246 results found
Venkatraman T, Honeyford C, Ram B, et al., 2022, Identifying local authority need for, and uptake of, school-based physical activity promotion in England – a cluster analysis, Journal of Public Health, Vol: 44, Pages: 694-703, ISSN: 1741-3842
Background:School-based physical activity interventions such as The Daily Mile (TDM) are widely promoted in children’s physical activity guidance. However, targeting such interventions to areas of greatest need is challenging since determinants vary across geographical areas. Our study aimed to identify local authorities in England with the greatest need to increase children’s physical activity and assess whether TDM reaches school populations in areas with the highest need.Methods:This was a cross-sectional study using routinely collected data from Public Health England. Datasets on health, census and the built environment were linked. We conducted a hierarchical cluster analysis to group local authorities by ‘need’ and estimated the association between ‘need’ and registration to TDM.Results:We identified three clusters of high, medium and low need for physical activity interventions in 123 local authorities. Schools in high-need areas were more likely to be registered with TDM (incidence rate ratio 1.25, 95% confidence interval: 1.12–1.39) compared with low-need areas.Conclusions:Determinants of children’s physical activity cluster geographically across local authorities in England. TDM appears to be an equitable intervention reaching schools in local authorities with the highest needs. Health policy should account for clustering of health determinants to match interventions with populations most in need.
Ma R, Foley K, Saxena S, 2022, Access to and use of contraceptive care during the first COVID-19 lockdown in the UK: a web-based survey., BJGP Open, Vol: 6
BACKGROUND: The first wave of lockdown measures to control the COVID-19 pandemic in the UK resulted in suspension of 'non-essential' services, including contraceptive care. AIM: To examine women's perceptions and experiences of contraceptive care in the UK during the first lockdown. DESIGN & SETTING: A cross-sectional survey during the lockdown period from March-June 2020. METHOD: An online questionnaire was designed asking women aged 16-54 years their experiences of contraceptive care during lockdown. Questions were based on Maxwell's evaluation framework on access, acceptability, relevance or appropriateness, and equity. It was promoted on social media from 27 May-9 June 2020. A descriptive analysis was conducted of quantitative data and thematic analysis of free-text data. RESULTS: In total, 214 responses were analysed. General practice was the source of contraception for 43.4% (n = 49) and 52.3% (n = 34) of responders before and during the lockdown, respectively. The study found 55.1% (n = 118) of responders, including regular and new users, were uncertain where or how to get contraception during the pandemic. Responders reported reduced access to contraception during lockdown, and some thought sexual health clinics and general practices were closed. Remote consultations and electronic prescriptions facilitated contraceptive access for some responders. Long-acting reversible contraception (LARC) was unavailable in some areas owing to restrictions, and alternatives were not acceptable to those who used methods for non-contraceptive benefits to treat medical conditions; for example, menorrhagia. CONCLUSION: The study highlighted the need for better information and signposting for contraception during lockdown. Contraception, including LARC, should be reframed as an essential service with robust signposting for pandemic planning and beyond.
van den Akker M, Dieckelmann M, Hussain MA, et al., 2022, Children and adolescents are not small adults: toward a better understanding of multimorbidity in younger populations., J Clin Epidemiol, Vol: 149, Pages: 165-171
Multimorbidity is of an increasing importance for the health of both children and adults but research has hitherto focused on adult multimorbidity. Hence, public awareness, practice, and policy lack vital information about multimorbidity in childhood and adolescence. We convened an international and interdisciplinary group of experts from six nations to identify key priorities supported by published evidence to strengthen research for children and adolescent with multimorbidity. Future research is encouraged (1) to develop a conceptual framework to capture unique aspects of child and adolescent multimorbidity-including definitions, characteristic patterns of conditions for different age groups, its dynamic nature through childhood and adolescence, and understanding of severity and trajectories for different clusters of multiple chronic conditions, (2) to define new indices to classify the presence of multimorbidity in children and adolescents, (3) to improve the availability and linkage of data across countries, (4) to synthesize evidence on the global phenomenon of multimorbidity in childhood and adolescence and health inequalities, and (5) to involve children and adolescents in research relevant to their health.
