bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental social position, in utero growth and risk of child development disorders: an administrative data based prospective cohort study
Authors: Playford Chris , Dibben Chris , Williamson Lee , Huang Zengyi
Published: April 2017

ABSTRACTObjectivesTo evaluate the influences of low birthweight and socioeconomic status upon child development disorders

ApproachIt has been recognised that low birthweight and socio-economic status impact cognitive development in children. Previous studies in Scotland investigated this relationship using the Scottish Mental Health Survey 1932, the Growing Up in Scotland (GUS) longitudinal survey, and the Aberdeen Children of the 1950s study. This paper examines this using the Scottish Longitudinal Study (SLS) linked with Maternity Inpatient and Day Case records and Child Health Systems Programme Pre-School (CHSP Pre-School) records. This is original because it extends previous work through large-scale contemporary data which has been routinely collected and is representative of the Scottish population. It also includes a novel design through the use of birth data from parents and children recorded within the SLS.

ResultsFrom this research it was identified that these child development measures were strongly associated with gestational-age specific birthweight and that fine motor, social and hearing abnormalities were much more likely for children with parents in lower grade occupations or who were long-term unemployed. These associations were net of other indicators of family socioeconomic position and birth outcomes, suggesting that infants from disadvantaged backgrounds remained more likely to experience these conditions beyond the differences that could be explained by other relevant factors (such as their birthweight).

ConclusionThese findings confirm and build upon previous analysis through the use of linked administrative data.
The effect of in utero exposure to alcohol, tobacco and cannabis on educational attainment in adolescence: findings from ALSPAC, a UK cohort study
Authors: Teyhan Alison , Evans Dave , Macleod John
Published: April 2017

ABSTRACT

ObjectivesAlcohol, tobacco and cannabis can cross the placenta, and could have long-lasting effects on the brain of the developing foetus. We examine whether exposure to these substances is associated with educational attainment in adolescence (Key Stage 4 [KS4], aged 16yrs), and consider whether any associations are due to an intrauterine causal mechanism.

ApproachWe use two main approaches: (1) a comparison of the risks associated with maternal substance use during pregnancy with the risks associated with paternal substance use at the same time, and (2) Mendelian Randomisation (MR). The population-based sample are from the Avon Longitudinal Study of Parents and Children. Educational attainment at KS4 was determined through linkage to the National Pupil Database: capped score of eight best subjects (converted to percentage). Mothers and their partners reported use of substances during the mother’s pregnancy via questionnaire. In observational complete-case analysis (n=6018), multilevel (child level 1, school level 2) linear models were used to examine the association between maternal and paternal substance use and KS4 attainment adjusted for potential confounders. In MR analysis, genetic markers associated with maternal alcohol (rs1229984) and tobacco (rs1051730) use were used to estimate the unconfounded effect of the exposures.

ResultsMaternal substance use in pregnancy was common (72% reported any alcohol, 22% any tobacco, and 2% any cannabis) and socially patterned (tobacco associated with deprivation, moderate alcohol and light cannabis with higher maternal education). In adjusted observational analyses, children of mothers who smoked had lower KS4 percentage scores (β -2.7, 95% CI -3.7 to -1.7) but a similar association was observed for paternal smoking (β -3.0, -3.8 to -2.2). Compared to children of non-drinkers in first trimester, children whose mothers drank ≥7 units per week had lower KS4 scores (β -4.6, -7.9 to -1.4), but children of lighter drinkers did not. The MR analyses were under-powered but provisional results suggest no association between maternal smoking and KS4 score, but that small amounts of alcohol could have a detrimental effect. Neither maternal nor paternal cannabis use was associated with educational attainment in observational analyses, but few mothers in our sample used cannabis regularly in pregnancy.

ConclusionsThe negative association in observational analysis between maternal smoking in pregnancy and child KS4 attainment is likely due to residual confounding rather than an intrauterine mechanism. Conversely, residual confounding may be masking a negative association between lower levels of alcohol drinking and KS4 attainment in observational analysis.
Qualitative content analysis for international comparison of data usage agreements
Authors: Haux Christian , Gabel Frank , Trescher Anna-Lena , Whelton Helen , Van der Heijden Geert , Listl Stefan , Knaup-Gregori Petra
Published: April 2017

ABSTRACT

ObjectivesThe multi-country-EU project ADVOCATE (Added Value for Oral Care) involves the analysis of routinely collected oral health care records from health insurance systems in six European countries, including NHS England and NHS Scotland. The data will be stored in a in a central repository using AnalytiXagility which adheres to strict privacy and security standards. Therefore, data usage agreements must be consented with all partners and being subjected to specific regulations in the respective nation. This will result in different aggregation levels for data integration, e. g. one of the partners does not allow the transfer of data that contain a personal identifier. To understand the variety of requirements and limitations in different countries, we performed a qualitative content analysis of the agreements.

ApproachA categorisation system for privacy and data protection aspects was developed. The aspects are based on privacy conditions mentioned in guidance documents, the agreements themselves and the project’s proposal. The agreements were examined for textual elements and systematically coded by three reviewers. Compliance between privacy conditions and the agreements was estimated using a nominal scale, whether the context was available in the agreement or not. The software MAXQDA was used for tagging relevant text passages.

