bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio-demographic and household characteristics of unmarried mothers as risk factors for low birthweight and infant death in Northern Ireland
Authors: Casson Karen , Given Joanne , Rosato Michael , Bunting Brendan , Gray Ann Marie
Published: June 2018

BackgroundCompared to married mothers, mothers who are not married when they register their child’s birth are at increased risk of having a low birthweight baby and infant death. Having a partner protects women from poor pregnancy outcomes to some extent but those who are living with, but not married to, their partner still do less well than those who are married. As it does not appear to be marriage itself which is protective, other factors such as maternal education and smoking, and household characteristics, such as accommodation type and familial support in the household, need to be examined.

AimTo explore the individual socio-demographic and household characteristics that are associated with low birthweight and infant death among unmarried mothers.

MethodsA population based cohort study will be conducted through the Administrative Data Research Network based on all registered live births 2010-2016 to women resident in Northern Ireland (NI).

General Register Office (GRO) birth records will be linked to the NI Maternity System and GRO infant death data to identify low birth weight (primary) and infant death (secondary) outcomes. Maternal individual socio-demographic and household characteristics will be provided through linkage to the 2011 census (ethnicity, highest level of education, support from family members living in the household); Enhanced Prescribing Database (maternal mental health prescriptions); 2010 NI Multiple Deprivation Measure (area level deprivation, including income and education domains, for the mother’s home address at the time of birth) and Valuation and Lands Agency Rating List (capital value of property of mother’s address).

Descriptive statistics and logistic regression will be used for the analysis.

ImpactIt is anticipated the findings will reduce the public health burden of low birthweight babies by directing interventions to targeted groups of mothers.
Engagement and Co-Design: Routes to Lawful Research?
Authors: Mourby Miranda , Smith Hannah
Published: June 2018

BackgroundThe ‘deficit’ model of engagement, which educates the public about research, has been subject to increasing criticism, as if people’s attitudes arise from ignorance which should be corrected. Nevertheless, a number of attempts to understand public views on the use of Administrative Data for research have used informative models.

This can be problematic from a legal perspective, as the law is concerned with data subjects’ ‘reasonable expectations’, not their hypothetical expectations had they received more information. Recent controversies around reasonable expectations have included Google DeepMind and Royal Free, as well as Cambridge Analytica.

ObjectivesThis paper considers how public engagement can help administrative data controllers meet their legal obligations when data are processed for research, and how to avoid confusion by placing too much reliance on the views of informed participants as a means of gauging wider public opinion.

MethodsWe refer to the findings of an exploratory study of individual attitudes towards Administrative Data Research, which indicate that views and norms around ADR are incipient and ambivalent, especially when compared to perceptions of ‘conventional’ medical research. We consider the legal obligations administrative data controllers have to shape reasonable expectations in light of this uncertainty.

FindingsEngagement which informs the public about research does have value. It indicates what the attitudes of the public might be, were certain facts about research more commonly known, and thus underscores the importance of public information campaigns. However, this work cannot provide an accurate representation of public opinion as a whole in the absence of wider dissemination of information across society.

ConclusionsThere will inevitably be a number of facets to public engagement: information, representation and transparency. Each of these will correlate differently with data controllers’ legal obligations, and it is essential to understand these connections.
Welsh Government Flying Start Programme Evaluation Using Linked Data
Authors: Lowe Sarah , McGinn Laura , Quintela Marcos , Player Luke , Tingay Karen
Published: June 2018

BackgroundFlying Start (FS) is the Welsh Government’s (WG) flagship Early Years programme for families with children aged less than 4 years of age. Running since 2006, the four entitlements are:

Free part-time childcare for 2-3 year olds

Enhanced Health Visiting

Parenting support

Speech, language, and communication support

ObjectivesCurrently, while we know which areas in Wales are receiving FS support, individual-level data on which child received what entitlements is not available. Area-level outcomes can be used as proxy indicators but the individual impact of receiving FS support cannot be examined.The project aims to evaluate FS by linking the FS cohort to a range of outcomes including health, education and social care.

MethodsA Dataflow Development Project (DDP) has been launched to install SAIL (Secure Anonymised Information Linkage) appliances into 6 pilot Local Authorities in Wales which will test acquiring and linking the individual level FS data from pilot Local Authorities with other datasets in SAIL.

