted with 8 commissioners of NHS dental services and 5 NHS general dental practitioners. Three focus group meetings were held with 14 NHS dental patients. All focus groups and interviews were audio recorded and transcribed verbatim. The data were analysed using a framework approach. Four themes were identified: 'commissioners' views of managing local NHS dental services'; 'the risks of commissioning for patient access'; 'costs, contract currency and commissioning constraints'; and 'local decision-making and future priorities'. Commissioners reported that much of their time was spent managing existing contracts rather than commissioning services. Patients were unclear about the NHS dental charge bands and dentists strongly criticised the contract's target-driven approach which was centred upon them generating 'units of dental activity'. NHS commissioners remained relatively constrained in their abilities to reallocate dental resources amongst contracts. The national focus upon practitioners achieving their units of dental activity appeared to outweigh interest in the quality of dental care provided. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  10. Childhood conduct disorder trajectories, prior risk factors and cannabis use at age 16: birth cohort study.

    Science.gov (United States)

    Heron, Jon; Barker, Edward D; Joinson, Carol; Lewis, Glyn; Hickman, Matthew; Munafò, Marcus; Macleod, John

    2013-12-01

    To investigate the prevalence of cannabis use and problem use in boys and girls at age 16 years, and to investigate the role of adversity in early life and of conduct disorder between the ages of 4 and 13 years as risk factors for these outcomes. Birth cohort study. England. A total of 4159 (2393 girls) participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort providing information on cannabis use at age 16. Cannabis use and problem cannabis use at age 16 were assessed by postal questionnaire. Material adversity, maternal substance use, maternal mental health and child conduct disorder were all assessed by maternal report. Cannabis use was more common among girls than boys (21.4% versus 18.3%, P = 0.005). Problem cannabis use was more common in boys than girls (3.6% versus 2.8%, P = 0.007). Early-onset persistent conduct problems were associated strongly with problem cannabis use [odds ratio (OR) = 6.46, 95% confidence interval (CI) = 4.06-10.28]. Residence in subsidized housing (OR = 3.10, 95% CI = 1.95, 4.92); maternal cannabis use (OR 8.84, 95% CI 5.64-13.9) and any maternal smoking in the postnatal period (OR = 2.69, 95% CI = 1.90-3.81) all predicted problem cannabis use. Attributable risks for adolescent problem cannabis use associated with the above factors were 25, 13, 17 and 24%, respectively. Maternal smoking and cannabis use, early material disadvantage and early-onset persistent conduct problems are important risk factors for adolescent problem cannabis use. This may have implications for prevention. © 2013 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

  11. Passive solar house design studies. Northern England and Scotland. Group 3. Single developer studies

    Energy Technology Data Exchange (ETDEWEB)

    Newton, M.; Tillotson, R.B.; Warren, B.F.; Wilkinson, W.; Wiltshire, T.J.

    1993-12-01

    During the progress of the Design Studies the methodology, particularly of the performance assessments had been evolving. It became apparent on completion of the reports on individual studies that meaningful comparisons across the studies needed a common methodology. As a result ETSU commissioned a number of further assessments, the results of which appear as an Addendum to this report. (author)

  12. Deep phenotyping of the unselected COPSAC2010 birth cohort study

    DEFF Research Database (Denmark)

    Bisgaard, Hans Flinker; Vissing, Nadja Hawwa; Carson, C. G.

    2013-01-01

    . Their children were followed at the clinic with deep phenotyping and collection of biological samples at nine regular visits until the age of 3 and at acute symptoms. Randomized controlled trials of high‐dose vitamin D and fish oil supplements were conducted during pregnancy, and a trial of azithromycin...... for acute lung symptoms was conducted in the children with recurrent wheeze. Seven hundred and thirty‐eight mothers were recruited from week 24 of gestation, and 700 of their children were included in the birth cohort. The cohort has an over‐representation of atopic parents. The participant satisfaction...... was high and the adherence equally high with 685 children (98%) attending the 1 year clinic visit and 667 children (95%) attending the 2 year clinic visit. The COPSAC2010 birth cohort study provides longitudinal clinical follow‐up with highly specific end‐points, exposure assessments, and biobanking...

  13. Risk for unemployment of cancer survivors: A Danish cohort study

    DEFF Research Database (Denmark)

    Carlsen, Kathrine; Dalton, Susanne Oksbjerg; Diderichsen, Finn

    2008-01-01

    to 20 years in a longitudinal register-based cohort study. Demographic, socioeconomic and health-related information were obtained through Danish administrative registers. RESULTS: Cancer survivors had a small but significantly increased risk for unemployment following cancer. Stratified analyses showed......AIM: To investigate whether cancer survivors are at an increased risk for unemployment after cancer. MATERIALS AND METHODS: A cohort of 65,510 patients who were part of the workforce in the year before diagnosis and a random sample of 316,925 age and gender-matched controls were followed for up...

  14. Fatal injuries while under the influence of psychoactive drugs: a cross-sectional exploratory study in England

    Directory of Open Access Journals (Sweden)

    Dryden Ruth

    2006-06-01

    Full Text Available Abstract Background Studies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI. The main aim of this study was to determine the nature, extent and pattern of FIUI. Methods This observational study covered the period January 1999 to December 2001. Data were provided by members of a study panel of coroners in England using a standard protocol. Sources of data for this study included autopsy protocols, death certificates, hospital records, police reports, toxicology reports and inquest transcripts. Inclusion criteria for this were (i the mention of one or more psychoactive substances as contributing to fatality; and (ii the presence of a Controlled Drug at post mortem. Results A total of 3,803 drug-related deaths of persons aged 16–64 years were reported by the study panel during the three-year period. The study panel accounted for 86% of drug-related deaths in England in this period. There were 147 FIUI cases (119 males, 28 females, giving a proportionate mortality ratio of approximately 4%. The majority of FIUI cases (84% were aged 16–44 years, with a median age at death of 33 years (Quartile deviation = 7. Fifty-six percent of FIUI occurred in urban areas of England. The population of the study jurisdictions aged 16–64 years contributed 49,545,766 person-years (py to the study, giving an annual crude rate of 3/1,000,000 person-years (py. Rates for male and females were 4.9 and 1.1/1,000,000 py respectively, giving a male/female rate ratio of 4.5 (95%CI = 2.9–6.8. The rates of intentional and unintentional FIUI were 2 and 1/1,000,000 py respectively. The leading mechanism for intentional FIUI was suffocation while the predominant mechanisms in unintentional FIUI were road traffic accidents and falls. There is a significant difference in the pattern of drug-specific risk between FIUI and fatal poisoning. Risks of intentional FIUI are elevated among Black and Minority Ethnic groups

  15. Predictors of birth-related post-traumatic stress symptoms: secondary analysis of a cohort study.

    Science.gov (United States)

    Furuta, Marie; Sandall, Jane; Cooper, Derek; Bick, Debra

    2016-12-01

    This study aimed to identify factors associated with birth-related post-traumatic stress symptoms during the early postnatal period. Secondary analysis was conducted using data from a prospective cohort study of 1824 women who gave birth in one large hospital in England. Post-traumatic stress symptoms were measured by the Impact of Event Scale at 6 to 8 weeks postpartum. Zero-inflated negative binomial regression models were developed for analyses. Results showed that post-traumatic stress symptoms were more frequently observed in black women and in women who had a higher pre-pregnancy BMI compared to those with a lower BMI. Women who have a history of mental illness as well as those who gave birth before arriving at the hospital, underwent an emergency caesarean section or experienced severe maternal morbidity or neonatal complications also showed symptoms. Women's perceived control during labour and birth significantly reduced the effects of some risk factors. A higher level of perceived social support during the postnatal period also reduced the risk of post-traumatic stress symptoms. From the perspective of clinical practice, improving women's sense of control during labour and birth appears to be important, as does providing social support following the birth.

  16. Perceived employability trajectories: A Swedish cohort study.

    Science.gov (United States)

    Törnroos Née Kirves, Kaisa; Bernhard-Oettel, Claudia; Leineweber, Constanze

    2017-07-27

    This study identified perceived employability trajectories and their associations with sleeping difficulties and depressive symptoms over time. The sample was part of the Swedish Longitudinal Survey on Health from 2008 to 2014 (n=4,583). Two stable trajectories (high and low perceived employability over time) and three trajectories with changes (increasing, decreasing, and V-shaped perceived employability over time) were identified. Workers with stable low perceived employability reported more sleeping difficulties and depressive symptoms than those who perceived high or increasing employability. Perceived employability is a rather stable personal resource, which is associated with well-being over time. However, changes in perceived employability do not seem to be echoed in well-being, at least not as immediately as theoretically expected.

  17. Patient satisfaction with hospital care and nurses in England: an observational study

    Science.gov (United States)

    Aiken, Linda H; Sloane, Douglas M; Ball, Jane; Bruyneel, Luk; Rafferty, Anne Marie; Griffiths, Peter

    2018-01-01

    Objectives To inform healthcare workforce policy decisions by showing how patient perceptions of hospital care are associated with confidence in nurses and doctors, nurse staffing levels and hospital work environments. Design Cross-sectional surveys of 66 348 hospital patients and 2963 inpatient nurses. Setting Patients surveyed were discharged in 2010 from 161 National Health Service (NHS) trusts in England. Inpatient nurses were surveyed in 2010 in a sample of 46 hospitals in 31 of the same 161 trusts. Participants The 2010 NHS Survey of Inpatients obtained information from 50% of all patients discharged between June and August. The 2010 RN4CAST England Nurse Survey gathered information from inpatient medical and surgical nurses. Main outcome measures Patient ratings of their hospital care, their confidence in nurses and doctors and other indicators of their satisfaction. Missed nursing care was treated as both an outcome measure and explanatory factor. Results Patients’ perceptions of care are significantly eroded by lack of confidence in either nurses or doctors, and by increases in missed nursing care. The average number of types of missed care was negatively related to six of the eight outcomes—ORs ranged from 0.78 (95% CI 0.68 to 0.90) for excellent care ratings to 0.86 (95% CI 0.77 to 0.95) for medications completely explained—positively associated with higher patient-to-nurse ratios (b=0.15, 95% CI 0.10 to 0.19), and negatively associated with better work environments (b=−0.26, 95% CI −0.48 to −0.04). Conclusions Patients’ perceptions of hospital care are strongly associated with missed nursing care, which in turn is related to poor professional nurse (RN) staffing and poor hospital work environments. Improving RN staffing in NHS hospitals holds promise for enhancing patient satisfaction. PMID:29326193

  18. Quantifying policy options for reducing future coronary heart disease mortality in England: a modelling study.

    Directory of Open Access Journals (Sweden)

    Shaun Scholes

    Full Text Available To estimate the number of coronary heart disease (CHD deaths potentially preventable in England in 2020 comparing four risk factor change scenarios.Using 2007 as baseline, the IMPACTSEC model was extended to estimate the potential number of CHD deaths preventable in England in 2020 by age, gender and Index of Multiple Deprivation 2007 quintiles given four risk factor change scenarios: (a assuming recent trends will continue; (b assuming optimal but feasible levels already achieved elsewhere; (c an intermediate point, halfway between current and optimal levels; and (d assuming plateauing or worsening levels, the worst case scenario. These four scenarios were compared to the baseline scenario with both risk factors and CHD mortality rates remaining at 2007 levels. This would result in approximately 97,000 CHD deaths in 2020. Assuming recent trends will continue would avert approximately 22,640 deaths (95% uncertainty interval: 20,390-24,980. There would be some 39,720 (37,120-41,900 fewer deaths in 2020 with optimal risk factor levels and 22,330 fewer (19,850-24,300 in the intermediate scenario. In the worst case scenario, 16,170 additional deaths (13,880-18,420 would occur. If optimal risk factor levels were achieved, the gap in CHD rates between the most and least deprived areas would halve with falls in systolic blood pressure, physical inactivity and total cholesterol providing the largest contributions to mortality gains.CHD mortality reductions of up to 45%, accompanied by significant reductions in area deprivation mortality disparities, would be possible by implementing optimal preventive policies.

  19. Etiology of atopy in infancy: The KOALA Birth Cohort Study

    NARCIS (Netherlands)

    Kummeling, I.; Thijs, C.; Penders, J.; Snijders, B.E.P.; Stelma, F.; Reimerink, J.; Koopmans, M.; Dagnelie, P.C.; Huber, M.; Jansen, M.C.J.F.; Bie, R. de; Brandt, P.A. van den

    2005-01-01

    The aim of the KOALA Birth Cohort Study in the Netherlands is to identify factors that influence the clinical expression of atopic disease with a main focus on lifestyle (e.g., anthroposophy, vaccinations, antibiotics, dietary habits, breastfeeding and breast milk composition, intestinal microflora

  20. A Phenomenological Study of an Indonesian Cohort Group's Transformative Learning

    Science.gov (United States)

    Budiraharjo, Markus

    2013-01-01

    This study was set to investigate how a cohort of ten Indonesian teachers experienced transformations in their teaching professionalism upon receiving an assignment of instructional leadership training to other school leaders. These ten teachers, who came from three different Indonesian Jesuit high schools and one archdiocese-based educational…

  1. The Tachikawa cohort of motor vehicle accident study investigating psychological distress: design, methods and cohort profiles.

    Science.gov (United States)

    Matsuoka, Yutaka; Nishi, Daisuke; Nakajima, Satomi; Yonemoto, Naohiro; Hashimoto, Kenji; Noguchi, Hiroko; Homma, Masato; Otomo, Yasuhiro; Kim, Yoshiharu

    2009-04-01

    The Tachikawa cohort of motor vehicle accident (TCOM) Study has been carried out in Tokyo since 2004. This study examined the association of medical and psychosocial variables evaluated shortly after admission to the acute critical care center with long-term psychiatric morbidity risk in patients with accidental injuries. Between May 2004 and January 2008, patients with accidental injury consecutively admitted were recruited to the TCOM Study. Psychiatric morbidity as a primary endpoint was measured using a structured clinical interview at 1, 6, 18 and 36 months after involvement in a motor vehicle accident (MVA). The baseline investigation consisted of self-administered questionnaires concerning acute psychological responses and personality. Medical information was obtained from patients' medical charts. Various socio-demographic data, health-related habits and psychosocial factors were assessed by interview. To examine potential biomarkers of psychological distress, blood samples were collected. Out of 344 patients who were asked to participate in this study, 300 (87%) patients with MVA-related injury were enrolled. Corresponding rates for the questionnaires on psychological responses and blood sampling were 98-99 and 79%, respectively. The cohort sample was composed of 78% men; the median age was 34 years; and 45% of the participants were motorcycle drivers. The TCOM Study should prove useful for researchers examining the association between bio-psychosocial variables and psychological distress and may contribute to the formation of a framework for providing care for patients with MVA-related injury.

  2. Costs and outcomes of improving population health through better social housing: a cohort study and economic analysis.

    Science.gov (United States)

    Bray, Nathan; Burns, Paul; Jones, Alice; Winrow, Eira; Edwards, Rhiannon Tudor

    2017-12-01

    We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing. An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards. Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (-£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p housing improvements may be a cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

  3. High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England.

    Science.gov (United States)

    Møller, Henrik; Riaz, Sharma P; Holmberg, Lars; Jakobsen, Erik; Lagergren, Jesper; Page, Richard; Peake, Michael D; Pearce, Neil; Purushotham, Arnie; Sullivan, Richard; Vedsted, Peter; Luchtenborg, Margreet

    2016-09-01

    It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission, and decreased mortality. The dataset for this analysis was based on cancer registration and hospital discharge data and comprised information on 15,738 non-small-cell lung cancer patients resident and diagnosed in England in 2006-2010 and treated by surgical resection. The number of lung cancer resections was computed for each hospital in each calendar year, and patients were assigned to a hospital volume quintile on the basis of the volume of their hospital. Hospitals with large lung cancer surgical resection volumes were less restrictive in their selection of patients for surgical management and provided a higher resection rate to their geographical population. Higher volume hospitals had shorter length of stay and the odds of re-admission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 d and 3% after 90 d. Patients from hospitals in the highest volume quintile had about half the odds of death within 30 d than patients from the lowest quintile. Variations in outcomes were generally small, but in the same direction, with consistently better outcomes in the larger hospitals. This gives support to the ongoing trend towards centralisation of clinical services, but service re-organisation needs to take account of not only the size of hospitals but also referral routes and patient access. Copyright © 2016. Published by Elsevier Ltd.

  4. Cardiovascular risk at health checks performed opportunistically or following an invitation letter. Cohort study.

    Science.gov (United States)

    Gulliford, Martin C; Khoshaba, Bernadette; McDermott, Lisa; Cornelius, Victoria; Ashworth, Mark; Fuller, Frances; Miller, Jane; Dodhia, Hiten; Wright, Alison J

    2017-06-17

    A population-based programme of health checks has been established in England. Participants receive postal invitations through a population-based call-recall system but health check providers may also offer health checks opportunistically. We compared cardiovascular risk scores for 'invited' and 'opportunistic' health checks. Cohort study of all health checks completed at 18 general practices from July 2013 to June 2015. For each general practice, cardiovascular (CVD) risk scores were compared by source of check and pooled using meta-analysis. Effect estimates were compared by gender, age-group, ethnicity and fifths of deprivation. There were 6184 health checks recorded (2280 invited and 3904 opportunistic) with CVD risk scores recorded for 5359 (87%) participants. There were 17.0% of invited checks and 22.2% of opportunistic health checks with CVD risk score ≥10%; a relative increment of 28% (95% confidence interval: 14-44%, P response to a standard invitation letter, potentially reducing the effect of uptake inequalities.

  5. Social Isolation and Mental Health at Primary and Secondary School Entry: A Longitudinal Cohort Study

    Science.gov (United States)

    Matthews, Timothy; Danese, Andrea; Wertz, Jasmin; Ambler, Antony; Kelly, Muireann; Diver, Ashleen; Caspi, Avshalom; Moffitt, Terrie E.; Arseneault, Louise

    2015-01-01

    Objective We tested whether children who are socially isolated early in their schooling develop mental health problems in early adolescence, taking into account their mental health and family risk at school entry. Method We used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 children born in England and Wales in 1994 and 1995. We measured social isolation using mothers’ and teachers’ reports at ages 5 and 12 years. We assessed mental health symptoms via mothers’ and teachers’ ratings at age 5 and self-report measures at age 12. We collected mother-reported information about the family environment when children were 5 years old. We conducted regression analyses to test concurrent and longitudinal associations between early family factors, social isolation, and mental health difficulties. Results At both primary and secondary school, children who were socially isolated experienced greater mental health difficulties. Children with behavioral problems or attention-deficit/hyperactivity disorder (ADHD) symptoms at age 5 years had an elevated risk of becoming more socially isolated at age 12. However, children who were isolated at age 5 did not have greater mental health symptoms at age 12, over and above pre-existing difficulties. Conclusion Although social isolation and mental health problems co-occur in childhood, early isolation does not predict worse mental health problems later on. However, children who exhibit problematic behaviors may struggle to cope with the social challenges that accompany their progression through the early school years. PMID:25721188

  6. Risk of venous thromboembolism in hospitalised cancer patients in England—a cohort study

    Directory of Open Access Journals (Sweden)

    Sonia Ratib

    2016-07-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a well-recognised and life-threatening complication in patients with cancer. However, the precise risk of VTE in hospitalised cancer patients in England has not been previously reported. Methods We conducted a cohort study using linked Hospital Episodes Statistics and Office for National Statistics mortality data. We determined the risk of VTE separately for 24 cancer sites following first hospitalisation for cancer (index date and how this varied by age, proximity from hospital admission, administration of chemotherapy and calendar time. Results Between 1998 and 2012, 3,558,660 patients were hospitalised for cancer. The cancer sites with the highest risk of VTE during initial hospitalisation for cancer were pancreatic (4.9 %, ovarian (4 % and liver (3.8 %. The three cancer sites with the highest risk of first VTE event within 6 months from discharge were pancreatic (3.7 %, oesophagus (3 % and stomach (2.8 %. For most cancers, the risk of VTE within 6 months from discharge was higher amongst patients who underwent chemotherapy compared to those who did not. The impact of age on risk of VTE varied considerably between cancer sites. Conclusions The risk of VTE amongst patients hospitalised for cancer varies greatly by cancer site, age, proximity from hospital admission, and chemotherapy administration.

  7. Cohort Profile: The Quebec Longitudinal Study of Kindergarten Children (QLSKC)

    OpenAIRE

    Rouquette, Alexandra; Côté, Sylvana M; Pryor, Laura E; Carbonneau, René; Vitaro, Frank; Tremblay, Richard E

    2012-01-01

    The Quebec Longitudinal Study of Kindergarten Children (QLSKC) is an ongoing population-based prospective longitudinal study presently spanning ages 6–29 years, designed to study the prevalence, risk factors, development and consequences of behavioural and emotional problems during elementary school. Kindergarten boys and girls attending French-speaking public schools in the Canadian province of Quebec during the 1986–87 and 1987–88 school years were included in the cohort: 2000 children repr...

  8. A cross-national study of differences in the identities of nursing in England and Australia and how this has affected nurses' capacity to respond to hospital reform.

    Science.gov (United States)

    Degeling, P; Hill, M; Kennedy, J; Coyle, B; Maxwell, S

    2000-06-01

    This paper examines similarities and differences in the identity of nursing in England and Australia. In doing this we examine how in each country nursing has developed different ideologies and strategies. Our analysis draws on data derived from a cross-national study of hospital staff in England and Australia. We demonstrate how differences in the occupational identity of nursing in each country are registered in their values, attitudes and beliefs. We suggest that these differences reflect the interplay of factors such as the strategic stances of nursing professional and industrial organisations and how nurses in each country have positioned themselves in responding to recent changes in health policy.

  9. Cohort Profile Update: The Norwegian Mother and Child Cohort Study (MoBa).

    Science.gov (United States)

    Magnus, Per; Birke, Charlotte; Vejrup, Kristine; Haugan, Anita; Alsaker, Elin; Daltveit, Anne Kjersti; Handal, Marte; Haugen, Margaretha; Høiseth, Gudrun; Knudsen, Gun Peggy; Paltiel, Liv; Schreuder, Patricia; Tambs, Kristian; Vold, Line; Stoltenberg, Camilla

    2016-04-01

    This is an update of the Norwegian Mother and Child Cohort Study (MoBa) cohort profile which was published in 2006. Pregnant women attending a routine ultrasound examination were initially invited. The first child was born in October 1999 and the last in July 2009. The participation rate was 41%. The cohort includes more than 114 000 children, 95 000 mothers and 75 000 fathers. About 1900 pairs of twins have been born. There are approximately 16 400 women who participate with more than one pregnancy. Blood samples were obtained from both parents during pregnancy and from mothers and children (umbilical cord) after birth. Samples of DNA, RNA, whole blood, plasma and urine are stored in a biobank. During pregnancy, the mother responded to three questionnaires and the father to one. After birth, questionnaires were sent out when the child was 6 months, 18 months and 3 years old. Several sub-projects have selected participants for in-depth clinical assessment and exposure measures. The purpose of this update is to explain and describe new additions to the data collection, including questionnaires at 5, 7, 8 and 13 years as well as linkages to health registries, and to point to some findings and new areas of research. Further information can be found at [www.fhi.no/moba-en]. Researchers interested in collaboration and access to the data can complete an electronic application available on the MoBa website above. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  10. Preventing violence-related injuries in England and Wales: a panel study examining the impact of on-trade and off-trade alcohol prices.

    Science.gov (United States)

    Page, Nicholas; Sivarajasingam, Vaseekaran; Matthews, Kent; Heravi, Saeed; Morgan, Peter; Shepherd, Jonathan

    2017-02-01

    To examine the influence of real on-trade and off-trade alcohol prices and socioeconomic and environmental factors on rates of violence-related emergency department (ED) attendances in England and Wales over an 8-year period. Anonymised injury data which included attendance date, age and gender of patients aged over 18 years who reported injury in violence were collected from a structured sample of 100 EDs across England and Wales between 1 January 2005 and 31 December 2012. Alcohol prices and socioeconomic measures were obtained from the UK Office for National Statistics. Panel techniques were used to derive a statistical model. Real on-trade (β=-0.661, pprices were negatively related with rates of violence-related ED attendance among the adult population of England and Wales, after accounting for the effects of regional poverty, income inequality, youth spending power and seasonal effects. It is estimated that over 6000 fewer violence-related ED attendances per year in England and Wales would result from a 1% increase in both on-trade and off-trade alcohol prices above inflation. Of the variables studied, changes in regional poverty and income inequality had the greatest effect on violence-related ED attendances in England and Wales. Small increases in the price of alcohol, above inflation, in both markets, would substantially reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales. Reforming the current alcohol taxation system may be more effective at reducing violence-related injury than minimum unit pricing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Recurrence of hyperemesis gravidarum across generations: population based cohort study

    OpenAIRE

    Vikanes, ?se; Skj?rven, Rolv; Grjibovski, Andrej M; Gunnes, Nina; Vangen, Siri; Magnus, Per

    2010-01-01

    Objective To estimate the risk of hyperemesis gravidarum (hyperemesis) according to whether the daughters and sons under study were born after pregnancies complicated by hyperemesis. Design Population based cohort study. Setting Registry data from Norway. Participants Linked generational data from the medical birth registry of Norway (1967-2006): 544?087 units of mother and childbearing daughter and 399?777 units of mother and child producing son. Main outcome measure Hyperemesis in daughters...

  12. Gamma-Glutamyltransferase and Cancer Incidence: The Ohsaki Cohort Study

    OpenAIRE

    Tsuboya, Toru; Kuriyama, Shinichi; Nagai, Masato; Hozawa, Atsushi; Sugawara, Yumi; Tomata, Yasutake; Kakizaki, Masako; Nishino, Yoshikazu; Tsuji, Ichiro

    2012-01-01

    Background Although experimental studies have shown that gamma-glutamyltransferase (GGT) has a role in tumor progression, epidemiologic evidence for a relationship between GGT and cancer incidence is limited. The present study investigated the association between GGT and cancer incidence and assessed the role of alcohol consumption in this association. Methods We examined a cohort of 15 031 Japanese adults aged 40 to 79 years who attended a health checkup in 1995 and were free of cancer at th...

  13. pilot studies to test the feasibility of a birth cohort study investigating ...

    African Journals Online (AJOL)

    1991-04-20

    Apr 20, 1991 ... Birth to Ten' is a birth cohort study currently being conducted in the Johannesburg-Soweto area. This paper describes the various pilot studies that were undertaken to investigate the feasibility of a cohort study in an urban area. These studies were designed to determine the monthly birth rate, the timing,.

  14. 'Birth to Ten' - pilot studies to test the feasibility of a birth cohort study ...

    African Journals Online (AJOL)

    Birth to Ten' is a birth cohort study currently being conducted in the Johannesburg-Soweto area. This paper describes the various pilot studies that were undertaken to investigate the feasibility of a cohort study in an urban area. These studies were designed to determine the monthly birth rate, the timing, frequency and ...

  15. Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study

    Science.gov (United States)

    Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

    2014-01-01

    Objective To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Design Modelling study using the Sheffield Alcohol Policy Model version 2.5. Setting England 2014-15. Population Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Interventions Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45p, and 50p per unit (7.9 g/10 mL) of pure alcohol. Main outcome measures Changes in mean consumption in terms of units of alcohol, drinkers’ expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. Results The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45p minimum unit price. Below cost selling is estimated to reduce harmful drinkers’ mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health—saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45p minimum unit price is estimated to save 624 deaths and 23 700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. Conclusions The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at

  16. Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study.

    Science.gov (United States)

    Brennan, Alan; Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

    2014-09-30

    To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Modelling study using the Sheffield Alcohol Policy Model version 2.5. England 2014-15. Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45 p, and 50 p per unit (7.9 g/10 mL) of pure alcohol. Changes in mean consumption in terms of units of alcohol, drinkers' expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45 p minimum unit price. Below cost selling is estimated to reduce harmful drinkers' mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45 p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health-saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45 p minimum unit price is estimated to save 624 deaths and 23,700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40 p and 50 p per unit, is estimated to have an approximately 40-50 times

  17. Impact on smoking of England's 2012 partial tobacco point of sale display ban: a repeated cross-sectional national study.

    Science.gov (United States)

    Kuipers, Mirte A G; Beard, Emma; Hitchman, Sara C; Brown, Jamie; Stronks, Karien; Kunst, Anton E; McNeill, Ann; West, Robert

    2017-03-01

    A partial tobacco point of sale (PoS) display ban was introduced in large shops (>280 m2 floor area) in England on 6 April 2012. The aim of this study was to assess the medium-term effects of the partial tobacco PoS display ban on smoking in England. Data were used from 129 957 respondents participating in monthly, cross-sectional household surveys of representative samples of the English adult population aged 18+ years from January 2009 to February 2015. Interrupted-time series regression models assessed step changes in the level of current smoking and cigarette consumption in smokers and changes in the trends postban compared with preban. Models were adjusted for sociodemographic variables and e-cigarette use, seasonality and autocorrelation. Potential confounding by cigarette price was accounted for by time, as price was almost perfectly correlated with time. Following the display ban, there was no immediate step level change in smoking (-3.69% change, 95% CI -7.94 to 0.75, p=0.102) or in cigarette consumption (β -0.183, 95% CI -0.602 to 0.236). There was a significantly steeper decline in smoking post display ban (-0.46% change, 95% CI -0.72 to -0.20, p=0.001). This effect was demonstrated by respondents in manual occupations (-0.62% change, 95% CI -0.72 to -0.20, p=0.001), but not for those in non-manual occupations (-0.42, 95% CI -0.90 to 0.06, p=0.084). Cigarette consumption declined preban period (β -0.486, 95% CI -0.633 to -0.339, p<0.001), but no significant change in cigarette consumption trend was observed (β 0.019, 95% CI -0.006 to 0.042, p=0.131). The partial tobacco PoS display ban introduced in England in April 2012 did not lead to an immediate decline in smoking, but was followed by a decline in the trend of smoking prevalence that could not be accounted for by seasonal factors, e-cigarette use or price changes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Perceived weight discrimination in England: a population-based study of adults aged ⩾50 years.

    Science.gov (United States)

    Jackson, S E; Steptoe, A; Beeken, R J; Croker, H; Wardle, J

    2015-05-01

    Despite a wealth of experimental studies on weight bias, little is known about weight discrimination at the population level. This study examined the prevalence and socio-demographic correlates of perceived weight discrimination in a large population-based sample of older adults. Data were from 5307 adults in the English Longitudinal Study of Ageing; a population-based cohort of men and women aged ⩾50 years. Weight discrimination was reported for five domains (less respect/courtesy; treated as less clever; poorer treatment in medical settings; poorer service in restaurants/stores; threatened/harassed) at wave 5 (2010-2011). Height and weight were measured at wave 4 (2008-2009). We used logistic regression to test the odds of weight discrimination in relation to weight status, age, sex, wealth, education and marital status. Perceived weight discrimination in any domain was reported by 4.6% of participants, ranging from 0.8% in the normal-weight participants through 0.9, 6.7, 24.2 and 35.1% in individuals who were overweight or met criteria for class I, II and III obesity. Overall, and in each situation, odds of perceived weight discrimination were higher in younger and less wealthy individuals. There was no interaction between weight status and any socio-demographic variable. Relative to normal-weight participants, odds ratios for any perceived weight discrimination were 1.13 (95% confidence interval 0.53-2.40) in those who were overweight, 8.86 (4.65-16.88) in those with class I obesity, 35.06 (18.30-67.16) in class II obese and 56.43 (27.72-114.87) in class III obese. Our results indicate that rates of perceived weight discrimination are comparatively low in individuals who are overweight or have class I obesity, but for those with class II/III obesity, >10% had experienced discrimination in each domain, and >20% had been treated with less respect or courtesy. These findings have implications for public policy and highlight the need for effective interventions

  19. Do people with risky behaviours participate in biomedical cohort studies?

    Directory of Open Access Journals (Sweden)

    Adams Robert J

    2006-01-01

    Full Text Available Abstract Background Analysis was undertaken on data from randomly selected participants of a bio-medical cohort study to assess representativeness. The research hypotheses was that there was no difference in participation and non-participations in terms of health-related indicators (smoking, alcohol use, body mass index, physical activity, blood pressure and cholesterol readings and overall health status and selected socio-demographics (age, sex, area of residence, education level, marital status and work status. Methods Randomly selected adults were recruited into a bio-medical representative cohort study based in the north western suburbs of the capital of South Australia – Adealide. Comparison data was obtained from cross-sectional surveys of randomly selected adults in the same age range and in the same region. The cohort participants were 4060 randomly selected adults (18+ years. Results There were no major differences between study participants and the comparison population in terms of current smoking status, body mass index, physical activity, overall health status and proportions with current high blood pressure and cholesterol readings. Significantly more people who reported a medium to very high alcohol risk participated in the study. There were some demographic differences with study participants more likely to be in the middle level of household income and education level. Conclusion People with risky behaviours participated in this health study in the same proportions as people without these risk factors.

  20. Pediatric palliative care patients: a prospective multicenter cohort study.

    Science.gov (United States)

    Feudtner, Chris; Kang, Tammy I; Hexem, Kari R; Friedrichsdorf, Stefan J; Osenga, Kaci; Siden, Harold; Friebert, Sarah E; Hays, Ross M; Dussel, Veronica; Wolfe, Joanne

    2011-06-01

    To describe demographic and clinical characteristics and outcomes of patients who received hospital-based pediatric palliative care (PPC) consultations. Prospective observational cohort study of all patients served by 6 hospital-based PPC teams in the United States and Canada from January to March 2008. There were 515 new (35.7%) or established (64.3%) patients who received care from the 6 programs during the 3-month enrollment interval. Of these, 54.0% were male, and 69.5% were identified as white and 8.1% as Hispanic. Patient age ranged from less than one month (4.7%) to 19 years or older (15.5%). Of the patients, 60.4% lived with both parents, and 72.6% had siblings. The predominant primary clinical conditions were genetic/congenital (40.8%), neuromuscular (39.2%), cancer (19.8%), respiratory (12.8%), and gastrointestinal (10.7%). Most patients had chronic use of some form of medical technology, with gastrostomy tubes (48.5%) being the most common. At the time of consultation, 47.2% of the patients had cognitive impairment; 30.9% of the cohort experienced pain. Patients were receiving many medications (mean: 9.1). During the 12-month follow-up, 30.3% of the cohort died; the median time from consult to death was 107 days. Patients who died within 30 days of cohort entry were more likely to be infants and have cancer or cardiovascular conditions. PPC teams currently serve a diverse cohort of children and young adults with life-threatening conditions. In contrast to the reported experience of adult-oriented palliative care teams, most PPC patients are alive for more than a year after initiating PPC.

  1. A qualitative study of state-level zoonotic disease surveillance in new England.

    Science.gov (United States)

    Scotch, M; Mattocks, K; Rabinowitz, P; Brandt, C

    2011-03-01

    Zoonotic diseases are infectious diseases transmittable between animals and humans and outbreaks of these diseases in animals can signify that humans are also infected (or vice versa). Thus, communication between animal and human health agencies is critical for surveillance. Understanding how these agencies conduct surveillance and share information is important for the development of successful automated zoonotic monitoring systems. Individual interviews were conducted with 13 professionals who perform animal or human zoonotic disease surveillance in one of the New England states. Questions centred on existing surveillance methods, collaborations between animal and human health agencies, and technological and data needs. The results showed that agencies routinely communicate over suspected zoonotic disease cases, yet there are barriers preventing automated electronic linking of health data of animals and humans. These include technological barriers and barriers due to sensitivity and confidentiality of information. Addressing these will facilitate the development of electronic systems for integrating animal and human zoonotic disease surveillance data. © 2010 Blackwell Verlag GmbH.

  2. Insomnia management in prisons in England and Wales: a mixed-methods study.

    Science.gov (United States)

    Dewa, Lindsay H; Hassan, Lamiece; Shaw, Jenny J; Senior, Jane

    2017-06-01

    Insomnia in prison is common; however, research is limited regarding the management strategies that prison establishments employ. To address this knowledge gap, we conducted a survey to identify how insomnia is detected, diagnosed and treated in adult prisons in England and Wales. Telephone interviews with a purposive sample of health-care managers were then conducted. The survey was sent to all establishments holding adult prisoners, covering screening and assessment methods to detect insomnia; treatment options, both pharmacological and non-pharmacological; the importance of insomnia as a treatable condition; and staff training available. Eighty-four (73%) prisons completed the survey. Few had a stepped approach to insomnia management, as recommended by National Institute for Health and Care Excellence (NICE) guidelines. The most common treatments available were sleep hygiene education and medication, offered by 94 and 88% of respondents, respectively. Analysis of telephone interviews revealed four main themes: insomnia as a normal occurrence in prison; the problem of medication in prison; the negative impact of the prison environment; and effective management of insomnia in prison. The current findings suggest that logistical, ethical and security barriers and a lack of staff knowledge and training impact negatively on the management of insomnia in prison. © 2017 European Sleep Research Society.

  3. A modified prescription-event monitoring study to assess the introduction of Flixotide Evohaler into general practice in England: an example of pharmacovigilance planning and risk monitoring.