ResultsThe initial coding scheme contains eight categories on top-level. They include, inter alia, aspects on data access, -preparation, -transmission, and -usage. The top-levels divide in up to four different levels of detail. The coding system was continuously adapted during full-text analysis. Initially, the agreements from the partners of Denmark and Germany were used. Characteristics in the agreements require a fine granularity of sub-categories. The German agreement, for example, names the whole institution as partner, whereas the Danish agreement differentiates in personal roles, each with own responsibilities.

ConclusionUndertaking an overview of privacy conditions can be a valuable step in comparing privacy and security requirements in different national regulations. The qualitative content analysis was found a suitable approach for this purpose because it enables the detection of fine characteristics. By using an incremental design, it is possible to adapt the coding system to include additional partners. However, the current coding system has the limitation that heterogeneity between the agreements leads to a fine granularity of categories that hamper the comparability between partners. Despite these problems, the approach allows the comparison of data privacy and supports the development of a data integration process for international harmonisation.
Preserving Privacy in the Face of Clients with Different Data Needs Using the NGLMS
Authors: Radbone Chris , Farrow James
Published: April 2017

ABSTRACT

ObjectivesSA NT DataLink’s Next Generation Linkage Management System (NGLMS) provides a novel approach to handling privileged or sensitive data for certain projects without having to replicate or duplicate databases and work to protect privacy. The NGLMS is a collection of records (nodes) and relationship (edges) that forms a graph (in the computer science sense) and is designed to support a mix-and-match and layered approach to data linkage projects. The NGLMS allows for the needs of different clients to be managed from the one graph data set while preserving privacy and honouring the requirement to protect sensitive information without having to relink or duplicate data.

ApproachThe NGLMS uses a layer-based approach to project description and design. Projects, a specific data linkage request for example, are composed of various data layers. The data layers consist of data sets, link information in the form of pairwise relationships. These layers are coupled with quality information, e.g. acceptable similarity thresholds and/or the types of relationships to consider as ‘linking’ two records, to construct an effective virtual data set which may be different for each project. A project can be constructed by composing existing linkage data (where it already exists) without having to perform new linkage comparisons.

ResultsA case study will be discussed where a data set containing extremely sensitive information (record pairings revealing name changes due to family court proceeding and protection orders) was received for incorporation into the data pool. This information is sensitive for which the particular data custodian who supplied the information would wish to have honoured by only incorporating their records for approved analysis, and otherwise excluded for other non-authorised analysis. By placing these data into a separate layer to be included in some projects and not others the sensitive nature of the data can be accommodated and its effects ‘turned on and off’ at will.

ConclusionThe flexible on-demand nature of data extraction and late clustering in the NGLMS Graph based approach the linkage allows for ad-hoc project construction and the dynamic inclusion and exclusion of data without the overhead of relinking data.
The Impact of Asthma on congenital anomalies, prematurity, birth centiles and infant feeding: retrospective population cohort analysis 2004-2010
Authors: Davies Gareth , Jordan Susan , Thayer Daniel , Tucker David , Dolk Helen
Published: April 2017

ABSTRACT

Objectives9.4% of pregnant women in Wales are prescribed medicines for asthma. Prescription of asthma medicines in early pregnancy is associated with increased prevalence of congenital anomalies (aOR 1.20, 1.08 - 1.34). The literature offers less consensus on more common adverse outcomes: premature delivery (<37 weeks), small for gestational age (<10th growth centile) (SGA), and failure to breastfeed.

ApproachRoutinely collected data from the all-Wales health and social care linked electronic databank (the Secure Anonymised Information Linkage [SAIL]) were interrogated. Data from the Office of National Statistics birth and deaths registry, the National Community Child Health Database (NCCHD), the Patient Episode Database for Wales, primary care prescription records and the Congenital Anomaly Register (CARIS) 2000-2010 were linked. Growth centiles were calculated from WHO standards. Prescriptions were classified using ATC categories and BTS guidelines. We included live born singletons without congenital anomalies. We excluded infants exposed to medicines known to carry higher risks than asthma medicines: insulin, AEDs, coumarins. Odds ratios, with 95% CIs, were calculated for use of asthma medicines 1 year either side of pregnancy.

Results357,989 pregnancies were identified in NCCHD 2000-2010. Data were available on 117,717 at delivery and 38,665 on breastfeeding at birth and 6-8 weeks 2004-2010. Data loss was due to suboptimal GP participation.Delivery before 37 weeks’ gestation and SGA were more common in those prescribed: any short acting beta2 agonists (SABA) (OR 1.12[CI 1.04-1.20], 1.15[1.08-1.28]); inhaled corticosteroids (ICS) (1.07[0.97-1.19], 1.18[1.09-1.29]); systemic corticosteroids (1.34[1.13-1.60], 1.23[1.06-1.43]).

At birth and 6-8 weeks, breastfeeding was less prevalent amongst those prescribed: SABAs (OR 0.90[CI 0.86-0.95], 0.87[0.82-0.93]); ICS (0.88[0.82-0.95], 0.85[0.78-0.93]); systemic corticosteroids (0.86 [0.76-0.98], 0.80[CI 0.69-0.94]).