FindingsThe project will report some emerging findings from the analysis of pilot data.

ImplicationsThere is a growing interest in using linked administrative data to evaluate government initiatives, and mounting enthusiasm in Local Government. If successful, this model is likely to be adopted by related WG programmes; improving the evidence base, facilitating effective evaluation, and adding to the data available for re-use in Wales.
Challenges in linking administrative data for monitoring bloodstream infection in neonatal units in England and Wales
Authors: Fraser Caroline , Gilbert Ruth , Blackburn Ruth , Muller-Pebody Berit , Harron Katie
Published: June 2018

Monitoring risk-adjusted trends of neonatal bloodstream infection is vital and linkage of neonatal electronic health records to national infection surveillance enables this. We demonstrate why changes in data quality over time must be accounted for to minimise spurious findings.

First, we evaluated the impact of changes in identifier completeness over time in each database, and determined variation in infection rates according to linkage method (deterministic linkage on NHS number or probabilistic linkage). Second, we will use multiple imputation when link status cannot be determined due to missing identifiers.

Completeness of NHS number in infection surveillance increased from 69% (3,296/4,792) in 2010 to 92% (3,037/3,307) in 2017. We linked 12,003 neonatal admissions to 15,571 infection episodes (2% of 497,936 admissions and 41% of 37,660 infections). The proportion of links that were deterministic changed from 83% (1,089/1,307) in 2010 to 96% (968/1,008) in 2017. Link status could not be determined for 12,094 infections due to missing identifiers; multiple imputation will be used to determine if any are links.

Spurious infection incidence rates can arise from changes in data quality, impacting the quality of linkage to clinical data. Linkage and imputation of missing data minimises spurious findings due to data quality.
Daily exposure to the retail food environment and the association with child BMI
Authors: Mizen Amy , Rodgers Sarah , Fry Richard
Published: June 2018

BackgroundThe dose-response relationship between exposure to food environments and obesity has not been widely investigated. This study examined whether increased retail food environment (RFE) exposure in children was associated with a larger body mass index (BMI).

ObjectivesGenerate household level daily exposure to the RFE for children aged 11-13 years and link these environmental exposure with health data in an anonymised data safe haven.

MethodsIndividually tailored environmental exposures were calculated in a GIS for home and school locations, and modelled walking routes to and from school. Local Authority food outlet data were used to generate the temporally accurate exposures. Exposures were linked to individual level health data in the SAIL databank for a cohort of individuals from south Wales aged 11-13 years, with BMI measurements. A fully adjusted multilevel regression model was fitted to investigate the association of RFE exposure with BMI.

FindingsHome exposure and exposure along the walk to school was significantly greater for children living in deprived catchments, compared with affluent school catchments (t = -5.25, p<0.05; t = -0.277, p<0.05, respectively). The RFE exposure along the walk home was the only environmental exposure positively associated with a higher BMI (0.22, p<0.05).

ConclusionsIncreased BMI was associated with greater REF exposure along the walk home from school. The findings suggest that the walk home from school may be important for developing interventions and policies to discourage unhealthy eating. Research should be undertaken to better understand child purchasing habits.
Are children who are treated for asthma and seasonal allergic rhinitis disadvantaged in their educational attainment when acutely exposed to air pollution and pollen? A feasibility study
Authors: Mizen Amy , Lyons Jane , Rodgers Sarah , Berridge Damon , Akbari Ashley , Wilkinson Paul , Milojevic Ai , Doherty Ruth , Dearden Lorraine , Lake Iain , Carruthers David , Strickland Sarah , Mavrogianni Anna , Davies Gwyneth
Published: June 2018

BackgroundThere is a lack of evidence of the adverse effects which air quality has on cognition for people with air quality-related health conditions, these are not widely documented in the literature. Educational attainment, as a proxy for cognition, may increase with improved air quality.

ObjectivesPrepare individual and household level linked environmental and health data for analysis within an anonymised safe haven; analyse the linked dataset for our study investigating: Cognition, Respiratory Tract illness and Effects of eXposure (CORTEX).