    Science.gov (United States)

    Perrio, Michael J; Wilton, Lynda V; Shakir, Saad A W

    2007-09-01

    A modified prescription-event monitoring (PEM) study was conducted to examine the safety of the introduction of the metered dose inhaler (MDI) Flixotide Evohaler (fluticasone with the propellant HFA 134a). Patients were identified from the first NHS prescriptions dispensed in England for Flixotide Evohaler. Postal questionnaires were sent to the prescribing doctor, requesting information including: demographic characteristics, severity of indication, concomitant medication, event data 3 months prior to and 3 months after the first prescription, and any reasons for stopping Flixotide. Pregnancies, deaths and selected events were followed up. Incidence density ratios (IDRs) were calculated to compare event rates 3 months before and 3 months after the introduction of Flixotide Evohaler. The cohort comprised 13 413 patients that were prescribed Flixotide Evohaler. The response rate was 64.0%. When the pre- and post-exposure periods were compared fewer patients had events in the post-exposure period, and there was no significant difference in the length of courses of oral steroid use. Eighteen patients experienced an event within 1 hour of using Flixotide Evohaler; these were minor with the exception of one case of angioneurotic facial oedema. Six of these events were assessed as possibly related to Flixotide Evohaler. During the study period there were an additional 13 patients with events assessed as possibly related to Flixotide Evohaler, including two reports of allergic reactions. The results suggest that the transition to Flixotide Evohaler was generally well tolerated. The modified methodology has contributed to the risk management of the introduction of this product. Copyright (c) 2007 John Wiley & Sons, Ltd.

  4. Why are there discrepancies between depressed patients' Global Rating of Change and scores on the Patient Health Questionnaire depression module? A qualitative study of primary care in England.

    Science.gov (United States)

    Robinson, Jude; Khan, Naila; Fusco, Louise; Malpass, Alice; Lewis, Glyn; Dowrick, Christopher

    2017-05-04

    Our aims were to investigate discrepancies between depressed patients' GlobalRating of Change (GRC) and scores on the Patient Health Questionnaire depression module (PHQ-9). Our objectives were to ascertain patients' views on the source and meaning of mismatches and assess their clinical significance. Qualitative study nested within a cohort, in a programme investigating the indications for prescribing antidepressants that will lead to a clinical benefit. Primary care practices in north-west England. We invited 32 adults with a recent diagnosis of depression and evidence of mismatch between GRC and PHQ-9 Scores to participate. Of these, 29 completed our interviews; most were women, identified as white British, had high school education or higher, were employed or retired and had been depressed for a long time. We conducted semistructured interviews with a topic guide, focusing on experiences of depression; treatment experiences and expectations; effectiveness of the questionnaires; reasons for the mismatch; and social factors. Interviews were transcribed and subjected to interpretative phenomenological analysis. We identified four themes as explanations for mismatch between GRC and PHQ-9: perceptions that GRC provided a more accurate assessment of current mental state than PHQ-9; impact of recent negative or positive life events on either measure; personal understanding of depression as normally fluctuating, and tendency to underscore on PHQ-9 as a means of self-motivation; and lack of recall. The combined used of the PHQ-9 and a more open question better captures the patient's unique experiences of mental health. This approach ascertains the relevance of symptoms to the individual's experience and influences treatment decisions. This study was an element of NIHR Programme Grant RP-PG 0610 10048. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise

  5. Hyperemesis gravidarum and pregnancy outcomes in the Norwegian mother and child cohort – a cohort study

    Science.gov (United States)

    2013-01-01

    Background Hyperemesis gravidarum (HG) characterized by excessive nausea and vomiting in early pregnancy, is reported to be associated with increased risks for low birthweight (LBW), preterm birth (PTB), small-for-gestational-age (SGA) and perinatal death. Conflicting results in previous studies underline the necessity to study HG’s potential effect on pregnancy outcomes using large cohorts with valid data on exposure and outcome measures, as well as potential confounders. This study aims to investigate associations between HG and adverse pregnancy outcomes using the Norwegian Mother and Child Cohort Study (MoBa). Methods All singleton pregnancies in MoBa from 1998 to 2008 were included. Multivariable regression was used to estimate relative risks, approximated by odds ratios, for PTB, LBW, SGA and perinatal death. Linear regression was applied to assess differences in birthweight and gestational age for children born to women with and without HG. Potential confounders were adjusted for. Results Altogether, 814 out of 71,468 women (or 1.1%) had HG. In MoBa HG was not associated with PTB, LBW or SGA. Babies born to women with HG were born on average 1 day earlier than those born to women without HG; (−0.97 day (95% confidence intervals (CI): -1.80 - -0.15). There was no difference in birthweight when maternal weight gain was adjusted for; (23.42 grams (95% CI: -56.71 - 9.86). Babies born by women with HG had lower risk for having Apgar score pregnancy outcomes. Pregnancies complicated with HG had a slightly shorter gestational length. There was no difference in birth weight according to maternal HG-status. HG was associated with an almost 40% reduced risk for having Apgar score < 7 after 1 minute, but not after 5 minutes. The clinical importance of these statistically significant findings is, however, rather limited. PMID:24004605

  6. Validating self-reported strokes in a longitudinal UK cohort study (Whitehall II: Extracting information from hospital medical records versus the Hospital Episode Statistics database

    Directory of Open Access Journals (Sweden)

    Britton Annie

    2012-06-01

    Full Text Available Abstract Background Valuable information on the determinants of non-fatal stroke can be obtained from longitudinal observational cohort studies. Such studies often rely on self-reported stroke events, which are best validated with external medical evidence. The aim of this paper is to compare the information on incident non-fatal stroke events arising from different sources. Methods We carried out a validation of self-reported stoke events among participants in the Whitehall II Study, a large UK based cohort study (baseline sample size 10,308 men and women. Results 106 stroke events were self-reported in three self-administered questionnaires between 2002 and 2009. Eight (7.5% of these events were discarded as false positives after medical review, 66 were validated by information from the NHS Hospital Episode Statistics (HES database in England, 16 by manual searches of hospital records alone, and 12 by letters from general practitioners alone. HES provided information on an additional (i.e. not self-reported 47 events coded as stroke during the period 2002 to 2009 in hospitals in England among the original baseline participants. Of these, 43 participants were no longer active in the study and 4 had completed questionnaires but not reported a stroke event. Conclusions Validating self-reported strokes in cohort studies with information from the NHS HES database was efficient and provided information on probable non-fatal stroke events among cohort members no longer in active follow-up. Manual extraction from hospital notes can provide supplementary information beyond that available in the HES discharge summary and was used to sub-type some strokes. However, the process was labour intensive. Multiple sources are needed to capture maximum information on stroke events but increasingly with hospitalisation in the acute phase of stroke, HES has an important role. Further development of HES is required to assure validity and coverage.

  7. Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study

    Directory of Open Access Journals (Sweden)

    Andrew Chee Keng Lee

    2017-09-01

    Full Text Available Abstract Background Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England. Methods We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as ‘Chinese’, and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops. Results Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, ‘cultural competency’ training, and locally adapted testing protocols may help. Conclusions Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle

  8. Food for Life: evaluation of the impact of the Hospital Food Programme in England using a case study approach

    Science.gov (United States)

    Orme, Judy; Pitt, Hannah; Jones, Matthew

    2017-01-01

    Objectives To evaluate the impact and challenges of implementing a Food for Life approach within three pilot NHS sites in 2014/2015 in England. Food for Life is an initiative led by the Soil Association, a non-governmental organisation in the UK that aims to encourage a healthy, sustainable food culture across communities. Design A case-study approach was undertaken using semi-structured interviews with staff and key stakeholders together with analysis of relevant documents such as meeting minutes, strategic plans and reports. Setting Three NHS Trusts in England. Participants Staff and key stakeholders. Main outcome measures Synthesis of key findings from semi-structured interviews and analysis of relevant documents. Results Key themes included the potential to influence contracting processes; measuring quality; food for staff and visitors; the role of food in hospitals, and longer term sustainability and impact. Participants reported that adopting the Food for Life approach had provided enormous scope to improve the quality of food in hospital settings and had provided levers and external benchmarks for use in contracting to help drive up standards of the food provided by external contractors for patients and staff. This was demonstrated by the achievement of an FFLCM for staff and visitor catering in all three organisations. Conclusions Participants all felt that the importance of food in hospitals is not always recognised. Engagement with Food for Life can produce a significant change in the focus on food within hospitals, and help to improve the quality of food and mealtime experience for staff, visitors and patients. PMID:29051822

  9. Exploring the scope of practice and training of obstetricians and gynaecologists in England, Italy and Belgium: a qualitative study.

    Science.gov (United States)

    Risso-Gill, Isabelle; Kiasuwa, Regine; Baeten, Rita; Caldarelli, Ilenia; Mitro, Silva; Merriel, Abi; Amadio, Giulia; McKee, Martin; Legido-Quigley, Helena

    2014-09-01

    This study explores the scope of practice of Obstetrics and Gynaecology specialists in Italy, Belgium and England, in light of the growth of professional and patient mobility within the EU which has raised concerns about a lack of standardisation of medical speciality practice and training. Semi-structured qualitative interviews were conducted with 29 obstetricians and gynaecologists from England, Belgium and Italy, exploring training and scope of practice, following a common topic guide. Interviews were recorded, transcribed and coded following a common coding framework in the language of the country concerned. Completed coding frames, written summaries and key quotes were then translated into English and were cross-analysed among the researchers to identify emerging themes and comparative findings. Although medical and specialty qualifications in each country are mutually recognised, there were great differences in training regimes, with different emphases on theory versus practice and recognition of different subspecialties. However all countries shared concerns about the impact of the European Working Time Directive on trainees' skills development. Reflecting differences in models of care, the scope of practice of OBGYN varied among countries, with pronounced differences between the public and private sector within countries. Technological advances and the growth of co-morbidities resulting from ageing populations have created new opportunities and greater links with other specialties. In turn new ethical concerns around abortion and fertility have also arisen, with stark cultural differences between the countries. Variations exist in the training and scope of practice of OBGYN specialists among these three countries, which could have significant implications for the expectations of patients seeking care and specialists practising in other EU countries. Changes within the specialty and advances in technology are creating new opportunities and challenges

  10. Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study.

    Science.gov (United States)

    Lee, Andrew Chee Keng; Vedio, Alicia; Liu, Eva Zhi Hong; Horsley, Jason; Jesurasa, Amrita; Salway, Sarah

    2017-09-26

    Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England. We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as 'Chinese', and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops. Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, 'cultural competency' training, and locally adapted testing protocols may help. Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle barriers within this population and the health system.

  11. The organisation of interagency training to safeguard children in England: a case study using realistic evaluation

    Directory of Open Access Journals (Sweden)

    Demi Patsios

    2010-11-01

    Full Text Available Background: Joint training for interagency working is carried out by Local Safeguarding Children Boards in England to promote effective local working to safeguard and promote the welfare of children.Purpose: This paper reports on the findings of the outputs and outcomes of interagency training to safeguard children in eight Local Safeguarding Children Boards.Methods: A review of Local Safeguarding Children Board documentation, observations of Local Safeguarding Children Board training sub-group meetings and a series of interviews with training key stakeholders in each Local Safeguarding Children Board were used to assess how partner agencies in the Local Safeguarding Children Boards carried out their statutory responsibilities to organise interagency training. 'Realistic Evaluation' was used to evaluate the mechanisms by which a central government mandate produced particular inter-agency training outputs (number of courses, training days and joint working outcomes (effective partnerships, within particular Local Safeguarding Children Board contexts.Results: The 'mandated partnership' imposed on Local Safeguarding Children Boards by central government left little choice but for partner agencies to work together to deliver joint training, which in turn affected the dynamics of working partnerships across the various sites. The effectiveness of the training sub group determined the success of the organisation and delivery of training for joint working. Despite having a central mandate, Local Safeguarding Children Boards had heterogeneous funding and training arrangements. These resulted in significant variations in the outputs in terms of the number of courses per 'children in need' in the locality and in the cost per course.Conclusions: Interagency training which takes account of the context of the Local Safeguarding Children Board is more likely to produce better trained staff, effective partnership working, and lead to better integrated

  12. Pupil-led sex education in England (RIPPLE study): cluster-randomised intervention trial.

    Science.gov (United States)

    Stephenson, J M; Strange, V; Forrest, S; Oakley, A; Copas, A; Allen, E; Babiker, A; Black, S; Ali, M; Monteiro, H; Johnson, A M

    Improvement of sex education in schools is a key part of the UK government's strategy to reduce teenage pregnancy in England. We examined the effectiveness of one form of peer-led sex education in a school-based randomised trial of over 8000 pupils. 29 schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). In intervention schools, peer educators aged 16-17 years delivered three sessions of sex education to 13-14 year-old pupils from the same schools. Primary outcome was unprotected (without condom) first heterosexual intercourse by age 16 years. Analysis was by intention to treat. By age 16 years, significantly fewer girls reported intercourse in the peer-led arm than in the control arm, but proportions were similar for boys. The proportions of pupils reporting unprotected first sex did not differ for girls (8.4% intervention vs 8.3% control) or for boys (6.2% vs 4.7%). Stratified estimates of the difference between arms were -0.4% (95% CI -3.7% to 2.8%, p=0.79) for girls and -1.4% (-4.4% to 1.6%, p=0.36) for boys. At follow-up (mean age 16.0 years [SD 0.32]), girls in the intervention arm reported fewer unintended pregnancies, although the difference was borderline (2.3% vs 3.3%, p=0.07). Girls and boys were more satisfied with peer-led than teacher-led sex education, but 57% of girls and 32% of boys wanted sex education in single-sex groups. Peer-led sex education was effective in some ways, but broader strategies are needed to improve young people's sexual health. The role of single-sex sessions should be investigated further.

  13. Variation in child body mass index patterns by race/ethnicity and maternal nativity status in the United States and England.

    Science.gov (United States)

    Martinson, Melissa L; McLanahan, Sara; Brooks-Gunn, Jeanne

    2015-02-01

    This paper examines body mass index (BMI) trajectories among children from different race/ethnic and maternal nativity backgrounds in the United States and England from early- to middle-childhood. This study is the first to examine race/ethnic and maternal nativity differences in BMI trajectories in both countries. We use two longitudinal birth cohort studies-The Fragile Families and Child Wellbeing Study (n = 3,285) for the United States and the Millennium Cohort Study (n = 6,700) for England to estimate trajectories in child BMI by race/ethnicity and maternal nativity status using multilevel growth models. In the United States our sample includes white, black, and Hispanic children; in England the sample includes white, black, and Asian children. We find significant race/ethnic differences in the initial BMI and BMI trajectories of children in both countries, with all non-white groups having significantly steeper BMI growth trajectories than whites. Nativity differences in BMI trajectories vary by race/ethnic group and are only statistically significantly higher for children of foreign-born blacks in England. Disparities in BMI trajectories are pervasive in the United States and England, despite lower overall BMI among English children. Future studies should consider both race/ethnicity and maternal nativity status subgroups when examining disparities in BMI in the United States and England. Differences in BMI are apparent in early childhood, which suggests that interventions targeting pre-school age children may be most effective at stemming childhood disparities in BMI.

  14. Residential radon and lung cancer: a cohort study in Galicia, Spain

    National Research Council Canada - National Science Library

    Raquel Barbosa-Lorenzo; Alberto Ruano-Ravina; Sara Cerdeira-Caramés; Mónica Raíces-Aldrey; Juan M. Barros-Dios

    .... The aim of this paper is to investigate this association through a cohort study. We designed an ambispective cohort study using the Galician radon map, Spain, with controls drawn from a previous case-control study...

  15. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers.

    Directory of Open Access Journals (Sweden)

    Sigurd Mikkelsen

    Full Text Available Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort. The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84 after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of

  16. Spatiotemporal study of elderly suicide in Korea by age cohort.

    Science.gov (United States)

    Joo, Y

    2017-01-01

    This study analyzed the spatiotemporal pattern and spatial diffusion of elderly suicide by age cohort, in Korea. The research investigated the elderly suicide rates of the 232 municipal units in South Korea between 2001 and 2011. The Gi* score, which is a spatially weighted indicator of area attributes, was used to identify hot spots and the spatiotemporal pattern of elderly suicide in the nation during the last 10 years. The spatial Markov matrix and spatial dynamic panel data model were employed to identify and estimate the diffusion effect. The suicide rate among elderly individuals 75 years and older was substantially higher than the rate for those between 65 and 74 years of age; however, the spatial patterns of the suicide clusters were similar between the two groups. From 2001 to 2011, the spatial distribution of elderly suicide hot spots differed each year. For both age cohorts, elderly suicide hot spots developed around the north area of South Korea in 2001 and moved to the mid-east area and the mid-western coastal area over 10 years. The spatial Markov matrix indicates that the change in the suicide rate of one area was affected by the suicide rates of neighbouring areas from the previous year, which suggests that suicide increase in one area inflates a neighbouring area's suicide rate over time. Using a spatial dynamic panel data model, elderly suicide diffusion effects were found to be statistically significant for both age cohorts even after economic and demographic indicators and a time variable are included. For individuals 75 years and older, the diffusion effect appeared to be larger. This study demonstrates that elderly suicide can spread spatially over time in both age cohorts. Thus, it is necessary to design a place-based and age-differentiated intervention policy that precisely considers the spatial diffusion of elderly suicide. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  17. Study Design and Cohort Description of DEFIB-WOMEN

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Nielsen, Jens Cosedis; Riahi, Sam

    2016-01-01

    Disease: Clinical and Psychological outcomes in WOMEN) study to examine gender differences on (1) patient-reported outcomes (PROs), (2) procedure- and device-related complications, and (3) ventricular tachyarrhythmia and mortality. This presents the study design and baseline characteristics of the cohort....... METHODS: DEFIB-WOMEN is a national, multicenter, prospective, observational study. First-time implanted patients are asked to complete PROs at several time points. Information on baseline and follow-up characteristics are captured from patients' medical records, purpose-designed questions, and the Danish...

  18. Long-Term Water Quality Studies in a Eutrophic Lake Catchment: Slapton Ley, SW England

    Science.gov (United States)

    Burt, T. P.; Worrall, F.; Howden, N. J. K.

    2014-12-01

    Monitoring is the process by which we keep the behaviour of the environment in view, an essential way of discovering whether there are significant undesirable changes taking place. Long-term datasets reveal important patterns for scientists to explain and are essential for testing hypotheses undreamt of at the time monitoring scheme was set up. Many environmental processes take place over relatively long periods of time; very often, subtle processes are embedded within highly variable systems so that their weak signal cannot be extracted without a long record. Slapton Ley is a freshwater coastal lagoon in SW England. The Ley is part of a National Nature Reserve, wetland 116 ha in area which is divided into two basins: the Higher Ley (39 ha) is mainly reed swamp; the Lower Ley (77 ha) is open water. In the 1960s it became apparent that the Ley was becoming increasingly eutrophic. In order to gauge water, sediment and nutrient inputs into the lake, measurements began on the main catchments in late 1969. Continuous monitoring of discharge and a weekly water-sampling programme have been maintained by the Slapton Ley Field Centre ever since. The monitoring programme has been supplemented by a number of research projects which have sought to identify the salient hydrological processes operating within the Slapton catchments and to relate these to the delivery of sediment and solute to the stream system. The nitrate issue has been of particular interest at Slapton; although many longer series exist for large rivers like the Thames, the long record of nitrate data for the Slapton catchments is unique in Britain for small rural basins. Other issues to be explored will be the phosphorus legacy in lake sediments and a long-term decline in lake pH. The Slapton water quality record has confirmed that undesirable changes are taking place, revealed evidence of important patterns to be explained, allowed testing of new hypotheses (e.g. links with land-use change) and helped

  19. Generating quantitative palaeoflood data from homogeneous lake sediments: a case-study from Brotherswater, northwest England

    Science.gov (United States)

    Schillereff, Daniel; Chiverrell, Richard; Macdonald, Neil; Hooke, Janet

    2016-04-01

    The scarcity of long-term hydrological data is a barrier to reliably determining the likelihood of floods becoming more frequent and/or intense in a warmer world. Lakes and their sediments are increasingly being used to reconstruct long-term, highly-resolved datasets of past floods but the ultimate goal, generating quantitative palaeohydrological data to augment flood frequency analyses, is a persistent challenge. To this end, ascertaining the autogenic and allogenic processes influencing the character and preservation potential of palaeoflood laminations and determining the minimum discharge at which a sedimentary imprint will be deposited in a particular system are two key precursors. Some success has been achieved at lakes containing annually-laminated sequences or where event layers exhibit well-defined lithological contacts. Many non-alpine and non-polar lakes, especially those in temperate regions, are instead characterised by visually-homogeneous, organic-rich sediments from which discrete flood laminations are difficult to discriminate. Working at Brotherswater, a small upland lake in northwest England, we have successfully demonstrated an approach to obtain flood frequency and magnitude data from this type of lake system by integrating a 16 month sediment trap deployment (CE 2013-2014) with the recent (CE 1962 - 2014) depositional record. The geochemical composition and end-member modelling of the trap data shed light on the seasonal variation in background sedimentation dynamics, specifically enhanced sediment supply during winter, spring diatom blooms and heightened summer productivity, which alter the signature of coarse-grained deposition in response to higher flows. Having pinpointed the characteristic flood end-member, comparison of the short-core palaeoflood reconstruction to local river discharge data was able to reveal the hydrological thresholds of this system: flood magnitudes calculated to have a four year recurrence interval are preserved in

  20. Increasing inequality in age of death at shared levels of life expectancy: A comparative study of Scotland and England and Wales.

    Science.gov (United States)

    Seaman, Rosie; Leyland, Alastair H; Popham, Frank

    2016-12-01

    There is a strong negative correlation between increasing life expectancy and decreasing lifespan variation, a measure of inequality. Previous research suggests that countries achieving a high level of life expectancy later in time generally do so with lower lifespan variation than forerunner countries. This may be because they are able to capitalise on lessons already learnt. However, a few countries achieve a high level of life expectancy later in time with higher inequality. Scotland appears to be such a country and presents an interesting case study because it previously experienced lower inequality when reaching the same level of life expectancy as its closest comparator England and Wales. We calculated life expectancy and lifespan variation for Scotland and England and Wales for the years 1950 to 2012, comparing Scotland to England and Wales when it reached the same level of life expectancy later on in time, and assessed the difference in the level of lifespan variation. The lifespan variation difference between the two countries was then decomposed into age-specific components. Analysis was carried out for males and females separately. Since the 1950s Scotland has achieved the same level of life expectancy at least ten years later in time than England and Wales. Initially it did so with lower lifespan variation. Following the 1980s Scotland has been achieving the same level of life expectancy later in time than England and Wales and with higher inequality, particularly for males. Decomposition revealed that higher inequality is partly explained by lower older age mortality rates but primarily by higher premature adult age mortality rates when life expectancy is the same. Existing studies suggest that premature adult mortality rates are strongly associated with the social determinants of health and may be amenable to social and economic policies. So addressing these policy areas may have benefits for both inequality and population health in Scotland.

  1. The Deepwater Horizon Oil Spill Coast Guard Cohort study.

    Science.gov (United States)

    Rusiecki, Jennifer; Alexander, Melannie; Schwartz, Erica G; Wang, Li; Weems, Laura; Barrett, John; Christenbury, Kate; Johndrow, David; Funk, Renée H; Engel, Lawrence S

    2017-09-12

    Long-term studies of oil spill responders are urgently needed as oil spills continue to occur. To this end, we established the prospective Deepwater Horizon (DWH) Oil Spill Coast Guard Cohort study. DWH oil spill responders (n=8696) and non-responders (n=44 823) who were members of the US Coast Guard (20 April-17 December 2010) were included. This cohort uses both prospective, objective health data from military medical encounters and cross-sectional survey data. Here, we describe the cohort, present adjusted prevalence ratios (PRs) estimating cross-sectional associations between crude oil exposure (none, low/medium, high) and acute physical symptoms, and present adjusted relative risks (RRs) based on longitudinal medical encounter data (2010-2012) for responders/non-responders and responders exposed/not exposed to crude oil. Responders and non-responders in this large cohort (n=53 519) have similar characteristics. Crude oil exposure was reported by >50% of responders. We found statistically significant associations for crude oil exposure with coughing (PRhigh=1.78), shortness of breath (PRhigh=2.30), wheezing (PRhigh=2.32), headaches (PRhigh=1.46), light-headedness/dizziness (PRhigh=1.96), skin rash/itching (PRhigh=1.87), diarrhoea (PRhigh=1.76), stomach pain (PRhigh=1.67), nausea/vomiting (PRhigh=1.48) and painful/burning urination (PRhigh=2.89) during deployment. Longitudinal analyses revealed that responders had elevated RRs for dermal conditions (RR=1.09), as did oil-exposed responders for chronic respiratory conditions (RR=1.32), asthma (RR=1.83) and dermal conditions (RR=1.21). We found positive associations between crude oil exposure and various acute physical symptoms among responders, as well as longer term health effects. This cohort is well positioned to evaluate both short-term and long-term effects of oil spill exposures using both self-reported and clinical health data. © Article author(s) (or their employer(s) unless otherwise stated in the

  2. Hyperemesis gravidarum and pregnancy outcomes in the Norwegian Mother and Child Cohort - a cohort study.

    Science.gov (United States)

    Vikanes, Åse V; Støer, Nathalie C; Magnus, Per; Grjibovski, Andrej M

    2013-09-03

    Hyperemesis gravidarum (HG) characterized by excessive nausea and vomiting in early pregnancy, is reported to be associated with increased risks for low birthweight (LBW), preterm birth (PTB), small-for-gestational-age (SGA) and perinatal death. Conflicting results in previous studies underline the necessity to study HG's potential effect on pregnancy outcomes using large cohorts with valid data on exposure and outcome measures, as well as potential confounders. This study aims to investigate associations between HG and adverse pregnancy outcomes using the Norwegian Mother and Child Cohort Study (MoBa). All singleton pregnancies in MoBa from 1998 to 2008 were included. Multivariable regression was used to estimate relative risks, approximated by odds ratios, for PTB, LBW, SGA and perinatal death. Linear regression was applied to assess differences in birthweight and gestational age for children born to women with and without HG. Potential confounders were adjusted for. Altogether, 814 out of 71,468 women (or 1.1%) had HG. In MoBa HG was not associated with PTB, LBW or SGA. Babies born to women with HG were born on average 1 day earlier than those born to women without HG; (-0.97 day (95% confidence intervals (CI): -1.80 - -0.15). There was no difference in birthweight when maternal weight gain was adjusted for; (23.42 grams (95% CI: -56.71 - 9.86). Babies born by women with HG had lower risk for having Apgar score < 7 after 1 minute (crude odds ratio was 0.64 (95% CI: 0.43 - 0.95)). No differences between the groups for Apgar score < 7 after 5 minutes were observed. Time-point for hospitalisation slightly increased differences in gestational age according to maternal HG status. HG was not associated with adverse pregnancy outcomes. Pregnancies complicated with HG had a slightly shorter gestational length. There was no difference in birth weight according to maternal HG-status. HG was associated with an almost 40% reduced risk for having Apgar score

  3. Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study.

    Science.gov (United States)

    Ahmadi-Abhari, Sara; Guzman-Castillo, Maria; Bandosz, Piotr; Shipley, Martin J; Muniz-Terrera, Graciela; Singh-Manoux, Archana; Kivimäki, Mika; Steptoe, Andrew; Capewell, Simon; O'Flaherty, Martin; Brunner, Eric J

    2017-07-05

    Objective  To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease. Design  Modelling study. Setting  General adult population of England and Wales. Participants  The English Longitudinal Study of Ageing (ELSA) is a representative panel study with six waves of data across 2002-13. Men and women aged 50 or more years, selected randomly, and their cohabiting partners were recruited to the first wave of ELSA (2002-03). 11392 adults participated (response rate 67%). To maintain representativeness, refreshment participants were recruited to the study at subsequent waves. The total analytical sample constituted 17 906 people. Constant objective criteria based on cognitive and functional impairment were used to ascertain dementia cases at each wave. Main outcome measures  To estimate calendar trends in dementia incidence, correcting for bias due to loss to follow-up of study participants, a joint model of longitudinal and time-to-event data was fitted to ELSA data. To forecast future dementia prevalence, the probabilistic Markov model IMPACT-BAM (IMPACT-Better Ageing Model) was developed. IMPACT-BAM models transitions of the population aged 35 or more years through states of cardiovascular disease, cognitive and functional impairment, and dementia, to death. It enables prediction of dementia prevalence while accounting for the growing pool of susceptible people as a result of increased life expectancy and the competing effects due to changes in mortality, and incidence of cardiovascular disease. Results  In ELSA, dementia incidence was estimated at 14.3 per 1000 person years in men and 17.0/1000 person years in women aged 50 or more in 2010. Dementia incidence declined at a relative rate of 2.7% (95% confidence interval 2.4% to 2.9%) for each year during 2002-13. Using IMPACT-BAM, we estimated there were approximately 767 000 (95% uncertainty

  4. Cohort Profile: The Nicotine Dependence in Teens (NDIT) Study

    OpenAIRE

    O'Loughlin, Jennifer; Brunet, Jennifer; DiFranza, Joseph; Gervais, Andre; Gray-Donald, Katherine; Karp, Igor; Sabiston, Catherine; Sylvestre, Marie-Pierre; Dugas, Erika N.; Engert, James C.; Low, Nancy C; Rachel F Tyndale

    2014-01-01

    The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999–2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999–2005), for a t...

  5. Schools That Make a Difference to Post-Compulsory Uptake of Physical Science Subjects: Some comparative case studies in England

    Science.gov (United States)

    Bennett, Judith; Lubben, Fred; Hampden-Thompson, Gillian

    2013-03-01

    This paper presents the findings of the qualitative component of a combined methods research study that explores a range of individual and school factors that influence the uptake of chemistry and physics in post-compulsory study in England. The first phase involves using the National Pupil Database to provide a sampling frame to identify four matched pairs of high-uptake and low-uptake schools by salient school factors. Case studies of these eight schools indicate that students employ selection strategies related to their career aspirations, their sense of identity and tactics, and their prior experience. The school factors influencing subject choice relate to school management, student support and guidance, and student empowerment. The most notable differences between students in high-uptake and low-uptake schools are that students in high-uptake schools appear to make a proactive choice in relation to career aspirations, rather than a reactive choice on the basis of past experience. Schools with a high uptake offer a diverse science curriculum in the final two years of compulsory study, set higher examination entry requirements for further study and, crucially, provide a range of opportunities for students to interact with the world of work and to gain knowledge and experience of science-related careers.

  6. Age, time period, and birth cohort differences in self-esteem: Reexamining a cohort-sequential longitudinal study.

    Science.gov (United States)

    Twenge, Jean M; Carter, Nathan T; Campbell, W Keith

    2017-05-01

    Orth, Trzesniewski, and Robins (2010) concluded that the nationally representative Americans' Changing Lives (ACL) cohort-sequential study demonstrated moderate to large age differences in self-esteem, and no birth cohort (generational) differences in the age trajectory. In a reanalysis of these data using 2 different statistical techniques, we find significant increases in self-esteem that could be attributed to birth cohort or time period. First, hierarchical linear modeling analyses with birth cohort as a continuous variable (vs. the multiple group formulation used by Orth et al.) find that birth cohort has a measurable influence on self-esteem through its interaction with age. Participants born in later years (e.g., 1960) were higher in self-esteem and were more likely to increase in self-esteem as they aged than participants born in earlier years (e.g., 1920). However, the estimated age trajectory up to age 60 is similar in Orth et al.'s results and in the results from our analyses including cohort. Second, comparing ACL respondents of the same age in 1986 versus 2002 (a time-lag design) yields significant birth cohort differences in self-esteem, with 2002 participants of the same age higher in self-esteem than those in 1986. Combined with some previous studies finding significant increases in self-esteem and positive self-views over time, these results suggest that cultural change in the form of cohort and time period cannot be ignored as influences in cross-sectional and longitudinal studies. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  7. China suboptimal health cohort study: rationale, design and baseline characteristics.

    Science.gov (United States)

    Wang, Youxin; Ge, Siqi; Yan, Yuxiang; Wang, Anxin; Zhao, Zhongyao; Yu, Xinwei; Qiu, Jing; Alzain, Mohamed Ali; Wang, Hao; Fang, Honghong; Gao, Qing; Song, Manshu; Zhang, Jie; Zhou, Yong; Wang, Wei

    2016-10-13

    Suboptimal health status (SHS) is a physical state between health and disease, characterized by the perception of health complaints, general weakness, chronic fatigue and low energy levels. SHS is proposed by the ancient concept of traditional Chinese medicine (TCM) from the perspective of preservative, predictive and personalized (precision) medicine. We previously created the suboptimal health status questionnaire 25 (SHSQ-25), a novel instrument to measure SHS, validated in various populations. SHSQ-25 thus affords a window of opportunity for early detection and intervention, contributing to the reduction of chronic disease burdens. To investigate the causative effect of SHS in non-communicable chronic diseases (NCD), we initiated the China suboptimal health cohort study (COACS), a longitudinal study starting from 2013. Phase I of the study involved a cross-sectional survey aimed at identifying the risk/protective factors associated with SHS; and Phase II: a longitudinal yearly follow-up study investigating how SHS contributes to the incidence and pattern of NCD. (1) Cross-sectional survey: in total, 4313 participants (53.8 % women) aged from 18 to 65 years were included in the cohort. The prevalence of SHS was 9.0 % using SHS score of 35 as threshold. Women showed a significantly higher prevalence of SHS (10.6 % in the female vs. 7.2 % in the male, P differed significantly between subjects of SHS (SHS score ≥35) and those of ideal health (SHS score difference in prevalence of SHS might partly explain the gender difference of incidence of certain chronic diseases. The COACS will enable a thorough characterization of SHS and establish a cohort that will be used for longitudinal analyses of the interaction between the genetic, lifestyle and environmental factors that contribute to the onset and etiology of targeted chronic diseases. The study together with the designed prospective cohort provides a chance to characterize and evaluate the effect of SHS

  8. Epidemiology and trends in non-fatal self-harm in three centres in England, 2000–2012: findings from the Multicentre Study of Self-harm in England

    Science.gov (United States)

    Geulayov, Galit; Kapur, Navneet; Turnbull, Pauline; Waters, Keith; Ness, Jennifer; Townsend, Ellen; Hawton, Keith

    2016-01-01

    Objectives Self-harm is a major health problem in many countries, with potential adverse outcomes including suicide and other causes of premature death. It is important to monitor national trends in this behaviour. We examined trends in non-fatal self-harm and its management in England during the 13-year period, 2000–2012. Design and setting This observational study was undertaken in the three centres of the Multicentre Study of Self-harm in England. Information on all episodes of self-harm by individuals aged 15 years and over presenting to five general hospitals in three cities (Oxford, Manchester and Derby) was collected through face-to-face assessment or scrutiny of emergency department electronic databases. We used negative binomial regression models to assess trends in rates of self-harm and logistic regression models for binary outcomes (eg, assessed vs non-assessed patients). Participants During 2000–2012, there were 84 378 self-harm episodes (58.6% by females), involving 47 048 persons. Results Rates of self-harm declined in females (incidence rate ratio (IRR) 0.98; 95% CI 0.97 to 0.99, pself-harm declined until 2008 (IRR 0.96; 95% CI 0.95 to 0.98, pself-harm were strongly correlated with suicide rates in England in males (r=0.82, p=0.0006) and females (r=0.74, p=0.004). Over 75% of self-harm episodes were due to self-poisoning, mainly with analgesics (45.7%), antidepressants (24.7%) and benzodiazepines (13.8%). A substantial increase in self-injury occurred in the latter part of the study period. This was especially marked for self-cutting/stabbing and hanging/asphyxiation. Psychosocial assessment by specialist mental health staff occurred in 53.2% of episodes. Conclusions Trends in rates of self-harm and suicide may be closely related; therefore, self-harm can be a useful mental health indicator. Despite national guidance, many patients still do not receive psychosocial assessment, especially those who self-injure. PMID:27130163

  9. Hospital admissions for viral meningitis in children in England over five decades: a population-based observational study.

    Science.gov (United States)

    Martin, Natalie G; Iro, Mildred A; Sadarangani, Manish; Goldacre, Raphael; Pollard, Andrew J; Goldacre, Michael J

    2016-11-01

    A substantial reduction in bacterial meningitis has occurred in the UK following successful implementation of immunisation programmes. Most childhood meningitis in developed countries is now caused by viruses. Long-term trends in paediatric viral meningitis in England have not previously been reported. The objective of this study is to report on epidemiological trends over time in childhood viral meningitis in England. In this population-based observational study, we used routinely collected hospital discharge records from English National Health Service hospitals from 1968-2011 to analyse annual age-specific admission rates for viral meningitis, including specific viral aetiologies, in children younger than 15 years. We analysed hospital discharge records from Jan 1, 1968, to Dec 31, 2011. Hospital admission rates for viral meningitis from Jan 1, 1968, to Dec 31, 1985, varied annually, with a mean of 13·5 admissions per 100 000 children aged less than 15 years, per year (95% CI 13·0-14·0). Admission rates declined during the late 1980s, and the mean number of admissions from 1989-2011 was 5·2 per 100 000 per year (5·1-5·3). This decrease was entirely in children aged 1-14 years. Admission rates for infants aged less than 1 year increased since 2005, to 70·0 per 100 000 (63·7-76·2) in 2011, which was driven by an increase in admission of infants aged 90 days or less. In 1968-85, the majority of cases in children were in those aged 1-14 years (22 150 [89%] of 24 920 admissions). In 2007-11, 1716 (72%) of 2382 cases were in infants. Admissions for mumps-related meningitis almost disappeared following introduction of the measles-mumps-rubella (MMR) vaccine in 1988. Admissions with a specified viral aetiology have increased since 2000. Trends in viral meningitis admissions have changed substantially over the past 50 years, and probably reflect the impact of the MMR vaccine programme and the use of more sensitive diagnostic techniques. None. Copyright

  10. Breast density and outcome of mammography screening: a cohort study

    DEFF Research Database (Denmark)

    Olsen, A H; Bihrmann, K; Jensen, M-B

    2009-01-01

    The purpose of this study was to investigate the effect of breast density on breast cancer (BC) mortality in a mammography screening programme. The cohort included 48 052 women participating in mammography screening in Copenhagen, Denmark, where biennial screening is offered to women aged 50......-69 years. We collected information for the years 1991-2001 on screening outcome, incident BCs (screen-, interval-, and later detected), and BC deaths. Breast density was dichotomised into fatty (F) and mixed/dense (M/D) breasts. Screening sensitivity was measured as the odds ratio of interval versus screen...