Ram B, Foley K, van Sluijs E, et al., 2022, Developing a core outcome set for physical activity interventions in primary schools: a modified-Delphi study, BMJ Open, ISSN: 2044-6055
Objectives To develop a core outcome set for physical activity interventions in primary schools.Design Modified-Delphi. Setting UK and international. Participants 104 participants from four stakeholder groups (educators, public health professionals, health researchers, parents); 16 children (aged 8-9 years) from one London primary school. Interventions Physical activity interventions.Methods Four-stage process: (1) outcomes extracted from relevant studies identified from an umbrella review, and a focus group; (2) list of outcomes produced and domains established; (3) stakeholders completed a 2-round Delphi survey by rating (Round 1) and re-rating (Round 2) each outcome on a 9-point Likert scale from ‘not important’ to ‘critical’; a >70% participant threshold identified the outcomes rated ‘critical’ to measure, and outcomes important to children were identified through a workshop; (4) a stakeholder meeting to achieve consensus of the outcomes to include in the core outcome set. Results Seventy-four studies were extracted from 53 reviews. A list of 50 outcomes was produced and three domains established: ‘physical activity and health’ (16 outcomes), ‘social and emotional health’ (22 outcomes), and ‘educational performance’ (12 outcomes). 104 participants completed survey Round 1; 65 participants completed both rounds. Thirteen outcomes met the threshold; children identified 8 outcomes. Fourteen outcomes achieved consensus to produce the core outcome set; five outcomes for physical activity and health (diet [varied and balanced], energy, fitness, intensity of physical activity, sleep [number of hours]); seven for social and emotional health (anxiety, depression, enjoyment, happiness, self-esteem, stress, wellbeing); and two outcomes for educational performance (concentration, focus).Conclusions We have developed the first core outcome set for physical activity interventions in primary schools in
Bottle A, Neale FK, Foley KA, et al., 2022, Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Saxena S, Skirrow H, Wighton K, 2022, Vaccinating children aged under 5 years against covid-19, BMJ: British Medical Journal, Pages: o1863-o1863, ISSN: 0959-535X
Saxena S, Skirrow H, Maini A, et al., 2022, Consenting children aged under 18 for vaccination and treatment, BMJ: British Medical Journal, Vol: 377, ISSN: 0959-535X
Vaccine programmes for young people during thecovid-19 pandemic have highlighted common legaland ethical dilemmas that can arise when consentingchildren aged under 18 for medical treatment orintervention.1 -3 These can be especially challengingwhen a parent or guardian’s views differ from thoseof the child.This article summarises the issues around consentingchildren under 18 for treatment using vaccination asan exemplar. Most of the article is based on guidanceand law in the UK; however, the principles behindthe laws described may be applicable in othersettings. We recommend that health professionalsoutside the UK also check their local laws regardingconsent for children’s treatments and vaccinations.
Smith HC, Saxena S, Petersen I, 2022, Maternal Postnatal Depression and Completion of Infant Immunizations: A UK Cohort Study of 196,329 Mother-Infant Pairs, 2006-2015., J Clin Psychiatry, Vol: 83
Objective: To examine the relationship between maternal postnatal depression and completion of infant vaccinations. Methods: We conducted a cohort study using data from The Health Improvement Network (THIN), a large UK primary care electronic health record database. We identified 196,329 mother-infant pairs in which the infant was born between 2006 and 2015. Postnatal depression was identified through antidepressant prescriptions or diagnoses or symptoms of depression in first year after childbirth. Primary outcome was completion of three 5-in-1 vaccination doses in infants before 1 year of age; this vaccine protects against diphtheria, tetanus, whooping cough, polio, and Haemophilus influenzae type b. We used Poisson regression models to compare likelihood of infant 5-in-1 vaccine uptake among children of women with a record of postnatal depression to likelihood among those without. Results: Of the 196,329 women, 20,802 (10.6%) had a record of postnatal depression and/or antidepressant prescription. There was no difference in infants' 5-in-1 vaccination completion between those of mothers with a record and those of mothers' without (adjusted incidence rate ratio [IRR] = 1.01; 95% CI, 0.99-1.02). Those from more socially deprived areas were less likely to complete infant vaccinations compared to those from the least deprived areas (IRR = 0.92; 95% CI, 0.90-0.93). Likelihood of completing infant vaccination decreased over time, comparing 2014-2015 to 2006-2007 (IRR = 0.90; 95% CI, 0.89-0.92). Conclusions: Among mothers who engage with primary care, maternal postnatal depression is not associated with lower rates of infant vaccination, though more research is needed to conclude if either more severe depression or unrecognized depression is associated with lower completion rates.