MethodsAnonymised, routinely collected health and education data were linked with high spatial resolution pollution measurements and daily pollen measurements to provide repeated cross-sectional cohorts (2009-2015) on 18,241 pupils across the city of Cardiff, using the SAIL databank. A fully adjusted multilevel linear regression analysis examined associations between health status and/or air quality. Cohort, school and individual level confounders were controlled for. We hope that using individual-level multi-location daily exposure assessment will help to clarify the role of traffic and prevent potential community-level confounding. Combined effects of air quality on variation in educational attainment between those treated for asthma and/or Severe Allergic Rhinitis (SAR), and those not treated, was also investigated.

FindingsAsthma was not associated with exam performance (p=0.7). However, SAR was positively associated with exam performance (p<0.001). Exposure to air pollution was negatively associated with educational attainment regardless of health status.

ConclusionsIrrespective of health status, air quality was negatively associated with educational attainment. Treatment seeking behaviour may explain the positive association between SAR and educational attainment. For a more accurate reflection of health status, health outcomes not subject to treatment seeking behaviours, such as emergency hospital admission, should be investigated.
Making sense of change and stability in looked after children’s care placements using state sequence analysis
Authors: Matthews Ben , Playford Chris , McGhee Janice , Mitchell Fiona , Dibben Chris
Published: June 2018

BackgroundLocal authorities in Scotland have a responsibility to provide support for vulnerable children and young people, known as ‘looked after children’. This support can include providing care for these children away from home, but there have been growing concerns that children with out of home placements may experience multiple placements before a stable home environment is established for them. As a result, policy changes have aimed to reduce the amount of instability which looked after children experience, but our current understanding of care placement stability in Scotland, and how this has changed over time, is limited.

ObjectivesThis project aims to develop our understanding of the patterns of instability experienced by children looked after away from home by applying state sequence analysis (SSA) administrative data regarding children’s care placements from 2008 to 2017 ( 70,000 children). Data are provided by Scottish Government.

Methods and FindingsSSA is a method commonly used to describe developmental processes which consist of changes between different states - in this case, types of care placement - and provides a number of tools to describe in/stability in these processes. In this paper we use SSA to analyse sequences of placements for multiple cohorts of children to give a detailed description of how placement stability for looked after children in Scotland has changed over the last decade, with results show differences in the typical placement sequence patterns for children of different ages. We and also discuss some methodological challenges which arise when implementing SSA using administrative data.

ConclusionsCombining SSA and administrative data provides a useful way to describe the typical patterns of looked after care placements, and how these patterns have changed over time.
Mining academic publications to automatically identify data sources
Authors: Anastasiou Athanasios , Tingay Karen
Published: June 2018

BackgroundDiscovering suitable datasets is an important part of health research, particularly for projects working with cohort data, but with the proliferation of so many national and international initiatives, it is becoming increasingly difficult for research teams to locate real world datasets that are most relevant to their project objectives.

MethodsTo assist researchers in this, we developed bibInsight, a data analysis platform to identify potentially useful data sources and more generally enable large scale research over bibliographical datasets.

Data source names were identified from a broad, topic specific literature search. Context-specific terms like “annual”, “longitudinal”, and “prospective” were used to train a classifier that identified potential datasets.

ResultsThe classifier was able to identify 1588 of 1961 abstracts as containing cohort-relevant information: a precision of approximately 80%.

Further analysis such as topic analysis, geographical mapping, and collaboration networks can refine and prioritise the search results to determine the most relevant data source(s) for a research project.

ConclusionsA very large amount of information, including data source description and use, remains unexploited in unstructured bibliographical datasets. Here, we used a thematic search to provide a more manageable starting point towards locating disease specific datasets.
Maternal vulnerability and birth interval in England: a birth cohort study using hospital episode statistics from 2006 to 2016
Authors: Wijlaars Linda , Blackburn Ruth , Gilbert Ruth
Published: June 2018

AimTo determine the association between birth interval for mothers with and without indicators of vulnerability.

MethodsWe included mothers who gave birth in 2011 recorded in Hospital Episode Statistics. Vulnerability indicators included diagnostic codes for mental health problems, adversity related injuries (ARI), material/social disadvantage (MSD) recorded in the previous five years, or age <20 years at index delivery.

We analyses birth interval using Cox proportional hazard models and adjusted for maternal and birth characteristics.

ResultsWe included 636,876 women, of whom 93,266 (14.6%) had indicators of vulnerability: 63,421 (10.0%) for mental health problems, 8,229 (1.2%) for ARI, 21,616 (3.4%) for MSD, and 32,622 (5.1%) were aged <20y.