ConclusionPrescription of asthma medicines is associated with higher prevalence of conditions predisposing to childhood ill-health. While routinely collected data is unable to account for confounding by indication, and the impact of asthma cannot be disentangled from that of its treatment, these findings indicate that prescription of asthma medicines offer a useful marker to target additional support throughout pregnancy and lactation.

FundingThis paper was developed from the EUROmediCAT project.
Investigating antimicrobial prescribing pattern before the development of CDI using data linkage
Authors: Pan Jiafeng , Kavanagh Kim , Marwick Charis , Wuiff Camilla , Davey Peter , Bryson Scott , Robertson Chris , Bennie Marion
Published: April 2017

ABSTRACTObjectivesPrior use of antimicrobials, in particular broad-spectrum antimicrobials, is associated with the development of Clostridium difficile infection (CDI). Our previous work has demonstrated increased risk with cumulative exposure but there is limited evidence on specific patterns of cumulative antimicrobial prescribing prior to infection. Understanding this pattern will help inform antimicrobial stewardship. This study aims to investigate the prescribing patterns for CDI cases with more than 4 weeks cumulative antimicrobial exposure during the 6 months prior to their CDI date.ApproachWe linked three Scottish patient-level data sets: laboratory confirmed CDI (ECOSS), prescriptions for antimicrobials in primary care (PIS) and all hospital admissions (SMR01). From ECOSS all cases of CDI reported in the period August 2010 to July 2013 were identified. Each CDI case was linked to SMR01 to allocate case type (either hospital or community associated) and to PIS for previous antimicrobial prescriptions. Visual representation of temporal exposure indicating both duration and drug type of each antimicrobial dispensed during the 6 month period before the infection was produced to clearly understand the pattern of prescribing.ResultsIn the study period, there were a total of 1557 community acquired CDI cases without recent (prior 3 months) hospitalisation. Among them, 287 (18%) cases had more than 4 weeks prior cumulative antimicrobial exposure accumulating a total of 1311 dispensed prescriptions. Cases had an average 4 (Q1:3,Q3:6) prescriptions and 2 (Q1:2,Q3:3) different types of antimicrobials dispensed. The timeline plot shows that repeated short duration prescriptions contributed more to cumulative exposure than long duration prophylaxis. The most common antimicrobials prescribed were amoxicillin (38% of cases), trimethoprim (30%) and flucloxacillin (27%). The median duration per prescription for each of these was less than 2 weeks. The antimicrobials that had a median duration of around a month per prescription were oxytetracycline (3%) and clindamycin (6%).

ConclusionsThis study of a national linked patient level data set contained sufficient numbers of cases to enable investigation of the prescribing pattern in individuals with highest risk cumulative exposure. This study uses NHS Scotland’s developing Infection Intelligence Platform which will place Scotland as a world leader in the use of health informatics to support infection control and antimicrobial stewardship.
Using Canadian data linkage to investigate the socioeconomic patterning of hospital burden for childbirth
Authors: Mah Sarah M. , Sanmartin Claudia , Rotermann Michelle , Khan Saeeda , Harper Sam , Ross Nancy A.
Published: April 2017

ABSTRACTObjectivesBirth and delivery in hospital is one of the most common medical procedures in Canadian hospitals, and can be used to assess equity in the delivery of health care. This study investigates the association between socioeconomic status and hospital burden for childbirth using linked Canadian survey and administrative databases, accounting for a wide array of other individual and health-care related characteristics.

ApproachA population-based record linkage between national health survey data and the Canadian Discharge Abstract Database (a census of all Canadian hospital separations) allowed the tracking of hospital utilization between 2005 and 2009 for which individual-level socioeconomic and demographic factors were also available. Length of stay for delivery, risk of pre-delivery hospitalization within 30 days of admission for delivery, and risk of maternal readmission within 30 days of discharge for delivery were the three measures of hospital utilization modeled.

ResultsComplete information for 7,163 deliveries of 5,568 women was available and used in the models of length of stay and risk of maternal admission pre- and post-delivery. In fully adjusted models, predicted length of stay was graded by household income with longest stays for lowest income women (2.79 days, 95% CI 2.61-2.92), followed by middle income women (2.63 days, 95% CI 2.50-2.76) and high income women (2.56 days, 95% CI 2.49-2.63). Factors intrinsic to routine hospital care and protocol such as province and vaginal versus Cesarean section delivery were stronger predictors of length of stay than income. Additionally, Aboriginal status, compounded with residing in a rural setting was associated with higher predicted probability of maternal readmission.