  11. Perceived age as clinically useful biomarker of ageing: cohort study

    DEFF Research Database (Denmark)

    Christensen, Kaare; Thinggaard, Mikael; McGue, Matt

    2009-01-01

    OBJECTIVE: To determine whether perceived age correlates with survival and important age related phenotypes. DESIGN: Follow-up study, with survival of twins determined up to January 2008, by which time 675 (37%) had died. SETTING: Population based twin cohort in Denmark. PARTICIPANTS: 20 nurses, 10...... increased with increasing discordance in perceived age within the twin pair-that is, the bigger the difference in perceived age within the pair, the more likely that the older looking twin died first. Twin analyses suggested that common genetic factors influence both perceived age and survival. Perceived...

  12. Serum YKL-40 and gestational diabetes - an observational cohort study

    DEFF Research Database (Denmark)

    Gybel-Brask, Dorte; Johansen, Julia S; Christiansen, Ib J

    2016-01-01

    To examine serum YKL-40 in women developing gestational diabetes mellitus (GDM). In the present large observational cohort study of 1179 pregnant women, we determined serum YKL-40 four times during pregnancy (at gestational age 12, 20, 25, and 32 weeks). Pregnancy outcome was obtained from medical...... and the oral glucose tolerance test results. In conclusion, YKL-40 significantly increased in pregnant women with GDM compared with women without GDM, probably reflecting the low-grade inflammation of GDM. However, we did not find an association between serum concentrations of YKL-40 in early pregnancy...

  13. Incidence of cancer among UK Gulf war veterans: cohort study

    OpenAIRE

    Macfarlane, Gj; Biggs, Am; Maconochie, N; Hotopf, M; Doyle, P; Lunt, M

    2003-01-01

    Objectives To determine whether incidence rates of cancer are higher in UK service personnel who were deployed in the Gulf war than in those not deployed and whether any increased risk of cancer is related to self reported exposures to potentially hazardous material during the period of deployment. Design A cohort study with follow up from 1 April 1991 (the end of the Gulf war) to 31 July 2002. Participants 51721 Gulf war veterans and 50 755 service personnel matched for age, sex, rank, servi...

  14. Operationalizing Frailty in the Atherosclerosis Risk in Communities Study Cohort.

    Science.gov (United States)

    Kucharska-Newton, Anna M; Palta, Priya; Burgard, Sheila; Griswold, Michael E; Lund, Jennifer L; Capistrant, Benjamin D; Kritchevsky, Stephen B; Bandeen-Roche, Karen; Windham, B Gwen

    2017-03-01

    Factors that may contribute to the development of frailty in late life have not been widely investigated. The Atherosclerosis Risk in Communities (ARIC) Study cohort presents an opportunity to examine relationships of midlife risk factors with frailty in late life. However, we first present findings on the validation of an established frailty phenotype in this predominantly biracial population of older adults. Among 6,080 participants, we defined frailty based upon the Cardiovascular Health Study (CHS) criteria incorporating measures of weight loss, exhaustion, slow walking speed, low physical activity, and low grip strength. Criterion and predictive validity of the frailty phenotype were estimated from associations between frailty status and participants' physical and mental health status, physiologic markers, and incident clinical outcomes. A total of 393 (6.5%) participants were classified as frail and 50.4% pre-frail, similar to CHS (6.9% frail, 46.6% pre-frail). In age-adjusted analyses, frailty was concurrently associated with depressive symptoms, low self-rated health, low medication adherence, and clinical biomarker levels (ie, cholesterol, hemoglobin A1c, white blood cell count, C-reactive protein, and hemoglobin). During 1-year follow-up, frailty was associated with falls, low physical ability, fatigue, and mortality. These findings support the validity of the CHS frailty phenotype in the ARIC Study cohort. Future studies in ARIC may elucidate early-life exposures that contribute to late-life frailty.

  15. Possibilities and considerations when merging dietary data from the world's two largest pregnancy cohorts: the Danish National Birth Cohort and the Norwegian Mother and Child Cohort Study.

    Science.gov (United States)

    Olsen, Sjurdur F; Birgisdottir, Bryndis Eva; Halldorsson, Thorhallur I; Brantsaeter, Anne Lise; Haugen, Margaretha; Torjusen, Hanne; Petersen, Sesilje B; Strøm, Marin; Meltzer, Helle Margrete

    2014-11-01

    To elucidate the research possibilities when merging data on maternal diet from the Danish National Birth Cohort (DNBC) and the Norwegian Mother and Child Cohort Study (MoBa), through comparison of (i) the methodology used for dietary assessment and (ii) the estimated intake of selected food groups in the two cohorts. Qualitative and quantitative comparison of the two dietary databases. Two national prospective pregnancy cohorts. Denmark, Norway. Comparison of food intake using food frequency questionnaires (FFQs). The FFQs had overlapping time windows and a majority of the questions in the two FFQs were comparable. Calculation principles shared similar features, including the software used and use of global questions to calibrate intakes of different food groups. A total of 63 food groups were defined that could be compared across the two cohorts; these were further aggregated down to 31 broader groups. A comparison of food intakes (grams/d) showed 39, 74 and 141% lower daily intakes of fish, potatoes and rice, respectively, in DNBC vs. MoBa and 39, 54 and 65% higher daily intakes of milk, butter and potatoes in DNBC vs. MoBa. For most other food groups, differences in consumption data were below 20%. The two FFQs are to a large extent compatible and substantial differences in dietary habits were observed between the two cohorts. This may strengthen studies using pooled analysis to examine diet-disease relations. This is a conclusion of great importance given the colossal and costly task involved to establish each of these two cohorts. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  16. A population-based, retrospective, cohort study of esophageal cancer missed at endoscopy.

    Science.gov (United States)

    Chadwick, Georgina; Groene, Oliver; Hoare, Jonathan; Hardwick, Richard H; Riley, Stuart; Crosby, Tom D; Hanna, George B; Cromwell, David A

    2014-07-01

    Several studies have suggested that a significant minority of esophageal cancers are missed at endoscopy The aim of this study was to estimate the proportion of esophageal cancers missed at endoscopy on a national level, and to investigate the relationship between miss rates and patient and tumor characteristics. This retrospective, population-based, cohort study identified patients diagnosed with esophageal cancer between April 2011 and March 2012 in England, using two linked databases (National Oesophago-Gastric Cancer Audit and Hospital Episode Statistics). The main outcome was the rate of previous endoscopy within 3 - 36 months of cancer diagnosis. This was calculated for the overall cohort and by patient characteristics, including tumor site and disease stage. A total of 6943 new cases of esophageal cancer were identified, of which 7.8 % (95 % confidence interval 7.1 - 8.4) had undergone endoscopy in the 3 - 36 months preceding diagnosis. Of patients with stage 0/1 cancers, 34.0 % had undergone endoscopy in the 3 - 36 months before diagnosis compared with 10.0 % of stage 2 cancers and 4.5 % of stage 3/4 cancers. Of patients with stage 0/1 cancers, 22.1 % were diagnosed after ≥ 3 endoscopies in the previous 3 years. Patients diagnosed with an upper esophageal lesion were more likely to have had an endoscopy in the previous 3 - 12 months (P = 0.040). The most common diagnosis at previous endoscopy was an esophageal ulcer (48.2 % of investigations). Esophageal cancer may be missed at endoscopy in up to 7.8 % of patients who are subsequently diagnosed with cancer. Endoscopists should make a detailed examination of the whole esophageal mucosa to avoid missing subtle early cancers and lesions in the proximal esophagus. Patients with an esophageal cancer may be misdiagnosed as having a benign esophageal ulcer. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies.

    Science.gov (United States)

    Jackson, Dan; White, Ian; Kostis, J B; Wilson, A C; Folsom, A R; Wu, K; Chambless, L; Benderly, M; Goldbourt, U; Willeit, J; Kiechl, S; Yarnell, J W G; Sweetnam, P M; Elwood, P C; Cushman, M; Psaty, B M; Tracy, R P; Tybjaerg-Hansen, A; Haverkate, F; de Maat, M P M; Thompson, S G; Fowkes, F G R; Lee, A J; Smith, F B; Salomaa, V; Harald, K; Rasi, V; Vahtera, E; Jousilahti, P; D'Agostino, R; Kannel, W B; Wilson, P W F; Tofler, G; Levy, D; Marchioli, R; Valagussa, F; Rosengren, A; Wilhelmsen, L; Lappas, G; Eriksson, H; Cremer, P; Nagel, D; Curb, J D; Rodriguez, B; Yano, K; Salonen, J T; Nyyssönen, K; Tuomainen, T-P; Hedblad, B; Engström, G; Berglund, G; Loewel, H; Koenig, W; Hense, H W; Meade, T W; Cooper, J A; De Stavola, B; Knottenbelt, C; Miller, G J; Cooper, J A; Bauer, K A; Rosenberg, R D; Sato, S; Kitamura, A; Naito, Y; Iso, H; Salomaa, V; Harald, K; Rasi, V; Vahtera, E; Jousilahti, P; Palosuo, T; Ducimetiere, P; Amouyel, P; Arveiler, D; Evans, A E; Ferrieres, J; Juhan-Vague, I; Bingham, A; Schulte, H; Assmann, G; Cantin, B; Lamarche, B; Despres, J-P; Dagenais, G R; Tunstall-Pedoe, H; Lowe, G D O; Woodward, M; Ben-Shlomo, Y; Davey Smith, G; Palmieri, V; Yeh, J L; Meade, T W; Rudnicka, A; Brennan, P; Knottenbelt, C; Cooper, J A; Ridker, P; Rodeghiero, F; Tosetto, A; Shepherd, J; Lowe, G D O; Ford, I; Robertson, M; Brunner, E; Shipley, M; Feskens, E J M; Di Angelantonio, E; Kaptoge, S; Lewington, S; Lowe, G D O; Sarwar, N; Thompson, S G; Walker, M; Watson, S; White, I R; Wood, A M; Danesh, J

    2009-04-15

    One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohorts with full confounder information, or use all cohorts but do not fully adjust for confounding. We propose using a bivariate random-effects meta-analysis model to use information from all available cohorts while still adjusting for all the potential confounders. Our method uses both the fully adjusted and the partially adjusted estimated effects in the cohorts with full confounder information, together with an estimate of their within-cohort correlation. The method is applied to estimate the association between fibrinogen level and coronary heart disease incidence using data from 154,012 participants in 31 cohorts

  18. Coding of Barrett's oesophagus with high-grade dysplasia in national administrative databases: a population-based cohort study.

    Science.gov (United States)

    Chadwick, Georgina; Varagunam, Mira; Brand, Christian; Riley, Stuart A; Maynard, Nick; Crosby, Tom; Michalowski, Julie; Cromwell, David A

    2017-06-09

    The International Classification of Diseases 10th Revision (ICD-10) system used in the English hospital administrative database (Hospital Episode Statistics (HES)) does not contain a specific code for oesophageal high-grade dysplasia (HGD). The aim of this paper was to examine how patients with HGD were coded in HES and whether it was done consistently. National population-based cohort study of patients with newly diagnosed with HGD in England. The study used data collected prospectively as part of the National Oesophago-Gastric Cancer Audit (NOGCA). These records were linked to HES to investigate the pattern of ICD-10 codes recorded for these patients at the time of diagnosis. All patients with a new diagnosis of HGD between 1 April 2013 and 31 March 2014 in England, who had data submitted to the NOGCA. The main outcome assessed was the pattern of primary and secondary ICD-10 diagnostic codes recorded in the HES records at endoscopy at the time of diagnosis of HGD. Among 452 patients with a new diagnosis of HGD between 1 April 2013 and 31 March 2014, Barrett's oesophagus was the only condition coded in 200 (44.2%) HES records. Records for 59 patients (13.1%) contained no oesophageal conditions. The remaining 193 patients had various diagnostic codes recorded, 93 included a diagnosis of Barrett's oesophagus and 57 included a diagnosis of oesophageal/gastric cardia cancer. HES is not suitable to support national studies looking at the management of HGD. This is one reason for the UK to adopt an extended ICD system (akin to ICD-10-CM). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Study design of DIACORE (DIAbetes COhoRtE – a cohort study of patients with diabetes mellitus type 2

    Directory of Open Access Journals (Sweden)

    Dörhöfer Lena

    2013-02-01

    Full Text Available Abstract Background Diabetes mellitus type 2 (DM2 is highly associated with increased risk for chronic kidney disease (CKD, end stage renal disease (ESRD and cardiovascular morbidity. Epidemiological and genetic studies generate hypotheses for innovative strategies in DM2 management by unravelling novel mechanisms of diabetes complications, which is essential for future intervention trials. We have thus initiated the DIAbetes COhoRtE study (DIACORE. Methods DIACORE is a prospective cohort study aiming to recruit 6000 patients of self-reported Caucasian ethnicity with prevalent DM2 for at least 10 years of follow-up. Study visits are performed in University-based recruiting clinics in Germany using standard operating procedures. All prevalent DM2 patients in outpatient clinics surrounding the recruiting centers are invited to participate. At baseline and at each 2-year follow-up examination, patients are subjected to a core phenotyping protocol. This includes a standardized online questionnaire and physical examination to determine incident micro- and macrovascular DM2 complications, malignancy and hospitalization, with a primary focus on renal events. Confirmatory outcome information is requested from patient records. Blood samples are obtained for a centrally analyzed standard laboratory panel and for biobanking of aliquots of serum, plasma, urine, mRNA and DNA for future scientific use. A subset of the cohort is subjected to extended phenotyping, e.g. sleep apnea screening, skin autofluorescence measurement, non-mydriatic retinal photography and non-invasive determination of arterial stiffness. Discussion DIACORE will enable the prospective evaluation of factors involved in DM2 complication pathogenesis using high-throughput technologies in biosamples and genetic epidemiological studies.

  20. A birth cohort study in the Middle East: the Qatari birth cohort study (QBiC phase I

    Directory of Open Access Journals (Sweden)

    Eman Sadoun

    2017-10-01

    Full Text Available Abstract Background The latest scientific reports raise concerns about the rapidly increasing burden of chronic diseases in the state of Qatar. Pregnant Qatari women often confront complications during pregnancy including gestational diabetes, hypertension, abortion and stillbirth. The investigation of early life environmental, genetic, nutritional and social factors that may affect lifelong health is of great importance. Birth cohort studies offer a great opportunity to address early life hazards and their possible long lasting effects on health. Methods/design The Qatari Birth Cohort study is the first mother-child cohort study in the Middle East Area that aims to assess the synergetic role of environmental exposure and genetic factors in the development of chronic disease and monitor woman and child health and/or obstetric characteristics with high prevalence. The present manuscript describes the recruitment phase of the study (duration: 2 years; expected number: 3000 families, where the pregnant Qatari women and their husbands are being contacted before the 15th week of gestation at the Primary Health Care Centers. The consented participants are interviewed to obtain information on several factors (sociodemographic characteristics, dietary habits, occupational/environmental exposure and maternal characteristics are assessed based on anthropometric measurements, spirometry, and blood pressure. Pregnant women are invited to provide biological samples (blood and urine in each trimester of their pregnancy, as well as cord blood at delivery. Fathers are also asked to provide biological samples. Discussion The present study provides invaluable insights into a wide range of early life factors affecting human health. With a geographical focus on the Middle East, it will be a resource for information to the wider scientific community and will allow the formulation of effective policies with a primary focus on public health interventions for maternal

  1. SECONDARY GASTROINTESTINAL MALIGNANCIES IN CHILDHOOD CANCER SURVIVORS: A COHORT STUDY

    Science.gov (United States)

    Henderson, Tara O.; Oeffinger, Kevin C.; Whitton, John; Leisenring, Wendy; Neglia, Joseph; Meadows, Anna; Crotty, Catherine; Rubin, David T.; Diller, Lisa; Inskip, Peter; Smith, Susan A.; Stovall, Marilyn; Constine, Louis S.; Hammond, Sue; Armstrong, Greg T.; Robison, Leslie L.; Nathan, Paul C.

    2012-01-01

    Background Childhood cancer survivors develop gastrointestinal malignancies more frequently and at a younger age than the general population, but risk factors for their development have not been well characterized. Objective To determine the risk and associated risk factors for gastrointestinal subsequent malignant neoplasms (SMN) in childhood cancer survivors. Design Retrospective cohort study. Setting The Childhood Cancer Survivor Study, a multi-center study of childhood cancer survivors diagnosed between 1970 and 1986. Patients 14,358 survivors of a malignancy diagnosed at cancer survivors than the general population (95% confidence interval [CI]: 3.5-6.1). Colorectal cancer SIR was 4.2 (95% CI: 2.8-6.3). The highest gastrointestinal SMN risk was associated with abdominal radiation (SIR=11.2, 95% CI: 7.6-16.4). However, survivors not exposed to radiation had a significantly increased risk (SIR=2.4, 95% CI-1.4-3.9). In addition to abdominal radiation, high dose procarbazine (RR=3.2, 95% CI 1.1-9.4) and platinum drugs (RR 7.6, 95% CI: 2.3-25.5) independently increased the gastrointestinal SMN risk. Limitations This cohort has not yet attained an age at which gastrointestinal malignancy risk is greatest. Conclusions Childhood cancer survivors, particularly those exposed to abdominal radiation, are at increased risk for gastrointestinal SMN. These findings suggest that surveillance of at-risk childhood cancer survivors should commence at a younger age than recommended for the general population. PMID:22665813

  2. Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England

    Directory of Open Access Journals (Sweden)

    Reidpath Daniel D

    2010-08-01

    Full Text Available Abstract Background Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign to promote vaccination against the human papilloma virus (HPV, the relationship between area deprivation and exposure was examined. Methods Taking advantage of a health promotion campaign to provide information to schools about HPV vaccination, a cross sectional study was conducted to examine the relationship between area level, social deprivation, and take-up of (i.e., exposure to available health promotion material. The sample was 4,750 schools across England, including government maintained and independent schools. The relationship between area deprivation and exposure was examined using bi- and multivariate logistic regression. Results It was found that schools in the least deprived quintile had 1.32 times the odds of requesting health promotion materials than schools in the most deprived areas (p = .01. This effect was independent of the school size, the type of school, and the geographic region. Conclusion The relationship between area deprivation and the impact of health promotion may be due, at least in part, to differential levels of exposure. The study was limited in scope, pointing to the need for more research, but also points to potentially important policy implications.

  3. ‘It's All a Bit Pantomime’: An Exploratory Study of Gay and Lesbian Adopters and Foster-Carers in England and Wales

    OpenAIRE

    Wood, Kate

    2015-01-01

    This paper reports the findings of a study identifying the experiences of gay and lesbian adopters and foster-carers in England and Wales. Qualitative interviews were conducted with twenty-four lesbians and gay men who had undertaken any part of the adoption or fostering application process since the implementation of the Adoption and Children Act of 2002. The study suggests that, whilst increasing numbers of lesbians and gay men are accessing fostering and adoption services, gender and sexua...

  4. A nationally representative study of maternal obesity in England, UK : trends in incidence and demographic inequalities in 619323 births, 1989-2007.

    OpenAIRE

    Heslehurst, N.; Rankin, J.; Wilkinson, J. R.; Summerbell, C D

    2010-01-01

    Background: There is an absence of national statistics for maternal obesity in the UK. This study is the first to describe a nationally representative maternal obesity research data set in England. Design: Retrospective epidemiological study of first trimester obesity. Methods: Data from 34 maternity units were analysed, including 619 323 births between 1989 and 2007. Data analysis included trends in first trimester maternal body bass index status over time, and geographical distribut...

  5. Vegetarianism, low meat consumption and the risk of colorectal cancer in a population based cohort study

    NARCIS (Netherlands)

    Gilsing, A.M.J.; Schouten, L.J.; Goldbohm, R.A.; Dagnelie, P.C.; Brandt, P.A. van den; Weijenberg, M.P.

    2015-01-01

    To study how a vegetarian or low meat diet influences the risk of colorectal cancer compared to a high meat diet, and to assess the explanatory role of factors associated with these diets. In the Netherlands Cohort Study – Meat Investigation Cohort (NLCS-MIC) (cohort of 10,210 individuals including

  6. Clinical course of multiple sclerosis: A nationwide cohort study.

    Science.gov (United States)

    Manouchehrinia, Ali; Beiki, Omid; Hillert, Jan

    2017-10-01

    The course of multiple sclerosis (MS) has been studied in several cohorts; however, results have varied significantly. To describe the clinical course of MS in a nationwide cohort of patients. Data from the Swedish MS register (SMSreg) were used to estimate the median time to the sustained Expanded Disability Status Scale (EDSS) scores 3.0, 4.0 and 6.0, onset of secondary progressive multiple sclerosis (SPMS) and death using Kaplan-Meier method. A possible effect of first-line treatments on age at EDSS 6.0 and SPMS was estimated. In all, 12,703 patients were included. Median ages at EDSS scores 3.0, 4.0 and 6.0 were 55.4 (95% confidence interval (CI): 54.8-55.8), 60.7 (95% CI: 60.1-61.2) and 64.3 (95% CI: 63.6-64.7), respectively. Median age at SPMS was 57.4 (95% CI: 56.9-57.9). The median age at the time of death was 80.5 (95% CI: 79.9-81.1). Males and progressive-onset patients showed higher risks of disability worsening. On average, treated patients gained 1.6 years (95% CI: 0.2-3) to EDSS 6.0 as a result of treatment. Ages at disability milestones in this population-based cohort were higher than previously described in clinic- and regional-based samples. Nevertheless, MS patients die at younger age and live at an average almost 20 years with moderate and 30 years with severe disability.

  7. Geography of hospital admissions for multiple sclerosis in England and comparison with the geography of hospital admissions for infectious mononucleosis: a descriptive study

    Science.gov (United States)

    Ramagopalan, Sreeram V; Hoang, Uy; Seagroatt, Valerie; Handel, Adam; Ebers, George C; Giovannoni, Gavin

    2011-01-01

    Objective It is well recognised that variation in the geographical distribution of multiple sclerosis (MS) exists. Early studies in England have shown the disease to have been more common in the North than the South. However, this could be an artefact of inaccurate diagnosis and ascertainment, and recent data on MS prevalence are lacking. In the present study, data were analysed to provide a more contemporary map of the distribution of MS in England and, as infectious mononucleosis (IM) has been shown to be associated with the risk of MS, the geographical distribution of IM with that of MS was compared. Methods Analysis of linked statistical abstracts of hospital data for England between 1999 and 2005. Results There were 56 681 MS patients. The admission rate for MS was higher in females (22/105; 95% CI 21.8 to 22.3) than males (10.4/105; 95% CI 10.2 to 10.5). The highest admission rate for MS was seen for residents of Cumbria and Lancashire (North of England) (20.1/105; 95% CI 19.3 to 20.8) and the lowest admission rate was for North West London residents (South of England) (12.4/105; 95% CI 11.8 to 13.1). The geographical distributions of IM and MS were significantly correlated (weighted regression coefficient (r (w))=0.70, p<0.0001). Admission rates for MS were lowest in the area quintile with the highest level of deprivation and they were also lowest in the area quintile with the highest percentage of population born outside the UK. A significant association between northernliness and MS remained after adjustment for deprivation and UK birthplace. Conclusions The results show the continued existence of a latitude gradient for MS in England and show a correlation with the distribution of IM. The data have implications for healthcare provision, because lifetime costs of MS exceed £1 million per case in the UK, as well as for studies of disease causality and prevention. PMID:21212107

  8. The development of substance use in adolescence: results from comparing two longitudinal studies in England and Germany

    Directory of Open Access Journals (Sweden)

    Mariotti Luca

    2011-07-01

    Full Text Available This paper compares the development of alcohol and cannabis use in two English and German adolescent cohorts, using longitudinal data from ongoing studies located in Peterborough and Duisburg respectively. We set out the two studies and detail the steps taken to make the comparisons presented. Unusually, this paper assesses this development simultaneously in both cohorts, using an under-utilized variation of a well-known technique (multiple-group multiple-cohort latent growth curve modelling. In keeping with expectations from other research, there are large differences in the proportions of young people in the two countries using cannabis and alcohol. The Peterborough cohort embarked on earlier initiation of both alcohol and cannabis use, and increase their frequency of use very quickly. Despite a one year chronological gap between the two study cohorts, the 13 year old Peterborough group drink (until drunk and smoke cannabis at the same level as the 15 year old versions of their German counterparts. Although there are some methodological differences between the two projects, the results appear to be valid.In questo articolo viene svolta una comparazione sullo sviluppo, nel corso dell’adolescenza, del consumo di droghe leggere e alcol tra un campione di giovani tedeschi e inglesi, utilizzando i dati di due studi longitudinali panel condotti rispettivamente in Germania e in Inghilterra. Per questo confronto viene utilizzata una tecnica particolare (multiple-group multiple-cohort latent growth curve modelling che permette di osservare similitudini e differenze nello sviluppo individuale del consumo di queste sostanze nel corso del tempo, con un’attenzione particolare alle differenze tra le due coorti. Nonostante alcune differenze di tipo metodologico tra i due studi, e comunque in sintonia con studi precedenti, si notano importanti differenze tra i due campioni. Il campione inglese infatti mostra un livello di consumo più alto rispetto a

  9. The Asia pacific cohort studies collaboration: a decade of achievements.

    Science.gov (United States)

    Woodward, Mark; Huxley, Rachel; Ueshima, Hirotsugu; Fang, Xianghua; Kim, Hyeon Chang; Lam, Tai-Hing

    2012-12-01

    The Asia Pacific Cohort Studies Collaboration (APCSC) was established in the late 1990s when there was a distinct shortfall in evidence of the importance of risk factors for cardiovascular disease in Asia. With few exceptions, most notably from Japan, most of the published reports on cardiovascular disease in the last century were from Western countries, and there was uncertainty how far etiological associations found in the West could be assumed to prevail in the East. Against this background, APCSC was set up as a pooling project, combining individual participant data (about 600,000 subjects) from all available leading cohort studies (36 from Asia and 8 from Australasia) in the region, to fill the knowledge gaps. In the past 10 years, APCSC has published 50 peer-reviewed publications of original epidemiological research, primarily concerned with coronary heart disease, stroke, and cancer. This work has established that Western risk factors generally act similarly in Asia and in Australasia, just as they do in other parts of the world. Consequently, strategies to reduce the prevalence of elevated blood pressure, obesity, and smoking are at least as important in Asia as elsewhere- and possibly more important when the vast size of Asia is considered. This article reviews the achievements of APCSC in the past decade, with an emphasis on coronary heart disease. Copyright © 2012 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  10. Delays in diagnosis of young females with symptomatic cervical cancer in England: an interview-based study.

    Science.gov (United States)

    Lim, Anita W; Ramirez, Amanda J; Hamilton, William; Sasieni, Peter; Patnick, Julietta; Forbes, Lindsay Jl

    2014-10-01

    Diagnosis may be delayed in young females with cervical cancer because of a failure to recognise symptoms. To examine the extent and determinants of delays in diagnosis of young females with symptomatic cervical cancer. A national descriptive study of time from symptoms to diagnosis of cervical cancer and risk factors for delay in diagnosis at all hospitals diagnosing cervical cancer in England. One-hundred and twenty-eight patients diagnosis of cervical cancer were interviewed. Patient delay was defined as ≥3 months from symptom onset to first presentation and provider delay as ≥ 3 months from first presentation to diagnosis. Forty (31%) patients had presented symptomatically: 11 (28%) delayed presentation. Patient delay was more common in patients cancer symptom. Provider delay was reported by 24/40 (60%); in some no report was found in primary care records of a visual inspection of the cervix and some did not re-attend after the first presentation for several months. Gynaecological symptoms were common (84%) among patients who presented via screening. Young females with cervical cancer frequently delay presentation, and not recognising symptoms as serious may increase the risk of delay. Delay in diagnosis after first presentation is also common. There is some evidence that UK guidelines for managing young females with abnormal bleeding are not being followed. © British Journal of General Practice 2014.

  11. Framing in policy processes: a case study from hospital planning in the National Health Service in England.

    Science.gov (United States)

    Jones, Lorelei; Exworthy, Mark

    2015-01-01

    This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Does childhood adversity account for poorer mental and physical health in second-generation Irish people living in Britain? Birth cohort study from Britain (NCDS).

    Science.gov (United States)

    Das-Munshi, Jayati; Clark, Charlotte; Dewey, Michael E; Leavey, Gerard; Stansfeld, Stephen A; Prince, Martin J

    2013-03-01

    Worldwide, the Irish diaspora experience elevated mortality and morbidity across generations, not accounted for through socioeconomic position. The main objective of the present study was to assess if childhood disadvantage accounts for poorer mental and physical health in adulthood, in second-generation Irish people. Analysis of prospectively collected birth cohort data, with participants followed to midlife. England, Scotland and Wales. Approximately 17 000 babies born in a single week in 1958. Six per cent of the cohort were of second-generation Irish descent. Primary outcomes were common mental disorders assessed at age 44/45 and self-rated health at age 42. Secondary outcomes were those assessed at ages 23 and 33. Relative to the rest of the cohort, second-generation Irish children grew up in marked material and social disadvantage, which tracked into early adulthood. By midlife, parity was reached between second-generation Irish cohort members and the rest of the sample on most disadvantage indicators. At age 23, Irish cohort members were more likely to screen positive for common mental disorders (OR 1.44; 95% CI 1.06 to 1.94). This had reduced slightly by midlife (OR 1.27; 95% CI 0.96 to 1.69). Although at age 23 second-generation cohort members were just as likely to report poorer self-rated health (OR 1.06; 95% CI 0.79 to 1.43), by midlife this difference had increased (OR 1.25; 95% CI 0.98 to 1.60). Adjustment for childhood and early adulthood adversity fully attenuated differences in adult health disadvantages. Social and material disadvantage experienced in childhood continues to have long-range adverse effects on physical and mental health at midlife, in second-generation Irish cohort members. This suggests important mechanisms over the life-course, which may have important policy implications in the settlement of migrant families.

  13. Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study.

    Science.gov (United States)

    Newbigging, Karen; Mohan, John; Rees, James; Harlock, Jenny; Davis, Alex

    2017-11-08

    Timely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. This study aims to address this. The study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact. The University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16-1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

  14. Dietary Fat Intake and Fecundability in 2 Preconception Cohort Studies

    DEFF Research Database (Denmark)

    Wise, Lauren A; Wesselink, Amelia K; Tucker, Katherine L

    2018-01-01

    American preconception cohort studies. Women who were attempting to become pregnant completed a validated food frequency questionnaire at baseline. Pregnancy status was updated bimonthly for 12 months or until pregnancy. Fecundability ratios (FR) and 95% confidence intervals were estimated using......The association between dietary fat and fertility is not well studied. We evaluated intakes of total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, trans fatty acids (TFA), ω-3 fatty acids, and ω-6 fatty acids in relation to fecundability in Danish and North......-response relationship (among persons who did not use fish oil supplements: for the fourth quartile vs. the first, FR = 1.40, 95% CI: 1.13, 1.73); no association was found in Danish women, among whom low intake was rare. In the present study, high TFA intake and low ω-3 fatty acid intake were associated with reduced...

  15. The Congenital Heart Disease Genetic Network Study: Cohort description.

    Science.gov (United States)

    Hoang, Thanh T; Goldmuntz, Elizabeth; Roberts, Amy E; Chung, Wendy K; Kline, Jennie K; Deanfield, John E; Giardini, Alessandro; Aleman, Adolfo; Gelb, Bruce D; Mac Neal, Meghan; Porter, George A; Kim, Richard; Brueckner, Martina; Lifton, Richard P; Edman, Sharon; Woyciechowski, Stacy; Mitchell, Laura E; Agopian, A J

    2018-01-01

    The Pediatric Cardiac Genomics Consortium (PCGC) designed the Congenital Heart Disease Genetic Network Study to provide phenotype and genotype data for a large congenital heart defects (CHDs) cohort. This article describes the PCGC cohort, overall and by major types of CHDs (e.g., conotruncal defects) and subtypes of conotrucal heart defects (e.g., tetralogy of Fallot) and left ventricular outflow tract obstructions (e.g., hypoplastic left heart syndrome). Cases with CHDs were recruited through ten sites, 2010-2014. Information on cases (N = 9,727) and their parents was collected through interviews and medical record abstraction. Four case characteristics, eleven parental characteristics, and thirteen parent-reported neurodevelopment outcomes were summarized using counts and frequencies and compared across CHD types and subtypes. Eleven percent of cases had a genetic diagnosis. Among cases without a genetic diagnosis, the majority had conotruncal heart defects (40%) or left ventricular outflow tract obstruction (21%). Across CHD types, there were significant differences (ptypes and subtypes, provides a reference work for investigators who are interested in collaborating with or using publically available resources from the PCGC.

  16. Relevance of cohort studies for the study of transplant infectious diseases.

    Science.gov (United States)

    Berger, Christoph; Boggian, Katia; Cusini, Alexia; van Delden, Christian; Garzoni, Christian; Hirsch, Hans H; Khanna, Nina; Koller, Michael; Manuel, Oriol; Meylan, Pascal; Nadal, David; Weisser, Maja; Mueller, Nicolas J

    2012-12-01

    The debate on the merits of observational studies as compared with randomized trials is ongoing. We will briefly touch on this subject, and demonstrate the role of cohort studies for the description of infectious disease patterns after transplantation. The potential benefits of cohort studies for the clinical management of patients outside of the expected gain in epidemiological knowledge are reviewed. The newly established Swiss Transplantation Cohort Study and in particular the part focusing on infectious diseases will serve as an illustration. A neglected area of research is the indirect value of large, multicenter cohort studies. These benefits can range from a deepened collaboration to the development of common definitions and guidelines. Unfortunately, very few data exist on the role of such indirect effects on improving quality of patient management. This review postulates an important role for cohort studies, which should not be viewed as inferior but complementary to established research tools, in particular randomized trials. Randomized trials remain the least bias-prone method to establish knowledge regarding the significance of diagnostic or therapeutic measures. Cohort studies have the power to reflect a real-world situation and to pinpoint areas of knowledge as well as of uncertainty. Prerequisite is a prospective design requiring a set of inclusive data coupled with the meticulous insistence on data retrieval and quality.

  17. A population-based cohort study of oral health in South Brazil : the Porto Alegre study

    OpenAIRE

    Haas, Alex Nogueira; GAIO,Eduardo José; Wagner, Marcius Comparsi; Rios, Fernando Silva; Costa,Ricardo dos Santos Araujo; Rösing, Cassiano Kuchenbecker; Oppermann, Rui Vicente; Albandar, Jasim M.; Susin, Cristiano

    2015-01-01

    Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals....

  18. A population-based cohort study of oral health in South Brazil: The Porto Alegre Study

    OpenAIRE

    Alex Nogueira Haas; Eduardo José Gaio; Marcius Comparsi Wagner; Fernando Silva Rios; Ricardo dos Santos Araujo Costa; Cassiano Kuchenbecker Rösing; Rui Vicente Oppermann; Jasim Albandar; Cristiano Susin

    2015-01-01

    Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals....

  19. Incidence and Prevalence of Childhood Epilepsy: A Nationwide Cohort Study.

    Science.gov (United States)

    Aaberg, Kari Modalsli; Gunnes, Nina; Bakken, Inger Johanne; Lund Søraas, Camilla; Berntsen, Aleksander; Magnus, Per; Lossius, Morten I; Stoltenberg, Camilla; Chin, Richard; Surén, Pål

    2017-05-01

    Epilepsy affects 0.5% to 1% of children and is the most frequent chronic neurologic condition in childhood. Incidence rates appear to be declining in high-income countries. The validity of epilepsy diagnoses from different data sources varies, and contemporary population-based incidence studies are needed. The study was based on the Norwegian Mother and Child Cohort Study. Potential epilepsy cases were identified through registry linkages and parental questionnaires. Cases were validated through medical record reviews and telephone interviews of parents. The study population included 112 744 children aged 3 to 13 years (mean 7.4 years) at end of registry follow-up (December 31, 2012). Of these, 896 had registry recordings and/or questionnaire reports of epilepsy. After validation, 587 (66%) met the criteria for an epilepsy diagnosis. The incidence rate of epilepsy was 144 per 100 000 person-years in the first year of life and 58 per 100 000 for ages 1 to 10 years. The cumulative incidence of epilepsy was 0.66% at age 10 years, with 0.62% having active epilepsy. The 309 children (34%) with erroneous reports of epilepsy from the registry and/or the questionnaires had mostly been evaluated for nonepileptic paroxysmal events, or they had undergone electroencephalography examinations because of other developmental or neurocognitive difficulties. Approximately 1 out of 150 children is diagnosed with epilepsy during the first 10 years of life, with the highest incidence rate observed during infancy. Validation of epilepsy diagnoses in administrative data and cohort studies is crucial because reported diagnoses may not meet diagnostic criteria for epilepsy. Copyright © 2017 by the American Academy of Pediatrics.