Over a third of mothers (242,401; 38.1%) had another live birth. Median birth interval was 957 days (5-95%centiles:433- 1694), and was shortest for women with ARIs (904 days,391- 1697).

Vulnerable mothers were more likely than women with no vulnerability indicators to have another live birth (HRadj:1.13, 95%CI:1.12-1.14), particularly teenage mothers (HRadj:1.53,1.50-1.55).

ConclusionsVulnerable mothers had a shorter subsequent birth interval and were more likely to have another birth in the next five years. Maternity care may be an appropriate time to target interventions to vulnerable families to enable choice about timing of subsequent pregnancy.
EUROlinkCAT: Common Data Model
Authors: Loane Maria , Densem James , Morris Joan , Tan Joachim
Published: June 2018

BackgroundOver 130,000 children are born in Europe every year with congenital anomalies which are a major cause of infant mortality, childhood morbidity and long-term disability. A European data linkage study (EUROlinkCAT) aims to investigate the health and educational outcomes of children up to 10 years of age with congenital anomalies, born between 1995 and 2014. While congenital anomaly data including information on potential risk factors are standardised across the EUROCAT network, information on mortality, morbidity and educational outcomes are not.

ObjectiveTo create a common data model that transforms key variables in local databases to standardised formats enabling data on health and educational outcomes to be pooled and analysed across multiple registries.

MethodTwenty-two EUROCAT registries in fourteen countries are participating in the study. Each registry records uniformly coded data on cases of congenital anomaly registered in their local population using the EUROCAT Data Management Program. The registries will link their congenital anomaly data to their local mortality, hospital discharge, prescriptions and educational data. The linked individual case data cannot leave the local institution or “safe haven” environment, therefore verification and validation of all derived variables, data transformations and proxy variables must be performed locally.

FindingsCreating a common data model is challenging as there are diverse coding classification systems, languages, healthcare and educational systems in Europe. As with many administrative datasets, the common data model is based on coded data rather than the often richer “free text” information.

ConclusionThe use of administrative datasets across Europe enables pooling of data on rare outcomes and allows hypotheses on the health and education of children to be investigated. However, a common data model must be applied to ensure that data from multiple sites conform to a standard format.
Health Inequalities in the British Nursing Workforce
Authors: Ball William , Kyle Richard , Atherton Iain , Dougall Nadine
Published: June 2018

BackgroundAverage health in the UK is improving, yet geographical inequalities in health persist. The relative difference between the least and most deprived is also growing. Recent policy interventions to reduce these inequalities have not been effective.

MethodsThis work compares Self-Rated Health using the ONS LS and SLS linked to an adjusted UK-consistent small-area Deprivation measure.

This study aims to compare Nurses to the general population to assess whether they also exhibit a social gradient in health. Using a single occupational group adjusts for potential confounders and tests whether characteristics of Nurses, such a good health literacy, degree education and above average income, are protective against inequalities.

ResultsIn Scotland, Nurses are more likely to be older, female, homeowners who live in less deprived areas with better Self-Rated Health than Non-Nurses. We will test whether the social gradient in health is observed for this occupational group.Forthcoming results from cross-national analysis will be presented at conference following disclosure checks.

ConclusionThe relationship between area deprivation and health may remain even in relatively privileged groups.

Results from this study may inform recommendations to improve the effectiveness of policy aimed at improving population health and reducing socio-economic inequalities in health
Using administrative data to inform operational and policy developments relating to family homelessness in the Dublin Region
Authors: Morrin Holly , O'Donoghue Hynes Bernie
Published: June 2018

BackgroundSince 2014 Ireland has seen an unprecedented growth in the number of families being accommodated in emergency accommodation, particularly in the Dublin Region. Indeed, family homelessness has become an issue of concern across Europe but there is also a widespread lack of data about the specific situation of homeless families (Baptista et al., 2017).

ObjectivesThis research uses administrative data to address this gap in knowledge and provide robust quantitative data on trends in family homelessness in the Dublin Region.

MethodsThe research was compiled using a combination of PASS data and data recorded from assessment forms completed with homeless clients by the housing sections in the four local authorities across the Dublin region. PASS, the national shared services database for all state funded NGO and local authority homeless services has uniquely allowed for analysis of data relating to the entire population of families newly experiencing homelessness in the Dublin Region since January 2016.