ConclusionsLow income women have marginally longer stays in hospital following birth events than do middle and high-income women in Canada that persist after adjustment for strong drivers of length of stay (parity and birth mode). While this may suggest that more complicated cases are benefiting from longer stays in hospital, it provokes the question as to whether there may be additional reductions in length of stay that could be achieved through resource redistribution to the prenatal period. Overall, the results suggest that equity goals of the Canadian health care system are being achieved for birth-related hospitalizations, and the availability of these linked data will be key for further comprehensive evaluation of population health status.
Long term health effects of NEET experiences: evidence from a longitudinal analysis of young people in Scotland
Authors: Feng Zhiqiang , Ralston Kevin , Everington Dawn , Dibben Chris
Published: April 2017

ABSTRACTBackgroundThis paper examines whether experiences of young people who are not in employment, education or training (NEET) are associated with adverse long-term outcomes in health. We used the Scottish Longitudinal Study (SLS), which includes information from the 1991, 2001, and 2011 censuses as well as from vital events, for a 5.3% representative sample of the Scottish population. Linked health data such as hospital admissions and prescribing in general practice are also available. We followed around 14,000 young people who were aged 16-19 in 1991 up to 2011.

MethodWe explored whether NEET young people in 1991 displayed higher risks of poor physical and mental health in the follow-up period. Poor physical health is measured by any admission into hospital and poor mental health is measured by prescription of anti-depressant and anti-anxiety medicine. We used descriptive and modelling approaches in our analysis. Covariates include a number of individual socioeconomic characteristics and local area characteristics in the models.

ResultsOur research found that over 40% of the cohort members have been admitted into hospital, while over 30% have been prescribed with anti-depressant and anti-anxiety drugs. The NEET status in 1991 appears to be associated with hospitalisation with adjusted odds ratio (OR) of 1.24 (95% Confidence Intervals (CIs): 1.08 – 1.42). Also the NEET experiences are associated with poor mental health with OR of 1.47 (95% CI: 1.27 – 1.71). Policy intervention is necessary in assisting NEET young people to re-engage in education or employment.
Political and Policy Arguments for Integrated Data
Authors: Brown Adalsteinn D , Boozary Andrew S , Henry David , Marchildon Greg , Schull Michael
Published: April 2017

ABSTRACT

IntroductionThere is little argument that integrated data can provide a valuable resource for improved health system management, planning, and accountability as well as discovery and commercial use, but policies to enable and support integrated data fall short of the potential represented by integrated data. To understand the current level of progress on policy for integrated data, we looked at two successful and two unsuccessful efforts to support the creation and use of integrated data in health systems.

Methods/ApproachWe used document and literature analysis to develop descriptions of the Icelandic Health Sector Database Act, the creation of the Institute for Clinical Evaluative Sciences in Ontario (Canada), the care.data initiative in the United Kingdom, and the Health Datapalooza initiative in the US and used an Ideas, Institutions and Actors framework to compare the experience with integrated data policy and politics.

Results and discussionOur analysis suggests that institutions around integrated data remain under-developed and largely focused on specific aspects of integrated data policy or use. There are at least two sets of dominant ideas around integrated data – data as a tool for economic development and health system performance and data as a threat to privacy and liberty – that are often diametrically opposed in different jurisdictions. To a great extent, powerful actors remain disengaged from integrated data discussions and leadership engaged in integrated data policy and politics remains isolated from larger policy and political discussions. The medical profession along with civil society groups can mount effective opposition to integrated data initiatives, although potentially for different reasons (accountability and privacy concerns respectively).

ConclusionsOur analysis suggests several key issues around successful integrated data policy and politics that support the importance of strong leadership, an incremental approach to institution building that focuses on public benefits, strongly alignment to missions that are congruent with societal values, and stronger attention to effective and rapid implementation of policy. In addition to the cases studied here, the success of smaller sub-national (e.g. state or provincial) efforts suggests that smaller efforts tend to work better although their success may not receive the attention that could support larger efforts to integrate data on the national level. Further work should focus chiefly on the extension of these arguments to non-health sectors to realize the full value of integrated data.
Improving primary care prescribing safety using routine data for intervention and evaluation: four trials in 500+ practices
Authors: Guthrie Bruce , Bennie Marion , Macbride-Stewart Sean , Dreischulte Tobias
Published: April 2017

ABSTRACTObjectivesHigh-risk prescribing in primary care is common and causes considerable harm, with for example, ~6% of emergency hospital admissions caused by adverse drug effects. Our aim is to rigorously develop and evaluate complex interventions to improve primary care prescribing safety using routine clinical and administrative data.

ApproachCo-design of interventions by joint academic and clinical teams with implementation embedded in NHS Scotland information and contractual systems. Routine data from general practice electronic medical records (EMRs) or from the NHS Scotland prescribing payment system are used to both underpin the interventions and allow evaluation. Two cluster-randomised trials in 295 general practices have been completed (EFIPPS and DQIP), and two trials in 298 practices are in progress (EPIPP and POEMS), involving ~55% of Scottish general practices in total. The completed EFIPPS trial was a three-arm cluster randomised trial of a routine data feedback intervention +/- a theory-informed behaviour intervention involving 262 (~95%) of practices in three health boards. The completed DQIP trial was a stepped-wedge cluster randomised trial in 33 (50%) practices in one Health Board, the intervention comprising a web-based informatics tool to identify patients needing review from practice EMRs and to facilitate and structure review, an educational outreach visit, and financial incentives to review patients. EPIPP is evaluating a more complex feedback intervention, where both arms receive an active intervention on a different topic, involving all 242 practices in one Health Board. POEMS is evaluating an ‘enhanced medication summary’ to support contractually required-polypharmacy reviews in older people taking 10 or more regular medications, involving all 56 practices in one Health Board.