  20. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies

    DEFF Research Database (Denmark)

    Jackson, D.; White, I.; Kostis, J.B.

    2009-01-01

    One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an...

  1. Health and function of participants in the Long Life Family Study: A comparison with other cohorts

    DEFF Research Database (Denmark)

    Newman, Anne B; Glynn, Nancy W; Taylor, Christopher A

    2011-01-01

    Individuals from families recruited for the Long Life Family Study (LLFS) (n= 4559) were examined and compared to individuals from other cohorts to determine whether the recruitment targeting longevity resulted in a cohort of individuals with better health and function. Other cohorts with similar...

  2. London, England

    Science.gov (United States)

    2003-01-01

    For almost 2,000 years, the River Thames has served as the life force of London, capital of the United Kingdom and one of the world's most famous cities. In AD 43 the Romans established the trading settlement of Londinium at a favorable crossing point on the river. The Romans remained until the 5th century, when the city came under Saxon control. The early 17th century saw enormous growth, but the deadly plague of 1664 and 1665 ravaged the population, and in the following year the Great Fire, which burned for four days, destroyed most of the city. A public transportation system and other city services in the early 19th century eased many of the increasing urban problems of the burgeoning capital of the wealthy British Empire. After coping with the devastating effects of bombing during World War II and the gradual dismantling of the empire, London today thrives as a vital modern metropolis. London is one of 100 cities being studied using ASTER data to map and monitor urban use patterns and growth.This image was acquired on October 12, 2001 by the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) on NASA's Terra satellite. With its 14 spectral bands from the visible to the thermal infrared wavelength region, and its high spatial resolution of 15 to 90 meters (about 50 to 300 feet), ASTER images Earth to map and monitor the changing surface of our planet.ASTER is one of five Earth-observing instruments launched December 18, 1999, on NASA's Terra satellite. The instrument was built by Japan's Ministry of Economy, Trade and Industry. A joint U.S./Japan science team is responsible for validation and calibration of the instrument and the data products.The broad spectral coverage and high spectral resolution of ASTER will provide scientists in numerous disciplines with critical information for surface mapping, and monitoring of dynamic conditions and temporal change. Example applications are: monitoring glacial advances and retreats; monitoring

  3. A study of cohort life cycles: Cohorts of native born Massachusetts women, 1830-1920.

    Science.gov (United States)

    Uhlenberg, P R

    1969-11-01

    Abstract This paper expands the conceptual apparatus offamily life cycle analysis and illustrates its usefulness by applying it to a population. There is a normatively sanctioned life cycle that a female born into American society is expected to follow as she moves from birth to death: she is expected to survive through childhood, marry, bear and rear children, and survive jointly with her husband until her children leave the home. Paul Glick, in several articles, has calculated mean ages at which these various events are experienced. The life cycle analysis proposed here, however, focuses on the distribution of women according to type of life cycle experienced. Starting with a cohort of 100,000 females, six alternative life cycle possibilities are differentiated and the number who follow each of the types is calculated. The six types are: (1) abbreviated, the female dies before she is exposed to the risk of marriage; (2) spinster, the woman is exposed to the risk of marriage but does not marry; (3) barren, the woman marries but remains childless; (4) dying mother, the woman has children but dies before the last one leaves home; (5) widowed mother, the woman has children and survives until they leave home, but her husband dies before that event; and (6) typical, the woman marries, has children, and survives jointly with her husband until the last one leaves home. Applying this approach to several cohorts of native-born Massachusetts women born at different times some striking changes appear. For example, the number of women from a birth cohort of 100,000 who follow the typical life cycle increases from 21,000 for the cohort born in 1830 to 57,000 for the cohort born in 1920. The demographic, social and economic implications of a change of this magnitude are of considerable consequence.

  4. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study.

    Science.gov (United States)

    Hippisley-Cox, Julia; Coupland, Carol; Brindle, Peter

    2017-05-23

    Objectives To develop and validate updated QRISK3 prediction algorithms to estimate the 10 year risk of cardiovascular disease in women and men accounting for potential new risk factors.Design Prospective open cohort study.Setting General practices in England providing data for the QResearch database.Participants 1309 QResearch general practices in England: 981 practices were used to develop the scores and a separate set of 328 practices were used to validate the scores. 7.89 million patients aged 25-84 years were in the derivation cohort and 2.67 million patients in the validation cohort. Patients were free of cardiovascular disease and not prescribed statins at baseline.Methods Cox proportional hazards models in the derivation cohort to derive separate risk equations in men and women for evaluation at 10 years. Risk factors considered included those already in QRISK2 (age, ethnicity, deprivation, systolic blood pressure, body mass index, total cholesterol: high density lipoprotein cholesterol ratio, smoking, family history of coronary heart disease in a first degree relative aged less than 60 years, type 1 diabetes, type 2 diabetes, treated hypertension, rheumatoid arthritis, atrial fibrillation, chronic kidney disease (stage 4 or 5)) and new risk factors (chronic kidney disease (stage 3, 4, or 5), a measure of systolic blood pressure variability (standard deviation of repeated measures), migraine, corticosteroids, systemic lupus erythematosus (SLE), atypical antipsychotics, severe mental illness, and HIV/AIDs). We also considered erectile dysfunction diagnosis or treatment in men. Measures of calibration and discrimination were determined in the validation cohort for men and women separately and for individual subgroups by age group, ethnicity, and baseline disease status.Main outcome measures Incident cardiovascular disease recorded on any of the following three linked data sources: general practice, mortality, or hospital admission records.Results 363

  5. Weight at birth and subsequent fecundability: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Cathrine Wildenschild

    Full Text Available To examine the association between a woman's birth weight and her subsequent fecundability.In this prospective cohort study, we included 2,773 Danish pregnancy planners enrolled in the internet-based cohort study "Snart-Gravid", conducted during 2007-2012. Participants were 18-40 years old at study entry, attempting to conceive, and were not receiving fertility treatment. Data on weight at birth were obtained from the Danish Medical Birth Registry and categorized as <2,500 grams, 2,500-2,999 grams, 3,000-3,999 grams, and ≥ 4,000 grams. In additional analyses, birth weight was categorized according to z-scores for each gestational week at birth. Time-to-pregnancy measured in cycles was used to compute fecundability ratios (FR and 95% confidence intervals (CI, using a proportional probabilities regression model.Relative to women with a birth weight of 3,000-3,999 grams, FRs adjusted for gestational age, year of birth, and maternal socio-demographic and medical factors were 0.99 (95% CI: 0.73;1.34, 0.99 (95% CI: 0.87;1.12, and 1.08 (95% CI: 0.94;1.24 for birth weight <2,500 grams, 2,500-2,999 grams, and ≥ 4,000 grams, respectively. Estimates remained unchanged after further adjustment for markers of the participant's mother's fecundability. We obtained similar results when we restricted to women who were born at term, and to women who had attempted to conceive for a maximum of 6 cycles before study entry. Results remained similar when we estimated FRs according to z-scores of birth weight.Our results indicate that birth weight appears not to be an important determinant of fecundability.

  6. Steroid withdrawal after renal transplantation: a retrospective cohort study.

    Science.gov (United States)

    Haller, Maria C; Kammer, Michael; Kainz, Alexander; Baer, Heather J; Heinze, Georg; Oberbauer, Rainer

    2017-01-12

    Immunosuppressive regimens in renal transplantation frequently contain corticosteroids, but many centers withdraw steroids as a consequence of unwanted side effects of steroids. The optimal timing to withdraw steroids after transplantation, however, remains unclear. The aim of this study was to determine an optimal time point following kidney transplantation that is associated with reduced mortality without jeopardizing the allograft to allow safe discontinuation of steroids. We conducted a retrospective cohort study and computed a concatenated landmark-stratified Cox supermodel to estimate hazard ratios and 95% confidence intervals for mortality and graft loss using dynamic propensity score matching to adjust for confounding by indication. A total of 6070 first kidney transplant recipients in the Austrian Dialysis and Transplant Registry who were transplanted between 1990 and 2012 were evaluated and classified according to steroid treatment status throughout follow-up after kidney transplantation; 2142 patients were withdrawn from steroids during the study period. Overall, 1131 patients lost their graft and 821 patients in the study cohort died. Steroid withdrawal within 18 months after transplantation was associated with an increased rate of graft loss compared to steroid maintenance during that time (6 months after transplantation: HR = 1.8; 95% CI, 1.3 to 2.6; 18 months after transplantation: HR = 1.3; 95% CI, 1.1 to 1.6; 24 months after transplantation: HR = 1.2; 95% CI, 0.9 to 1.5), while mortality was not different between groups. Our findings suggest that steroid withdrawal after anti-IL-2 induction in the first 18 months after transplantation is associated with an increased risk of allograft loss.

  7. Health Technology Assessment (HTA) Case Studies: Factors Influencing Divergent HTA Reimbursement Recommendations in Australia, Canada, England, and Scotland.

    Science.gov (United States)

    Allen, Nicola; Walker, Stuart R; Liberti, Lawrence; Salek, Sam

    2017-03-01

    To evaluate the national regulatory, health technology assessment (HTA), and reimbursement pathways for public health care in Australia, Canada, England, and Scotland, to compare initial Canadian national HTA recommendations with the initial decisions of the other HTA agencies, and to identify factors for differing national HTA recommendations between the four HTA agencies. Information from the public domain was used to develop a regulatory process map for each jurisdiction and to compare the HTA agencies' reimbursement recommendations. Medicines that were reviewed by all four agencies and received a negative recommendation from only one agency were selected as case studies. All four countries have a national HTA agency. Their reimbursement recommendations are guided by both clinical efficacy and cost-effectiveness, and the necessity for patient input. Their activities, however, vary because of different mandates and their unique political, social, and population needs. All have an implicit or explicit quality-adjusted life-year threshold. The seven divergent case studies demonstrate examples in which new medicine-indication pairs have been rejected because of uncertainties surrounding a range of factors including cost-effectiveness, comparator choice, clinical benefit, safety, trial design, and submission timing. The four HTA agencies selected for inclusion in this study share common factors, including a focus on clinical efficacy and cost-effectiveness in their decision-making processes. The differences in recommendations could be considered to be due to an individual agency's approach to risk perception, and the comparator choice used in clinical and cost-effectiveness studies. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. perinatal depression in a cohort study of Iranian women

    Directory of Open Access Journals (Sweden)

    Gholam Reza Kheirabadi

    2010-01-01

    Full Text Available Introduction: Childbearing years in the women’s life are associated with the highest risk of depression. Despite the results of some studies that suggested, depression during pregnancy has been associated with poor prenatal care, substance abuse, low birth weight, and preterm delivery and introduced antenatal depression and anxiety as predictors of postnatal depression, researches during past 25 years have focused mostly on postpartum depression so depression during pregnancy is relatively neglected. Materials and methods: We studied depression during third trimester of pregnancy and after delivery, using prospectively gathered data from a cohort of 1898 women. We compared depressive symptom score and the proportion of mothers above a threshold, to indicate probable depressive disorder at each stage. Results: Point prevalence of depressed pregnant women (clinical depression based on BDI score greater than 20 in last trimester of pregnancy, was 22.8% and postnatal rate of depression based on EPD score greater than 12 between 6 to 8 weeks after delivery, was 26.3%. Incidence of PPD in 6 to 8 weeks after delivery in those who were not clinically depressed during pregnancy was, 20.1%. Discussion: We found that history of depression, unplanned pregnancy; being housewife and having 3 or more children were variables with significant relation to ante partum depression. Two main risk factors for post partum depression in this cohort study, were previous history of depression and depression during current pregnancy that highlight the importance of these two variables assessment during pregnancy in order to facilitate timely identification of women at risk.

  9. Glucocorticoid receptor haplotype and metabolic syndrome: the Lifelines cohort study.

    Science.gov (United States)

    Wester, Vincent L; Koper, Jan W; van den Akker, Erica L T; Franco, Oscar H; Stolk, Ronald P; van Rossum, Elisabeth F C

    2016-12-01

    An excess of glucocorticoids (Cushing's syndrome) is associated with metabolic syndrome (MetS) features. Several single-nucleotide polymorphisms (SNPs) in the glucocorticoid receptor (GR) gene influence sensitivity to glucocorticoids and have been associated with aspects of MetS. However, results are inconsistent, perhaps due to the heterogeneity of the studied populations and limited samples. Furthermore, the possible association between functional GR SNPs and prevalence of MetS remains unexplored. Cross-sectional population-based cohort study. MetS presence and carriage of functional GR SNPs (BclI, N363S, ER22/23EK, GR-9beta) were determined in 12 552 adult participants from Lifelines, a population-based cohort study in the Netherlands. GR SNPs were used to construct GR haplotypes. Five haplotypes accounted for 99.9% of all GR haplotypes found. No main effects of functional GR haplotypes on MetS were found, but the association of GR haplotype 4 (containing N363S) with MetS was influenced by interaction with age, sex and education status (P haplotype 4 increased MetS presence in younger men (at or below the median age of 47; odds ratio 1.77, P = 0.005) and in people of low education status (odds ratio 1.48, P = 0.039). A glucocorticoid receptor haplotype that confers increased sensitivity to glucocorticoids appears to increase the risk of metabolic syndrome, but only among younger men and less educated individuals, suggesting gene-environment interactions. © 2016 European Society of Endocrinology.

  10. Understanding Bullying Experiences among Sexual Minority Youths in England. Centre for Longitudinal Studies Working Paper 2015/8

    Science.gov (United States)

    Henderson, Morag

    2015-01-01

    The detrimental consequences for victims of bullying are well established. Despite this there remains little empirical evidence about the relationship between sexual minority status including Lesbian, Gay and Bisexual (LGB) and bullying among young people in England. The aim of this paper is to identify whether LGB youth are more at risk of…

  11. Self-Esteem and Academic Achievement: A Comparative Study of Adolescent Students in England and the United States

    Science.gov (United States)

    Booth, Margaret Zoller; Gerard, Jean M.

    2011-01-01

    Utilizing mixed methodology, this paper investigates the relationship between self-esteem and academic achievement for young adolescents within two Western cultural contexts: the United States and England. Quantitative and qualitative data from 86 North American and 86 British adolescents were utilized to examine the links between self-esteem and…

  12. The Role of Teachers' Orientation to Learning in Professional Development and Change: A National Study of Teachers in England

    Science.gov (United States)

    Opfer, V. Darleen; Pedder, David G.; Lavicza, Zsolt

    2011-01-01

    This paper uses results from a national survey of teachers in England to test a hypothesised model of teacher orientation to learning (consisting of beliefs, practice and experiences about learning) and its relationship to teacher learning change. Results from a structural equation modeling process of 1126 teacher survey responses show that…

  13. Incorporating global warming risks in power sector planning: A case study of the New England region. Volume 2, Appendices

    Energy Technology Data Exchange (ETDEWEB)

    Krause, F.; Busch, J.; Koomey, J.

    1992-11-01

    The following topics are described in reference to electric power production in New England: Fuel Prices; Emission Factors and Externality Surcharges; Cost and Potential of Demand-Site Efficiency Improvements; Fuel Switching; Conventional Utility Generation; Gas Supply Constraints; Cogeneration Potential; Biomass Resources; Potential Power Production from Municipal Solid Waste; and Wind Resource Potential.

  14. Inclusive Physical Education? A Study of the Management of National Curriculum Physical Education and Unplanned Outcomes in England

    Science.gov (United States)

    Haycock, David; Smith, Andy

    2010-01-01

    One key aspect of the growing policy emphasis on educational inclusion in England has been the tendency for physical education (PE) to be used as an important vehicle of social policy targeted at promoting the inclusion of young disabled people and those with special educational needs in mainstream schools. Drawing on aspects of figurational…

  15. The Changing Face of Teaching in England and Portugal: A Study of Work Experiences of Secondary School Teachers.

    Science.gov (United States)

    Day, Christopher; Pacheco, Jose; Flores, Maria Annuncao; Hadfield, Mark; Morgado, Jose C.

    2003-01-01

    Investigates the perceived effects of educational reform among secondary school teachers in England and Portugal, focusing on teachers' experiences in these two communities, which are in different transition phases. By doing so, it is possible, even within the different cultures, to identify common problems teachers experience within the reforms…

  16. Risk factors in clinically diagnosed presenile dementia of the Alzheimer type: a case-control study in northern England.

    Science.gov (United States)

    Forster, D P; Newens, A J; Kay, D W; Edwardson, J A

    1995-01-01

    STUDY OBJECTIVE--To investigate the relationship between presenile dementia of the Alzheimer type (PDAT) and family history, medical history, cigarette smoking, and exposure to aluminum. DESIGN--A case-control study in which 109 cases of clinically diagnosed PDAT and 109 controls matched for age and sex were compared for exposure to the risk factors. Odds ratios (ORs) were calculated using McNemar's test. SETTING--The northern health region of England. PATIENTS--Cases comprised those under 65 years diagnosed as having dementia by specialist services, who met clinical algorithm criteria for Alzheimer's disease (AD). Cases were confirmed at interview. MAIN RESULTS--Comparing cases with controls, (ORs) significantly greater than unity were obtained when there was a first degree relative with dementia (OR 2.5, 95% confidence interval 1.05, 6.56), any relative with dementia (OR 2.1, 95% CI 1.01, 4.55), and any relative aged less than 65 with dementia (OR 8.0, 95% CI 1.07, 348). Exposure to moderate levels of cigarette smoking (cumulative) was not significant; nor was exposure to aluminum in drinking water, diet, and medicinal sources. CONCLUSION--In this study of modest statistical power, a family history of dementia was confirmed as a risk factor in PDAT. No significant relationship between exposure to aluminium in water supplies, tea, and antacids was found. What is important, however, is the bioavailability of all dietary aluminium, determined by the concentrations of dissolved silicon in water: this requires further investigation. PMID:7629459

  17. Adult patients' experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England.

    Science.gov (United States)

    Broughton, Jessica; Harris, Sarah; Beasant, Lucy; Crawley, Esther; Collin, Simon M

    2017-06-02

    Few studies have explored patients' experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England. Semi-structured interviews were conducted during the period June-September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views. Three themes were identified: 'Journey to specialist services'; 'Things that help or hinder treatment'; and 'Support systems'. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants' experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients' experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society. The experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients' journeys towards an improved quality of life. This improvement came about through a process which included validation of patients' experiences, acceptance of change, practical advice and support, and therapeutic outcomes.

  18. Early life risk factors for obesity in childhood: cohort study

    Science.gov (United States)

    Reilly, John J; Armstrong, Julie; Dorosty, Ahmad R; Emmett, Pauline M; Ness, A; Rogers, I; Steer, Colin; Sherriff, Andrea

    2005-01-01

    Objective To identify risk factors in early life (up to 3 years of age) for obesity in children in the United Kingdom. Design Prospective cohort study. Setting Avon longitudinal study of parents and children, United Kingdom. Participants 8234 children in cohort aged 7 years and a subsample of 909 children (children in focus) with data on additional early growth related risk factors for obesity. Main outcome measures Obesity at age 7 years, defined as a body mass index 3 95th centile relative to reference data for the UK population in 1990. Results Eight of 25 putative risk factors were associated with a risk of obesity in the final models: parental obesity (both parents: adjusted odds ratio, 10.44, 95% confidence interval 5.11 to 21.32), very early (by 43 months) body mass index or adiposity rebound (15.00, 5.32 to 42.30), more than eight hours spent watching television per week at age 3 years (1.55, 1.13 to 2.12), catch-up growth (2.60, 1.09 to 6.16), standard deviation score for weight at age 8 months (3.13, 1.43 to 6.85) and 18 months (2.65, 1.25 to 5.59); weight gain in first year (1.06, 1.02 to 1.10 per 100 g increase); birth weight, per 100 g (1.05, 1.03 to 1.07); and short (< 10.5 hours) sleep duration at age 3 years (1.45, 1.10 to 1.89). Conclusion Eight factors in early life are associated with an increased risk of obesity in childhood. PMID:15908441

  19. Prevalence of Hypertensive Phenotypes After Preeclampsia: A Prospective Cohort Study.

    Science.gov (United States)

    Ditisheim, Agnès; Wuerzner, Grégoire; Ponte, Belen; Vial, Yvan; Irion, Olivier; Burnier, Michel; Boulvain, Michel; Pechère-Bertschi, Antoinette

    2018-01-01

    Preeclampsia is associated with increased cardiovascular and renal risk. The aim of this prospective cohort study was to characterize the early postpartum blood pressure (BP) profile after preeclampsia. We enrolled 115 women with preeclampsia and 41 women with a normal pregnancy in a prospective cohort study. At 6 to 12 week postpartum, we assessed the prevalence of different hypertensive phenotypes using 24-hour ambulatory BP monitoring (ABPM), as well as the risk of salt sensitivity and the variability of BP derived from ABPM parameters. Among patients with preeclampsia, 57.4% were still hypertensive at the office. Daytime ABP was significantly higher in the preeclampsia group (118.9±15.0/83.2±10.4 mm Hg) than in controls (104.8±7.9/71.6±5.3 mm Hg; P preeclampsia women remained hypertensive on ABPM in the postpartum, of whom 24.3% were still under antihypertensive treatment; 17.9% displayed a white-coat hypertension and 11.6% had masked hypertension. In controls, 2.8% had white-coat hypertension; none had masked hypertension or needed hypertensive treatment. The prevalence of nondippers was similar 59.8% in the preeclampsia group versus 51.4% in controls. High-risk class of salt sensitivity of BP was increased in preeclampsia women (48.6%) compared with controls (17.1%); P preeclampsia. This finding may help identify women who should be included in a postpartum cardiovascular risk management program. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01095939. © 2017 American Heart Association, Inc.

  20. Listeria monocytogenes infection in the over-60s in England between 2005 and 2008: a retrospective case-control study utilizing market research panel data.

    Science.gov (United States)

    Gillespie, Iain A; Mook, Piers; Little, Christine L; Grant, Kathie; Adak, Goutam K

    2010-11-01

    A retrospective case-control study of listeriosis in patients in England aged over 60 years is described. The incidence of listeriosis in patients aged ≥60 years in England has doubled since 2001; hence, the investigation of risk factors for infection in this group is important to inform on prevention and control. Standardized epidemiological information has been sought on cases since 2005, but the value of the data accrued is limited without some perception of exposure prevalence in the population at risk of listeriosis. The exposures of listeriosis cases aged ≥60 years reported in England from 2005 to 2008 were compared to those of market research panel members representing the same population (i.e., residents of England aged ≥60 years) and time period. Exposures were grouped to facilitate comparison. Odds ratios and 95% confidence intervals were calculated. Cases were more likely than panel members to report the consumption of cooked meats (beef and ham/pork, but not poultry), cooked fish (specifically smoked salmon) and shellfish (prawns), dairy products (most noticeably milk but also certain cheeses), and mixed salads. They were less likely to report the consumption of other forms of seafood, dairy spread, other forms of dairy, sandwiches, and fresh vegetables. The diversity of high-risk food exposures reflects the ubiquity of the microorganism in the environment and/or the susceptibility of those at risk, and suggests that a wider variety of foods can give rise to listeriosis. Food safety advice on avoiding listeriosis should be adapted accordingly. While not inexpensive, the application of market research data to infectious disease epidemiology can add value to routine surveillance data.

  1. Public attitudes towards alcohol control policies in Scotland and England: Results from a mixed-methods study.

    Science.gov (United States)

    Li, Jessica; Lovatt, Melanie; Eadie, Douglas; Dobbie, Fiona; Meier, Petra; Holmes, John; Hastings, Gerard; MacKintosh, Anne Marie

    2017-03-01

    The harmful effects of heavy drinking on health have been widely reported, yet public opinion on governmental responsibility for alcohol control remains divided. This study examines UK public attitudes towards alcohol policies, identifies underlying dimensions that inform these, and relationships with perceived effectiveness. A cross-sectional mixed methods study involving a telephone survey of 3477 adult drinkers aged 16-65 and sixteen focus groups with 89 adult drinkers in Scotland and England was conducted between September 2012 and February 2013. Principal components analysis (PCA) was used to reduce twelve policy statements into underlying dimensions. These dimensions were used in linear regression models examining alcohol policy support by demographics, drinking behaviour and perceptions of UK drinking and government responsibility. Findings were supplemented with a thematic analysis of focus group transcripts. A majority of survey respondents supported all alcohol policies, although the level of support varied by type of policy. Greater enforcement of laws on under-age sales and more police patrolling the streets were strongly supported while support for pricing policies and restricting access to alcohol was more divided. PCA identified four main dimensions underlying support on policies: alcohol availability, provision of health information and treatment services, alcohol pricing, and greater law enforcement. Being female, older, a moderate drinker, and holding a belief that government should do more to reduce alcohol harms were associated with higher support on all policy dimensions. Focus group data revealed findings from the survey may have presented an overly positive level of support on all policies due to differences in perceived policy effectiveness. Perceived effectiveness can help inform underlying patterns of policy support and should be considered in conjunction with standard measures of support in future research on alcohol control policies

  2. Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study.

    Science.gov (United States)

    Dale, Jeremy; Russell, Rachel; Scott, Emma; Owen, Katherine

    2017-08-17

    General practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans. Online questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach. Doctors approaching the end of 3-year GP vocational training in the West Midlands, England. 178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers.The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work-life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media. This study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level. © Article author(s) (or their employer(s) unless

  3. A high resolution study of benthic foraminifera, planktonic foraminifera and geochemistry of the latest cenomanian at eastbourne, england

    Science.gov (United States)

    Gustafsson, M.; Petrizzo, M.-R.; Tsikos, H.; Turgeon, S.

    2003-04-01

    The Eastbourne section in southern England is the most expanded and complete Cenomanian/Turonian boundary interval (CTBI) record in NW Europe. A high time resolution study of benthic and planktonic foraminifera, chemical element data and stable isotope records for oxygen and carbon has been performed on this section. The objective of this study is to obtain detailed information of changes in productivity during the build-up of the global carbon isotope excursion. Milankovitch cyclicity apparently correlates with benthic foraminiferal fluctuations through the Plenus Marls. Generally it is the high productivity indicators Praebulimina elata and Gavelinella dakotensis that fluctuate. This indicates a fluctuation in the productivity, perhaps controlled by upwelling. During the build-up of the carbon isotope excursion there is a general decrease in species richness for both benthic and planktonic foraminifera. We observed a significant long-term change in benthic foraminiferal assemblages that indicates an environmental change from oligotrophic to eutrophic conditions. While oligotrophic taxa dominates within the lower part of the Plenus Marls, the high productivity indicators P. elata and G. dakotensis successively take over and dominates in the upper part of the marls. A change in the planktonic foraminiferal assemblages also indicates a change from oligotrophic to more eutrophic conditions. After the first carbon isotope peak the oligotrophic indicating Rotalipora cushmani decreases in number and become extinct the assemblage is then dominated by more opportunistic taxa. Above in the second carbon isotope peak high numbers of Whiteinellids and Heterohelicids probably indicate the establishment of more eutrophic conditions. The oxygen isotopes and initial Mg/Ca and Sr/Ca measurements on picked planktonic foraminifera seem to register a decrease in temperature or more likely an increasing degree of diagenetic alteration upwards throughout the Plenus Marls.

  4. Self-harm and life problems: findings from the Multicentre Study of Self-harm in England.

    Science.gov (United States)

    Townsend, Ellen; Ness, Jennifer; Waters, Keith; Kapur, Navneet; Turnbull, Pauline; Cooper, Jayne; Bergen, Helen; Hawton, Keith

    2016-02-01

    Self-harm is a major clinical problem and is strongly linked to suicide. It is important to understand the problems faced by those who self-harm to design effective clinical services and suicide prevention strategies. We investigated the life problems experienced by patients presenting to general hospitals for self-harm. Data for 2000-2010 from the Multicentre Study of Self-harm in England were used to investigate life problems associated with self-harm and their relationship to patient and clinical characteristics, including age, gender, repeat self-harm and employment status. Of 24,598 patients (36,431 assessed episodes), 57% were female and with a mean age of 33.1 years (SD 14.0 years), 92.6% were identified as having at least one contributing life problem. The most frequently reported problems at first episode of self-harm within the study period were relationship difficulties (especially with partners). Mental health issues and problems with alcohol were also very common (especially in those aged 35-54 years, and those who repeated self-harm). Those who repeated self-harm were more likely to report problems with housing, mental health and dealing with the consequences of abuse. Self-harm usually occurs in the context of multiple life problems. Clinical services for self-harm patients should have access to appropriate care for provision of help for relationship difficulties and problems concerning alcohol and mental health issues. Individualised clinical support (e.g. psychological therapy, interventions for alcohol problems and relationship counselling) for self-harm patients facing these life problems may play a crucial role in suicide prevention.

  5. Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data.

    Directory of Open Access Journals (Sweden)

    Manisha Nair

    Full Text Available As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1 the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI by reproducing an Australian indicator using routinely available hospital data, 2 the impact of modifications to the indicator to address potential data quality issues, 3 the reliability of the indicator.We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES database of the Health and Social care Information centre (HSCIC. A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.EMMOI included 26 morbid events (17 diagnosis and 9 procedures. Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.

  6. Achieving progress through clinical governance? A national study of health care managers' perceptions in the NHS in England.

    Science.gov (United States)

    Freeman, T; Walshe, K

    2004-10-01

    A national cross sectional study was undertaken to explore the perceptions concerning the importance of, and progress in, aspects of clinical governance among board level and directorate managers in English acute, ambulance, and mental health/learning disabilities (MH/LD) trusts. A stratified sample of acute, ambulance, and mental health/learning disabilities trusts in England (n = 100), from each of which up to 10 board level and 10 directorate level managers were randomly sampled. Fieldwork was undertaken between April and July 2002 using the Organisational Progress in Clinical Governance (OPCG) schedule to explore managers' perceptions of the importance of, and organisational achievement in, 54 clinical governance competency items in five aggregated domains: improving quality; managing risks; improving staff performance; corporate accountability; and leadership and collaboration. The difference between ratings of importance and achievement was termed a shortfall. Of 1916 individuals surveyed, 1177 (61.4%) responded. The competency items considered most important and recording highest perceived achievement related to corporate accountability structures and clinical risks. The highest shortfalls between perceived importance and perceived achievement were reported in joint working across local health communities, feedback of performance data, and user involvement. When aggregated into domains, greatest achievement was perceived in the assurance related areas of corporate accountability and risk management, with considerably less perceived achievement and consequently higher shortfalls in quality improvement and leadership and collaboration. Directorate level managers' perceptions of achievement were found to be significantly lower than those of their board level colleagues on all domains other than improving performance. No differences were found in perceptions of achievement between different types of trusts, or between trusts at different stages in the Commission

  7. Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data.

    Science.gov (United States)

    Nair, Manisha; Kurinczuk, Jennnifer J; Knight, Marian

    2016-01-01

    As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1) the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI) by reproducing an Australian indicator using routinely available hospital data, 2) the impact of modifications to the indicator to address potential data quality issues, 3) the reliability of the indicator. We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES) database of the Health and Social care Information centre (HSCIC). A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies. EMMOI included 26 morbid events (17 diagnosis and 9 procedures). Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out. While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.

  8. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Brauer, Charlotte; Pedersen, Ellen Bøtker

    2016-01-01

    of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort). The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar...

  9. Experiences of University Life for Students with Asperger's Syndrome: A Comparative Study between Spain and England

    Science.gov (United States)

    Casement, Sue; Carpio de los Pinos, Carmen; Forrester-Jones, Rachel

    2017-01-01

    Research has consistently shown that young people with Asperger's Syndrome (AS) are likely to experience increased anxiety during new social situations; yet, studies have been regionally and culturally bound. The aim of this study was to explore how higher education students with AS experienced attending university in two European countries: the…

  10. Social selection in cohort studies and later representation of childhood psychiatric diagnoses: The Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Madsen, Kathrine Bang; Hohwü, Lena; Zhu, Jin Liang

    2017-01-01

    AIM: This study aimed to estimate the relative representation of childhood psychiatric diagnoses and use of psychotropic medication in the Danish National Birth Cohort (DNBC) compared to the general population. METHODS: The general population was identified as all childbirths in Denmark during 1998...

  11. Glycemic Control and the Risk of Tuberculosis: A Cohort Study.

    Science.gov (United States)

    Lee, Pin-Hui; Fu, Han; Lai, Ting-Chun; Chiang, Chen-Yuan; Chan, Chang-Chuan; Lin, Hsien-Ho

    2016-08-01

    Diabetes is a well-known risk factor for tuberculosis (TB) and is increasingly prevalent in low- and middle-income countries, where the burden of TB is high. Glycemic control has the potential to modify the risk of TB. However, there are few studies on the association between glycemic control and TB risk, and the results are inconsistent. We assembled a cohort using 123,546 individuals who participated in a community-based health screening service in northern Taiwan from 5 March 2005 to 27 July 2008. Glycemic control was measured using fasting plasma glucose (FPG) at the time of screening. The cohort was followed up to 31 December 2012 for the occurrence of TB by cross-matching the screening database to the national health insurance database. Multiple imputation was used to handle missing information. During a median follow-up of 4.6 y, 327 cases of TB occurred. In the multivariable Cox regression model, diabetic patients with poor glycemic control (FPG > 130 mg/dl) had a significantly higher hazard of TB (adjusted hazard ratio [aHR] 2.21, 95% CI 1.63-2.99, p diabetes. The hazard of TB in diabetic patients with good glycemic control (FPG ≤ 130 mg/dl) did not differ significantly from that in nondiabetic individuals (aHR 0.69, 95% CI 0.35-1.36, p = 0.281). In the linear dose-response analysis, the hazard of TB increased with FPG (aHR 1.06 per 10-mg/dl increase in FPG, 95% CI 1.03-1.08, p diabetic patients and may contribute to the control of TB in settings where diabetes and TB are prevalent.

  12. Cohort profile: the Quebec Longitudinal Study of Kindergarten Children (QLSKC).

    Science.gov (United States)

    Rouquette, Alexandra; Côté, Sylvana M; Pryor, Laura E; Carbonneau, René; Vitaro, Frank; Tremblay, Richard E

    2014-02-01

    The Quebec Longitudinal Study of Kindergarten Children (QLSKC) is an ongoing population-based prospective longitudinal study presently spanning ages 6-29 years, designed to study the prevalence, risk factors, development and consequences of behavioural and emotional problems during elementary school. Kindergarten boys and girls attending French-speaking public schools in the Canadian province of Quebec during the 1986-87 and 1987-88 school years were included in the cohort: 2000 children representative of the population and 1017 children exhibiting disruptive behaviour problems. To date, 12 waves of data have been collected, and three generations of participants have been involved in the study (i.e. the study child, his parents and the first child of the study child). Information on demographics, psycho-social and lifestyle factors, child and family member characteristics (physical and mental health), and outcomes such as psychiatric diagnoses, delinquency or school diploma were assessed during three important developmental stages (childhood, adolescence and early adulthood). Blood samples were also collected in early adulthood for genetic analyses. Information on publications, available data and access to data can be found on the following website (http://www.gripinfo.ca/Grip/Public/www/).

  13. Cohort Profile: The Quebec Longitudinal Study of Kindergarten Children (QLSKC)

    Science.gov (United States)

    Tremblay, Richard E

    2014-01-01

    The Quebec Longitudinal Study of Kindergarten Children (QLSKC) is an ongoing population-based prospective longitudinal study presently spanning ages 6–29 years, designed to study the prevalence, risk factors, development and consequences of behavioural and emotional problems during elementary school. Kindergarten boys and girls attending French-speaking public schools in the Canadian province of Quebec during the 1986–87 and 1987–88 school years were included in the cohort: 2000 children representative of the population and 1017 children exhibiting disruptive behaviour problems. To date, 12 waves of data have been collected, and three generations of participants have been involved in the study (i.e. the study child, his parents and the first child of the study child). Information on demographics, psycho-social and lifestyle factors, child and family member characteristics (physical and mental health), and outcomes such as psychiatric diagnoses, delinquency or school diploma were assessed during three important developmental stages (childhood, adolescence and early adulthood). Blood samples were also collected in early adulthood for genetic analyses. Information on publications, available data and access to data can be found on the following website (http://www.gripinfo.ca/Grip/Public/www/). PMID:23159828

  14. Early Childhood IQ Trajectories in Individuals Later Developing Schizophrenia and Affective Psychoses in the New England Family Studies.