FindingsDedicated data collection and analysis of such administrative data has produced interesting findings covering not only profiles and reasons for family homelessness but also families’ rates of progression through homeless services. Of note was that one in six families departed homeless services without active engagement with support services, a figure previously unreported.

ConclusionsThe combined use of administrative and PASS data gives a more complete picture of patterns of service use and engagement with homeless services among families newly experiencing homelessness. Detailed findings were passed on to operational staff to both plan for services to support families experiencing homelessness and to assist in developing a regional and national response to the issue of housing supply.
Finding Maternal Siblings in Birth Registration Data to form a Pregnancy Spine – Data Linkage & Graph Based Methods for Unknown Cluster Sizes
Authors: Tomlin Charles , Gammon Shelley , Morris Charles , O'Brien Charlotte
Published: June 2018

We have developed an innovative methodology to link maternal siblings within 2000-2005 England and Wales Birth Registration data, to form a Pregnancy Spine, a unification of all births to each unique mother. Key challenges were Blocking & Cluster resolution.

To optimise geographic blocking, Internal Migration data was incorporated to map likely geographic movement of mothers between births.

Following probabilistic linkage, sibling clusters were modelled as a graph and their structure optimised using community detection methods. Childhood statistics data relating to child DOB were incorporated to evaluate accuracy and remove false links.

Our development has resulted in a new blocking and cluster resolution method. We developed new ways to assess sibling group accuracy, beyond traditional classifier metrics, and infer error rates.We applied our method to Registration Data used in earlier studies for QA of our methods.

Using this, and other maternal sibling composition statistics, we present results showing that a high degree of accuracy was obtained for standard and new evaluation metrics.

These methods will improve other linkage projects linking unknown clusters sizes/multiple datasets, or longer time period longitudinal linkage. To this Spine, researchers can append and link other data sources to answer questions about maternal and child health outcomes.
Tackling health inequalities in access to Child and Adolescent Mental Health Services (CAMHS) using neighbourhood profiling of administrative data
Authors: Harris Rachel , Wilson Scott
Published: June 2018

BackgroundReducing health inequalities includes addressing access to and use of services, including considering how deprivation may affect service engagement and referrals. NHS Greater Glasgow and Clyde (NHSGGC) are close to the national average for most CAMHS benchmarking indicators, including waiting times, and referrals received and accepted. When comparing UK rates of Did Not Attends (DNA), however, NHSGGC were fourth highest in 2016. More detailed analysis of service use was thus of interest. While some service and patient risk factors are known, this study used data from NHSGGC’s electronic children’s health record system to develop neighbourhood profiles of access and use.

Objectives

To analyse activity within communities so health resourcescan be best targeted.

To help clinical teams plan services and develop newmodels matched to local need.

MethodsPatient-level administrative data was linked to geographic and population data to identify outlying areas of demand. Data on referrals, open cases, appointments and DNAs were extracted and population-based analyses undertaken with 120,000 data points, linked to 273 neighbourhoods across NHSGGC.

FindingsGeomaps were used to highlight variation in activity, demand and population at neighbourhood and NHSGGC levels. Unexpectedly low levels of population reach (open cases/population under 18s) were found in some areas (Govanhill, 0.5%, relative to NHSGGC, 1.94%). Yet, the high level of DNAs in some East Glasgow areas is as one would predict given deprivation levels.

ConclusionsFindings have been used to identify potential improvements and to target communities who could benefit most. For example, West Dunbartonshire teams noticed high DNA rates in two neighbourhoods, both geographically distant from clinics. Satellite clinics have been introduced to improve attendance by reducing travel time and costs for families.

Neighbourhood profiles have proved valuable in highlighting population based trends and supporting comparisons locally and relative to NHSGGC wide benchmarks.
A Comparison of Mental Health Performance Indicators in Canada
Authors: Smith Mark , Butler Amanda , Lesage Alain , Kurdyak Paul , Adair Carol , Vigod Simone , Jones Wayne
Published: June 2018

BackgroundThere is growing recognition of the need for consistent and reliable reporting on mental health and addiction (MHA) services in Canada. While there have been improvements in the area of reporting within provinces, comparable measures across provinces are often confined to hospitalization data. The aim of this project was to test the feasibility of creating MHA performance indicators that could be compared across Canadian provinces.