ResultsThe simpler EFIPPS intervention reduced high-risk prescribing by 12% by 15 months after feedback started. We are currently examining what happened in the year after feedback ceased. The more intensive DQIP intervention reduced high-risk prescribing by 37% at 12 months. This effect was sustained in the 12 months after the financial incentives ceased because the intervention reduced new high-risk prescribing. The DQIP intervention also led to large reductions in related emergency hospital admissions with gastrointestinal bleeding, acute kidney injury and heart failure.

ConclusionWe have shown that informatics-based interventions using routine data and co-designed with clinicians and managers are effective in improving primary care prescribing safety. The presentation will describe our approach to intervention development and implementation, show examples of the interventions, and present outcomes and process evaluation data from the two completed trials.
Under-coding of secondary conditions in coded hospital health data: impact of co-existing conditions, death status and number of codes in a record
Authors: Peng Mingkai , Southern Danielle , Williamson Tyler , Quan Hude
Published: April 2017

ABSTRACTObjectivesAdministrative health data including hospital discharge abstract data have been widely collected and analyzed for various purposes, including disease surveillance, case-mix costing, tracking healthcare system performance, policy-making and research. This study examined the coding validity of hypertension, diabetes, obesity and depression related to the presence of their co-existing conditions, death status and number of diagnosis codes in hospital discharge abstract data (DAD).

ApproachWe randomly selected around 4000 DAD records from four teaching hospitals in Alberta, Canada and reviewed their charts to extract 31 conditions listed in Charlson and Elixhauser comorbidity indices. Conditions associated with the four study conditions were identified through multivariable logistic regression. We examined the coding validity of the four study conditions related to whether their co-existing conditions were coded, whether the patient died in hospital and the total number of diagnosis codes recorded in a DAD record.Results Hypertension, diabetes, obesity and depression are generally secondary diagnosis and their validity are affected by the coding of their co-existing conditions. The sensitivity for the four conditions increased as the total number of diagnosis codes in the record increased. The impact of death status on coding validity for the four conditions was minimal.ConclusionThe coding validity of conditions is closely related to its clinical importance and complexity of patients’ case mix. We recommend mandatory coding of certain secondary diagnosis to meet the need of health research based on administrative health data.
Comparing a primary care dataset with a questionnaire based health survey
Authors: Atkinson Mark , Kennedy Jonathan , Brophy Sinead
Published: April 2017

ABSTRACTObjectivesThe Welsh Health Survey (WHS) has been carried out annually since 2003. Approximately 15000 adults and 3000 children are interviewed each year on a wide range of health related questions. From 2013, adult participants were asked to consent to their data being linked and incorporated into the SAIL databank, allowing linkage to the SAIL datasets. Here we focus on linkage to primary care, General Practitioner (GP), data.

This provides a unique opportunity to compare some clinical concepts which are represented in both datasets. The questionnaires in the WHS are taken at a set moment in time and are standardised for everyone questioned, and are more complete. In comparison the GP data collects responses over the patients’ interactions with the GP, but the information may have been elicited in different ways and data are much more likely to be missing.

ApproachWe have chosen a small number of variables scored in both datasets for comparison. BMI and its core variables height and weight are the principal numeric variables found in both datasets. Smoking behaviour is coded for 96% of people in the GP data, alcohol consumption for 79% and exercise for 62%. In contrast, in the WHS data, coding is for 99% (smoking), 99% (alcohol) and 97% (exercise).

ResultsThe 2013 WHS had 4362 participants linked to the SAIL databank, and 7332 from the 2014 WHS. Of these, 95 % had either an exact match or a probabilistic match of 0.9 or above, with 6869 people (63 %) of the combined WHS dataset having linked GP data.

Of those with GP data, 5997 (87%) have weights in the GP data at any date. But only 2429 (35%) have weights within 1 year before and 1 year after the questionnaire date. Of the 2429, 135 have no weight in the WHS data.

ConclusionsFor those using WHS data, the data can be enhanced with a temporal dimension, while the GP data user can augment missing values from the WHS. Both the GP and WHS can gain confirmation from each other. This allows the non-randomness of missingness in the GP dataset to be assessed.
Developing and Validating Electronic Medical Record Based Case Definitions for Liver Diseases and Comorbidities
Authors: Xu Yuan , Li Ning , Lu Mingshan , Myers Robert , Dixon Elijah , Walker Robin , Quan Hude
Published: April 2017

ABSTRACTObjectiveChina has collected high volume of electronic health record (EMR) data. The rich information in EMR data could be used for health services research. The first challenge is developing methods for extracting study variables. Our study aimed to develop and validate data extraction methods for defining clinical conditions.

ApproachThe EMRs were from Beijing You-An Hospital, a leading liver diseases specialized teaching hospital affiliated with Capital Medical University in China. We developed EMR based case definitions for extracting common liver diseases and comorbidities in Charlson and Elixhauser comorbidity algorithms. We developed the EMR case definitions based on the fundamental EMR structure and clinical expertise. To determine validity of the EMR case definitions, we calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each case definition based on the “gold standard”: randomly selected 450 charts review conducted by two hepatologists. The agreement between the two reviewers was assessed by kappa value.

