Publications
285 results found
Jayasooriya N, Saxena S, Blackwell J, et al., 2024, Associations between prior healthcare use, time to diagnosis, and clinical outcomes in Inflammatory Bowel Disease: a nationally representative population-based cohort study, BMJ Open Gastroenterology, ISSN: 2054-4774
GBD 2021 Demographics Collaborators, 2024, Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021, The Lancet, ISSN: 0140-6736
BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV pr
Skirrow H, Foley K, Bedford H, et al., 2024, Impact of pregnancy vaccine uptake and socio-demographic determinants on subsequent childhood Measles, Mumps and Rubella vaccine uptake: a UK birth cohort study, Vaccine, Vol: 42, Pages: 322-331, ISSN: 0264-410X
BACKGROUND: We examined the association between socio-demographic determinants and uptake of childhood Measles, Mumps & Rubella (MMR) vaccines and the association between pregnant women's pertussis vaccine uptake and their children's MMR vaccine uptake. METHODS: We used nationally-representative linked mother-baby electronic records from the United Kingdom's Clinical-Practice-Research-Datalink. We created a birth cohort of children born between 01.01.2000 and 12.12.2020. We estimated the proportion vaccinated with first MMR vaccine by age 2 years and first and second MMR vaccines by age 5 years. We used survival-analysis and Cox proportional hazard models to examine the association between deprivation, ethnicity and maternal age and pertussis vaccination in pregnancy and children's MMR uptake. RESULTS: Overall, 89.4 % (710,797/795,497) of children had first MMR by age 2 years and 92.6 % (736,495/795,497) by age 5 years. Among children still in the cohort when second MMR was due, 85.9 % (478,480/557,050) had two MMRs by age 5 years. Children from the most-deprived areas, children of Black ethnicity and children of mothers aged < 20 years had increased risk of being unvaccinated compared with children from the least-deprived areas, White children and children of mothers aged 31-40 years: first MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) & HR:0.89 (CI:0.88-0.90) respectively. Deprivation was the determinant associated with the greatest risk of missed second MMR: adjusted HR:0.82 (CI:0.81-0.83). Children of mothers vaccinated in pregnancy were more likely than children of unvaccinated mothers to have MMR vaccines after adjusting for ethnicity, deprivation, and maternal age (First and Second MMRs adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53). CONCLUSION: Children from most-deprived areas are less likely to have MMR vaccines compared with childre
Baillie S, Norton C, Saxena S, et al., 2024, Chronic abdominal pain in inflammatory bowel disease: a practical guide., Frontline Gastroenterol, Vol: 15, Pages: 144-153, ISSN: 2041-4137
Pain is common in inflammatory bowel disease (IBD), yet many patients feel their pain is not addressed by healthcare professionals. Listening to a patient's concerns about pain, assessing symptoms and acknowledging the impact these have on daily life remain crucial steps in addressing pain in IBD. While acute pain may be effectively controlled by pain medication, chronic pain is more complex and often pharmacological therapies, particularly opioids, are ineffective. Low-dose tricyclic antidepressants and psychological approaches, including cognitive-behavioural therapy, have shown some promise in offering effective pain management while lifestyle changes such as a trial of low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet in those with overlapping irritable bowel syndrome may also reduce pain. Patients benefit from a long-term, trusting relationship with their healthcare professional to allow a holistic approach combining pharmacological, psychological, lifestyle and dietary approaches to chronic pain. We present a practical review to facilitate management of chronic abdominal pain in IBD.
Porras-Segovia A, Pascual-Sanchez A, Greenfield G, et al., 2023, Early risk factors for self-injurious thoughts and behaviours: a UK population-based study of 219,581 people, Behavioral Sciences, Vol: 14, ISSN: 2076-328X
Mental disorders are a major problem among young people. To identify early risk factors of self-injurious thoughts and behaviours (SITB) among young adults with mental health problems, this case-control study drew data from the Clinical Practice Research Datalink (CPRD), a primary care database covering 8% of the UK population. We explored the role of early factors (presenting at 8-14 years old) for suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) in young adulthood (age 18-25 years) by performing logistic regressions. Our sample consisted of 219,581 participants, of which 6.51% had at least one SITB in young adulthood. Early risk factors for SITB included early NSSI, suicidal ideation, sexual abuse, behavioural problems, and mood and psychotic symptoms. Frequency of GP visits had a protective effect. Lack of access to mortality data, ethnicity, and socioeconomic status was a limitation of the current study. In conclusion, early symptoms in late childhood/early adolescence can be the start of long-standing problems going into adult life. The training of primary care providers in suicide risk assessment and proper co-ordination with child and adolescent mental health services are crucial for suicide prevention.