    Science.gov (United States)

    Agnew-Blais, Jessica C; Buka, Stephen L; Fitzmaurice, Garrett M; Smoller, Jordan W; Goldstein, Jill M; Seidman, Larry J

    2015-07-01

    Individuals who develop schizophrenia in adulthood exhibit, on average, deficits in childhood cognition relative to healthy controls. However, it remains unclear when in childhood such deficits emerge and whether they are stable across childhood or change (increase or decrease) across development. Importantly, whether the trajectory of childhood cognition differs among youth who later develop affective psychoses (AP) vs schizophrenia as adults remains unresolved. Subjects in the Collaborative Perinatal Project were administered the Stanford-Binet IQ test at age 4 and the Wechsler Intelligence Scale for Children at age 7. A total of 9809 (54.7%) participants in the New England Study sites were tested at both ages, including 37 who later developed schizophrenia spectrum psychoses (SSP) and 39 who later developed AP. Logistic regression models examined the association of level of and change in childhood IQ and later SSP or AP. Lower overall childhood IQ was associated with higher risk of SSP. Additionally, there was a small mean increase in IQ in the SSP group relative to a mean decrease in the control group from age 4 to 7 such that positive change in IQ was significantly associated with a higher risk of SSP. Neither overall level nor change in IQ was associated with risk of AP. The results are consistent with neurocognitive impairment throughout early childhood specifically for children who later develop schizophrenia, affirming the theory of atypical neurodevelopment in premorbid schizophrenia. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  15. Whether the weather influences pain? Results from the EpiFunD study in North West England.

    Science.gov (United States)

    Macfarlane, Tatiana V; McBeth, John; Jones, Gareth T; Nicholl, Barbara; Macfarlane, Gary J

    2010-08-01

    To determine whether the report of pain is influenced by meteorological conditions. A population-based study (Epidemiology of Functional Disorders) was conducted in North West England. Subjects were mailed a questionnaire that enquired about pain on the day of completion ('any pain') and chronic widespread pain (CWP) as defined by the ACR, as well as about the potential mediating factors, sleep quality, exercise and mood, between the weather and pain. Hourly information on sunshine, precipitation, air temperature and pressure was available from a local weather station. Analysis of relationships was done by Cox regression and described as prevalence ratios (PRs) with 95% CIs. Between January 2005 and December 2006, questionnaires from 2491 subjects were returned: 42% of the subjects reported 'any pain' on the day of completion, whereas 15% of the subjects had CWP. For both 'any pain' and CWP, the PR was the highest in winter (46.1 and 22.2%, respectively) followed by autumn (45.4 and 17.9%, respectively) and spring (41.9 and 14.7%, respectively) and lowest in summer (35.6 and 9.5%, respectively). Persons were less likely to report pain on days with >5.8 h of sunshine (any pain: PR = 0.87, 95% CI 0.82, 0.93; CWP: PR = 0.56; 95% CI 0.38, 0.84) and with average temperature of >17.5 degrees C (any pain: PR = 0.74, 95% CI 0.66, 0.83; CWP: PR = 0.40; 95% CI 0.34, 0.48). These relationships were partly explained by persons reporting taking more exercise and having better sleep quality and a more positive mood on days with sunshine and higher temperatures. CONCLUSIONS;. Although a strong relationship between lack of sunshine, lower temperatures and pain reporting has been demonstrated, pain is not an inevitable consequence of such climatic conditions.

  16. Variations in the hospital management of self-harm and patient outcome: a multi-site observational study in England.

    Science.gov (United States)

    Cooper, Jayne; Steeg, Sarah; Gunnell, David; Webb, Roger; Hawton, Keith; Bennewith, Olive; House, Allan; Kapur, Navneet

    2015-03-15

    Studies have shown wide variations in delivery of self-harm services but it is unclear how these relate to important outcomes such as self-harm repetition. Data were collected on self-harm presentations and hospital management from 31 hospitals in England. Key staff were interviewed about service provision for self-harm patients and responses were mapped to a 21-item service quality scale. Our main outcome was repeat hospital-presenting self-harm within six months. 6347 individuals presented with 7599 episodes of self-harm during a three month period in 2010-2011. Re-attendance with self-harm within six months of index episode occurred in 21% (1308/6347) of individuals (range between hospitals 9-27%). We found little association between clinical management at hospital level (i.e. proportion of episodes receiving psychosocial assessment, medical or psychiatric admission, and referral to statutory or non-statutory services) and repetition rate. The median score on service quality scale was 14.5 (range between hospitals 10.5-19). There was no evidence of correlation between total service quality score and repetition of self-harm (Spearman׳s r=-0.06, p=0.73) or between individual service items and repetition. We did not explore certain aspects of service provision e.g. quality of psychosocial assessments and length of admission. Hospital presentation for repeat self-harm may not be the most reliable measure of service quality. At aggregate level aspects of management and service structures did not appear to be associated with self-harm repetition rates. Future research should focus on better understanding the processes underlying the delivery of services at hospital level and their relationship to outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Parental views of children's physical activity: a qualitative study with parents from multi-ethnic backgrounds living in England.

    Science.gov (United States)

    Trigwell, Joanne; Murphy, Rebecca Catherine; Cable, Nigel Timothy; Stratton, Gareth; Watson, Paula Mary

    2015-10-02

    Guidelines recommend children and young people participate in at least 60 min of physical activity (PA) every day, however, findings from UK studies show PA levels of children vary across ethnic groups. Since parents play an instrumental role in determining children's PA levels, this article aims to explore parental views of children's PA in a multi-ethnic sample living in a large city in the North-West of England. Six single-ethnic focus groups were conducted with 36 parents of school-aged children (4 to 16 years) with a predominantly low socio-economic status (SES). Parents self-identified their ethnic background as Asian Bangladeshi (n = 5), Black African (n = 4), Black Somali (n = 7), Chinese (n = 6), White British (n = 8) and Yemeni (n = 6). Focus group topics included understanding of PA, awareness of PA guidelines, knowledge of benefits associated with PA and perceived influences on PA in childhood. Data were analysed thematically using QSR NVivo 9.0. Parents from all ethnic groups valued PA and were aware of its benefits, however they lacked awareness of PA recommendations, perceived school to be the main provider for children's PA, and reported challenges in motivating children to be active. At the environmental level, barriers to PA included safety concerns, adverse weather, lack of resources and lack of access. Additional barriers were noted for ethnic groups from cultures that prioritised educational attainment over PA (Asian Bangladeshi, Chinese, Yemeni) and with a Muslim faith (Asian Bangladeshi, Black Somali, Yemeni), who reported a lack of culturally appropriate PA opportunities for girls. Parents from multi-ethnic groups lacked awareness of children's PA recommendations and faced barriers to promoting children's PA out of school, with certain ethnic groups facing additional barriers due to cultural and religious factors. It is recommended children's PA interventions address influences at all socio-ecological levels, and

  18. What factors are important in smoking cessation and relapse in women from deprived communities? A qualitative study in Southeast England.

    Science.gov (United States)

    Memon, A; Barber, J; Rumsby, E; Parker, S; Mohebati, L; de Visser, R O; Venables, S; Fairhurst, A; Lawson, K; Sundin, J

    2016-05-01

    Women are relatively more susceptible to smoking-related diseases and find it more difficult to quit; however, little research exists on factors associated with smoking cessation and relapse in women. We examined attitudes towards and perceptions of factors associated with smoking cessation and relapse in women from deprived communities. Qualitative interview study. Participants included eleven women, smokers and ex-smokers, from disadvantaged communities in East Sussex, England, who had used the National Health Service (NHS) stop smoking service. Data were collected through a focus group and semi-structured interviews, and subjected to thematic analysis. Participants opined that it is more difficult for women to quit smoking than men. Women felt that postcessation weight gain was inevitable and acted as a barrier to quitting. Hormonal fluctuations during the menstrual cycle and greater levels of stress were perceived as obstacles to quitting and reasons for relapse. Conversely, the women cited effects of smoking on physical appearance, oral hygiene and guilt about exposing children to passive smoke as powerful motivators to quit; and highlighted the impact of public health campaigns that focused on these factors. Views diverged on whether quitting with someone close to you is a help or hindrance. Other themes including alcohol intake, daily routine and being in the presence of smokers emerged as situational triggers of relapse. Interventions that address women's concerns related to postcessation weight gain, hormonal fluctuations during the menstrual cycle and stress may aid with smoking cessation and reduce relapse. Public health campaigns should consider the impact of smoking on physical appearance and the effect of passive smoke on children. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  19. Prospective evaluation of associations between prenatal cortisol and adulthood coronary heart disease risk: the New England family study.

    Science.gov (United States)

    Stinson, Lynda J; Stroud, Laura R; Buka, Stephen L; Eaton, Charles B; Lu, Bing; Niaura, Raymond; Loucks, Eric B

    2015-04-01

    Increasing evidence suggests that early life factors may influence coronary heart disease (CHD) risk; however, little is known about the contributions of prenatal cortisol. Objectives were to prospectively assess the associations of maternal cortisol levels during pregnancy with offspring's 10-year CHD risk during middle age. Participants were 262 mother-offspring dyads from the New England Family Study. Maternal free cortisol was assessed in third-trimester maternal serum samples. Ten-year CHD risk was calculated in offspring at a mean age of 42 years, using the validated Framingham risk algorithm incorporating diabetes, systolic and diastolic blood pressure, total and high-density lipoprotein cholesterol, smoking, age, and sex. In multivariable-adjusted linear regression analyses adjusted for age and race/ethnicity, high versus low maternal cortisol tertile was associated with 36.7% (95% confidence interval [CI] = 8.4% to 72.5%) greater mean 10-year CHD risk score in women. There was no association in men (-2.8%, 95% CI = -23.8% to 24.0%). Further adjustment for in utero socioeconomic position showed 26.1% (95% CI = -0.5% to 59.9%) greater CHD risk in women. Adjustment for maternal age and size for gestational age had little effect on findings. Maternal prenatal cortisol levels were positively associated with 10-year CHD risk among female, and not male, offspring. Adjusting for socioeconomic position during pregnancy reduced effect size in women, suggesting that it may be a common prior factor in both maternal cortisol and CHD risk. These findings provide evidence that targeting mothers who have elevated prenatal cortisol levels, including elevated cortisol in the setting of low socioeconomic position, may potentially reduce long-term CHD risk in their offspring.

  20. A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England.

    Science.gov (United States)

    Dykes, Fiona

    2005-09-01

    To explore the nature of interactions between midwives and breast-feeding women within postnatal wards. A critical ethnographic study using participant observation and focused interviews. Two maternity units in Northern England, UK. 61 postnatal women and 39 midwives. The interactions between midwives and women were encompassed by the global theme of 'taking time and touching base'. However, most encounters were characterised by an absence of 'taking time' or 'touching base'. This related to midwives' experiences of temporal pressure and inability to establish relationality with women due to their working patterns. The global theme was underpinned by five organising themes: 'communicating temporal pressure'; 'routines and procedures'; 'disconnected encounters'; 'managing breast feeding'; and 'rationing information'. The organisational culture within the postnatal wards contributed to midwives experiencing profound temporal pressures and an inability to establish relationality with women. Within this context, the needs of breast-feeding women for emotional, esteem, informational and practical support were largely unmet. Transformative action is required to dramatically reorganise the provision of hospital-based, postnatal ward midwifery care in parts of the UK. This should include a re-conceptualisation of caring time, with recognition that midwives need sufficient time in order to give time to others. This, in turn, requires recognition that caring time is cyclical and rhythmical, allowing for relationality, sociability, mutuality and reciprocity. The midwifery staffing structure in postnatal wards needs to be reviewed, as it is unacceptable to midwives and service users for staff to be rapidly relocated according to other demands within the institution. Most radically, it is argued that now is the time to reconsider the suitability of the hospital as the place and space within which women commence their breast-feeding journey.

  1. The New England Drought Study: Water Resources Planning Metropolitan Boston, Massachusetts

    National Research Council Canada - National Science Library

    Joyce, Charles

    1994-01-01

    The study has traced the water resources planning experience for the metropolitan Boston area from the 17th century to the present in order to investigate how current planning has evolved from seeking...

  2. Ten years of progress in the Hokkaido birth cohort study on environment and children's health: cohort profile--updated 2013.

    Science.gov (United States)

    Kishi, Reiko; Kobayashi, Sachiko; Ikeno, Tamiko; Araki, Atsuko; Miyashita, Chihiro; Itoh, Sachiko; Sasaki, Seiko; Okada, Emiko; Kobayashi, Sumitaka; Kashino, Ikuko; Itoh, Kumiko; Nakajima, Sonomi

    2013-11-01

    The Hokkaido Study on Environment and Children's Health is an ongoing cohort study that began in 2002. The study consists of two prospective birth cohorts, the Sapporo cohort (n = 514) and the Hokkaido large-scale cohort (n = 20,940). The primary goals of this study are to first examine the potential negative effects of perinatal environmental chemical exposures on birth outcomes, including congenital malformations and growth retardation; second, to evaluate the development of allergies, infectious diseases and neurodevelopmental disorders and perform longitudinal observations of the children's physical development to clarify the causal relationship between these outcomes and environmental chemicals; third, to identify individuals genetically susceptible to environmental chemicals; finally, to identify the additive effects of various environmental factors in our daily life, such as secondhand smoke exposure or low folate intake during early pregnancy. In this paper, we introduce our recent progress in the Hokkaido study with a cohort profile updated in 2013. For the last ten years, we followed pregnant women and their offspring, measuring various environmental chemicals, i.e., PCB, OH-PCB and dioxins, PFCs (Perfluorinated Compounds), Organochlorine pesticides, Phthalates, bisphenol A and mercury. We discovered that the concentration of toxic equivalents (TEQ) of dioxin and other specific congeners of PCDF or PCDD have effects on birth weight, infants' neurodevelopment and immune function. There were significant gender differences in these effects; our results suggest that male infants have more susceptibility to those chemical exposures than female infants. Interestingly, we found maternal genetic polymorphisms in AHR, CYP1A1 or GSTs that significantly modified the dioxin concentrations in maternal blood, suggesting different dioxin accumulations in the bodies of individuals with these genotypes, which would lead to different dioxin exposure levels. These genetic

  3. A comparison of Cox and logistic regression for use in genome-wide association studies of cohort and case-cohort design

    Science.gov (United States)

    Staley, James R; Jones, Edmund; Kaptoge, Stephen; Butterworth, Adam S; Sweeting, Michael J; Wood, Angela M; Howson, Joanna M M

    2017-01-01

    Logistic regression is often used instead of Cox regression to analyse genome-wide association studies (GWAS) of single-nucleotide polymorphisms (SNPs) and disease outcomes with cohort and case-cohort designs, as it is less computationally expensive. Although Cox and logistic regression models have been compared previously in cohort studies, this work does not completely cover the GWAS setting nor extend to the case-cohort study design. Here, we evaluated Cox and logistic regression applied to cohort and case-cohort genetic association studies using simulated data and genetic data from the EPIC-CVD study. In the cohort setting, there was a modest improvement in power to detect SNP–disease associations using Cox regression compared with logistic regression, which increased as the disease incidence increased. In contrast, logistic regression had more power than (Prentice weighted) Cox regression in the case-cohort setting. Logistic regression yielded inflated effect estimates (assuming the hazard ratio is the underlying measure of association) for both study designs, especially for SNPs with greater effect on disease. Given logistic regression is substantially more computationally efficient than Cox regression in both settings, we propose a two-step approach to GWAS in cohort and case-cohort studies. First to analyse all SNPs with logistic regression to identify associated variants below a pre-defined P-value threshold, and second to fit Cox regression (appropriately weighted in case-cohort studies) to those identified SNPs to ensure accurate estimation of association with disease. PMID:28594416

  4. Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide.

    Science.gov (United States)

    Hawton, Keith; Linsell, Louise; Adeniji, Tunde; Sariaslan, Amir; Fazel, Seena

    2014-03-29

    Self-harm and suicide are common in prisoners, yet robust information on the full extent and characteristics of people at risk of self-harm is scant. Furthermore, understanding how frequently self-harm is followed by suicide, and in which prisoners this progression is most likely to happen, is important. We did a case-control study of all prisoners in England and Wales to ascertain the prevalence of self-harm in this population, associated risk factors, clustering effects, and risk of subsequent suicide after self-harm. Records of self-harm incidents in all prisons in England and Wales were gathered routinely between January, 2004, and December, 2009. We did a case-control comparison of prisoners who self-harmed and those who did not between January, 2006, and December, 2009. We also used a Bayesian approach to look at clustering of people who self-harmed. Prisoners who self-harmed and subsequently died by suicide in prison were compared with other inmates who self-harmed. 139,195 self-harm incidents were recorded in 26,510 individual prisoners between 2004 and 2009; 5-6% of male prisoners and 20-24% of female inmates self-harmed every year. Self-harm rates were more than ten times higher in female prisoners than in male inmates. Repetition of self-harm was common, particularly in women and teenage girls, in whom a subgroup of 102 prisoners accounted for 17,307 episodes. In both sexes, self-harm was associated with younger age, white ethnic origin, prison type, and a life sentence or being unsentenced; in female inmates, committing a violent offence against an individual was also a factor. Substantial evidence was noted of clustering in time and location of prisoners who self-harmed (adjusted intra-class correlation 0·15, 95% CI 0·11-0·18). 109 subsequent suicides in prison were reported in individuals who self-harmed; the risk was higher in those who self-harmed than in the general prison population, and more than half the deaths occurred within a month of self

  5. Assessing the order of magnitude of outcomes in single-arm cohorts through systematic comparison with corresponding cohorts: An example from the AMOS study

    Directory of Open Access Journals (Sweden)

    Kienle Gunver S

    2008-03-01

    Full Text Available Abstract Background When a therapy has been evaluated in the first clinical study, the outcome is often compared descriptively to outcomes in corresponding cohorts receiving other treatments. Such comparisons are often limited to selected studies, and often mix different outcomes and follow-up periods. Here we give an example of a systematic comparison to all cohorts with identical outcomes and follow-up periods. Methods The therapy to be compared (anthroposophic medicine, a complementary therapy system had been evaluated in one single-arm cohort study: the Anthroposophic Medicine Outcomes Study (AMOS. The five largest AMOS diagnosis groups (A-cohorts: asthma, depression, low back pain, migraine, neck pain were compared to all retrievable corresponding cohorts (C-cohorts receiving other therapies with identical outcomes (SF-36 scales or summary measures and identical follow-up periods (3, 6 or 12 months. Between-group differences (pre-post difference in an A-cohort minus pre-post difference in the respective C-cohort were divided with the standard deviation (SD of the baseline score of the A-cohort. Results A-cohorts (5 cohorts with 392 patients were similar to C-cohorts (84 cohorts with 16,167 patients regarding age, disease duration, baseline affection and follow-up rates. A-cohorts had ≥ 0.50 SD larger improvements than C-cohorts in 13.5% (70/517 of comparisons; improvements of the same order of magnitude (small or minimal differences: -0.49 to 0.49 SD were found in 80.1% of comparisons; and C-cohorts had ≥ 0.50 SD larger improvements than A-cohorts in 6.4% of comparisons. Analyses stratified by diagnosis had similar results. Sensitivity analyses, restricting the comparisons to C-cohorts with similar study design (observational studies, setting (primary care or interventions (drugs, physical therapies, mixed, or restricting comparisons to SF-36 scales with small baseline differences between A- and C-cohorts (-0.49 to 0.49 SD also had

  6. Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England

    Science.gov (United States)

    Grainge, Matthew J.; West, Joe; Fleming, Kate M.; Nelson-Piercy, Catherine; Tata, Laila J.

    2014-01-01

    Impact on the timing of first postpartum venous thromboembolism (VTE) for women with specific risk factors is of crucial importance when planning the duration of thromboprophylaxis regimen. We observed this using a large linked primary and secondary care database containing 222 334 pregnancies resulting in live and stillbirth births between 1997 and 2010. We assessed the impact of risk factors on the timing of postpartum VTE in term of absolute rates (ARs) and incidence rate ratios (IRRs) using a Poisson regression model. Women with preeclampsia/eclampsia and postpartum acute systemic infection had the highest risk of VTE during the first 3 weeks postpartum (ARs ≥2263/100 000 person-years; IRR ≥2.5) and at 4-6 weeks postpartum (AR ≥1360; IRR ≥3.5). Women with body mass index (BMI) >30 kg/m2 or those having cesarean delivery also had elevated rates up to 6 weeks (AR ≥1425 at 1-3 weeks and ≥722 at 4-6 weeks). Women with postpartum hemorrhage or preterm birth, had significantly increased VTE rates only in the first 3 weeks (AR ≥1736; IRR ≥2). Our findings suggest that the duration of the increased VTE risk after childbirth varies based on the type of risk factors and can extend up to the first 3 to 6 weeks postpartum. PMID:25157182

  7. Changing Fatherhood: An Exploratory Qualitative Study with African and African Caribbean Men in England

    Science.gov (United States)

    Williams, Robert; Hewison, Alistair; Wildman, Stuart; Roskell, Carolyn

    2013-01-01

    This paper presents findings from a qualitative study undertaken with 46 African and African Caribbean men exploring their experiences of fatherhood. Data analysis was informed by Connell's theoretical work on changing gender relations. Findings indicate that fathers' lives were mediated by masculinities, racism, gender, migration and generational…

  8. Perceptions, Attitudes, and Choosing to Study Foreign Languages in England: An Experimental Intervention

    Science.gov (United States)

    Taylor, Florentina; Marsden, Emma J.

    2014-01-01

    The declining interest in foreign languages in English-speaking countries has been attributed to negative societal attitudes and specific pupil attitudes and perceptions. While various initiatives have aimed to encourage language study, little research has systematically documented the relationship among perceptions, attitudes, and actually opting…

  9. A longitudinal study of migration propensities for mixed ethnic unions in England and Wales

    NARCIS (Netherlands)

    Zhiqiang, F.; Van Ham, M.; Boyle, P.; Raab, G.M.

    2012-01-01

    Most studies investigating residential segregation of ethnic minorities ignore the fact that the majority of adults live in couples. In recent years there has been a growth in the number of mixed ethnic unions that involve a minority member and a white member. To our knowledge, hardly any research

  10. A Longitudinal Study of Migration Propensities for Mixed-Ethnic Unions in England and Wales

    NARCIS (Netherlands)

    Feng, Z.; Van Ham, M.; Boyle, P.; Raab, G.M.

    2013-01-01

    Most studies investigating residential segregation of ethnic minorities ignore the fact that the majority of adults live in couples. In recent years there has been a growth in the number of mixed-ethnic unions that involve a minority member and a white member. To our knowledge, hardly any research

  11. A Longitudinal Study of Migration Propensities for Mixed Ethnic Unions in England and Wales (discussion paper)

    NARCIS (Netherlands)

    Feng, Z.; Van Ham, M.; Boyle, P.; Raab, G.M.

    2012-01-01

    Most studies investigating residential segregation of ethnic minorities ignore the fact that the majority of adults live in couples. In recent years there has been a growth in the number of mixed ethnic unions that involve a minority member and a white member. To our knowledge, hardly any research

  12. Children's Human Rights Education as a Counter to Social Disadvantage: A Case Study from England

    Science.gov (United States)

    Covell, Katherine; Howe, R. Brian; Polegato, Jillian L.

    2011-01-01

    Background: Children's rights education in schools has many social and educational benefits. Among them are a deeper understanding of rights and social responsibility, an improved school climate, and greater school engagement and achievement. Purpose: The purpose of this study was to assess whether children's rights education has the power to…

  13. An Ethiopian birth cohort study: the study design | Asefa | Ethiopian ...

    African Journals Online (AJOL)

    93. We report here on the design and on the methods used in the study and describe the principal health outcomes. Infants were visited bimonthly until their first birthday. Background data on the physical, cultural and economic environment of ...

  14. International Network of Chronic Kidney Disease cohort studies (iNET-CKD): a global network of chronic kidney disease cohorts.

    Science.gov (United States)

    Dienemann, Thomas; Fujii, Naohiko; Orlandi, Paula; Nessel, Lisa; Furth, Susan L; Hoy, Wendy E; Matsuo, Seiichi; Mayer, Gert; Methven, Shona; Schaefer, Franz; Schaeffner, Elke S; Solá, Laura; Stengel, Bénédicte; Wanner, Christoph; Zhang, Luxia; Levin, Adeera; Eckardt, Kai-Uwe; Feldman, Harold I

    2016-09-02

    Chronic kidney disease (CKD) is a global health burden, yet it is still underrepresented within public health agendas in many countries. Studies focusing on the natural history of CKD are challenging to design and conduct, because of the long time-course of disease progression, a wide variation in etiologies, and a large amount of clinical variability among individuals with CKD. With the difference in health-related behaviors, healthcare delivery, genetics, and environmental exposures, this variability is greater across countries than within one locale and may not be captured effectively in a single study. Studies were invited to join the network. Prerequisites for membership included: 1) observational designs with a priori hypotheses and defined study objectives, patient-level information, prospective data acquisition and collection of bio-samples, all focused on predialysis CKD patients; 2) target sample sizes of 1,000 patients for adult cohorts and 300 for pediatric cohorts; and 3) minimum follow-up of three years. Participating studies were surveyed regarding design, data, and biosample resources. Twelve prospective cohort studies and two registries covering 21 countries were included. Participants age ranges from >2 to >70 years at inclusion, CKD severity ranges from stage 2 to stage 5. Patient data and biosamples (not available in the registry studies) are measured yearly or biennially. Many studies included multiple ethnicities; cohort size ranges from 400 to more than 13,000 participants. Studies' areas of emphasis all include but are not limited to renal outcomes, such as progression to ESRD and death. iNET-CKD (International Network of CKD cohort studies) was established, to promote collaborative research, foster exchange of expertise, and create opportunities for research training. Participating studies have many commonalities that will facilitate comparative research; however, we also observed substantial differences. The diversity we observed across

  15. Outcomes of pregnancy complicated with hyperthyroidism: a cohort study.

    Science.gov (United States)

    Luewan, Suchaya; Chakkabut, Patom; Tongsong, Theera

    2011-02-01

    To determine maternal and fetal outcomes of women complicated with hyperthyroidism compared with those in normal pregnant women. This cohort study was conducted on singleton pregnant women complicated by hyperthyroidism without other medical complications between January 1994 and December 2008, at tertiary center. The normal controls were identified to match the cases with the ratio of 2:1. The baseline characteristics as well as maternal and fetal outcomes were analyzed and compared for pregnancy outcomes. Of the 203 pregnant women diagnosed for hyperthyroidism, 180 cases met the inclusion criteria, and 360 controls were matched. The activity of the disease was controlled to be euthyroid state in most cases. Maternal complications were comparable between both groups except that the study group had potentially higher incidence of pregnancy-induced hypertension. The mean gestational age (± SD), and mean birth weight were significantly lower in the study group. The incidence of fetal growth restriction, fetus with low birth weight and preterm births were significantly higher in the study group with a relative risk of 1.3, 1.4, and 1.3, respectively. Pregnant women with hyperthyroidism were significantly associated with an increased risk of fetal growth restriction, preterm birth and low birth weight and had a tendency to have a higher rate of pregnancy-induced hypertension.

  16. Measuring socioemotional functioning in a national birth cohort study.

    Science.gov (United States)

    Andreassen, Carol; West, Jerry

    2007-11-01

    An accumulating body of research suggests that the capacities children acquire that prepare them for learning in formal educational settings are multilevel and complex with multiple contributing factors that begin in infancy. A new U.S. longitudinal study, the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), is designed to enable researchers to examine how an array of children's capacities and skills function individually and jointly to promote or hinder the acquisition of school readiness. The ECLS-B follows a nationally representative sample of 10,688 children born in the U.S. in 2001. Baseline data on the children and their families were collected at 9 months of age with follow-up at ages 2, 4, and kindergarten entry. Information on study children's socioemotional development is derived from several sources: videotaped mother-child interactions, parent interviews, and field staff observations. Because attachment is such an important indicator of children's socioemotional development during the toddler period, the study devoted considerable resources to designing an attachment measure. The Toddler Attachment Sort-45 (TAS-45) was designed to meet the need for a simple yet valid measure that did not require extensive training for field staff to administer easily. The TAS-45 generates the classical attachment categories and security and dependency scores. Copyright © 2007 Michigan Association for Infant Mental Health.

  17. Warfarin and fibrinolysis - a challenging combination: an observational cohort study

    Directory of Open Access Journals (Sweden)

    Luurila Harri

    2011-04-01

    Full Text Available Abstract Background Patients presenting with ST-segment elevation myocardial infarction (STEMI frequently use warfarin. Fibrinolytic agents and warfarin both increase bleeding risk, but only a few studies have been published concerning the bleeding risk of warfarin-prescribed patients receiving fibrinolysis. The objective of this study was to define the prevalence for intracranial haemorrhage (ICH or major bleeding in patients on warfarin treatment receiving pre-hospital fibrinolysis. Methods This was an observational cohort study. Data for this retrospective case series were collected in Helsinki Emergency Medical Service catchment area from 1.1.1997 to 30.6.2010. All warfarin patients with suspected ST-segment elevation myocardial infarction (STEMI, who received pre-hospital fibrinolysis, were included. Bleeding complications were detected from Medical Records and classified as ICH, major or minor bleeding. Results Thirty-six warfarin patients received fibrinolysis during the study period. Fourteen patients had bleeding complications. One (3%, 95% CI 0-15% patient had ICH, six (17%, 95% CI 7-32% had major and seven (19%, 95% CI 9-35% had minor bleeding. The only fatal bleeding occurred in a patient with ICH. Patients' age, fibrinolytic agent used or aspirin use did not predispose to bleeding complications. High International Normalized Ratio (INR seemed to predispose to bleedings with values over 3, but no statistically significant difference was found. Conclusions Bleedings occur frequently in warfarin patients treated with fibrinolysis in the real world setting, but they are rarely fatal.

  18. Methylene blue for postcardiopulmonary bypass vasoplegic syndrome: A cohort study

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    Michael Mazzeffi

    2017-01-01

    Full Text Available Background: Methylene blue (MB has been used to treat refractory hypotension in a variety of settings. Aims: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB vasoplegic syndrome (VS in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. Setting and Design: This was conducted in a tertiary care medical center; this study was a retrospective cohort study. Materials and Methods: Adult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response. Results: Eighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004, and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02. A positive response had no correlation with in-hospital mortality (P = 0.09. Conclusions: MB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response.

  19. Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods study

    Directory of Open Access Journals (Sweden)

    Nicholl Jon

    2007-06-01

    Full Text Available Abstract Background Recently, there has been a surge of international interest in combining qualitative and quantitative methods in a single study – often called mixed methods research. It is timely to consider why and how mixed methods research is used in health services research (HSR. Methods Documentary analysis of proposals and reports of 75 mixed methods studies funded by a research commissioner of HSR in England between 1994 and 2004. Face-to-face semi-structured interviews with 20 researchers sampled from these studies. Results 18% (119/647 of HSR studies were classified as mixed methods research. In the documentation, comprehensiveness was the main driver for using mixed methods research, with researchers wanting to address a wider range of questions than quantitative methods alone would allow. Interviewees elaborated on this, identifying the need for qualitative research to engage with the complexity of health, health care interventions, and the environment in which studies took place. Motivations for adopting a mixed methods approach were not always based on the intrinsic value of mixed methods research for addressing the research question; they could be strategic, for example, to obtain funding. Mixed methods research was used in the context of evaluation, including randomised and non-randomised designs; survey and fieldwork exploratory studies; and instrument development. Studies drew on a limited number of methods – particularly surveys and individual interviews – but used methods in a wide range of roles. Conclusion Mixed methods research is common in HSR in the UK. Its use is driven by pragmatism rather than principle, motivated by the perceived deficit of quantitative methods alone to address the complexity of research in health care, as well as other more strategic gains. Methods are combined in a range of contexts, yet the emerging methodological contributions from HSR to the field of mixed methods research are currently

  20. Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods study.

    Science.gov (United States)

    O'Cathain, Alicia; Murphy, Elizabeth; Nicholl, Jon

    2007-06-14

    Recently, there has been a surge of international interest in combining qualitative and quantitative methods in a single study--often called mixed methods research. It is timely to consider why and how mixed methods research is used in health services research (HSR). Documentary analysis of proposals and reports of 75 mixed methods studies funded by a research commissioner of HSR in England between 1994 and 2004. Face-to-face semi-structured interviews with 20 researchers sampled from these studies. 18% (119/647) of HSR studies were classified as mixed methods research. In the documentation, comprehensiveness was the main driver for using mixed methods research, with researchers wanting to address a wider range of questions than quantitative methods alone would allow. Interviewees elaborated on this, identifying the need for qualitative research to engage with the complexity of health, health care interventions, and the environment in which studies took place. Motivations for adopting a mixed methods approach were not always based on the intrinsic value of mixed methods research for addressing the research question; they could be strategic, for example, to obtain funding. Mixed methods research was used in the context of evaluation, including randomised and non-randomised designs; survey and fieldwork exploratory studies; and instrument development. Studies drew on a limited number of methods--particularly surveys and individual interviews--but used methods in a wide range of roles. Mixed methods research is common in HSR in the UK. Its use is driven by pragmatism rather than principle, motivated by the perceived deficit of quantitative methods alone to address the complexity of research in health care, as well as other more strategic gains. Methods are combined in a range of contexts, yet the emerging methodological contributions from HSR to the field of mixed methods research are currently limited to the single context of combining qualitative methods and

  1. The Midland and North of England Stillbirth Study (MiNESS).

    Science.gov (United States)

    Platts, Jayne; Mitchell, Edwin A; Stacey, Tomasina; Martin, Bill L; Roberts, Devender; McCowan, Lesley; Heazell, Alexander E P

    2014-05-21

    The United Kingdom has one of the highest rates of stillbirth in Europe, resulting in approximately 4,000 stillbirths every year. Potentially modifiable risk factors for late stillbirths are maternal age, obesity and smoking, but the population attributable risk associated with these risk factors is small.Recently the Auckland Stillbirth Study reported that maternal sleep position was associated with late stillbirth. Women who did not sleep on their left side on the night before the death of the baby had double the risk compared with sleeping on other positions. The population attributable risk was 37%. This novel observation needs to be replicated or refuted. Case control study of late singleton stillbirths without congenital abnormality. Controls are women with an ongoing singleton pregnancy, who are randomly selected from participating maternity units booking list of pregnant women, they are allocated a gestation for interview based on the distribution of gestations of stillbirths from the previous 4 years for the unit. The number of controls selected is proportional to the number of stillbirths that occurred at the hospital over the previous 4 years. Interviewer administered questionnaire and data extracted from medical records. 415 cases and 830 controls. This takes into account a 30% non-participation rate, and will detect an OR of 1.5 with a significance level of 0.05 and power of 80% for variables with a prevalence of 57%, such as non-left sleeping position. Mantel-Haenszel odds ratios and unconditional logistic regression to adjust for potential confounders. The hypotheses to be tested here are important, biologically plausible and amenable to a public health intervention. Although this case-control study cannot prove causation, there is a striking parallel with research relating to sudden infant death syndrome, where case-control studies identified prone sleeping position as a major modifiable risk factor. Subsequently mothers were advised to sleep

  2. Magnetotelluric studies in and adjacent to the Northumberland Basin, Northern England

    Science.gov (United States)

    Parr, R. S.; Hutton, V. R. S.

    1993-12-01

    During the past decade broadband magnetotelluric (MT) soundings, with d.c. resistivity soundings at some sites, have been undertaken in three separate field studies in and around the Northumberland Basin, a region of great interest to earth scientists on account of the proposed location there of the Iapetus Suture. As a result of an increase in cultural noise during this period, the data from the last two studies have been processed using a new robust constrained impedance tensor estimation program. The resulting apparent resistivity and phase data from these studies, together with those from the first broadband study and some earlier MT responses from the region, have now all been modelled using an interpretative modelling procedure. New information has been provided by the MT models on basement depths and, by integrating these new estimates with those from gravity modelling and seismic studies both on land and offshore, a detailed basement topography map has been compiled for the region. The deep eletrical resistivity structure has been modelled along a NW-SE traverse from the Weardale Granite of the Alston Block across the Northumberland Basin to the Southern Uplands of Scotland. Underlying the more conductive sedimentary rocks, the basement rock is found to have resistivities which range from about 100 μ m in the Northumberland Basin to more than 1000 μ m in the Alston Block and probably of the same order in the Southern Uplands. A mid-crustal conductor exists along the whole traverse, which is well resolved and has a southward dip beneath the Weardale Granite. Under the Northumberland Basin, the conductor is less well resolved and thus an apparent northward dip can only be regarded as tentative. Comparison of the pseudo-2D and full 2D models resulting from this study and from earlier MT and magnetovariational (MV) studies in Southern Scotland with new MT and joint MT and MV inversions of Livelybrooks et al. (Phys. Earth Planet. Inter., 81: 67-84 (1993)) for

  3. Health workers cohort study: methods and study design

    Directory of Open Access Journals (Sweden)

    Edgar Denova-Gutiérrez

    2016-12-01

    Full Text Available Objective. To examine different health outcomes that are associated with specific lifestyle and genetic factors. Materials and methods. From March 2004 to April 2006, a sample of employees from three different health and academic institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013, participants completed a self-administered questionnaire, a physical examination, and provided blood samples. Results. A total of 10 729 participants aged 6 to 94 years were recruited at baseline. Of these, 70% were females, and 50% were from the Mexican Social Security Institute. Nearly 42% of the adults in the sample were overweight, while 20% were obese. Conclusion. Our study can offer new insights into disease mechanisms and prevention through the analysis of risk factor information in a large sample of Mexicans.