ResultsIn total, 69,864 EMRs for adult patients with liver disease admitted between 2010 and 2015 were included in this study. Among these patients, we identified 13,763 (19.7%) PLC, 18,654 (26.7%) Hepatitis B Virus (HBV), 4681 (6.7%) Hepatitis C Virus (HCV), 18,933 (27.1%) cirrhosis, 7,964 (11.4%) diabetes, 8,523 (12.2%) hypertension, 3,283 (4.7%) Fluid and Electrolyte Disorder (FED), 3,563 (5.1%) renal disease and 1,258 (1.8%) Cerebrovascular Disease (CEVD). Between the two reviewers, the Kappa values fell between 0.65 and 1.00. Of the 450 EMRs reviewed, the two reviewers identified 95 (21.1%) PLC, 197 (43.8%) HBV, 40 (8.9%) HCV, 146 (32.4%) cirrhosis, 39 (8.7%) diabetes, 45 (10.0%) hypertension, 25 (5.6%) FED, 26 (5.8%) renal disease and 8 (1.8%) CEVD. Compared to chart review, the sensitivity, specificity, PPV and NPV of the algorithms for above conditions are respectively: (PLC) 100%, 99.44%, 97.94%, 100%; (HBV) 61.93%, 99.21%, 98.39%, 76.99%; (HCV) 72.50%, 99.51%, 93.55%, 97.37%; (cirrhosis) 78.77%, 98.36%, 95.83%, 90.61%; (diabetes) 97.44%, 98.05%, 82.61%, 99.75%; (hypertension) 95.00%, 99.72%, 97.44%, 99.45%; (FED) 71.43%, 100.00%, 100.00%, 99.09%; (renal disease) 96.15% 100.00% 100.00% 99.76%; (CEVD) 100.00%, 99.77%, 88.89%, 100.00%.

ConclusionOur EMR case definitions of above conditions had high validity and could be applied to extract clinical variables including major liver diseases and comorbidities from Chinese EMR. This extracting method could be modified slightly for extracting other medical conditions from Chinese EMRs.
Social Data Linkage Environment
Authors: Trudeau Richard
Published: April 2017

ABSTRACTObjectivesThe Social Data Linkage Environment (SDLE) at Statistics Canada promotes the innovative use of existing administrative and survey data to address important research questions and inform socio-economic policy through record linkage. It expands the potential of data integration across multiple domains, such as health, justice, education and income, through the creation of linked analytical data files without the need to collect additional data from Canadians.ApproachAt the core of the SDLE is a Derived Record Depository (DRD), essentially a national dynamic relational data base containing only basic personal identifiers. The DRD is created by linking selected Statistics Canada source index files for the purpose of producing a list of unique individuals. These files are brought into the environment, processed and linked only once to the DRD. Each individual in the DRD is assigned an SDLE identifier. Some of the source index files used to build the DRD include tax records, vital statistics registration records (births and deaths), and immigrant data. Updates to these data files are linked to the DRD on an ongoing basis. Only basic personal identifiers are stored in the DRD. Examples of personal identifiers stored in the DRD include surnames, given names, date of birth, sex, insurance numbers, parents' names, marital status, addresses (including postal codes), telephone numbers, immigration date, emigration date and date of death. The paired SDLE identifiers and source index file record IDs resulting from the record linkage are stored in a Key Registry. To reduce the risk of privacy intrusiveness and to minimize the risk of disclosure, source files are separated into source index files and source data files. Employees performing the record linkages in SDLE have access to only the basic personal identifiers needed for linkage. Employees who build the analytical files for research have access only to the data stripped of personal identifiers.ResultsThe SDLE is a highly secure environment that facilitates the creation of linked population data files for social analysis. It is not a large integrated data base.ConclusionThe SDLE program facilitates pan-Canadian social and economic statistical research. It is a record linkage environment that: increases the relevance of existing surveys without collecting new data; substantially increases the use of administrative data; generates new information without additional data collection; maintains the highest privacy and data security standards; and promotes a standardized approach to record linkage processes and methods.
Early onset preeclampsia: using population data to assess recurrence risk and adverse pregnancy outcomes
Authors: Roberts Christine L. , Seeho Sean K. , Algert Charles S. , Ford Jane B.
Published: April 2017

ABSTRACTObjectiveUse linked perinatal data to determine the subsequent pregnancy rate after a pregnancy with early onset preeclampsia and, among those who have a subsequent pregnancy, the risk of recurrence and adverse pregnancy outcomes.

ApproachPreeclampsia is a hypertensive disorder of pregnancy associated with adverse outcomes for the mother and baby. Although rare, when preeclampsia occurs before 34 weeks of gestation, the risk of adverse outcomes is markedly increased primarily due to prematurity. Despite the desire for another child, many women are anxious about becoming pregnant again because of concerns of recurrent complications in a next pregnancy but information for counselling is sparse. We undertook a population-based record linkage cohort study using longitudinally-linked birth and hospital records from New South Wales (Australia) to create medical and obstetric histories. The study population included nulliparous women with a singleton pregnancy and early onset preeclampsia who gave birth between 2001 and 2010 (the index pregnancy), with follow-up for a subsequent birth through 2012. Early onset preeclampsia was defined as a hospital record (antenatal and/or delivery hospitalisations) with a diagnosis of preeclampsia and delivery before 34 weeks gestation. Outcomes included subsequent pregnancy, and among women with a consecutive subsequent birth, the preeclampsia recurrence rate and adverse pregnancy outcome rates.