Jayasooriya N, Pollok RC, Blackwell J, et al., 2023, Adherence to 5-aminosalicylic acid maintenance treatment in young people with ulcerative colitis: a retrospective cohort study in primary care, British Journal of General Practice, Vol: 73, Pages: e850-e857, ISSN: 0960-1643
Background: Maintenance treatment with 5-aminosalicylic acid (5-ASA) is recommended in ulcerative colitis (UC), but accurate estimates of discontinuation and adherence in adolescents transitioning to young adulthood are lacking.Aim: To determine rates and risk factors for discontinuation and adherence to oral 5-ASA in adolescents and young adults 1 year following diagnosis of UC.Design and setting: Observational cohort study using the UK Clinical Practice Research Datalink among adolescents and young adults (aged 10–24 years) diagnosed with UC between 1 January 1998 and 1 May 2016.Method: Time to oral 5-ASA discontinuation (days) and adherence rates (proportion of days covered) were calculated during the first year of treatment using Kaplan–Meier survival analysis. Cox regression models were built to estimate the impact of sociodemographic and health-related risk factors.Results: Among 607 adolescents and young adults starting oral 5-ASA maintenance treatment, one-quarter (n = 152) discontinued within 1 month and two- thirds (n = 419) within 1 year. Discontinuation was higher among those aged 18–24 years (74%) than younger age groups (61% and 56% in those aged 10–14 and 15–17 years, respectively). Adherence was lower among young adults than adolescents (69% in those aged 18–24 years versus 80% in those aged 10–14 years). Residents in deprived versus affluent postcodes were more likely to discontinue treatment (adjusted hazard ratio [aHR] 1.46, 95% confidence interval [CI] = 1.10 to 1.92). Early corticosteroid use for an acute flare lowered the likelihood of oral 5-ASA discontinuation (aHR 0.68, 95% CI = 0.51 to 0.90).Conclusion: The first year of starting long-term therapies in adolescents and young adults diagnosed with UC is a critical window for active follow-up of maintenance treatment, particularly in those aged 18–24 years and those living in deprived postcodes.
Skirrow H, Foley K, Bedford H, et al., 2023, Maternal predictors of timeliness & uptake of Measles, Mumps & Rubella vaccine: A birth cohort study, 16th European Public Health Conference 2023, Publisher: Oxford University Press, ISSN: 1101-1262
Skirrow H, Foley K, Lewis C, et al., 2023, ‘Why did nobody ask us?’, parents’ views on childhood vaccines: A co-production research study, European Public Health Conference
Ram B, Van Sluijs E, Chalkley A, et al., 2023, Real-world application of a scalable school-based physical activity intervention: A cross-sectional survey of the implementation of The Daily Mile in Greater London primary schools, PLOS ONE, Vol: 18, ISSN: 1932-6203
Phillips SM, Summerbell C, Hesketh KR, et al., 2023, Co-design and content validity of the movement measurement in the early years (MoveMEY) tool for assessing movement behaviour of pre-school aged children, International Journal of Behavioral Nutrition and Physical Activity, Vol: 20, Pages: 1-16, ISSN: 1479-5868
BACKGROUND: Movement behaviours (physical activity, sedentary behaviour, and sleep) are important for pre-school children's health and development. Currently, no tools with appropriate content validity exist that concurrently capture these movement behaviours in young children. The aim of this study was to co-design and assess the content validity of a novel tool to concurrently measure movement behaviours in pre-school aged children (aged 3-4 years). METHODS: We followed four distinct steps to develop and assess the content validity of Movement Measurement in the Early Years (MoveMEY): (1) We conducted an extensive literature search, to identify pre-existing proxy measurement tools (questionnaires and diaries) to inform the design of a novel tool, which aimed to effectively capture movement behaviour guidelines of pre-school aged children. (2) We facilitated focus group discussions with parents and carers of pre-school aged children (n = 11) and (3) a qualitative survey with free text responses was completed by topic relevant researchers (n = 6), to co-design the measurement tool. (4) We assessed the content validity of the developed tool, MoveMEY, through interviews with parents of pre-school aged children (n = 12) following piloting of the tool. RESULTS: We developed an initial version of MoveMEY based on the format of an existing questionnaire and by mapping the content of questions to the guidelines. Co-design of MoveMEY resulted in changes to the format (e.g. short questionnaire to a seven-day diary) and content (e.g. inclusion of 'general information' questions on illness, disabilities and sleep disturbances; question on screen time before bed). Content validity assessment demonstrated that the items of MoveMEY were relevant and comprehensive for the assessment of children's movement behaviours. MoveMEY was felt to be comprehensible, however, parental suggestions were implemented to finalise and improve MoveMEY (e.g.