  4. Adolescent cannabis and tobacco use and educational outcomes at age 16: birth cohort study.

    Science.gov (United States)

    Stiby, Alexander I; Hickman, Matthew; Munafò, Marcus R; Heron, Jon; Yip, Vikki L; Macleod, John

    2015-04-01

    To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Birth cohort study. England. The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer-assisted questionnaire and serum cotinine. The main outcomes were performance in standardized assessments at 16 [Key Stage 4, General Certificate of Secondary Education (GCSE)] in English and mathematics (mean scores), completion of five or more assessments at grade C level or higher and leaving school having achieved no qualifications. Analyses were sequentially adjusted for multiple covariates using a hierarchical approach. Covariates considered were: maternal substance use (ever tobacco or cannabis use, alcohol use above recommended limits); life course socio-economic position (family occupational class, maternal education, family income); child sex; month and year of birth; child educational attainment prior to age 11 (Key Stage 2); child substance use (tobacco, alcohol and cannabis) prior to age 15 and child conduct disorder. In fully adjusted models both cannabis and tobacco use at age 15 were associated with subsequent adverse educational outcomes. In general, the dose-response effect seen was consistent across all educational outcomes assessed. Weekly cannabis use was associated negatively with English GCSE results [grade point difference (GPD), -5.93, 95% confidence interval (CI) = -8.34, -3.53] and with mathematics GCSE results (GPD, -6.91, 95% CI = -9.92, -3.89). Daily tobacco smoking was associated negatively with English GCSE (GPD, -11.90, 95% CI = -13.47, -10.33) and with mathematics GCSE (GPD, -16.72, 95% CI = -18.57, -14.86). The greatest attenuation of these effects was seen on adjustment for other substance use and conduct disorder. Following

  5. Health workers cohort study: methods and study design

    OpenAIRE

    Edgar Denova-Gutiérrez; Flores, Yvonne N; Katia Gallegos-Carrillo; Paula Ramírez-Palacios; Berenice Rivera-Paredez; Paloma Muñoz-Aguirre; Rafael Velázquez-Cruz; Leticia Torres-Ibarra; Joacim Meneses-León; Pablo Méndez-Hernández; Rubí Hernández-López; Eduardo Salazar-Martínez; Talavera, Juan O.; Juan Tamayo; Susana Castañón

    2016-01-01

    Objective. To examine different health outcomes that are associated with specific lifestyle and genetic factors. Materials and methods. From March 2004 to April 2006, a sample of employees from three different health and academic institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013), participants completed a self-administered questionnaire, a physical examination, and provided blood samples. Results. A...

  6. A Pragmatic Cross-Cultural Study of Complaints Expressions in Jordan and England

    Directory of Open Access Journals (Sweden)

    Nisreen Al-Khawaldeh

    2016-09-01

    Full Text Available Research shows an increasing interest in the area of cross-cultural pragmatics due to the existence of diverse problematic pragmatic norms (Al-Khawaldeh and Zegarac, 2013. It has been found that identifying cross-cultural differences in linguistic expression and socio-pragmatic norms of communicative acts would help to reduce problems in cross-cultural communication (Meier, 2010. To the best of the researcher's knowledge, no study has been conducted to compare the linguistic expression of complaining by Jordanian native speakers of Arabic and native speakers of English. To bridge the research gap, this study compares the number and types of politeness strategies that Jordanian native speakers of Arabic and native speakers of English use to complain. The study investigates the cultural styles and politeness strategies used by Jordanian native speakers Arabic and native speakers of English for expressing complaints. The analysis of the Discourse-Completion Tasks’ (DCT results revealed that eleven complaints strategies were the most commonly-used by both groups, namely opting out, general annoyance, direct threat, accusation, prayer, advice, irony, rejoinder that shows no disapproval, exclamation, request for repair, and request for explanation. These strategies are manifested in the speech of both languages to save the hearer's face and remain polite when performing the inherently face-threatening speech act of complaint. Though both groups used various complaints strategies at overall frequencies that were closer, they were statistically distinguishable in the type of the linguistic expression of complaints, i.e. opting out and prayer. The results are then discussed from the universality and cultures-specificity perspective.

  7. Indoor Carbon Monoxide: A Case Study in England for Detection and Interventions to Reduce Population Exposure

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    L. J. McCann

    2013-01-01

    Full Text Available Background. Potential exposure to carbon monoxide (CO in private homes is largely unquantified. Aim. To estimate prevalence of potential exposure to CO in residential dwellings and describe associated interventions in an inner-city community. Methods. A housing association in London, Hackney Homes, began fitting CO alarms in the 22,831 local authority homes it is responsible for in January 2010. A gas engineer investigated each alarm activation and recorded the information on a standard form. We undertook a cross-sectional study of all 22,831 homes, using data from these forms. Descriptive analysis was performed, including incidence, monthly variation, cause of alarm activation, and actions taken. Results. Between November 2011 and April 2012, 106 incidents were reported. Of these, 34.6% identified an issue with a gas appliance, and 10.6% identified misuse of cooking methods as the cause of activation. Relevant interventions were put in place, including disconnection of the gas appliance and education around cooking methods. Discussion. Little is known about the burden of CO poisoning in residential dwellings. This study provides important information on the path to quantifying population exposure to CO as well as establishing a possible approach to access this key information and realistic interventions to reduce potential exposure.

  8. Indoor carbon monoxide: a case study in England for detection and interventions to reduce population exposure.

    Science.gov (United States)

    McCann, L J; Close, R; Staines, L; Weaver, M; Cutter, G; Leonardi, G S

    2013-01-01

    Potential exposure to carbon monoxide (CO) in private homes is largely unquantified. To estimate prevalence of potential exposure to CO in residential dwellings and describe associated interventions in an inner-city community. A housing association in London, Hackney Homes, began fitting CO alarms in the 22,831 local authority homes it is responsible for in January 2010. A gas engineer investigated each alarm activation and recorded the information on a standard form. We undertook a cross-sectional study of all 22,831 homes, using data from these forms. Descriptive analysis was performed, including incidence, monthly variation, cause of alarm activation, and actions taken. Between November 2011 and April 2012, 106 incidents were reported. Of these, 34.6% identified an issue with a gas appliance, and 10.6% identified misuse of cooking methods as the cause of activation. Relevant interventions were put in place, including disconnection of the gas appliance and education around cooking methods. Little is known about the burden of CO poisoning in residential dwellings. This study provides important information on the path to quantifying population exposure to CO as well as establishing a possible approach to access this key information and realistic interventions to reduce potential exposure.

  9. Work Domain Analysis for understanding medication safety in care homes in England: an exploratory study.

    Science.gov (United States)

    Lim, Rosemary H M; Anderson, Janet E; Buckle, Peter W

    2016-01-01

    Medication safety and errors are a major concern in care homes. In addition to the identification of incidents, there is a need for a comprehensive system description to avoid the danger of introducing interventions that have unintended consequences and are therefore unsustainable. The aim of this study was to explore the impact and uniqueness of Work Domain Analysis (WDA) to facilitate an in-depth understanding of medication safety problems within the care home system and identify the potential benefits of WDA to design safety interventions to improve medication safety. A comprehensive, systematic and contextual overview of the care home medication system was developed for the first time. The novel use of the abstraction hierarchy (AH) to analyse medication errors revealed the value of the AH to guide a comprehensive analysis of errors and generate system improvement recommendations that took into account the contextual information of the wider system. It is widely acknowledged that a systems approach is necessary to improve medication safety. This study used a cognitive engineering method, Work Domain Analysis, to map the care home medication system and analyse medication errors. A macro-level view of the system was developed and this has provided a knowledge base for future interventions.

  10. Cohort description: The Danish study of Functional Disorders

    Directory of Open Access Journals (Sweden)

    Dantoft TM

    2017-02-01

    Full Text Available Thomas Meinertz Dantoft,1 Jeanette Frost Ebstrup,1 Allan Linneberg,1–3 Sine Skovbjerg,1 Anja Lykke Madsen,1 Jesper Mehlsen,4 Louise Brinth,4 Lene Falgaard Eplov,5 Tina Wisbech Carstensen,6,7 Andreas Schroder,6,7 Per Klausen Fink,6,7 Erik Lykke Mortensen,8 Torben Hansen,9 Oluf Pedersen,9 Torben Jørgensen1,10,11 1Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 3Department of Clinical Experimental Research, Rigshospitalet, Glostrup, 4Coordinating Research Centre, Bispebjerg and Frederiksberg Hospital, Frederiksberg, 5Mental Health Centre Copenhagen, Research Unit, Mental Health Services, Capital Region of Denmark, Copenhagen, 6The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 7Faculty of Health Sciences, University of Aarhus, Aarhus, 8Department of Public Health and Center for Healthy Aging, 9Novo Nordisk Foundation Center for Basic Metabolic Research, 10Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 11Faculty of Medicine, Aalborg University, Aalborg, Denmark Abstract: The Danish study of Functional Disorders (DanFunD cohort was initiated to outline the epidemiology of functional somatic syndromes (FSS and is the first larger coordinated epidemiological study focusing exclusively on FSS. FSS are prevalent in all medical settings and can be defined as syndromes that, after appropriate medical assessment, cannot be explained in terms of a conventional medical or surgical disease. FSS are frequent and the clinical importance varies from vague symptoms to extreme disability. No well-described medical explanations exist for FSS, and how to delimit FSS remains a controversial topic. The specific aims with the cohort were to test delimitations of FSS, estimate prevalence and incidence rates, identify risk factors

  11. Exploring the value of mental health nurses working in primary care in England: A qualitative study.

    Science.gov (United States)

    McLeod, K; Simpson, A

    2017-08-01

    WHAT IS KNOWN ON THE SUBJECT?: Primary care and, in particular, general practice (GP) are often first point of access to health care. International evidence suggests that healthcare systems oriented towards primary care may produce better outcomes, at lower costs and with higher user satisfaction. Despite this, there are noted deficiencies and variations in the quality of care in primary care for patients with mental health problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emerging models of providing mental health services in primary care are poorly understood. This paper evaluates a mental health nurse-led Primary Care Liaison Service (PCLS), developed in 2011 in inner London. The findings suggest that this type of service can improve the quality of care for people presenting with mental health problems within primary care, specifically due to improved integration, clinical effectiveness, patient-centred care, access and efficiency. The study also highlighted challenges such as staff retention within this new role and setting appropriate referral criteria. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This is a relatively new service, and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. The extent to which the findings are transferable will depend on service configuration and local demographics which can vary. Further research within this area could give more detail on the impact of such teams on health outcomes, recovery rates, secondary care referrals and accident and emergency attendances, and its cost-effectiveness. Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse (PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives

  12. Ethnic and socioeconomic influences on childhood blood pressure: the Child Heart and Health Study in England.

    Science.gov (United States)

    Thomas, Claudia; Nightingale, Claire M; Donin, Angela S; Rudnicka, Alicja R; Owen, Christopher G; Cook, Derek G; Whincup, Peter H

    2012-11-01

    Compared to UK white European adults, UK black African-Caribbean adults have higher mean SBP and DBP; UK South Asian adults have higher mean DBP but lower SBP. Information on blood pressure (BP) in UK children from different ethnic groups is limited. The aim of this study was to compare BP levels in UK children of black African-Caribbean, South Asian and white European origin. BP and body build were measured in 5666 children in a cross-sectional study of UK primary school children of South Asian, black African-Caribbean and white European origin aged 9-10 years. Ethnic and socioeconomic differences in BP were obtained from multilevel linear regression models. After adjustment for height and adiposity, black African-Caribbean children had lower mean SBP than white Europeans [difference 1.62  mmHg, 95% confidence interval (CI) 0.86-2.38  mmHg], whereas mean DBP was similar (difference 0.58  mmHg, 95% CI -0.12 to 1.28  mmHg). The lower SBP was particularly marked in black African rather than Caribbean children (P  =  0.002). South Asian children had lower mean SBP (difference 1.10  mmHg, 95% CI 0.34-1.86  mmHg) than white Europeans and higher mean DBP (difference 1.07  mmHg, 95% CI 0.37-1.76  mmHg). The higher mean DBP was particularly marked among Indian and Bangladeshi, rather than Pakistani, children (P  =  0.01). BP was unrelated to socioeconomic circumstances; ethnic differences in BP were not affected by socioeconomic adjustment. A BP pattern similar to that in adults is present in UK South Asian but not in UK black African-Caribbean children at 9-10 years.

  13. Adult height of preterm infants: a longitudinal cohort study.

    Science.gov (United States)

    Ferguson, E C; Wright, N P; Gibson, A T; Carney, S; Wright, A; Wales, J K

    2017-06-01

    Many infants born prematurely experience growth failure following delivery, with subsequent catch-up growth. Traditionally catch-up was thought to be complete in the first few years of life. Most studies have focused on groups of infants defined by birth weight, for example <1500 g, resulting in disproportionate numbers of small for gestational age infants. This study aimed to determine whether appropriate weight for gestation (AGA) preterm born children reach their expected adult height when compared with term controls. This UK based prospective longitudinal cohort study recruited 204 preterm children born at a tertiary neonatal unit during 1994 and 50 matched controls. Growth parameters have been assessed annually until the completion of growth. There was no significant difference in the final height SD score (SDS) of children born at term (n=30) and those born prematurely and AGA (n=70) (0.45 term vs 0.22 preterm). Catch-up growth however, continued throughout the whole of childhood. When the difference between final height SDS and mid-parental height SDS were compared, there were again no significant differences (0.13 term vs 0.03 preterm). Those born prematurely with an AGA achieve a comparable adult height to children born at term, however, catch-up growth continues for much longer than traditionally thought. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Cohort Profile: The Nicotine Dependence in Teens (NDIT) Study.

    Science.gov (United States)

    O'Loughlin, Jennifer; Dugas, Erika N; Brunet, Jennifer; DiFranza, Joseph; Engert, James C; Gervais, Andre; Gray-Donald, Katherine; Karp, Igor; Low, Nancy C; Sabiston, Catherine; Sylvestre, Marie-Pierre; Tyndale, Rachel F; Auger, Nathalie; Auger, Nathalie; Mathieu, Belanger; Tracie, Barnett; Chaiton, Michael; Chenoweth, Meghan J; Constantin, Evelyn; Contreras, Gisèle; Kakinami, Lisa; Labbe, Aurelie; Maximova, Katerina; McMillan, Elizabeth; O'Loughlin, Erin K; Pabayo, Roman; Roy-Gagnon, Marie-Hélène; Tremblay, Michèle; Wellman, Robert J; Hulst, Andraeavan; Paradis, Gilles

    2015-10-01

    The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and 2011-12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor (www.nditstudy.ca). © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  15. Adhesive capsulitis and dynamic splinting: a controlled, cohort study

    Directory of Open Access Journals (Sweden)

    Willis F Buck

    2009-09-01

    Full Text Available Abstract Background Adhesive Capsulitis (AC affects patient of all ages, and stretching protocols are commonly prescribed for this condition. Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis. The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC. Methods This controlled, cohort study, was conducted at four physical therapy, sports medicine clinics in Texas and California. Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention. The intervention categories were as follows: Group I (Control; Group II (Physical Therapy exclusively with standardized protocols; Group III; (Shoulder Dynasplint system exclusively; Group IV (Combined treatment with Shoulder Dynasplint and standardized Physical Therapy. The duration of this study was 90 days for all groups, and the main outcome measures were change in active, external rotation. Results Significant difference was found for all treatment groups (p Conclusion The difference for the combined treatment group was attributed to patients' receiving the best PT combined with structured "home therapy" that contributed an additional 90 hours of end-range stretching. This adjunct should be included in the standard of care for adhesive Capsulitis. Trial Registration Trial Number: NCT00873158

  16. Breastfeeding rates and duration in Germany: a Bavarian cohort study.

    Science.gov (United States)

    Kohlhuber, Martina; Rebhan, Barbara; Schwegler, Ursula; Koletzko, Berthold; Fromme, Hermann

    2008-05-01

    Breastfeeding is the recommended feeding for all healthy infants. The aim of our study was to assess the current state of breastfeeding prevalence, duration and behaviour in Bavaria, Germany as a basis for targeting breastfeeding promotion measures. The Bavarian Breastfeeding Study is a prospective cohort study of 3822 mothers who delivered in April 2005 in Bavaria, Germany. Breastfeeding duration and determinants such as socioeconomic status, attitudes towards breastfeeding, birth mode and breastfeeding problems were assessed by questionnaires 2-6 d after birth and 2, 4, 6, and 9 months after birth. The initial breastfeeding rate was 90 %. After 4 months 61 % still breastfed (any breastfeeding). In the multivariate analyses the main influencing factor reducing breastfeeding initiation was the partner's negative attitude towards breastfeeding (OR 21.79; 95 % CI 13.46, 35.27). No initial breastfeeding was also associated with lower education, maternal grandmother's negative attitude and pre-term birth. Protective factors were primary breastfeeding experience and information on breastfeeding before birth. Breastfeeding duration breastfeeding problems (OR 7.56; 95 % CI 6.21, 9.19), smoking, lower education, partner's negative attitude and Caesarean section. Since the attitude of family members is an important influencing factor on breastfeeding rates, breastfeeding promotion should also target the partners of pregnant women and the families of newborn infants. Public health interventions such as more effective support for the management of breastfeeding problems, especially in lower social status families, should be implemented and their effectiveness should be critically evaluated.

  17. Complex regional pain syndrome 1 – the Swiss cohort study

    Directory of Open Access Journals (Sweden)

    Perez Roberto SGM

    2008-06-01

    Full Text Available Abstract Background Little is known about the course of Complex Regional Pain Syndrome 1 and potential factors influencing the course of this disorder over time. The goal of this study is a to set up a database with patients suffering from suspected CRPS 1 in an initial stadium, b to perform investigations on epidemiology, diagnosis, prognosis, and socioeconomics within the database and c to develop a prognostic risk assessment tool for patients with CRPS 1 taking into account symptomatology and specific therapies. Methods/design Prospective cohort study. Patients suffering from a painful swelling of the hand or foot which appeared within 8 weeks after a trauma or a surgery and which cannot be explained by conditions that would otherwise account for the degree of pain and dysfunction will be included. In accordance with the recommendations of International Classification of Functioning, Disability and Health (ICF model, standardised and validated questionnaires will be used. Patients will be monitored over a period of 2 years at 6 scheduled visits (0 and 6 weeks, 3, 6, 12, and 24 months. Each visit involves a physical examination, registration of therapeutic interventions, and completion of the various study questionnaires. Outcomes involve changes in health status, quality of life and costs/utility. Discussion This paper describes the rationale and design of patients with CRPS 1. Ideally, potential risk factors may be identified at an early stage in order to initiate an early and adequate treatment in patients with increased risk for delayed recovery. Trial registration Not applicable

  18. Complex regional pain syndrome 1--the Swiss cohort study.

    Science.gov (United States)

    Brunner, Florian; Bachmann, Lucas M; Weber, Ulrich; Kessels, Alfons G H; Perez, Roberto S G M; Marinus, Johan; Kissling, Rudolf

    2008-06-23

    Little is known about the course of Complex Regional Pain Syndrome 1 and potential factors influencing the course of this disorder over time. The goal of this study is a) to set up a database with patients suffering from suspected CRPS 1 in an initial stadium, b) to perform investigations on epidemiology, diagnosis, prognosis, and socioeconomics within the database and c) to develop a prognostic risk assessment tool for patients with CRPS 1 taking into account symptomatology and specific therapies. Prospective cohort study. Patients suffering from a painful swelling of the hand or foot which appeared within 8 weeks after a trauma or a surgery and which cannot be explained by conditions that would otherwise account for the degree of pain and dysfunction will be included. In accordance with the recommendations of International Classification of Functioning, Disability and Health (ICF model), standardised and validated questionnaires will be used. Patients will be monitored over a period of 2 years at 6 scheduled visits (0 and 6 weeks, 3, 6, 12, and 24 months). Each visit involves a physical examination, registration of therapeutic interventions, and completion of the various study questionnaires. Outcomes involve changes in health status, quality of life and costs/utility. This paper describes the rationale and design of patients with CRPS 1. Ideally, potential risk factors may be identified at an early stage in order to initiate an early and adequate treatment in patients with increased risk for delayed recovery.

  19. Cohort profile: the Saskatchewan Rural Health Study-adult component.

    Science.gov (United States)

    Pahwa, Punam; Rana, Masud; Pickett, William; Karunanayake, Chandima P; Amin, Khalid; Rennie, Donna; Lawson, Josh; Kirychuk, Shelley; Janzen, Bonnie; Koehncke, Niels; Dosman, James

    2017-12-11

    Less is known about the respiratory health of general farming and non-framing populations. A longitudinal Saskatchewan Rural Health Study (SRHS) was conducted to explore the association between individual and contextual factors with respiratory health outcomes in these populations. Hence, the objectives are to: (i) describe the updated methodology of longitudinal SRHS-an extension of baseline survey methodology published earlier; (ii) compare baseline characteristics and the prevalences of respiratory health outcomes between drops-outs and completers; and (iii) summarize key findings based on baseline survey data. The SRHS was a prospective cohort study conducted in two phases: baseline survey in 2010 and a follow-up in 2014. Each survey consisted of two components, self-administered questionnaire and clinical assessments. At baseline, 8261 participants (≥ 18 years) (4624 households) and at follow-up, 4867 participants (2797 households) completed the questionnaires. Clinical assessments on lung functions and/or allergies were conducted among a sub-group of participants from both the surveys. To date, we published 15 peer-reviewed manuscripts and 40 abstracts in conference proceedings. Findings from the study will improve the knowledge of respiratory disease etiology and assist in the development and targeting of prevention programs for rural populations in Saskatchewan, Canada.

  20. Methadone and perinatal outcomes: a retrospective cohort study.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-02-01

    OBJECTIVE: The purpose of this study was to examine the relationship among methadone maintenance treatment, perinatal outcomes, and neonatal abstinence syndrome. STUDY DESIGN: This was a retrospective cohort study of 61,030 singleton births at a large maternity hospital from 2000-2007. RESULTS: There were 618 (1%) women on methadone at delivery. Methadone-exposed women were more likely to be younger, to book late for antenatal care, and to be smokers. Methadone exposure was associated with an increased risk of very preterm birth <32 weeks of gestation (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.40-4.34), being small for gestational age <10th percentile (aOR, 3.27; 95% CI, 2.49-4.28), admission to the neonatal unit (aOR, 9.14; 95% CI, 7.21-11.57), and diagnosis of a major congenital anomaly (aOR, 1.94; 95% CI, 1.10-3.43). There was a dose-response relationship between methadone and neonatal abstinence syndrome. CONCLUSION: Methadone exposure is associated with an increased risk of adverse perinatal outcomes, even when known adverse sociodemographic factors have been accounted for. Methadone dose at delivery is 1 of the determinants of neonatal abstinence syndrome.

  1. Glycemic Control and the Risk of Tuberculosis: A Cohort Study.

    Directory of Open Access Journals (Sweden)

    Pin-Hui Lee

    2016-08-01

    Full Text Available Diabetes is a well-known risk factor for tuberculosis (TB and is increasingly prevalent in low- and middle-income countries, where the burden of TB is high. Glycemic control has the potential to modify the risk of TB. However, there are few studies on the association between glycemic control and TB risk, and the results are inconsistent.We assembled a cohort using 123,546 individuals who participated in a community-based health screening service in northern Taiwan from 5 March 2005 to 27 July 2008. Glycemic control was measured using fasting plasma glucose (FPG at the time of screening. The cohort was followed up to 31 December 2012 for the occurrence of TB by cross-matching the screening database to the national health insurance database. Multiple imputation was used to handle missing information. During a median follow-up of 4.6 y, 327 cases of TB occurred. In the multivariable Cox regression model, diabetic patients with poor glycemic control (FPG > 130 mg/dl had a significantly higher hazard of TB (adjusted hazard ratio [aHR] 2.21, 95% CI 1.63-2.99, p < 0.001 compared to those without diabetes. The hazard of TB in diabetic patients with good glycemic control (FPG ≤ 130 mg/dl did not differ significantly from that in nondiabetic individuals (aHR 0.69, 95% CI 0.35-1.36, p = 0.281. In the linear dose-response analysis, the hazard of TB increased with FPG (aHR 1.06 per 10-mg/dl increase in FPG, 95% CI 1.03-1.08, p < 0.001. Assuming the observed association between glycemic control and TB was causal, an estimated 7.5% (95% CI 4.1%-11.5% of incident TB in the study population could be attributed to poor glycemic control. Limitations of the study include one-time measurement of fasting glucose at baseline and voluntary participation in the health screening service.Good glycemic control could potentially modify the risk of TB among diabetic patients and may contribute to the control of TB in settings where diabetes and TB are prevalent.

  2. A cohort mortality study of leather tanners in Tuscany, Italy.

    Science.gov (United States)

    Iaia, Tonina E; Bartoli, Dusca; Calzoni, Paola; Comba, Pietro; De Santis, Marco; Dini, Flavia; Farina, Giuseppe A; Valiani, Mauro; Pirastu, Roberta

    2006-06-01

    Work in leather tanning may involve exposure to a wide range of chemicals. Some of these are carcinogens or suspected carcinogens. Increased risk for a number of cancers have been reported, although there are considerable inconsistencies between studies. The present study investigates the mortality of leather tanners in Tuscany, Italy. Tanneries were selected from the 1996 Valdarno Inferiore Tanneries Census and were in operation since December 31, 1970. Employees were followed until December 31, 1998 through company records, and the National and Regional Death Index. Demographic and work history data were abstracted from company payrolls. Regional mortality rates were used to calculate Standardized Mortality Ratio (SMR). Analyses were completed for the overall cohort (men and women) and for men who ever worked as of finisher, chrome tanners, and vegetable tanner (only men). The cohort consisted of 4,874 workers (4,150 males and 724 females) employed in 92 tanneries active in 1996 and operating on December 31, 1970. Ascertainment of vital status and cause of death were completed for all individuals by the end of follow-up, December 31, 1998. Males showed increases for cancer of the endocrine glands (SMR 5.67, 4 observed (obs), 90% Confidence Intervals (CI) 195-1,308), blood diseases (SMR 3.29, 4 obs, 90% CI 112-753), mental disorders (SMR 1.95, 6 obs, 90% CI 85-385), violence and accidents (SMR 1.30, 54 obs, 90% CI 102-163). Mortality from myeloid leukemia was increased in males (SMR 2.08, 5 obs, 90% CI 82-437) and in females (SMR 5.99, 2 obs, 90% CI 106-1,887). One death from nasal cancer was observed versus 0.2 expected. Mortality from lung cancer was increased among finishers (SMR 1.45, 19 obs, 90% CI 95-212), an increase was observed also for bladder cancer (SMR 1.25, 2 obs, 90% CI 22-393) and pancreatic cancer (SMR 1.20, 2 obs, 90% CI 21-379). The study confirms previous observations among tanners of increased mortality from lung, bladder, and pancreatic

  3. Ethnicity and excess mortality in severe mental illness: a cohort study.

    Science.gov (United States)

    Das-Munshi, Jayati; Chang, Chin-Kuo; Dutta, Rina; Morgan, Craig; Nazroo, James; Stewart, Robert; Prince, Martin J

    2017-05-01

    Excess mortality in severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders) is well described, but little is known about this inequality in ethnic minorities. We aimed to estimate excess mortality for people with severe mental illness for five ethnic groups (white British, black Caribbean, black African, south Asian, and Irish) and to assess the association of ethnicity with mortality risk. We conducted a longitudinal cohort study of individuals with a valid diagnosis of severe mental illness between Jan 1, 2007, and Dec 31, 2014, from the case registry of the South London and Maudsley Trust (London, UK). We linked mortality data from the UK Office for National Statistics for the general population in England and Wales to our cohort, and determined all-cause and cause-specific mortality by ethnicity, standardised by age and sex to this population in 2011. We used Cox proportional hazards regression to estimate hazard ratios and a modified Cox regression, taking into account competing risks to derive sub-hazard ratios, for the association of ethnicity with all-cause and cause-specific mortality. We identified 18 201 individuals with a valid diagnosis of severe mental illness (median follow-up 6·36 years, IQR 3·26-9·92), of whom 1767 died. Compared with the general population, age-and-sex-standardised mortality ratios (SMRs) in people with severe mental illness were increased for a range of causes, including suicides (7·65, 95% CI 6·43-9·04), non-suicide unnatural causes (4·01, 3·34-4·78), respiratory disease (3·38, 3·04-3·74), cardiovascular disease (2·65, 2·45-2·86), and cancers (1·45, 1·32-1·60). SMRs were broadly similar in different ethnic groups with severe mental illness, although the south Asian group had a reduced SMR for cancer mortality (0·49, 0·21-0·96). Within the cohort with severe mental illness, hazard ratios for all-cause mortality and sub-hazard ratios for natural

  4. Dementia risk after spontaneous intracerebral haemorrhage: a prospective cohort study.

    Science.gov (United States)

    Moulin, Solène; Labreuche, Julien; Bombois, Stéphanie; Rossi, Costanza; Boulouis, Gregoire; Hénon, Hilde; Duhamel, Alain; Leys, Didier; Cordonnier, Charlotte

    2016-07-01

    Dementia occurs in at least 10% of patients within 1 year after stroke. However, the risk of dementia after spontaneous intracerebral haemorrhage that accounts for about 15% of all strokes has not been investigated in prospective studies. We aimed to determine the incidence of dementia and risk factors after an intracerebral haemorrhage. We did a prospective observational cohort study in patients with spontaneous intracerebral haemorrhage from the Prognosis of Intracerebral Haemorrhage (PITCH) cohort who were admitted to Lille University Hospital, Lille, France. We included patients aged 18 years and older with parenchymal haemorrhage on the first CT scan. Exclusion criteria were pure intraventricular haemorrhage; intracerebral haemorrhage resulting from intracranial vascular malformation, intracranial venous thrombosis, head trauma, or tumour; haemorrhagic transformation within an infarct; and referral from other hospitals. Median follow-up was 6 years. We studied risk factors (clinical and neuroradiological [MRI] biomarkers) of new-onset dementia as per a prespecified subgroup analysis, according to intracerebral haemorrhage location. Dementia diagnosis was based on the National Institute on Aging-Alzheimer's Association criteria for all-cause dementia. We did multivariable analyses using competing risk analyses, with death during follow-up as a competing event. From the 560 patients with spontaneous intracerebral haemorrhage enrolled in the PITCH cohort between Nov 3, 2004 and March 29, 2009, we included 218 patients (median age 67·5 years) without pre-existing dementia who were alive at 6 months follow-up. 63 patients developed new-onset dementia leading to an incidence rate of 14·2% (95% CI 10·0-19·3) at 1 year after intracerebral haemorrhage, and incidence reached 28·3% (22·4-34·5) at 4 years. The incidence of new-onset dementia was more than two times higher in patients with lobar intracerebral haemorrhage (incidence at 1 year 23·4%, 14·6-33·3

  5. Study protocol. A prospective cohort study of unselected primiparous women: the pregnancy outcome prediction study

    Directory of Open Access Journals (Sweden)

    White Ian R

    2008-11-01

    Full Text Available Abstract Background There have been dramatic changes in the approach to screening for aneuploidy over the last 20 years. However, the approach to screening for other complications of pregnancy such as intra-uterine growth restriction, pre-eclampsia and stillbirth remains largely unchanged. Randomised controlled trials of routine application of high tech screening methods to the general population have generally failed to show improvement in outcome. We have previously reviewed this and concluded it was due, in large part, to poor performance of screening tests. Here, we report a study design where the primary aim is to generate clinically useful methods to screen women to assess their risk of adverse pregnancy outcome. Methods/design We report the design of a prospective cohort study of unselected primiparous women recruited at the time of their first ultrasound scan. Participation involves serial phlebotomy and obstetric ultrasound at the dating ultrasound scan (typically 10–14 weeks, 20 weeks, 28 weeks and 36 weeks gestation. In addition, maternal demographic details are obtained; maternal and paternal height are measured and maternal weight is serially measured during the pregnancy; maternal, paternal and offspring DNA are collected; and, samples of placenta and membranes are collected at birth. Data will be analysed as a prospective cohort study, a case-cohort study, and a nested case-control study. Discussion The study is expected to provide a resource for the identification of novel biomarkers for adverse pregnancy outcome and to evaluate the performance of biomarkers and serial ultrasonography in providing clinically useful prediction of risk.

  6. The nature of methadone diversion in England: a Merseyside case study

    Directory of Open Access Journals (Sweden)

    Duffy Paul

    2012-01-01

    Full Text Available Abstract Background Methadone maintenance treatment (MMT is a key element in treatment for opiate addiction; however concerns about the diversion of methadone remain. More current empirical data on methadone diversion are required. This research investigated the market for diverted methadone in Merseyside, UK, in order to provide a case study which can be transferred to other areas undertaking methadone maintenance treatment on a large scale. Methods Questionnaires were completed (in interview format with 886 past year users of methadone recruited both in and out of prescribing agencies. Topic areas covered included current prescribing, obtaining and providing methadone, reasons for using illicit methadone and other drug use. Results Large proportions of participants had obtained illicit methadone for use in the past year with smaller proportions doing so in the past month. Proportions of participants buying and being given methadone were similar. Exchange of methadone primarily took place between friends and associates, with 'dealers' rarely involved. Gender, age, whether participant's methadone consumption was supervised and whether the aims of their treatment had been explained to them fully, influenced the extent to which participants were involved in diverting or using diverted methadone. Conclusion Methadone diversion is widespread although drug users generally do not make use of illicit methadone regularly (every month. The degree of altruism involved in the exchange of methadone does not negate the potential role of this action in overdose or the possibility of criminal justice action against individuals. Treatment agencies need to emphasise these risks whilst ensuring that treatment aims are effectively shared with clients to ensure adherence to treatment.

  7. Governing body nurses' experiences of clinical commissioning groups: an observational study of two clinical commissioning groups (CCGs) in England

    OpenAIRE

    Allan, Helen T.; Dixon, Roz; Lee, Gay; Savage, Jan; Tapson, Christine

    2017-01-01

    Clinical commissioning groups (CCGs) were set up under the Health & Social Care Act (2012) in England to commission healthcare services for local communities. Governing body nurses (GBNs) provide nursing leadership to commissioning services on CCGs. Little is known about how nurses function on clinical commissioning groups. We conducted observations of seven formal meetings, three informal observation sessions, and seven interviews from January 2015 to July 2015 in two CCGs in the South of En...

  8. Leaders and leadership in a climate of uncertainty:a case study of structural change in England

    OpenAIRE

    Rayner, Stephen M

    2017-01-01

    The research reported in this article contributes new understanding of leadership in the context of change, by investigating how the views, values and professional practices of those in leadership roles were revealed, interplayed and changed during a period of turbulence in a school in England. The governors of the school proposed changing the school’s legal status from a local-authority school to an academy, which is an independent school funded by the State but governed and managed by an Ac...

  9. Study on the prescribing patterns of antipsychotic medication in a rural England Community Mental Health Team.

    Science.gov (United States)

    Seshadri, Madhavan; Elsemary, Ahmed; Thalitaya, Madhusudan Deepak; Chikodzore, Lawrence; Nagalingam, Priya

    2017-09-01

    Providing comprehensive services for about 400 patients in the South Herefordshire area, the community mental health team manages cases of varying severity and complexity, ranging from Schizophrenia, to neuroses and disorders of adult personality. Antipsychotic medication remains a mainstay of treatment and management for patients under the team case load; hence a need exists for a detailed look into the prescription patterns of such medications. The aim of this study was to look into the prescribing patterns of antipsychotics for a sample of 50 patients in the South Herefordshire community team during the year of 2016 (from Jan 2016 to Dec 2016), as well as investigate whether these antipsychotics were licensed to be used for the corresponding diagnoses of these patients. We also looked into whether patients were prescribed antipsychotics within BNF limits. As a part of this audit we looked into whether patients were made aware that they were on unlicensed antipsychotics or on above the BNF maximum doses of antipsychotics. A random sample of 50 patients was taken from the case load of the South community team as is documented on RIO. The mean age of the patients in the sample was 46.1 (SD= ±14.6) Sample selection was done by selecting every seventh patient in the patient case load (if not using antipsychotics the next patient was chosen). Patients studied involved those with F1-F19 Mental and behavioural disorders due to psychoactive substance use, F20-F29 Schizophrenia/Schizotypal/Delusional disorder, F31 Bipolar affective disorders, F32 Depression, F40-F48 Anxiety Neurotic and stress related disorders and somatoform disorders, F50-F59 Behaviour syndromes associated with physiological disturbances and physical factors, F60-F69 Disorders of adult personality and behaviour. The patients selected had to be followed up by the recovery team during the year 2016 and they had to be on an antipsychotic medication at any point during that time period. A scale was

  10. Smoking and other risk factors for pancreatic cancer: a cohort study in men in Lithuania

    National Research Council Canada - National Science Library

    Kuzmickiene, Irena; Everatt, Ruta; Virviciute, Dalia; Tamosiunas, Abdonas; Radisauskas, Ricardas; Reklaitiene, Regina; Milinaviciene, Egle

    2013-01-01

    .... We investigated the association between different lifestyle, biological and anthropometric factors and the risk of pancreatic cancer in a prospective population-based cohort study from Kaunas, Lithuania...