ResultsOf 1473 (4.0/1000) nulliparous women who had early onset preeclampsia in the index pregnancy, 60% had evidence of any subsequent pregnancy compared to 66% for women without preeclampsia (P<0.001). Of 758 women with early onset preeclampsia and a subsequent singleton birth ≥20 weeks gestation, 256 (33.8%) had preeclampsia in the subsequent pregnancy but only 57 (7.5%) had recurrent early onset preeclampsia. Most women (717, 94.6%) progressed to a later gestational age in their subsequent pregnancy. The median overall increase in gestational age at delivery was 6 weeks (interquartile range [IQR] 4 to 8) and among the women with recurrent preeclampsia the median increase in gestation in the subsequent pregnancy was 5 weeks (IQR 2 to 7). Outcomes in the subsequent pregnancy included 4.2% postpartum haemorrhage, 3.4% severe maternal morbidity, 2.6% Apgar <7 at 5 minutes, 16.2% small-for gestational-age and 1.7% perinatal deaths.

ConclusionsMost women with early onset preeclampsia had good outcomes in their subsequent pregnancy. For rare conditions, linked population data with accurately recorded information can provide robust estimates of outcomes that can inform clinical counselling.
Emergency department attendance after telephone triage
Authors: Gibson Amy , Randall Deborah , Tran Duong , Byrne Mary , Lawler Anthony , Havard Alys , Robinson Maureen , Jorm Louisa
Published: April 2017

ABSTRACTObjectivesTo measure compliance with telephone helpline advice to attend an emergency department (ED) and the acuity of patients who presented to ED following a call. ApproachPopulation based, observational cohort study of all calls (n=1.04 million) to the healthdirect helpline over four years made by residents of New South Wales (NSW), Australia, linked to records of ED presentations, hospital admissions and death registrations using probabilistic data linkage. Outcomes measured include: compliance with dispositions to attend an ED, self-referral to ED by patients given low urgency dispositions, predictors of compliance and self-referral, and triage levels at ED presentation. This helpline dataset had not been previously linked with clinical outcome data, and this is the largest population-based linkage of telephone triage data conducted internationally.Results67.2% of patients were compliant with dispositions to attend an ED and the great majority of these (95.2%) attended within four hours of the call. Compliance was highest in patients aged 10-14 years, in residents of major cities and inner regional areas, in middle socio-economic quintiles, in calls triaged after-hours by nurses, in patients who had not been frequent callers to the service, and in callers with an original intention matching the disposition. In patients receiving a low-urgency disposition, 6.2% attended ED within 24 hours of the call (50.4% of these within four hours). Predictors of self-referral included older patient age, and calls triaged after hours. Calls from remote areas and areas in high socio-economic quintiles and where the original intention was similar to the disposition, were less likely to self-refer to ED. After age-adjustment, healthdirect compliant patients who attended ED were significantly less likely (7.7%) to receive the least urgent triage category (Australasian Triage Scale [ATS] 5) compared to the general NSW ED population (16.9%). Compliant healthdirect ED attenders also included a significantly higher proportion of patients triaged as the more urgent ATS 3 (37.0%) compared to the general NSW population (30.0%).Conversely, patients who self-referred to the ED did not differ significantly from the general population in allocation to lower urgency categories. ConclusionThis large population-based data linkage study provides precise estimates of ED attendance following calls to a telephone triage service, and details the predictors of ED attendance. The findings with regard to triage categories at ED presentation indicate that the healthdirect helpline is not referring substantial numbers of low-urgency patients to EDs.
Previous hospital admissions in risk adjustment for mortality of elderly patients admitted with hip fracture
Authors: Machareth Helen , Coeli Cláudia , Pinheiro Rejane
Published: April 2017

ABSTRACTIntroductionThe Hospital Information System of the Brazilian Unified Health System (SIH-SUS) can be an important tool in evaluating care through comparisons of mortality rates among hospitals. However, the SIH-SUS has limited availability of data on comorbidities, which are needed in order to measure the severity of patients' condition for risk adjustment when comparing mortality among hospitals.

ObjectivesTo analyze previous hospital admissions as an indicator of severity of patients' condition using as an example hip fracture admissions.

ApproachWe analyzed 1984 patients with 62 years of age or older with hip fracture who were admitted to the public health system in Rio de Janeiro City between 2010 and 2011. The causes of previous hospital admissions were obtained through probabilistic record linkage with the SIH-SUS for all causes of admissions between 2008 and 2010. We analyzed the association between the patient having had a any previous admission, adjusted by sex and age, with hospital death, through a logistic regression model. We also analyzed the association between groups of causes of admission with hospital death.