Foley K, Maile E, Bottle R, et al., 2022, Impact of covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020, British Journal of General Practice, ISSN: 0960-1643
Background: The NHS response to covid-19 altered provision and access to primary care.Aim: To examine the impact of covid-19 on general practitioner (GP) contacts with children and young people in England. Design and Setting: Longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink Aurum database.Methods: We included all children and young people younger than 25 years registered with a GP. We compared the number of total, remote and face-to-face contacts during the first UK lockdown (March to June 2020) with the mean contacts for comparable weeks from 2015 to 2019.Results: We examined 47 607 765 GP contacts with 4 307 120 million children and young people. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 had greater falls in total contacts (>50%) compared with infants and 15-24s. Face-to-face contacts fell by 88% with the greatest falls occurring among children aged 1-14 (> 90%). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote, mitigating the total fall (31%). Conclusion: During the covid-19 pandemic, children and young people’s contact with GPs fell, particularly for face-to-face assessment. This may be explained by a lower incidence of respiratory illnesses due to fewer social contacts and changing health seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.
Blackwell J, Saxena S, Jayasooriya N, et al., 2022, Stoma Formation in Crohn's Disease and the Likelihood of Antidepressant Use: A Population-Based Cohort Study, CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol: 20, Pages: E703-E710, ISSN: 1542-3565
Phillips SM, Summerbell C, Hobbs M, et al., 2021, A systematic review of the validity, reliability, and feasibility of measurement tools used to assess the physical activity and sedentary behaviour of pre-school aged children, International Journal of Behavioral Nutrition and Physical Activity, Vol: 18, Pages: 1-28, ISSN: 1479-5868
Physical activity (PA) and sedentary behaviour (SB) of pre-school aged children are associated with important health and developmental outcomes. Accurate measurement of these behaviours in young children is critical for research and practice in this area. The aim of this review was to examine the validity, reliability, and feasibility of measurement tools used to assess PA and SB of pre-school aged children.Searches of electronic databases, and manual searching, were conducted to identify articles that examined the measurement properties (validity, reliability or feasibility) of measurement tools used to examine PA and/or SB of pre-school aged children (3-7 years old). Following screening, data were extracted and risk of bias assessment completed on all included articles. A total of 69 articles, describing 75 individual studies were included. Studies assessed measurement tools for PA (n=27), SB (n=5), and both PA and SB (n=43). Outcome measures of PA and SB differed between studies (e.g. moderate to vigorous activity, step count, posture allocation). Most studies examined the measurement properties of one measurement tool only (n=65). Measurement tools examined included: calorimetry, direct observation, combined heart rate and accelerometry, heart rate monitors, accelerometers, pedometers, and proxy report (parent, carer or teacher reported) measures (questionnaires or diaries). Studies most frequently assessed the validity (criterion and convergent) (n=65), face and content validity (n=2), test-retest reliability (n=10) and intra-instrument reliability (n=1) of the measurement tools. Feasibility data was abstracted from 41 studies.Multiple measurement tools used to measure PA and SB in pre-school aged children showed some degree of validity, reliability and feasibility, but often for different purposes. Accelerometers, including the Actigraph (in particular GT3X versions), Actical, ActivPAL and Fitbit (Flex and Zip), and proxy reported measurement tools used in co
Greenfield G, Okoli O, Quezada Yamamoto H, et al., 2021, Characteristics of frequently attending children in hospital emergency departments: a systematic review, BMJ Open, Vol: 11, Pages: 1-7, ISSN: 2044-6055
Objective: To summarise the literature on frequent attendances to hospital emergency departments and describe sociodemographic and clinical characteristics of children who attend EDs frequently.Setting: Hospital emergency departments.Participants: Children <21 years, attending hospital emergency departments frequently.Primary outcome measures: Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year.Results: We included 21 studies representing 6,513,627 children. Between 0.3% to 75% of all paediatric ED users were frequent users. Most studies defined 4 or more visits per year as a “frequent ED” usage. Children who were frequent ED users were more likely to be less than 5 years old. In the US, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis.Conclusions: The review included a wide range of information across various health systems, however children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary-care oriented conditions.