  11. Spatial Accessibility of Primary Care in England: A Cross-Sectional Study Using a Floating Catchment Area Method.

    Science.gov (United States)

    Bauer, Jan; Müller, Ruth; Brüggmann, Dörthe; Groneberg, David A

    2017-07-07

    To analyze the general practitioners (GPs) with regard to the degree of urbanization, social deprivation, general health, and disability. Small area population data and GP practice data in England. We used a floating catchment area method to measure spatial GP accessibility with regard to the degree of urbanization, social deprivation, general health, and disability. Data were collected from the Office for National Statistics and the general practice census and analyzed using a geographic information system. In all, 25.8 percent of the population in England lived in areas with a significant low GP accessibility (mean z-score: -4.2); 27.6 percent lived in areas with a significant high GP accessibility (mean z-score: 7.7); 97.8 percent of high GP accessibility areas represented urban areas, and 31.1 percent of low GP accessibility areas represented rural areas (correlation of accessibility and urbanity: r = 0.59; paccessibility throughout England. However, socially deprived areas did not have poorer spatial access to GPs. © Health Research and Educational Trust.

  12. 75 FR 9902 - Proposed Collection; Comment Request; The Agricultural Health Study: A Prospective Cohort Study...

    Science.gov (United States)

    2010-03-04

    ... history information for respondents enrolled in the Agriculture Health Study. This represents a request to... Health Study: A Prospective Cohort Study of Cancer and Other Disease Among Men and Women in Agriculture... Disease Among Men and Women in Agriculture (NCI) (OMB : 0925-0406). Type of Information Collection Request...

  13. Gamma-glutamyltransferase and cancer incidence: the Ohsaki cohort study.

    Science.gov (United States)

    Tsuboya, Toru; Kuriyama, Shinichi; Nagai, Masato; Hozawa, Atsushi; Sugawara, Yumi; Tomata, Yasutake; Kakizaki, Masako; Nishino, Yoshikazu; Tsuji, Ichiro

    2012-01-01

    Although experimental studies have shown that gamma-glutamyltransferase (GGT) has a role in tumor progression, epidemiologic evidence for a relationship between GGT and cancer incidence is limited. The present study investigated the association between GGT and cancer incidence and assessed the role of alcohol consumption in this association. We examined a cohort of 15 031 Japanese adults aged 40 to 79 years who attended a health checkup in 1995 and were free of cancer at that time. GGT was measured using the Szasz method. The participants were then followed from 1 January 1996 until 31 December 2005, and cancer incidence was recorded by using the Miyagi Regional Cancer Registry. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed for each quartile of GGT and compared. The lowest quartile (GGT cancers. Among participants in the highest quartile (GGT ≥31.0 IU/ml), the multivariate HR for any cancer was 1.28 (95% CI, 1.08-1.53; P for trend, cancer was significantly greater than unity, and the HRs for esophageal, pancreatic, and breast cancers were greater than unity but not significantly so. This positive trend was observed only in current drinkers. Our findings suggest that there is a positive relationship between GGT and cancer incidence only for alcohol-related cancers in current drinkers and that the positive association of GGT with cancer incidence largely reflects alcohol consumption.

  14. Labor Induction with Orally Administrated Misoprostol: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Tove Wallstrom

    2017-01-01

    Full Text Available Introduction. One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings. Material and Methods. Retrospective cohort study of 4002 singleton pregnancies with a gestational age ≥34 w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously used methods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS rate, acid-base status in cord blood, Apgar score 1500 ml (PPH. Results. The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p<0.001. No significant difference in the frequency of low Apgar score (p=0.3, low aPh in cord blood (p=0.1, or PPH (p=0.4 between the different methods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston⁎⁎ (Propess® (aor = 2.9 (1.6–5.2. Conclusion. Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.

  15. Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.

    Science.gov (United States)

    Steel, N; Hardcastle, A C; Bachmann, M O; Richards, S H; Mounce, L T A; Clark, A; Lang, I; Melzer, D; Campbell, J

    2014-10-24

    We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment. The English Longitudinal Study of Ageing, a panel study of 12,765 participants aged 50 years and older in four waves from 2004 to 2011, selected using a stratified random sample of households in England. Distribution of illness burden, diagnosis and treatment by wealth was estimated using regression analysis. The main outcome measures were ORs for the illness burden, diagnosis and treatment, respectively, adjusted for age, sex and wealth. We estimated the illness burden for angina with the Rose Angina scale, diabetes with fasting glycosylated haemoglobin, depression with the Centre for Epidemiologic Studies Depression Scale, osteoarthritis with self-reported pain and disability and cataract with self-reported poor vision. Medical diagnoses were self-reported for all conditions. Treatment was defined as β-blocker prescription for angina, surgery for osteoarthritis and cataract, and receipt of predefined effective interventions for diabetes and depression. Compared with the wealthiest, the least wealthy participant had substantially higher odds for illness burden from any of the five conditions at all four time points, with ORs ranging from 4.2 (95% CI 2.6 to 6.8) for diabetes to 15.1 (11.4 to 20.0) for osteoarthritis. The ORs for diagnosis and treatment were smaller in all five conditions, and ranged from 0.9 (0.5 to 1.4) for diabetes treatment to 4.5 (3.3 to 6.0) for angina diagnosis. The substantially higher illness burden in less wealthy participants was not matched by appropriately higher levels of diagnosis and treatment. Published by the BMJ

  16. Night work and breast cancer in women: A Swedish cohort study

    NARCIS (Netherlands)

    Äkerstedt, T.; Knutsson, A.; Narusyte, J.; Svedberg, P.; Kecklund, L.G.; Alexanderson, K.

    2015-01-01

    Objectives Recent research has suggested a moderate link between night work and breast cancer in women, mainly through case–control studies, but non-significant studies are also common and cohort studies are few. The purpose of the present study was to provide new information from cohort data

  17. Predicting persistent disabling low back pain in general practice: a prospective cohort study.

    Science.gov (United States)

    Jones, Gareth T; Johnson, Ruth E; Wiles, Nicola J; Chaddock, Carol; Potter, Richard G; Roberts, Chris; Symmons, Deborah P M; Macfarlane, Gary J

    2006-05-01

    Patients may adopt active and/or passive coping strategies in response to pain. However, it is not known whether these strategies may also precede the onset of chronic symptoms and, if so, whether they are independent predictors of prognosis. To examine, in patients with low back pain in general practice, the prognostic value of active and passive coping styles, in the context of baseline levels of pain, disability and pain duration. Prospective cohort study. Nine general practices in north west England. Patients consulting their GP with a new episode of low back pain were recruited to the study. Information on coping styles, pain severity, disability, duration, and a brief history of other chronic pain symptoms was recorded using a self-completion postal questionnaire. Participants were then sent a follow-up questionnaire, 3 months after their initial consultation, to assess the occurrence of low back pain. The primary outcome was persistent disabling low back pain, that is, low back pain at 3-month follow-up self-rated as >or=20 mm on a 100 mm visual analogue scale, and >or=5 on the Roland and Morris Disability Questionnaire. A total of 974 patients took part in the baseline survey, of whom 922 (95%) completed a follow-up questionnaire; 363 individuals (39%) reported persistent disabling pain at follow-up. Persons who reported high levels of passive coping experienced a threefold increase in the risk of persistent disabling low back pain (relative risk [RR] = 3.0; 95% confidence interval [CI] = 2.3 to 4.0). In contrast, active coping was associated with neither an increase nor a decrease in the risk of a poor prognosis. After adjusting for baseline pain severity, disability, and other measures of pain and pain history, persons who reported a high passive coping score were still at 50% increased risk of a poor outcome (RR = 1.5; 95% CI = 1.1 to 2.0). Patients who report passive coping strategies experience a significant increase in the risk of persistent symptoms

  18. Carvedilol use is associated with reduced cancer risk: A nationwide population-based cohort study.

    Science.gov (United States)

    Lin, Chin-Sheng; Lin, Wei-Shiang; Lin, Cheng-Li; Kao, Chia-Hung

    2015-04-01

    To investigate the effect of carvedilol on the incidence of cancer in a large population-based cohort study. Data were obtained from the Taiwan National Health Insurance Research Database. The cohort study included 6771 patients who received long-term carvedilol treatment between 2000 and 2010 (carvedilol cohort) and 6771 matched controls (noncarvedilol cohort). A Cox proportional hazards model was used to evaluate the risk of cancer in the patients treated with carvedilol. With the mean follow-up period of 5.17 years and 4.93 years in the carvedilol and noncarvedilol cohorts, respectively, the patients in the carvedilol cohort had a 26% reduction of cancer risk compared with those in the noncarvedilol cohort (hazard ratio [HR]=0.74; 95% confidence interval [CI]=0.63-0.87; pcancer site, treatment with carvedilol in the carvedilol cohort resulted in significantly lower incidence of stomach and lung cancers than in the noncarvedilol cohort. This nationwide population-based cohort study demonstrated that long-term treatment with carvedilol is associated with reduced upper gastrointestinal tract and lung cancer risk, indicating that carvedilol could be a potential agent in these cancers prevention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Mortality in dementia with Lewy bodies compared with Alzheimer’s dementia: a retrospective naturalistic cohort study

    Science.gov (United States)

    Farooq, Redwan; Menon, Vandana B; Cardinal, Rudolf N; O’Brien, John T

    2017-01-01

    Objectives To use routine clinical data to investigate survival in dementia with Lewy bodies (DLB) compared with Alzheimer’s dementia (AD). DLB is the second most common dementia subtype after AD, accounting for around 7% of dementia diagnoses in secondary care, though studies suggest that it is underdiagnosed by up to 50%. Most previous studies of DLB have been based on select research cohorts, so little is known about the outcome of the disease in routine healthcare settings. Setting Cambridgeshire & Peterborough NHS Foundation Trust, a mental health trust providing secondary mental health care in England. Sample 251 DLB and 222 AD identified from an anonymised database derived from electronic clinical case records across an 8-year period (2005–2012), with mortality data updated to May 2015. Results Raw (uncorrected) median survival was 3.72 years for DLB (95% CI 3.33 to 4.14) and 6.95 years for AD (95% CI 5.78 to 8.12). Controlling for age at diagnosis, comorbidity and antipsychotic prescribing the model predicted median survival for DLB was 3.3 years (95% CI 2.88 to 3.83) for males and 4.0 years (95% CI 3.55 to 5.00) for females, while median survival for AD was 6.7 years (95% CI 5.27 to 8.51) for males and 7.0 years (95% CI 5.92 to 8.73) for females. Conclusion Survival from first presentation with cognitive impairment was markedly shorter in DLB compared with AD, independent of age, sex, physical comorbidity or antipsychotic prescribing. This finding, in one of the largest clinical cohorts of DLB cases assembled to date, adds to existing evidence for poorer survival for DLB versus AD. There is an urgent need for further research to understand possible mechanisms accounting for this finding. PMID:29101136

  20. Dioxins and endometriosis: cohort study of women in West Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Diliberto, J.; Birnbaum, L. [U.S. Environmental Protection Agency, NHEERL, ETD, Research Triangle Park, NC (United States); Staats, D.A. [West Virginia Dept. of Environmental Protection, Charleston, WV (United States); Staats, D.A.; Becker, J.; Jude, D.; Chouinard, S.C.; Smith, T. [Marshall Univ. Medical Center, Huntington, WV (United States); Sirinek, L. [West Virginia Dept. of Environmental Protection, Wheeling, WV (United States); Clark, G. [Xenobiotic Detection Systems Inc., Durham, NC (United States); Landy, R. [U.S. Environmental Protection Agency, Region 3, ESC, Ft. Meade, MD (United States)

    2004-09-15

    The women in this endometriosis/dioxin health study reside in the Kanawha/Ohio River Valley area of West Virginia and comprise a potential cluster (cohort) of individuals who have been exposed to dioxins (dioxin and dioxin-like chemicals) at background levels higher than those seen in other areas of the United States. The emissions from an unique constellation of chemical industries appear to have led to high levels of environmental dioxin contaminants. In addition, this area has a high incidence of endometriosis. Previous animal studies, both in nonhuman primates and rodents, have demonstrated a correlation between dioxin exposure and endometriosis. Human epidemiology studies have suggested an association but have not demonstrated a statistically significant correlation, possibly due to limitations in study design such as insufficient numbers, measurement of only TCDD rather than total equivalents to TCDD (TEQs), and/or lack of surgical ascertainment of endometriosis. The present study is addressing these issues. Thus, we have the unusual congruence of identified emission sources and high background levels of dioxins and a potentially related elevation of endometriosis. Endometriosis is a condition suffered by women in which the endometrial tissue, that usually lines the uterus, migrates to other areas. Most commonly it is found in the abdomen, bladder, ovaries or bowel. Patients with endometriosis experience pelvic pain, irregular bleeding, infertility and other problems. Immune suppression has been associated with severe endometriosis. This debilitating condition is a poorly understood disease. In the United States, this condition affects millions of women in their reproductive years and is showing up more frequently in very young women. Endometriosis will seriously impact future fertility and health care utilization. Data suggest that the rate of endometriosis in the Kanawha and Ohio River valleys is higher than is seen in other regions of the United States.

  1. Occupation and Bladder Cancer in a Population-Based Case-control Study in Northern New England

    Science.gov (United States)

    Colt, Joanne S.; Karagas, Margaret R.; Schwenn, Molly; Baris, Dalsu; Johnson, Alison; Stewart, Patricia; Verrill, Castine; Moore, Lee E.; Lubin, Jay; Ward, Mary H.; Samanic, Claudine; Rothman, Nathaniel; Cantor, Kenneth P.; Beane Freeman, Laura E.; Schned, Alan; Cherala, Sai; Silverman, Debra T.

    2010-01-01

    Objectives We used data from a large, population-based case-control study in New England to examine relationships between occupation, industry, and bladder cancer risk. Methods Lifetime occupational histories were obtained by personal interview from 1,158 patients newly diagnosed with urothelial carcinoma of the bladder between 2001 and 2004 among residents of Maine, New Hampshire, and Vermont, and from 1,402 population controls selected from Department of Motor Vehicle records (ages 30 to 64 years) or Medicare beneficiary records (65 to 79 years). Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for demographic factors, smoking, and employment in high-risk occupations other than the one being analyzed. Results Male precision metalworkers and metalworking/plasticworking machine operators had significantly elevated risks and significant trends in risk with duration of employment (precision metalworkers: OR=2.2; CI: 1.4, 3.4, Ptrend =0.0065; metalworking/plasticworking machine operators: OR=1.6; CI: 1.01, 2.6, Ptrend=0.047). Other occupations/industries for which risk increased significantly with duration of employment included: for men, textile machine operators, mechanics/repairers, automobile mechanics, plumbers, computer systems analysts, information clerks, and landscape and horticultural services industry workers; and for women, service occupations, health services, cleaning and building services, management-related occupations, electronic components and accessories manufacturing, and transportation equipment manufacturing. Men reporting use of metalworking fluids (MWF) had a significantly elevated bladder cancer risk (OR=1.7; 95% CI: 1.1, 2.5), Conclusions Our findings for metalworkers and for MWF exposure support the hypothesis that some component(s) of MWF may be carcinogenic to the bladder in humans. Our results also corroborate many other previously-reported associations between bladder

  2. Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North-West England.

    Science.gov (United States)

    Thomson, Gill; Downe, Soo

    2016-09-01

    to identify the emotional and support needs of pregnant multigravida women who have experienced adverse responses associated with a previous childbirth experience. four maternity hospitals in North-West England. 100 surveys were distributed at an anomaly scan clinic in each of four maternity hospitals (total n=400). The survey included an adapted version of a Post-Traumatic Stress Disorder Symptom Scale to explore trauma responses at two broad time points: (a) following a previous birth and (b) during the current pregnancy. Participants were also asked about the optimal time to receive support post-birth, and the type and provider of support they had accessed/would have liked to access. Descriptive and inferential statistics were undertaken on the quantitative data. The qualitative data were analysed using a basic thematic approach. multigravida pregnant women aged 18+ years. the overall response rate was 28% (n=112); 43% (n=46) of the women had experienced negative/trauma responses associated with a previous birth, 74% of whom (n=34) continued/re-experienced adverse responses in their current pregnancy. Most commonly reported trauma responses were difficulties in recalling the previous birth(s), avoiding memories associated with it, and the distress associated with these memories when they were recalled. Approximately 54% (n=25) had received some form of support post-birth, and variations in preferred timing of postnatal support provision were reported. Information on available support and opportunities to discuss the birth with a maternity professional were identified most frequently as preferred support options. women's views about what might work should form the basis for effectiveness studies in this area. Among the participants in this study there was evidence of unmet support needs relating to negative or traumatic responses to a previous birth. The range of preferred timing and types of support indicate that flexible needs-based support options should be

  3. [Prognosis in pediatric traumatic brain injury. A dynamic cohort study].

    Science.gov (United States)

    Vázquez-Solís, María G; Villa-Manzano, Alberto I; Sánchez-Mosco, Dalia I; Vargas-Lares, José de Jesús; Plascencia-Fernández, Irma

    2013-01-01

    traumatic brain injury is a main cause of hospital admission and death in children. Our objective was to identify prognostic factors of pediatric traumatic brain injury. this was a dynamic cohort study of traumatic brain injury with 6 months follow-up. The exposition was: mild or moderate/severe traumatic brain injury, searching for prognosis (morbidity-mortality and decreased Glasgow scale). Relative risk and logistic regression was estimated for prognostic factors. we evaluated 440 patients with mild traumatic brain injury and 98 with moderate/severe traumatic brain injury. Morbidity for mild traumatic brain injury was 1 %; for moderate/severe traumatic brain injury, 5 %. There were no deaths. Prognostic factors for moderate/severe traumatic brain injury were associated injuries (RR = 133), fractures (RR = 60), street accidents (RR = 17), night time accidents (RR = 2.3) and weekend accidents (RR = 2). Decreased Glasgow scale was found in 9 %, having as prognostic factors: visible injuries (RR = 3), grown-up supervision (RR = 2.5) and time of progress (RR = 1.6). there should be a prognosis established based on kinetic energy of the injury and not only with Glasgow Scale.

  4. The protective role of trait anxiety: a longitudinal cohort study.

    Science.gov (United States)

    Lee, W E; Wadsworth, M E J; Hotopf, M

    2006-03-01

    Most research has indicated that neuroticism (or trait anxiety) is associated with only negative outcomes. Such a common, heritable and variable trait is expected to have beneficial as well as detrimental effects. We tested the hypothesis that trait anxiety in childhood reduces the risk of dying from accidental causes in early adult life. A longitudinal, population-based, birth cohort study of 4,070 men and women born in the UK in 1946. Trait anxiety as judged by teachers when the participants were 13 and 15 years old, and the neuroticism scale of a Maudsley Personality Inventory (MPI) when the participants were 16 years old. Outcomes were deaths, deaths from accidents, non-fatal accidents, and non-fatal accidents requiring medical intervention. Adolescents with low trait anxiety had higher rates of accident mortality to age 25 [low anxiety at 13, hazard ratio (HR) 5.9, low anxiety at 15, HR 1.8]. Low trait anxiety in adolescence was associated with decreased non-accidental mortality after age 25 (low anxiety at 13, HR 0; low anxiety at 15, HR 0.7; low neuroticism at 16, HR 0.7). High trait anxiety measured in adolescence is associated with reduced accidents and accidental death in early adulthood but higher rates of non-accidental mortality in later life.

  5. Fertility Treatment and Childhood Epilepsy - a Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Kettner, Laura Ozer; Kesmodel, Ulrik Schiøler; Ramlau-Hansen, Cecilia Høst

    2017-01-01

    BACKGROUND: Fertility treatment includes hormonal stimulation of the woman and in vitro manipulation of gametes and embryos that may influence prenatal brain development. We aimed to investigate the association between fertility treatment and childhood epilepsy, including specific types of treatm......BACKGROUND: Fertility treatment includes hormonal stimulation of the woman and in vitro manipulation of gametes and embryos that may influence prenatal brain development. We aimed to investigate the association between fertility treatment and childhood epilepsy, including specific types...... of treatment and indications, as well as subtypes of epilepsy. METHODS: In this nationwide birth cohort study, we included all pregnancies in Denmark resulting in live-born singletons, 1995-2003. Children conceived by fertility treatment and children developing epilepsy (until 2013) were identified from Danish...... national registers. RESULTS: A total of 565,116 pregnancies were included; 8,071 children (1.4%) developed epilepsy. Children conceived after ovulation induction or intrauterine insemination had a slightly higher risk of childhood epilepsy (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.00, 1...

  6. Recurrent pericarditis in children and adolescents: a multicentre cohort study.

    Science.gov (United States)

    Imazio, Massimo; Brucato, Antonio; Pluymaekers, Nikki; Breda, Luciana; Calabri, Giovanni; Cantarini, Luca; Cimaz, Rolando; Colimodio, Filomena; Corona, Fabrizia; Cumetti, Davide; Cuccio, Chiara Di Blasi Lo; Gattorno, Marco; Insalaco, Antonella; Limongelli, Giuseppe; Russo, Maria Giovanna; Valenti, Anna; Finkelstein, Yaron; Martini, Alberto

    2016-09-01

    Limited data are available about recurrent pericarditis in children. We sought to explore contemporary causes, characteristics, therapies and outcomes of recurrent pericarditis in paediatric patients. A multicentre (eight sites) cohort study of 110 consecutive cases of paediatric patients with at least two recurrences of pericarditis over an 11-year period (2000-2010) [median 13 years, interquartile range (IQR) 5, 69 boys]. Recurrences were idiopathic or viral in 89.1% of cases, followed by postpericardiotomy syndrome (9.1%) and familial Mediterranean fever (0.9%). Recurrent pericarditis was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) in 80.9% of cases, corticosteroids in 64.8% and colchicine was added in 61.8%. Immunosuppressive therapies were administered in 15.5% of patients after subsequent recurrences. After a median follow-up of 60th months, 528 subsequent recurrences were recorded (median 3, range 2-25). Corticosteroid-treated patients experienced more recurrences (standardized risk of recurrence per 100 person-years was 93.2 for patients treated with corticosteroids and 45.2 for those without), side effects and disease-related hospitalizations (for all P pericarditis developed in 2.7% of patients. Recurrent pericarditis has an overall favourable prognosis in children, although it may require frequent readmissions and seriously affect the quality of life, especially in patients treated with corticosteroids. Colchicine or anakinra therapies were associated with significant decrease in the risk of recurrence.

  7. The use of new technologies in Cohort studies

    Directory of Open Access Journals (Sweden)

    Carlos Antonio Bruno da Silva

    2010-03-01

    élites de posicionamento (GPS para a localização de residências, o uso de coletas de DNA para comparações futuras, as bases de dados institucionais e governamentais são fontes de informações que abreviam, minimizam gastos e dão maior confiabilidade aos estudos de muito longa duração.Tem-se visto antigos trabalhos realizados há décadas sendo submetidos a novas avaliações estatísticas com o desenvolvimento de novas teorias e descobertas. Neste número da revista brasileira em promoção da saúde, acompanhamos o nascimento de uma nova coorte(14, que acompanhará a evolução dos determinantes de saúde de população de uma grande comunidade do Nordeste do Brasil.REFERÊNCIAS1. Morabia A, Guthold R. Wilhelm Weinberg’s 1913Large Retrospective Cohort Study: a rediscovery. Am JEpidemiol. 2007;165(7:727-33.2. Doll R. Cohort studies: history of the method. II.Retrospective cohort studies. Soz Praventivmed.2001;46(3:152-60. Erratum in: Soz Praventivmed2002;47(2:90.3. Dawber TR, Meadors GF, Moore Jr. FE. Epidemiologicalapproaches to heart disease: the Framingham Study.Am J Public Health Nations Health. 1951;41(3:279-81.4. Fonseca MGU, Peres F, Firmo JOA, Uchoa E.,Percepção de risco: maneiras de pensar e agirno manejo de agrotóxicos. Ciênc saúde coletiva[periódico na Internet]. 2007 Mar [acesso em 2010Maio 26]; 12(1:39-50. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000100009&lng=en&nrm=iso. doi: 10.1590/S1413-81232007000100009.5. Victora CG, Barros FC. Cohort profile: the 1982Pelotas (Brazil birth cohort study. Int J Epidemiol.2006;35(2:237-42.6. Armenian HK (editor. Applications of the case-controlmethod. Epidemiol Rev. 1994;16:1-164.7. Samet JM, Muñoz A. Evolution of the cohort study.Epidemiol Rev. 1998;20(1:1-14.8. Doll R. Cohort studies: history of the method. II.Retrospective cohort studies. Soz Praventivmed.2001;46(3:152-60. Erratum in: Soz Praventivmed2002;47(2:909. Lima-Costa MF, Barreto SM. Tipos de

  8. Perinatal depression in a cohort study on Iranian women

    Directory of Open Access Journals (Sweden)

    Gholam Reza Kheirabadi

    2010-01-01

    Full Text Available Background: Childbearing years in the women′s life are associated with the highest risk of depression. In this study depression in third trimester of pregnancy and after delivery was studied. Depressive symptom score and the proportion of mothers above a threshold were compared to indicate probable depressive disorder at each stage. Methods: This prospective cohort study was conducted in rural areas of Isfahan province of Iran from September 2007 to January 2008. Subjects were all in their third trimester and followed up from the beginning of the study to 6- 8 weeks postpartum. At all, 2156 pregnant women completed the self report questionnaires but 258 were excluded because they were incomplete and final analysis was done with 1898 samples. At the final stage the sample size was decreased to 1291. Results: The prevalence of depression based on BDI score greater than 20 in last trimester of pregnancy, was 22.8% and rate of depression based on EPD score greater than 12 between 6 to 8 weeks after delivery, was 26.3%. Incidence of Post Partum Depression (PPD in 6 to 8 weeks after delivery in those who were not clinically depressed during preg-nancy was 20.1%. Results showed that history of depression, unplanned pregnancy, being housewife and having 3 or more children had significant relation with ante partum depression. Conclusions: Two main risk factors for post partum depression are previous history of depression and depression during current pregnancy. It is important to assess these variables during pregnancy in order to facilitate timely identifi-cation of women at risk.

  9. Women's intentions to breastfeed: a population-based cohort study.

    Science.gov (United States)

    Lutsiv, O; Pullenayegum, E; Foster, G; Vera, C; Giglia, L; Chapman, B; Fusch, C; McDonald, S D

    2013-11-01

    Given that intention to breastfeed is a strong predictor of breastfeeding initiation and duration, the objectives of this study were to estimate the population-based prevalence and the factors associated with the intention to breastfeed. Retrospective population-based cohort study. All hospitals in Ontario, Canada (1 April 2009-31 March 2010). Women who gave birth to live, term, singletons/twins. Patient, healthcare provider, and hospital factors that may be associated with intention to breastfeed were analysed using univariable and multivariable regression. Population-based prevalence of intention to breastfeed and its associated factors. The study included 92,364 women, of whom 78,806 (85.3%) intended to breastfeed. The odds of intending to breastfeed were higher amongst older women with no health problems and women who were cared for exclusively by midwives (adjusted OR 3.64, 95% CI 3.13-4.23). Being pregnant with twins (adjusted OR 0.73, 95% CI 0.57-0.94), not attending antenatal classes (adjusted OR 0.58, 95% CI 0.54-0.62), having previous term or preterm births (adjusted OR 0.79, 95% CI 0.78-0.81, and adjusted OR 0.87, 95% CI 0.82-0.93, respectively), and delivering in a level-1 hospital (adjusted OR 0.85, 95% CI 0.77-0.93) were associated with a lower intention to breastfeed. In this population-based study ~85% of women intended to breastfeed their babies. Key factors that are associated with the intention to breastfeed were identified, which can now be targeted for intervention programmes aimed at increasing the prevalence of breastfeeding and improving overall child and maternal health. © 2013 RCOG.

  10. Regression analysis for secondary response variable in a case-cohort study.

    Science.gov (United States)

    Pan, Yinghao; Cai, Jianwen; Kim, Sangmi; Zhou, Haibo

    2017-12-29

    Case-cohort study design has been widely used for its cost-effectiveness. In any real study, there are always other important outcomes of interest beside the failure time that the original case-cohort study is based on. How to utilize the available case-cohort data to study the relationship of a secondary outcome with the primary exposure obtained through the case-cohort study is not well studied. In this article, we propose a non-parametric estimated likelihood approach for analyzing a secondary outcome in a case-cohort study. The estimation is based on maximizing a semiparametric likelihood function that is built jointly on both time-to-failure outcome and the secondary outcome. The proposed estimator is shown to be consistent, efficient, and asymptotically normal. Finite sample performance is evaluated via simulation studies. Data from the Sister Study is analyzed to illustrate our method. © 2017, The International Biometric Society.

  11. A cross-sectional questionnaire study of the rules governing pupils’ carriage of inhalers for asthma treatment in secondary schools in North East England

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    Wendy Funston

    2016-05-01

    Full Text Available Objectives. The primary objective of this study was to assess the rules governing secondary school pupils’ carriage of inhalers for emergency treatment of asthma in the North East of England. Design. This study was based upon a postal questionnaire survey. Setting. The setting for this study was mainstream free-to-attend secondary schools which admit 16 year old pupils within the 12 Local Authority areas which make up the North East of England. Participants. All 153 schools meeting the inclusion criteria were invited to participate in the study, of which 106 (69% took part. Main Outcome Measures. Our three main outcome measures were: whether pupils are permitted to carry inhalers on their person while at school; whether advance permission is required for pupils to carry inhalers, and from whom; and whether the school has an emergency ‘standby’ salbutamol inhaler for use in asthma emergencies, as permitted since October 2014 under recent amendments to The Human Medicines Regulations 2012. Results. Of 98 schools submitting valid responses to the question, 99% (n = 97 permitted pupils to carry inhalers on their person while at school; the remaining school stored pupils’ inhalers in a central location within the school. A total of 22% of included schools (n = 22 required parental permission before pupils were permitted to carry inhalers. Of 102 schools submitting valid responses to the question, 44% (n = 45 had purchased a ‘standby’ salbutamol inhaler for use in asthma emergencies. Conclusions. Most secondary schools in North East England permit pupils to carry inhalers on their person. The requirement in a minority of schools for parental permission to be given possibly contravenes the standard ethical practices in clinical medicine for children of this age. Only a minority of schools hold a ‘standby’ salbutamol inhaler for use in asthma emergencies. Wider availability may improve outcomes for asthma emergencies occurring in schools.

  12. Selecting the appropriate study design: Case–control and cohort study designs

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    Aamir Omair

    2016-01-01

    Full Text Available This article discusses the observational analytic study designs, i.e., case–control and cohort studies. These two study designs are useful for testing a hypothesis to determine the association between a risk factor and a disease. The analysis for both the studies is based on the conventional 2 × 2 table with the disease status in columns and the risk factor status in rows. The case–control studies start from the disease status and compare the exposure to the risk factor(s between the diseased (cases and the not diseased (controls groups. The odds ratio is determined to compare the proportion of exposed persons in the two groups. The cohort studies start from the exposure to the risk factor status and compare the incidence of the disease in the exposed and not exposed groups. The relative risk compares the incidence between the two groups. The 95% confidence interval is estimated for both studies to determine an actual association between the risk factor and the disease. The strengths and limitations of the two study designs differ based on the direction of the two designs. The case–control study goes backward from the disease status so is more useful for rare diseases and for evaluating multiple risk factors, but it cannot determine causality, and there are chances of recall bias affecting the results of the study. The cohort studies are generally prospective in design from the exposure status and can determine the causal association between the risk factor and the disease. However, the cohort studies are more expensive and require a longer time as well as a larger sample size; the loss to follow-up and misclassification biases can affect the results of the cohort studies.

  13. Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study.

    Science.gov (United States)

    Fisher, Helen L; Moffitt, Terrie E; Houts, Renate M; Belsky, Daniel W; Arseneault, Louise; Caspi, Avshalom

    2012-04-26

    To test whether frequent bullying victimisation in childhood increases the likelihood of self harming in early adolescence, and to identify which bullied children are at highest risk of self harm. The Environmental Risk (E-Risk) longitudinal study of a nationally representative UK cohort of 1116 twin pairs born in 1994-95 (2232 children). England and Wales, United Kingdom. Children assessed at 5, 7, 10, and 12 years of age. Relative risks of children's self harming behaviour in the six months before their 12th birthday. Self harm data were available for 2141 children. Among children aged 12 who had self harmed (2.9%; n=62), more than half were victims of frequent bullying (56%; n=35). Exposure to frequent bullying predicted higher rates of self harm even after children's pre-morbid emotional and behavioural problems, low IQ, and family environmental risks were taken into account (bullying victimisation reported by mother: adjusted relative risk 1.92, 95% confidence interval 1.18 to 3.12; bullying victimisation reported by child: 2.44, 1.36 to 4.40). Victimised twins were more likely to self harm than were their non-victimised twin sibling (bullying victimisation reported by mother: 13/162 v 3/162, ratio=4.3, 95% confidence interval 1.3 to 14.0; bullying victimisation reported by child: 12/144 v 7/144, ratio=1.7, 0.71 to 4.1). Compared with bullied children who did not self harm, bullied children who self harmed were distinguished by a family history of attempted/completed suicide, concurrent mental health problems, and a history of physical maltreatment by an adult. Prevention of non-suicidal self injury in young adolescents should focus on helping bullied children to cope more appropriately with their distress. Programmes should target children who have additional mental health problems, have a family history of attempted/completed suicide, or have been maltreated by an adult.

  14. Alcohol and ovarian cancer risk: Results from the Netherlands Cohort Study

    NARCIS (Netherlands)

    Schouten, L.J.; Zeegers, M.P.A.; Goldbohm, R.A.; Brandt, P.A. van den

    2004-01-01

    Objective: To study alcohol consumption in relation to ovarian cancer risk in a prospective cohort study. Methods: The Netherlands Cohort Study on diet and cancer was initiated in 1986. A self-administered questionnaire on dietary habits and other risk factors for cancer was completed by 62,573

  15. Dietary patterns associated with male lung cancer risk in the Netherlands Cohort Study

    NARCIS (Netherlands)

    Balder, H.F.; Goldbohm, R.A.; Brandt, P.A. van den

    2005-01-01

    The objective of this article was to study the association between dietary patterns and lung cancer incidence in the Netherlands Cohort Study on Diet and Cancer. The baseline measurement of this prospective case cohort study that was completed by 58,279 men in 1986 included a self-administered

  16. Applying Natural Sciences to Studying History: Regarding the Example of England and the Industrial Revolution Part II

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    Lucy Badalian

    2011-04-01

    Full Text Available In the previous article of this series we presented a bio-ecological approach to studying history. It was shown that societies from the first civilizations to our days are techno-ecosystems (coenoses and do not differ much from the natural ecosystems of a lake or a forest, which are also restricted by their supplies of food. Historically, a succession of distinctive nestled geo-climatic zones was domesticated as the older ones were exhausted due to growing demographic pressure. In this context, evolution is not synonymous with competition. Cooperation of mutually dependent species is crucial for domesticating a new ecosystem, while at specific moments in its lifecycle, competition intensifies leading to speciation. In this article, we use this concept for analyzing a specific society. We show that the Industrial Revolution was England’s specific adaptation to the limitations of its geo-climatic zone. Timber, the main resource of the pre-industrial age, was essential for ship building and metal smelting. It was abundant in its main rival’s, France’s, geo-climatic habitat, but scarce in deforested England. Using its abundant local resource, coal, in an innovative way, this particular society, just like an emergent biological species, gained an evolutionary edge over its neighbors by opening access to new sources of food. The “workshop of the world” started with export-oriented textile production and ended as the major colonial power of its time. At the start of its rise to supremacy, during the 1805 battle at Trafalgar, Lord Nelson smashed the combined French-Spanish navies using short and light cast-iron cannons. They were much less precise than the long bronze ones favored by Napoleon, but, in the right hands, gave the first taste of industrial might to the England’s foes. Under Britain’s dominance, the 19th century’s Oikumene was completely remade and covered with smokestacks. We show subsequent stages of England

  17. An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study.

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    Robertson, Judith H; Thomson, Ann M

    2016-02-01

    to explore how midwives׳ personal involvement in clinical negligence litigation affects their midwifery practice. descriptive phenomenological study using semi-structured interviews. in 2006-2007 in-depth interviews were conducted in participants׳ homes or at their place of work and focused on participants׳ experience of litigation. Participants were recruited from various regions of England. 22 National Health Service (NHS) midwives who had been alleged negligent. clinical practice affected was an increase in documentation, fear of practising outside clinical guidelines and electronic fetal monitoring of women at low obstetric risk; these changes were not widespread. Changes in practice were sometimes perceived negatively and sometimes positively. Forming a good relationship with childbearing women was judged to promote effective midwifery care but litigation had affected the ability of a minority of midwives to advocate for women if this relationship had not been established. Litigation could result in loss of confidence leading to self-doubt, isolation, increased readiness to seek medical assistance and avoidance of working in the labour ward, perceived as an area with a high risk of litigation. A blame culture in the NHS was perceived by several midwives. In contrast an open non-punitive culture resulted in midwives readily reporting mistakes to risk managers. Litigation lowered midwifery morale and damaged professional reputations, particularly when reported in the newspapers. Some midwives expressed thoughts of leaving midwifery or taking time off work because of litigation but only one was actively seeking other employment, another took sick leave and one had left midwifery and returned to nursing. litigation can have a negative effect on midwives׳ clinical practice and morale and fosters a culture of blame within the NHS. education regarding appropriate documentation, use or non-use of electronic fetal monitoring and the legal status of clinical

  18. Family social support, community "social capital" and adolescents' mental health and educational outcomes: a longitudinal study in England.