Pollok R, Jayasooriya N, Baillie S, et al., 2023, Letter: delays to diagnosis of IBD-Challenges requiring a systematic approach. Authors' reply, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 57, Pages: 1479-1479, ISSN: 0269-2813
Creese H, Saxena S, Nicholls D, et al., 2023, The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study., EClinicalMedicine, Vol: 60, Pages: 1-13, ISSN: 2589-5370
BACKGROUND: Mental illness and obesity are among the biggest challenges to population health, they are linked, and may be modifiable during adolescence. We aimed to determine intervening pathways between mental health and BMI z-score symptoms across adolescence. METHODS: In this longitudinal cohort study, we used path models to examine self-reported dieting, happiness with appearance, self-esteem and bullying at 14 years as potential mediators of the cross-lagged relationship between mental health (via the Strengths and Difficulties Questionnaire) and Body Mass Index (BMI) z-score at 11 and 17 years by sex in the UK Millennium Cohort Study, a prospective cohort study of 18,818 children born in the UK between September 1st, 2000, and January 31st, 2002. Full, incomplete data on all singleton children still participating in the study by age 11 years were analysed in GSEM via maximum likelihood estimation (N = 12,450). FINDINGS: We found happiness with appearance and self-esteem, but not dieting or bullying, mediated the relationship between BMI age 11 and mental health age 17. Each increase in BMI z-score at 11 years was associated with 0.12 increase for boys and a 0.19 increase for girls in scores of unhappiness with appearance (boys: b 0.12, 95% C.I.; girls b 0.19, C.I. 0.14 to 0.23) and a 16% increase for boys and a 22% increase for girls in odds of low self-esteem (boys OR 1.16, 95% C.I. 1.07 to 1.26; girls: OR 1.22, 95% C.I. 1.15 to 1.30) at 14 years. In turn, for both boys and girls, being unhappy with appearance and low self-esteem at 14 years were associated with a greater likelihood of emotional and externalizing symptoms at 17 years. INTERPRETATION: Early prevention strategies to encourage healthy physical and mental development of children need to focus on the promotion of positive body-mage and self-esteem. FUNDING: The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR).
Pollok R, Baillie S, Jayasooriya N, et al., 2023, Letter: diagnostic delay in inflammatory bowel disease-Authors' reply, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 57, Pages: 1205-1206, ISSN: 0269-2813
Jayasooriya N, Saxena S, Pollok RC, 2023, Letter: fulminant onset complicated inflammatory bowel disease (IBD) - a unique subtype? Authors' reply, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 57, Pages: 1194-1195, ISSN: 0269-2813
Jayasooriya N, Baillie S, Blackwell J, et al., 2023, Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 57, Pages: 635-652, ISSN: 0269-2813
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- Citations: 11
Mytton OT, Nicholls D, Saxena S, et al., 2023, Approach to a child or young person with concerns about excess weight., BMJ, Vol: 380
Hart A, Miller L, Hamborg T, et al., 2023, What is the relationship between fatigue, pain and urgency in people with inflammatory bowel disease? Results of the IBD-BOOST survey in 8486 participants, Publisher: OXFORD UNIV PRESS, Pages: I130-I132, ISSN: 1873-9946
Foley KA, Maile EJ, Bottle A, et al., 2022, How did the covid-19 pandemic affect lower respiratory tract infections in young children in England?, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 32, ISSN: 1101-1262
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, Vol: 12, Pages: 1-11, 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
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.
Creese H, Lai E, Mason K, et al., 2022, Disadvantage in early-life and persistent asthma in adolescents: a UK cohort study, THORAX, Vol: 77, Pages: 854-864, ISSN: 0040-6376
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- Citations: 3
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, JOURNAL OF CLINICAL EPIDEMIOLOGY, Vol: 149, Pages: 165-171, ISSN: 0895-4356
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- Citations: 4
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.
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
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- Citations: 3
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
Foley KA, Saxena SK, Majeed A, et al., 2022, Author response., Br J Gen Pract, Vol: 72, Pages: 318-318
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.
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, JOURNAL OF CLINICAL PSYCHIATRY, Vol: 83, ISSN: 0160-6689
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Jayasooriya N, Baillie S, Blackwell J, et al., 2022, IMPACT OF TIME TO DIAGNOSIS ON INFLAMMATORY BOWEL DISEASE OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS, Annual Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A52-A53, ISSN: 0017-5749
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