Creese H, Lai E, Mason K, et al., 2021, Disadvantage in early-life and persistent asthma in adolescents: a UK cohort study, THORAX, Vol: 77, Pages: 854-864, ISSN: 0040-6376
Ram B, Foley K, van Sluijs E, et al., 2021, A core outcome set for school-based physical activity interventions: an international consensus, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Ram B, Chalkley A, van Sluijs E, et al., 2021, Implementation of The Daily Mile (TM) : survey of primary schools in Greater London, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Saxena S, Skirrow H, Bedford H, et al., 2021, Covid-19 vaccines for teenagers: conversations and consent, BMJ, Vol: 374, Pages: 1-2, ISSN: 1759-2151
Paulson KR, Kamath AM, Alam T, et al., 2021, Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 870-905, ISSN: 0140-6736
BackgroundSustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.MethodsWe completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.FindingsGlobal U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019.
Venkatraman T, Honeyford K, Ram B, et al., 2021, IDENTIFYING LOCAL AUTHORITY NEED FOR, AND UPTAKE OF, SCHOOL-BASED PHYSICAL ACTIVITY INTERVENTIONS IN ENGLAND - A CLUSTER ANALYSIS USING ROUTINE DATA, Publisher: BMJ PUBLISHING GROUP, Pages: A24-A25, ISSN: 0143-005X
Blackwell J, Saxena S, Petersen I, et al., 2021, Depression in individuals who subsequently develop inflammatory bowel disease: a population-based nested case-control study, GUT, Vol: 70, Pages: 1642-1648, ISSN: 0017-5749
Galles NC, Liu PY, Updike RL, et al., 2021, Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1, The Lancet, Vol: 398, Pages: 503-521, ISSN: 0140-6736
BackgroundMeasuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time.MethodsFor this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development.FindingsBy 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4–82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5–42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4–41·3] in 1980 to 83·6% [82·3–84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4–44·1) in 1980 to 79·8% (78·4–81·1) in 2019
Norton C, Syred J, Kerry S, et al., 2021, Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial, Trials, Vol: 22, ISSN: 1745-6215
BackgroundDespite being in clinical remission, many people with inflammatory bowel disease (IBD) live with fatigue, chronic abdominal pain and bowel urgency or incontinence that limit their quality of life. We aim to test the effectiveness of an online self-management programme (BOOST), developed using cognitive behavioural principles and a theoretically informed logic model, and delivered with facilitator support.Primary research questionIn people with IBD who report symptoms of fatigue, pain or urgency and express a desire for intervention, does a facilitator-supported tailored (to patient needs) online self-management programme for fatigue, pain and faecal urgency/incontinence improve IBD-related quality of life (measured using the UK-IBDQ) and global rating of symptom relief (0–10 scale) compared with care as usual?MethodsA pragmatic two-arm, parallel group randomised controlled trial (RCT), of a 12-session facilitator-supported online cognitive behavioural self-management programme versus care as usual to manage symptoms of fatigue, pain and faecal urgency/incontinence in IBD. Patients will be recruited through a previous large-scale survey of unselected people with inflammatory bowel disease. The UK Inflammatory Bowel Disease Questionnaire and global rating of symptom relief at 6 months are the co-primary outcomes, with multiple secondary outcomes measured also at 6 and 12 months post randomisation to assess maintenance. The RCT has an embedded pilot study, health economics evaluation and process evaluation.We will randomise 680 patients, 340 in each group. Demographic characteristics and outcome measures will be presented for both study groups at baseline. The UK-IBDQ and global rating of symptom relief at 6 and 12 months post randomisation will be compared between the study groups.DiscussionThe BOOST online self-management programme for people with IBD-related symptoms of fatigue, pain and urgency has been designed to be easily sca
Saxena S, Skirrow H, Wighton K, 2021, Should the UK vaccinate children and adolescents against covid-19?, BMJ: British Medical Journal, Vol: 374, ISSN: 0959-535X