    Science.gov (United States)

    Rothon, Catherine; Goodwin, Laura; Stansfeld, Stephen

    2012-05-01

    To examine the associations between family social support, community "social capital" and mental health and educational outcomes. The data come from the Longitudinal Study of Young People in England, a multi-stage stratified nationally representative random sample. Family social support (parental relationships, evening meal with family, parental surveillance) and community social capital (parental involvement at school, sociability, involvement in activities outside the home) were measured at baseline (age 13-14), using a variety of instruments. Mental health was measured at age 14-15 (GHQ-12). Educational achievement was measured at age 15-16 by achievement at the General Certificate of Secondary Education. After adjustments, good paternal (OR = 0.70, 95% CI 0.56-0.86) and maternal (OR = 0.65, 95% CI 0.53-0.81) relationships, high parental surveillance (OR = 0.81, 95% CI 0.69-0.94) and frequency of evening meal with family (6 or 7 times a week: OR = 0.77, 95% CI 0.61-0.96) were associated with lower odds of poor mental health. A good paternal relationship (OR = 1.27, 95% CI 1.06-1.51), high parental surveillance (OR = 1.37, 95% CI 1.20-1.58), high frequency of evening meal with family (OR = 1.64, 95% CI 1.33-2.03) high involvement in extra-curricular activities (OR = 2.57, 95% CI 2.11-3.13) and parental involvement at school (OR = 1.60, 95% CI 1.37-1.87) were associated with higher odds of reaching the educational benchmark. Participating in non-directed activities was associated with lower odds of reaching the benchmark (OR = 0.79, 95% CI 0.70-0.89). Building social capital in deprived communities may be one way in which both mental health and educational outcomes could be improved. In particular, there is a need to focus on the family as a provider of support.

  19. The Netherlands Cohort Study – Meat Investigation Cohort; a population-based cohort over-represented with vegetarians, pescetarians and low meat consumers

    Science.gov (United States)

    2013-01-01

    Background Vegetarian diets have been associated with lower risk of chronic disease, but little is known about the health effects of low meat diets and the reliability of self-reported vegetarian status. We aimed to establish an analytical cohort over-represented with vegetarians, pescetarians and 1 day/week meat consumers, and to describe their lifestyle and dietary characteristics. In addition, we were able to compare self-reported vegetarians with vegetarians whose status has been confirmed by their response on the extensive food frequency questionnaire (FFQ). Study methods Embedded within the Netherlands Cohort Study (n = 120,852; including 1150 self-reported vegetarians), the NLCS-Meat Investigation Cohort (NLCS-MIC) was defined by combining all FFQ-confirmed-vegetarians (n = 702), pescetarians (n = 394), and 1 day/week meat consumers (n = 1,396) from the total cohort with a random sample of 2–5 days/week- and 6–7 days/week meat consumers (n = 2,965 and 5,648, respectively). Results Vegetarians, pescetarians, and 1 day/week meat consumers had more favorable dietary intakes (e.g. higher fiber/vegetables) and lifestyle characteristics (e.g. lower smoking rates) compared to regular meat consumers in both sexes. Vegetarians adhered to their diet longer than pescetarians and 1 day/week meat consumers. 75% of vegetarians with a prevalent cancer at baseline had changed to this diet after diagnosis. 50% of self-reported vegetarians reported meat or fish consumption on the FFQ. Although the misclassification that occurred in terms of diet and lifestyle when merely relying on self-reporting was relatively small, the impact on associations with disease risk remains to be studied. Conclusion We established an analytical cohort over-represented with persons at the lower end of the meat consumption spectrum which should facilitate prospective studies of major cancers and causes of death using ≥20.3 years of follow-up. PMID:24289207

  20. Intergenerational relations and child development in England

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    Tanskanen Antti O.

    2017-03-01

    Full Text Available Evolutionary studies have shown that in many traditional populations the beneficial effects of grandparental presence for grandchildren may vary according to the sex and lineage of the grandparents, as well as by the sex of the grandchild. However, few studies have investigated the relevance of these factors in modern developed societies. The present investigation uses the Millennium Cohort Study (n = 4,636 children to analyse the association between grandparental investment and child development in contemporary England. Grandparental investment is measured by parent-grandparent contact frequencies at the child’s age of 3 and child development by “early learning goals” over the first year of primary school assessed with the Foundation Stage Profile (FSP. Children whose mothers reported contacts with maternal grandparents receive higher FSP scores compared to those with no contact at all. In addition, children whose fathers reported daily contacts with paternal grandfathers have lower FSP scores than other children. The study provides evidence of the relevance of grandparental investment on grandchild development also in developed societies. The results are discussed with reference to the grandmother hypothesis, sex-specific reproductive strategies and sex chromosome hypothesis.

  1. Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers (INWORKS): an international cohort study.

    Science.gov (United States)

    Leuraud, Klervi; Richardson, David B; Cardis, Elisabeth; Daniels, Robert D; Gillies, Michael; O'Hagan, Jacqueline A; Hamra, Ghassan B; Haylock, Richard; Laurier, Dominique; Moissonnier, Monika; Schubauer-Berigan, Mary K; Thierry-Chef, Isabelle; Kesminiene, Ausrele

    2015-07-01

    There is much uncertainty about the risks of leukaemia and lymphoma after repeated or protracted low-dose radiation exposure typical of occupational, environmental, and diagnostic medical settings. We quantified associations between protracted low-dose radiation exposures and leukaemia, lymphoma, and multiple myeloma mortality among radiation-monitored adults employed in France, the UK, and the USA. We assembled a cohort of 308,297 radiation-monitored workers employed for at least 1 year by the Atomic Energy Commission, AREVA Nuclear Cycle, or the National Electricity Company in France, the Departments of Energy and Defence in the USA, and nuclear industry employers included in the National Registry for Radiation Workers in the UK. The cohort was followed up for a total of 8.22 million person-years. We ascertained deaths caused by leukaemia, lymphoma, and multiple myeloma. We used Poisson regression to quantify associations between estimated red bone marrow absorbed dose and leukaemia and lymphoma mortality. Doses were accrued at very low rates (mean 1.1 mGy per year, SD 2.6). The excess relative risk of leukaemia mortality (excluding chronic lymphocytic leukaemia) was 2.96 per Gy (90% CI 1.17-5.21; lagged 2 years), most notably because of an association between radiation dose and mortality from chronic myeloid leukaemia (excess relative risk per Gy 10.45, 90% CI 4.48-19.65). This study provides strong evidence of positive associations between protracted low-dose radiation exposure and leukaemia. Centers for Disease Control and Prevention, Ministry of Health, Labour and Welfare of Japan, Institut de Radioprotection et de Sûreté Nucléaire, AREVA, Electricité de France, National Institute for Occupational Safety and Health, US Department of Energy, US Department of Health and Human Services, University of North Carolina, Public Health England. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers (INWORKS): an international cohort study

    Science.gov (United States)

    Leuraud, Klervi; Richardson, David B; Cardis, Elisabeth; Daniels, Robert D; Gillies, Michael; O'Hagan, Jacqueline A; Hamra, Ghassan B; Haylock, Richard; Laurier, Dominique; Moissonnier, Monika; Schubauer-Berigan, Mary K; Thierry-Chef, Isabelle; Kesminiene, Ausrele

    2015-01-01

    Summary Background There is much uncertainty about the risks of leukaemia and lymphoma after repeated or protracted low-dose radiation exposure typical of occupational, environmental, and diagnostic medical settings. We quantified associations between protracted low-dose radiation exposures and leukaemia, lymphoma, and multiple myeloma mortality among radiation-monitored adults employed in France, the UK, and the USA. Methods We assembled a cohort of 308 297 radiation-monitored workers employed for at least 1 year by the Atomic Energy Commission, AREVA Nuclear Cycle, or the National Electricity Company in France, the Departments of Energy and Defence in the USA, and nuclear industry employers included in the National Registry for Radiation Workers in the UK. The cohort was followed up for a total of 8·22 million person-years. We ascertained deaths caused by leukaemia, lymphoma, and multiple myeloma. We used Poisson regression to quantify associations between estimated red bone marrow absorbed dose and leukaemia and lymphoma mortality. Findings Doses were accrued at very low rates (mean 1·1 mGy per year, SD 2·6). The excess relative risk of leukaemia mortality (excluding chronic lymphocytic leukaemia) was 2·96 per Gy (90% CI 1·17–5·21; lagged 2 years), most notably because of an association between radiation dose and mortality from chronic myeloid leukaemia (excess relative risk per Gy 10·45, 90% CI 4·48–19·65). Interpretation This study provides strong evidence of positive associations between protracted low-dose radiation exposure and leukaemia. Funding Centers for Disease Control and Prevention, Ministry of Health, Labour and Welfare of Japan, Institut de Radioprotection et de Sûreté Nucléaire, AREVA, Electricité de France, National Institute for Occupational Safety and Health, US Department of Energy, US Department of Health and Human Services, University of North Carolina, Public Health England. PMID:26436129

  3. Developmental origins of physical fitness: the Helsinki Birth Cohort Study.

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    Minna K Salonen

    Full Text Available BACKGROUND: Cardiorespiratory fitness (CRF is a major factor influencing health and disease outcomes including all-cause mortality and cardiovascular disease. Importantly CRF is also modifiable and could therefore have a major public health impact. Early life exposures play a major role in chronic disease development. Our aim was to explore the potential prenatal and childhood origins of CRF in later life. METHODS/PRINCIPAL FINDINGS: This sub-study of the HBCS (Helsinki Birth Cohort Study includes 606 men and women who underwent a thorough clinical examination and participated in the UKK 2-km walk test, which has been validated against a maximal exercise stress test as a measure of CRF in population studies. Data on body size at birth and growth during infancy and childhood were obtained from hospital, child welfare and school health records. Body size at birth was not associated with adult CRF. A 1 cm increase in height at 2 and 7 years was associated with 0.21 ml/kg/min (95% CI 0.02 to 0.40 and 0.16 ml/kg/min (95% CI 0.03 to 0.28 higher VO2max, respectively. Adjustment for adult lean body mass strengthened these findings. Weight at 2 and 7 years and height at 11 years became positively associated with CRF after adult lean body mass adjustment. However, a 1 kg/m(2 higher BMI at 11 years was associated with -0.57 ml/kg/min (95% CI -0.91 to -0.24 lower adult VO2max, and remained so after adjustment for adult lean body mass. CONCLUSION/SIGNIFICANCE: We did not observe any significant associations between body size at birth and CRF in later life. However, childhood growth was associated with CRF in adulthood. These findings suggest, importantly from a public point of view, that early growth may play a role in predicting adult CRF.

  4. Trace elements and cognitive impairment: an elderly cohort study.

    Science.gov (United States)

    Smorgon, C; Mari, E; Atti, A R; Dalla Nora, E; Zamboni, P F; Calzoni, F; Passaro, A; Fellin, R

    2004-01-01

    Dementia is one of the most pressing public health problems with social and economic implication. The form called cognitive impairment non-dementia (CIND)represents a subclinical phase of dementia. Different studies have shown a possible effect of micro- and macro-nutrients on cognitive function. Trace elements, being involved in metabolic processes and redox reactions in the central nervous system (CNS), could influence the cognitive functions. This study evaluated the presence of an eventual correlation between serum trace element concentrations and cognitive function in a group of subjects with CIND and manifest dementia (Alzheimer dementia = AD, and vascular dementia = VaD), and compared them with a control group. Thirty -five patients were enrolled in this study. Each patient underwent a clinical and biochemical examination. We also performed a neuropsychological and functional assessment (the Milan overall dementia assessment = MODA, activities of daily living = ADL, and instrumental activities of daily living = IADL), and a computerized tomographic (CT) cerebral scan. Patients were than divided in 4 groups according to the obtained diagnosis (Controls, CIND, AD, VaD). The presence of any acute or chronic conditions, affecting cognitive functions, was considered as exclusion criteria. A blood sample was collected to determine iron (Fe), zinc (Zn), manganese (Mn), selenium (Se), cobalt (Co), chromium (Cr), copper (Cu),molybdenum (Mo) and aluminium (Al) serum concentrations (chromatographic,spectrophotometric methods). In our cohort we found a positive correlation between cognitive function, expressed as the MODA score, and Se, Cr, Co and Fe serum levels,while a negative correlation was observed between MODA score, Cu and Al serum levels.Moreover, some statistically significant differences in Se, Cr, Co, Cu and Al concentrations were found among the groups. According to these results, we may suppose that Se, Cr and Co protect cognitive function, Cu influences

  5. The safety of field tubal sterilization: a cohort study.

    Science.gov (United States)

    Siswosudarmo, R

    1991-01-01

    A cohort study on female sterilization has been carried out to compare the safety of field-based procedures with hospital-based procedures. A total of 217 women were recruited, consisting of 103 field-based and 114 hospital-based acceptors. Married and healthy women 20-45 years of age, having at least two living children, not obese, no history of major abdominal surgery, no signs of acute pelvic inflammatory disease, and no contraindication to ketamin were included in the study. Women with severe pelvic adhesions encountered during surgery were excluded from the study. The ambulatory procedure was used for all acceptors except those who were sterilized in hospital immediately after delivery. They were asked to come to th Sarjito Hospital (hospital-based) or Puskesmas (primary health care center or field-based), after fasting the night before. Ketamin, 50-100 mg, was used intravenously for general anesthesia. Minilaparotomy followed by the Pomeroy method was used for standard female tubal sterilization. Tetracycline, 3 x 500 mg was given for five days prophylactically. Follow-up was carried out one and six weeks after the day of operation. Data were processed with an IBM-compatible PC, using version 3.0 SPSS program. Students t-test, chi-square test and relative risk (95% confidence limit (CL)) were used for statistical analysis. Both groups were comparable in terms of age, parity, body weight, and body height. The duration of operation in the field was somewhat longer than that in the hospital, i.e. 24.58 vs 21.14 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Dietary Fat Intake and Fecundability in 2 Preconception Cohort Studies.

    Science.gov (United States)

    Wise, Lauren A; Wesselink, Amelia K; Tucker, Katherine L; Saklani, Shilpa; Mikkelsen, Ellen M; Cueto, Heidi; Riis, Anders H; Trolle, Ellen; McKinnon, Craig J; Hahn, Kristen A; Rothman, Kenneth J; Sørensen, Henrik Toft; Hatch, Elizabeth E

    2018-01-01

    The association between dietary fat and fertility is not well studied. We evaluated intakes of total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, trans fatty acids (TFA), ω-3 fatty acids, and ω-6 fatty acids in relation to fecundability in Danish and North American preconception cohort studies. Women who were attempting to become pregnant completed a validated food frequency questionnaire at baseline. Pregnancy status was updated bimonthly for 12 months or until pregnancy. Fecundability ratios (FR) and 95% confidence intervals were estimated using multivariable proportional probabilities regression. Intakes of total fat and saturated, monounsaturated, polyunsaturated, and ω-6 fatty acids were not appreciably associated with fecundability. TFA intake was associated with reduced fecundability in North American women (for the fourth quartile vs. the first, FR = 0.86, 95% confidence interval (CI): 0.71, 1.04) but not Danish women (for the fourth quartile vs. the first, FR = 1.04, 95% CI: 0.86, 1.25), though intake among Danish women was low. In North America, ω-3 fatty acid intake was associated with higher fecundability, but there was no dose-response relationship (among persons who did not use fish oil supplements: for the fourth quartile vs. the first, FR = 1.40, 95% CI: 1.13, 1.73); no association was found in Danish women, among whom low intake was rare. In the present study, high TFA intake and low ω-3 fatty acid intake were associated with reduced fecundity. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Mortality in patients with psoriasis. A retrospective cohort study.

    Science.gov (United States)

    Masson, Walter; Rossi, Emiliano; Galimberti, María Laura; Krauss, Juan; Navarro Estrada, José; Galimberti, Ricardo; Cagide, Arturo

    2017-06-07

    The immune and inflammatory pathways involved in psoriasis could favor the development of atherosclerosis, consequently increasing mortality. The objectives of this study were: 1) to assess the mortality of a population with psoriasis compared to a control group, and 2) to assess the prevalence of cardiovascular risk factors. A retrospective cohort was analyzed from a secondary database (electronic medical record). All patients with a diagnosis of psoriasis at 1-01-2010 were included in the study and compared to a control group of the same health system, selected randomly (1:1). Subjects with a history of cardiovascular disease were excluded from the study. A survival analysis was performed considering death from any cause as an event. Follow-up was extended until 30-06-2015. We included 1,481 subjects with psoriasis and 1,500 controls. Prevalence of cardiovascular risk factors was higher in the group with psoriasis. The average follow-up time was 4.6±1.7 years. Mortality was higher in psoriasis patients compared to controls (15.1 vs. 9.6 events per 1,000 person-year, P<.005). Psoriasis was seen to be significantly associated with increased mortality rates compared to the control group in the univariate analysis (HR 1.58, 95% CI 1.16-2.15, P=.004) and after adjusting for cardiovascular risk factors (HR 1.48, 95% CI 1.08-2.3, P=.014). In this population, patients with psoriasis showed a higher prevalence for the onset of cardiovascular risk factors as well as higher mortality rates during follow-up. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  8. Alcohol consumption during pregnancy and perinatal results: a cohort study

    Directory of Open Access Journals (Sweden)

    Mariana Sbrana

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: Alcohol consumption during pregnancy is a significant social problem that may be associated with adverse perinatal outcomes. The aim of this study was to describe alcohol consumption during pregnancy and to study its association with low birth weight, newborns small for gestational age and preterm birth. DESIGN AND SETTING: Nested cohort study, in the city of Ribeirão Preto, São Paulo, Brazil. METHODS: 1,370 women and their newborns were evaluated. A standardized questionnaire on health and lifestyle habits was applied to the mothers. Anthropometry was performed on the newborns. Alcohol consumption was defined as low, moderate or high, as defined by the World Health Organization. Adjusted logistic regression analysis was used. RESULTS: 23% of the women consumed alcohol during pregnancy. Consumption mainly occurred in the first trimester (14.8% and decreased as the pregnancy progressed. The median alcohol intake was 3.89 g (interquartile range, IQR = 8 g per day. In the unadjusted analysis, alcohol consumption increased the risk of low birth weight almost twofold (odds ratio, OR 1.91; 95% confidence interval, CI: 1.25-2.92. The risk was lower in the adjusted analysis (OR 1.62; 95% CI: 1.03-2.54. Alcohol consumption did not show associations with small for gestational age or preterm birth. There was greater risk of low birth weight and newborns small for gestational age and preterm birth among mothers who were both smokers and drinkers. CONCLUSIONS: The alcohol consumption rate during pregnancy was 23% and was independently associated with low birth weight, but there was no risk of newborns small for gestational age or preterm birth.

  9. Epidemiology and public health in 1906 England: Arthur Newsholme's methodological innovation to study breastfeeding and fatal diarrhea.

    Science.gov (United States)

    Morabia, Alfredo; Rubenstein, Beth; Victora, Cesar G

    2013-07-01

    In 1906 Arthur Newsholme linked artificial feeding and fatal diarrhea in infants aged one year and younger on the basis of two independent sources of information: mortality registration and a three-year (1903-1905) census of infants from Brighton, United Kingdom. Artificial feeding was more common in the infants who had died (89.3%) than in those in the survey (22.3%). However, boldly assuming the two data sources were nested, Newsholme computed the risks of fatal diarrhea: these were 48 times greater for infants fed fresh cow's milk and 94 times greater for those fed condensed milk than for infants who were exclusively breastfed. This mode of computing risks and risk ratios before the invention of the cohort study design was more innovative than was the usual investigation techniques of his contemporary epidemiologists. Newsholme's conclusions were consistent with the current knowledge that breastfeeding protects against fatal diarrhea.

  10. Recurrence of hyperemesis gravidarum across generations: population based cohort study

    Science.gov (United States)

    Skjærven, Rolv; Grjibovski, Andrej M; Gunnes, Nina; Vangen, Siri; Magnus, Per

    2010-01-01

    Objective To estimate the risk of hyperemesis gravidarum (hyperemesis) according to whether the daughters and sons under study were born after pregnancies complicated by hyperemesis. Design Population based cohort study. Setting Registry data from Norway. Participants Linked generational data from the medical birth registry of Norway (1967-2006): 544 087 units of mother and childbearing daughter and 399 777 units of mother and child producing son. Main outcome measure Hyperemesis in daughters in mother and childbearing daughter units and hyperemesis in female partners of sons in mother and child producing son units. Results Daughters who were born after a pregnancy complicated by hyperemesis had a 3% risk of having hyperemesis in their own pregnancy, while women who were born after an unaffected pregnancy had a risk of 1.1% (unadjusted odds ratio 2.9, 95% confidence interval 2.4 to 3.6). Female partners of sons who were born after pregnancies complicated by hyperemesis had a risk of 1.2% (1.0, 0.7 to 1.6). Daughters born after a pregnancy not complicated by hyperemesis had an increased risk of the condition if the mother had hyperemesis in a previous or subsequent pregnancy (3.2 (1.6 to 6.4) if hyperemesis had occurred in one of the mother’s previous pregnancies and 3.7 (1.5 to 9.1) if it had occurred in a later pregnancy). Adjustment for maternal age at childbirth, period of birth, and parity did not change the estimates. Restrictions to firstborns did not influence the results. Conclusions Hyperemesis gravidarum is more strongly influenced by the maternal genotype than the fetal genotype, though environmental influences along the maternal line cannot be excluded as contributing factors. PMID:21030362

  11. Factors Influencing Hospital Stay for Pulmonary Embolism. A Cohort Study.

    Science.gov (United States)

    Rodríguez-Núñez, Nuria; Ruano-Raviña, Alberto; Abelleira, Romina; Ferreiro, Lucía; Lama, Adriana; González-Barcala, Francisco J; Golpe, Antonio; Toubes, María E; Álvarez-Dobaño, José M; Valdés, Luis

    2017-08-01

    The aim of this study was to identify factors influencing hospital stay due to pulmonary embolism. We performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19). We included 965 patients with a median stay of 8 days (IQR 6-13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42-13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07-2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07-2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85-3.48) when oral anticoagulation (OAC) was initiated 2-3 days after admission, and 2.43 (95% CI: 1.16-5.07) when initiated at 4-5 days, compared to OAC initiation at 0-1 days. sPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Influence of Handheld Mobiles on Parotid: A Cohort Study

    Directory of Open Access Journals (Sweden)

    Gracelin E Ranjitha

    2017-01-01

    Full Text Available Introduction: Mobile phones generate heat and radiofrequency radiation. The parotid gland is one potential target, because mobile phones are pressed against the side of the face where the gland is located. Aims and Objectives: To compare the effect of mobile phone radiation on parotid gland volume, systolic velocity, salivary flow rate, and protein concentration between the dominant and the nondominant side of mobile phone usage among heavy mobile phone users. Materials and Methods: Ultrasonography of the superior lobe of parotid was performed bilaterally to measure gland volume. Systolic velocity of the external carotid artery in gland was calculated bilaterally using color Doppler imaging. Saliva flow rate was measured bilaterally with modified Schrimer strip. Carlson-Crittenden device was used to collect 0.5 ml saliva sample from the duct and biuret assay was done to determine the protein concentration. Settings and Design: A cohort study was conducted with 50 undergraduate students of a dental college based on the inclusion and exclusion criteria. Statistical Analysis Used: Pearson correlation test was used to correlate and compare changes in the parameters of parotid gland and analyzed to a significant level of 0.05. Results: The volume, systolic velocity of blood flow of the external carotid artery, the salivary flow rate, and protein concentration of the parotid gland were significantly more by 11.9, 18, 23, and 8%, respectively, on the dominant side than the nondominant side of mobile phone usage. Conclusion: The study emphasized that prolonged mobile phone usage causes biological changes in parotid gland.

  13. Maternal caffeine consumption and infant nighttime waking: prospective cohort study.

    Science.gov (United States)

    Santos, Iná S; Matijasevich, Alicia; Domingues, Marlos R

    2012-05-01

    Coffee and other caffeinated beverages are commonly consumed in pregnancy. In adults, caffeine may interfere with sleep onset and have a dose-response effect similar to those seen during insomnia. In infancy, nighttime waking is a common event. With this study, we aimed to investigate if maternal caffeine consumption during pregnancy and lactation leads to frequent nocturnal awakening among infants at 3 months of age. All children born in the city of Pelotas, Brazil, during 2004 were enrolled on a cohort study. Mothers were interviewed at delivery and after 3 months to obtain information on caffeine drinking consumption, sociodemographic, reproductive, and behavioral characteristics. Infant sleeping pattern in the previous 15 days was obtained from a subsample. Night waking was defined as an episode of infant arousal that woke the parents during nighttime. Multivariable analysis was performed by using Poisson regression. The subsample included 885 of the 4231 infants born in 2004. All but 1 mother consumed caffeine in pregnancy. Nearly 20% were heavy consumers (≥300 mg/day) during pregnancy and 14.3% at 3 months postpartum. Prevalence of frequent nighttime awakeners (>3 episodes per night) was 13.8% (95% confidence interval: 11.5%-16.0%). The highest prevalence ratio was observed among breastfed infants from mothers consuming ≥300 mg/day during the whole pregnancy and in the postpartum period (1.65; 95% confidence interval: 0.86-3.17) but at a nonsignificant level. Caffeine consumption during pregnancy and by nursing mothers seems not to have consequences on sleep of infants at the age of 3 months.

  14. Chest wall syndrome among primary care patients: a cohort study

    Directory of Open Access Journals (Sweden)

    Verdon François

    2007-09-01

    Full Text Available Abstract Background The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS. Methods Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Results Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6% patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. Conclusion CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration.

  15. Trial of labour in twin pregnancies: a retrospective cohort study.

    Science.gov (United States)

    de Castro, H; Haas, J; Schiff, E; Sivan, E; Yinon, Y; Barzilay, E

    2016-05-01

    To assess the success rate of vaginal delivery among women with twin pregnancies; the Twin Birth Study has shown that vaginal delivery and caesarean section are equally safe for twin delivery but >40% of the planned vaginal delivery group delivered by caesarean section. A retrospective cohort study. A tertiary medical centre. A total of 2194 women with twin pregnancies not complicated with very low birthweight. Planned mode of delivery was documented in the woman's electronic record upon entering the delivery room. Information regarding maternal age at delivery, parity, gestational age, presentation, previous history of caesarean delivery, birthweight and Apgar score was collected from the obstetric electronic charts. Rate of vaginal twin delivery. Of the 2194 women included, 1311 twin pregnancies had planned caesarean delivery and 883 underwent a trial of labour. Of the 883 women who underwent a trial of labour, the rate of vaginal delivery was 86.9%, whereas the rates of caesarean delivery and combined vaginal-caesarean delivery were 11.1% and 2.0%, respectively. Presentation of second twin, gestational age and maternal age did affect the chances of success. Nulliparity [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.4-4.05], Foley induction of labour (OR 2.33, 95% CI 1.38-3.91) and body mass index >30 kg/m(2) (OR 1.76, 95% CI 1.03-3) were independent risk factors for caesarean delivery. The rate of vaginal delivery among women with twin pregnancies who undergo labour can be high, especially in women who laboured spontaneously and have delivered before. The rate of vaginal delivery of twins can be high, especially in women who have delivered before. © 2015 Royal College of Obstetricians and Gynaecologists.

  16. Menstrual Pattern following Tubal Ligation: A Historical Cohort Study

    Directory of Open Access Journals (Sweden)

    Shahideh Jahanian Sadatmahalleh

    2016-12-01

    Full Text Available Background: Tubal ligation (TL is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders. Materials and Methods: A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group and on 140 women using condom as the main contraceptive method (Non-TL group. They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC was also used to measure the menstrual blood loss. Results: Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002. Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006, hypermenorrhea (12.1 vs. 2.1%, P=0.002, menorrhagia (62.9 vs. 22.1%, P<0.0001 and menometrorrhagia (15.7 vs. 3.6%, P=0.001 than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001. According to logistic regression, age odds ratio [(OR=1.08, confidence interval (CI:1.07-1.17, P=0.03], TL (OR=5.95, CI:3.45-10.26, P<0.0001 and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001 were significantly associated with menorrhagia. Conclusion: We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

  17. Morbidity in expatriates--a prospective cohort study.

    Science.gov (United States)

    Patel, Dipti; Easmon, Charles; Seed, Paul; Dow, Carol; Snashall, David

    2006-08-01

    Expatriates comprise an important, but rarely studied subset of international travellers. This study was performed to assess the incidence of health events in an expatriate group and to evaluate factors affecting this incidence. A cohort of 2020 Foreign and Commonwealth Office (FCO) staff and partners living abroad were followed-up over 1 year. The main outcome measure was incidence of illness or injury serious enough to require consultation with a doctor. Data collection was by means of a self-administered questionnaire. Poisson regression was used to estimate the rates of health events and to test for association between health events and a number of independent variables. The incidence of health events was 21%. Trauma (incidence 5%), musculoskeletal disorders (incidence 4%) and infectious disease (incidence 3%) were the principal causes of morbidity. The incidence of psychological disorders was low (1%). Of significance, employees were at increased risk of morbidity when compared to partners, with a higher incidence of health events [incidence rate ratio (IRR) 1.4, 95% CI 1.1-1.9] and psychological disorders (IRR 5.9, 95% CI 1.0-34.1). Moreover, unaccompanied employees were at increased risk of health events (IRR 1.3, 95% CI 1.0-1.7), and of traumatic injury (IRR 2.3, 95% CI 1.3-4.3) when compared to accompanied employees. While the morbidity in FCO personnel is low in comparison to other expatriate groups, the higher risk of morbidity in employees and unaccompanied individuals merits further research, particularly to ascertain whether work demands, isolation or risk-taking behaviour are contributory factors.

  18. Viral Co-infection and Leprosy Outcomes: A Cohort Study.

    Science.gov (United States)

    Machado, Paulo R L; Machado, Lídia M; Shibuya, Mayume; Rego, Jamile; Johnson, Warren D; Glesby, Marshall J

    2015-01-01

    The role of the host immunity in determining leprosy clinical forms and complications is well recognized, implying that changes in the immune status may interfere with several aspects of the disease. Therefore, we hypothesized that the presence of viral co-infections and associated immunological changes will have a clinical impact on leprosy outcomes. The aim of our study was to determine the clinical impact of human immunodeficiency virus (HIV), human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on the development of reactions, neuritis, neuropathy and relapses. Cohort study in 245 leprosy subjects from Bahia, Brazil. Patients were followed from the time of diagnosis until at least the end of multidrug therapy. Viral co-infection was detected in 36 out of the 245 patients (14.7%). Specific co-infection rates were 10.6% for HBV, 2.9% for HIV, 2.5% for HTLV-1 and 0.8% for HCV. All four groups of co-infected patients had higher rates of neuritis and nerve function impairment compared to non co-infected leprosy subjects. The relapse rate was also higher in the co-infected group (8.3%) versus patients without co-infection (1.9%); relative risk 4.37, 95% confidence interval 1.02-18.74. Leprosy patients should be screened for HBV, HCV, HIV and HTLV-1 co-infections. Besides contributing to better health care, this measure will facilitate the early detection of severe complications through targeting of higher risk patients.

  19. Acute hepatic porphyria and cancer risk: a nationwide cohort study.

    Science.gov (United States)

    Baravelli, C M; Sandberg, S; Aarsand, A K; Nilsen, R M; Tollånes, M C

    2017-09-01

    Acute hepatic porphyria (AHP) is considered to be a risk factor for primary liver cancer (PLC), but varying risk estimates have been published. Our aim was to investigate the risk of PLC and other cancers in persons with AHP using a nationwide cohort design. Given that greater numbers of women than men tend to have manifest and more severe AHP, a further aim was to investigate sex differences in this risk. The study sample consisted of all Norwegian residents aged 18 years or older during the period 2000-2011. Persons with AHP (n = 251) were identified through the Norwegian Porphyria Centre, and patients with a cancer diagnosis were identified by linkage to the Cancer Registry of Norway. For persons with AHP, the annual incidence rate of PLC was 0.35%. PLC risk was substantially higher for individuals with an AHP diagnosis compared to the reference population [adjusted hazard ratio (aHR) 108, 95% confidence interval (CI) 56-207]. In a meta-analysis of published studies on PLC and AHP, including ours, women had a higher risk than men. In addition, our results suggested that persons with AHP may have increased risks of kidney (aHR 7.4, 95% CI 2.4-23.1) and endometrial cancers (aHR 6.2, 95% CI 2.0-19.3). Our findings confirmed a substantially higher risk of PLC associated with AHP compared to the general population. In a meta-analysis, the risk was shown to be greater for women than men. The novel findings of a moderate to substantial association between AHP and kidney and endometrial cancers should be investigated further. © 2017 The Association for the Publication of the Journal of Internal Medicine.

  20. Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

    Science.gov (United States)

    Newton, John N; Briggs, Adam D M; Murray, Christopher J L; Dicker, Daniel; Foreman, Kyle J; Wang, Haidong; Naghavi, Mohsen; Forouzanfar, Mohammad H; Ohno, Summer Lockett; Barber, Ryan M; Vos, Theo; Stanaway, Jeffrey D; Schmidt, Jürgen C; Hughes, Andrew J; Fay, Derek F J; Ecob, Russell; Gresser, Charis; McKee, Martin; Rutter, Harry; Abubakar, Ibrahim; Ali, Raghib; Anderson, H Ross; Banerjee, Amitava; Bennett, Derrick A; Bernabé, Eduardo; Bhui, Kamaldeep S; Biryukov, Stanley M; Bourne, Rupert R; Brayne, Carol E G; Bruce, Nigel G; Brugha, Traolach S; Burch, Michael; Capewell, Simon; Casey, Daniel; Chowdhury, Rajiv; Coates, Matthew M; Cooper, Cyrus; Critchley, Julia A; Dargan, Paul I; Dherani, Mukesh K; Elliott, Paul; Ezzati, Majid; Fenton, Kevin A; Fraser, Maya S; Fürst, Thomas; Greaves, Felix; Green, Mark A; Gunnell, David J; Hannigan, Bernadette M; Hay, Roderick J; Hay, Simon I; Hemingway, Harry; Larson, Heidi J; Looker, Katharine J; Lunevicius, Raimundas; Lyons, Ronan A; Marcenes, Wagner; Mason-Jones, Amanda J; Matthews, Fiona E; Moller, Henrik; Murdoch, Michele E; Newton, Charles R; Pearce, Neil; Piel, Frédéric B; Pope, Daniel; Rahimi, Kazem; Rodriguez, Alina; Scarborough, Peter; Schumacher, Austin E; Shiue, Ivy; Smeeth, Liam; Tedstone, Alison; Valabhji, Jonathan; Williams, Hywel C; Wolfe, Charles D A; Woolf, Anthony D; Davis, Adrian C J

    2015-01-01

    Summary Background In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. Methods We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or

  1. Anthropometry, physical activity, and endometrial cancer risk: Results from the Netherlands Cohort Study

    NARCIS (Netherlands)

    Schouten, L.J.; Goldbohm, R.A.; Brandt, P.A. van den

    2004-01-01

    Although obesity is an established risk factor for endometrial cancer, evidence linking risk to height, weight change since age 20, and physical activity is limited. In this case-cohort study, 62 573 women from The Netherlands Cohort Study on Diet and Cancer were followed up from 1986 to 1995, and

  2. Toenail selenium status and the risk of Barrett's esophagus: The Netherlands Cohort Study

    NARCIS (Netherlands)

    Steevens, J.; Schouten, L.J.; Driessen, A.L.C.; Huysentruyt, C.J.R.; Keulemans, Y.C.A.; Goldbohm, R.A.; Brandt, P.A. van den

    2010-01-01

    Objective: To investigate the association between selenium and the risk of Barrett's esophagus (BE), the precursor lesion of esophageal adenocarcinoma. Methods: Data from the prospective Netherlands Cohort Study were used. This cohort study was initiated in 1986, when 120,852 subjects aged 55-69

  3. The Milan Geriatrics 75+ Cohort Study : unravelling the determinants of healthy ageing and longevity

    NARCIS (Netherlands)

    Ogliari, Giulia

    2016-01-01

    Current evidence on older adults is derived from population-based cohort studies and randomized controlled trials, which may not include frail individuals. Data are lacking on older outpatients, a potentially diverse population. Therefore, we initiated the Milan Geriatrics 75+ Cohort Study, a

  4. Sensor, a population-based cohort study on gastroenteritis in the Netherlands: incidence and etiology.

    NARCIS (Netherlands)

    Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Wannet, W.J.B.; Vinje, J; Leusden, F. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    A prospective population-based cohort study with a nested case- control study was conducted to estimate the incidence of gastroenteritis and the associated pathogens in the general Dutch population. Follow-up of two consecutive cohorts was performed by weekly reporting cards from december 1998 to

  5. Is cancer survival associated with cancer symptom awareness and barriers to seeking medical help in England? An ecological study

    Science.gov (United States)

    Niksic, Maja; Rachet, Bernard; Duffy, Stephen W; Quaresma, Manuela; Møller, Henrik; Forbes, Lindsay JL

    2016-01-01

    Background: Campaigns aimed at raising cancer awareness and encouraging early presentation have been implemented in England. However, little is known about whether people with low cancer awareness and increased barriers to seeking medical help have worse cancer survival, and whether there is a geographical variation in cancer awareness and barriers in England. Methods: From population-based surveys (n=35 308), using the Cancer Research UK Cancer Awareness Measure,