ResultsHaving had at least one previous hospital admission due to any cause before the admission for hip fracture was associated with a 77% increase in the odds of hospital death (CI 95% = 1.06 – 2.94). Among comorbidities, the most relevant were severe or moderate kidney disease with OR = 20.196 (CI 95% = 3.042 – 134.092), ischemic diseases with OR = 9.099 (CI 95% = 0.973 – 85.106), pneumonia with OR = 3.619 (CI 95% = 0.977 – 13.401) and diverse fractures and lesions with OR = 2.041 (CI 95% = 0.900 – 4.627). We were not able to analyze the association for some comorbidities due to an absence in outcome variability in some groups.

ConclusionResults point to a promising use of previous hospital admissions in the Hospital Information System as a proxy for patient's risk adjustment.
Escola sem partido na Educação do Campo
Authors: Bezerra Maria Cristina Dos Santos , Bezerra Neto Luiz
Published: April 2017

Desde o início da Idade Moderna, a escola carrega uma função social, qual seja? Ensinar, transmitir os conhecimentos construídos e acumulados pela sociedade ao longo da história da humanidade. Assim, a escola tem a função de transmitir o que de melhor a humanidade construiu em termos de ciências, filosofia, artes, linguagens, etc. O ensino da física, da matemática, da língua vernácula e das línguas estrangeiras é realizado nas escolas, bem como é nas escolas que se ensina fundamentos de filosofia, de sociologia, de psicologia, assim como história, geografia etc. Assim, a escola se transformou na principal agência de formação e transmissão de conhecimento e formação dos povos, independentemente da nacionalidade. Desde a Revolução Francesa, tem havido uma luta em defesa de uma escola que possa ser laica, republicana e que possa atender a todos com igualdade.
De la problematización social a la problematización pública del derecho educativo de migrantes indígenas en contextos urbanos: la educación de los niños y niñas qom (toba) en Rosario, Santa Fe, Argentina (1986-1990)
Authors: Corbetta Silvina
Published: April 2017

La migración qom que recepciona la ciudad de Rosario, Santa Fe (Argentina) constituyó avanzados los años 80 aquello que desde el análisis de políticas públicas se denomina problema público, originado desde un problema social de progresivo dinamismo, producto de los flujos continuos de migrantes indígenas a la ciudad, y con ellos, la llegada de los niños y niñas indígenas a las escuelas criollas instaladas en cercanía de lo que fue el primer asentamiento qom. El artículo se realiza con base al marco teórico-conceptual que aportan los estudios de política pública con eje en las tres primeras fases del ciclo de la política pública: (i) surgimiento y percepción del problema, (ii) el ingreso a la agenda pública y (iii) la formulación y decisión del programa de la política. ¿Cómo se enuncia entre los actores el problema social? ¿Cuál fue el proceso que permitió – por primera vez- convertir en problema público, la educación de los niños migrantes e indígenas de Rosario a fines de los años 80 y de principios de los 90? ¿Cómo surgieron en ese contexto los actores indígenas? ¿Qué luchas, intereses de actores privados y factores colaborativos diversos confluyeron en las primeras fases del emergente ciclo de vida de la citada política? El artículo pretende analizar el modo en que se configura, fundamentalmente, la demanda educativa de migrantes internos indígenas a través de la educación. La estrategia metodológica es de corte cualitativo. La información se construyó con base a entrevistas, revisión bibliográfica y análisis de normativas. Palabras clave: Migración Urbana Indígena. Educación Intercultural Bilingüe. Comunidad Qom.
Projeto Político-Pedagógico: uma possibilidade de gestão democrática
Authors: Costa Daianny Madalena
Published: April 2017

Neste artigo, partimos da promulgação da Constituição Federal (1988), enquanto um marco a favor da democracia, a qual estabeleceu a educação como direito social (art 6º), que visa o pleno desenvolvimento humano (art. 205) e que tem a gestão democrática como princípio (art. 206, VI). Dela decorreu o conjunto de legislações posteriormente. Porém, por mais que uma lei aponte para um fim, é inegável a participação da sociedade para que efetivamente se consolide. Assim, por meio de uma metodologia dialógica, entre ação-reflexão-ação, analisaremos a construção dos projetos políticos-pedagógicos (PPPs) enquanto uma possibilidade viável de gestão democrática, realizada numa rede municipal de educação, de uma cidade da região Metropolitana do Vale do Paraíba, no estado de São Paulo. Bobbio (1986) afirma que “para o regime democrático, o estar em transformação é seu Estado natural: a democracia é dinâmica, o despotismo é estático e sempre igual a si mesmo” (p. 9). Desse modo, buscar princípios democráticos, significa compreendê-los em transformação e permanente negação aos autoritarismos e despotismos que fazem parte dos jogos do poder. Consideramos, portanto, que os PPPs podem ser a proposta enunciada para um planejamento participativo e democrático e, ao mesmo tempo, seu guardião. Ou seja, da mesma forma que o convite realizado para sua preparação seja por meio de uma construção coletiva, democrática e participativa, a gestão democrática será pautada enquanto “um capítulo”, construída no cerne do documento, que remeta a uma constante apropriação, amadurecimento e sustentação da vida escolar como princípio democrático. Palavras-chave: Projeto Político-Pedagógico. Democracia. Participação.