Coughlan CH, Ruzangi J, Neale FK, et al., 2021, Social and ethnic group differences in healthcare use by children aged 0-14 years: a population-based cohort study in England from 2007 to 2017., Archives of Disease in Childhood, Vol: 107, Pages: 32-39, ISSN: 0003-9888
OBJECTIVE: To describe social and ethnic group differences in children's use of healthcare services in England, from 2007 to 2017. DESIGN: Population-based retrospective cohort study. SETTING/PATIENTS: We performed individual-level linkage of electronic health records from general practices and hospitals in England by creating an open cohort linking data from the Clinical Practice Research Datalink and Hospital Episode Statistics. 1 484 455 children aged 0-14 years were assigned to five composite ethnic groups and five ordered groups based on postcode mapped to index of multiple deprivation. MAIN OUTCOME MEASURES: Age-standardised annual general practitioner (GP) consultation, outpatient attendance, emergency department (ED) visit and emergency and elective hospital admission rates per 1000 child-years. RESULTS: In 2016/2017, children from the most deprived group had fewer GP consultations (1765 vs 1854 per 1000 child-years) and outpatient attendances than children in the least deprived group (705 vs 741 per 1000 child-years). At the end of the study period, children from the most deprived group had more ED visits (447 vs 314 per 1000 child-years) and emergency admissions (100 vs 76 per 1000 child-years) than children from the least deprived group.In 2016/2017, children from black and Asian ethnic groups had more GP consultations than children from white ethnic groups (1961 and 2397 vs 1824 per 1000 child-years, respectively). However, outpatient attendances were lower in children from black ethnic groups than in children from white ethnic groups (732 vs 809 per 1000 child-years). By 2016/2017, there were no differences in outpatient, ED and in-patient activity between children from white and Asian ethnic groups. CONCLUSIONS: Between 2007 and 2017, children living in more deprived areas of England made greater use of emergency services and received less scheduled care than children from affluent neighbourhoods. Children from Asian and black ethnic grou
Ram B, Chalkley A, van Sluijs E, et al., 2021, Impact of The daily Mile on children's physical and mental health and educational attainment in primary schools; iMprOVE cohort study protocol, BMJ Open, Vol: 11, ISSN: 2044-6055
Introduction: School-based active mile initiatives such as The Daily Mile (TDM) are widely promoted to address shortfalls in meeting physical activity recommendations. The iMprOVE Study aims to examine the impact of TDM on children’s physical and mental health and educational attainment throughout primary school.Methods and analysis: iMprOVE is a longitudinal quasi-experimental cohort study. We will send a survey to all state-funded primary schools in Greater London to identify participation in TDM. The survey responses will be used for non-random allocation to either the intervention group (Daily Mile schools) or to the control group (non-Daily Mile schools). We aim to recruit 3533 year 1 children (aged 5–6 years) from 77 primary schools and follow them up annually until the end of their primary school years. Data collection taking place at baseline (children in school year 1) and each primary school year thereafter includes device-based measures of moderate-to-vigorous physical activity (MVPA) and questionnaires to measure mental health (Strengths and Difficulties Questionnaire) and educational attainment (ratings from ‘below expected’ to ‘above expected levels’). The primary outcome is the mean change in MVPA minutes from baseline to year 6 during the school day among the intervention group compared with controls. We will use multilevel linear regression models adjusting for sociodemographic data and participation in TDM. The study is powered to detect a 10% (5.5 min) difference between the intervention and control group which would be considered clinically significant.Ethics and dissemination: Ethics has been approved from Imperial College Research Ethics Committee, reference 20IC6127. Key findings will be disseminated to the public through research networks, social, print and media broadcasts, community engagement opportunities and schools. We will work with policy-makers for direct application and impact of our findings.
Blackwell J, Alexakis C, Saxena S, et al., 2021, The association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a population-based study, BMJ Open Gastroenterology, Vol: 8, ISSN: 2054-4774
Background: Animal studies indicate a potential protective role of antidepressant medication (ADM) in models of colitis but the effect of their use in humans with ulcerative colitis (UC) remains unclear. Objective: To study the relationship between ADM use and corticosteroid dependency in UC. Design: Using the Clinical Practice Research Datalink we identified patients diagnosed with UC between 2005-2016. We grouped patients according to serotonin selective reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) exposure in the 3 years following diagnosis: 'continuous users', 'intermittent users' and 'non users'. We used logistic regression to estimate the adjusted risk of corticosteroid dependency between ADM exposure groups. Results: We identified 6373 patients with UC. 5,230 (82%) use no ADMs, 627 (10%) were intermittent SSRI users and 282 (4%) were continuous SSRI users, 246 (4%) were intermittent TCA users and 63 (1%) were continuous TCA users. Corticosteroid dependency was more frequent in continuous SSRI and TCA users compared with non-users (19% vs. 24% vs. 14%, respectively, χ2 p=0.002). Intermittent SSRI and TCA users had similar risks of developing corticosteroid dependency to non-users (SSRI: OR 1.19, 95%CI 0.95-1.50, TCA: OR 1.14, CI 0.78-1.66). Continuous users of both SSRIs and TCAs had significantly higher risks of corticosteroid dependency compared to non-users (SSRI: OR 1.62, CI 1.15-2.27, TCA: OR 2.02, CI 1.07-3.81). Conclusions: Continuous ADM exposure has no protective effect in routine clinical practice in UC and identifies a population of patients requiring more intensive medical therapy. ADM use is a flag for potentially worse clinical outcomes in UC.
Jayasooriya N, Saxena S, Blackwell J, et al., 2021, Impact of consultation frequency and time to diagnosis on subsequent Inflammatory Bowel Disease outcomes, Publisher: OXFORD UNIV PRESS, Pages: S242-S243, ISSN: 1873-9946
Blackwell J, Saxena S, Jayasooriya N, et al., 2021, Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study, Journal of Crohn's and Colitis, Vol: 15, Pages: 203-211, ISSN: 1873-9946
Background and AimsLack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD).AimsTo determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn’s Disease (CD) and ulcerative colitis (UC).MethodsCase-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016.ResultsWe identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98).ConclusionsThere is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.
Greenfield G, Blair M, Aylin P, et al., 2021, Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data, Emergency Medicine Journal, Vol: 38, Pages: 146-150, ISSN: 1472-0205
BACKGROUND:Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. AIM:To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals. METHOD:We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups. RESULTS:One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively). CONCLUSION:One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.
Venkatraman T, Honeyford K, Costelloe C, et al., 2021, Sociodemographic profiles, educational attainment and physical activity associated with The Daily Mile™ registration in primary schools in England – a national cross-sectional linkage study, Journal of Epidemiology and Community Health, Vol: 75, Pages: 137-144, ISSN: 0143-005X
ObjectiveTo examine primary school and local authority characteristics associated with registrationfor The Daily Mile (TDM), an active mile initiative aimed at increasing physical activity inchildren.DesignA cross-sectional linkage study using routinely collected data.SettingAll state funded primary schools in England from 2012-2018(n=15,815).Results3,502 of all 15,815(22.1%) state funded primary schools in England were registered to doTDM, ranging from 16% in the East Midlands region to 31% in Inner London.Primary schools registered for TDM had larger mean pupil numbers compared with schoolsthat had not registered (300 vs 269 respectively). There was a higher proportion of TDMregistered schools in urban areas compared with non-urban areas. There was local authorityvariation in the likelihood of school registration (ICC: 0.094).After adjusting for school and local authority characteristics, schools located in a majorurban conurbation (OR 1.46 (95%CI:1.24-1.71) urban vs. rural) and schools with a higherproportion of disadvantaged pupils had higher odds of being registered to the TDM (OR 1.16(95%CI:1.02-1.33)). Area based physical activity and schools’ educational attainment wasnot significantly associated with registration to TDM.ConclusionOne in five primary schools in England has registered for The Daily Mile since 2012. TDMappears to be a wide-reaching school based physical activity intervention that is reachingmore disadvantaged primary school populations in urban areas where obesity prevalence ishighest. TDM registered schools include those with both high and low educationalattainment and are in areas with high and low physical activity
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.