MethodsA team of scientists from five provinces collaboratively developed the following six MHA performance indicators for ages 10 and up, using hospital, emergency, physician billing and mortality data (pop. 33.2 million):

Access to the same family physician for people with MHA problems

First contact for MHA problems was in an emergency department

Physician follow-up after hospitalization for MHA problems

Rate of suicide attempts among people diagnosed with MHA problems

Suicide rates among people diagnosed with MHA problems

Mortality of people diagnosed with MHA problems

To facilitate meaningful inter-provincial comparisons, consensus definitions and standardized analytic processes were developed. Within age groups, 95% CI’s were calculated to determine if there were significant differences across years within age bands. Results are presented in a comparative format.

FindingsWe found similar patterns across provinces but significant variation in the absolute rates, with no province consistently best across all indicators. In general, outcomes were poor among adolescents and young adults compared to older groups.

ConclusionsThe results of this pilot indicate the process is feasible and meaningful. Future work could include generating comparisons on a regular basis to track system improvement; development of other measures of importance to stakeholders; and the expansion of the process to other provinces and territories. To our knowledge, this is the first report of provincial teams working collaboratively to generate comparable data on the performance of mental health services in Canada.
Using the Northern Ireland Maternity System (NIMATS) to determine the relationship of Body Mass Index (BMI) in the pregnant population with other chronic conditions and with pregnancy and birth outcomes
Authors: Gillespie Mary , Bunting Brendan , Sinclair Marlene , Condell Joan
Published: June 2018

BackgroundIncreasing numbers of women living with chronic conditions are becoming pregnant (JÃ¸lving et al., 2016). The presence of chronic conditions can contribute to adverse outcomes in pregnancy and in later life for mother and infant (Gilmore et al., 2015; Schetter and Tanner, 2012). Over recent years, the role of increasing BMI in pregnancy has gained prominence, with risk factors for maternal obesity well documented in literature.

AimTo determine the relationship between BMI and other chronic conditions (multimorbidity) and pregnancy and birth outcomes in Northern Ireland.

MethodA cross-sectional cohort study was undertaken using data from the NIMATS database (2014-2015), accessed via the Honest Broker Service, with approval by the Office for Research Ethics Committees Northern Ireland (ORECNI) and the Honest Broker Governance Board.

ResultsRegression analyses demonstrated statistically significant relationships between increasing BMI and maternal conditions such as asthma, diabetes, epilepsy, hypertension, mental health and thyroid disease as well as a number of labour and birth outcomes. Mostly, these relationships were shown to increase with increasing BMI.

DiscussionThe findings from this study have important implications for the provision of preconception care, maternity services (including health professional training), child health services and the public health agenda.
Trends in the Risk to Wellbeing of a Community Population
Authors: Hyden Deborah
Published: June 2018

BackgroundThis paper reports on the work of a project resulting from the collaboration of Queens University Belfast and the North Down Community Network (NDCN). Although North Down has an affluent reputation, local knowledge within the NDCN indicates there may be pockets of deprivation related poor wellbeing.

ObjectivesTo identify areas of unmet need in a local context.

MethodUsing data from the Northern Ireland Longitudinal Study (NILS) we adopted a multi-cohort approach to examine the links between household risk factors during childhood and physical/mental health to construct a predictive model of future health outcomes in the 46 super output areas (SOAs) of the North Down Area.

FindingsWhile preliminary results showed that the average probability for poor physical and mental health was likely to decline, two SOAs were likely to see an increase in poor physical health, one of which was also likely to witness an increase in poor mental health. Nonetheless, there were concerns regarding the magnitude of effect sizes between SOAs.

ConclusionsWhile results from this report may assist the NDCN to target areas in most need of resources to improve health and social care, lessons learned from this project are informative for future models of knowledge co-production intended to serve the public good.
Learning Disability and Northern Ireland: Achieving Proportionate Universalism through Administrative Data Research
Authors: Murphy Jamie , McBride Orla , Hanna-Trainor Lisa , Taggart Laurence , Shevlin Mark , Heslop Pauline , McConkey Roy , Glover Gyles
Published: June 2018

BackgroundThe Department of Health, Social Services & Public Safety’s policy document ‘Fit and Well – Changing Lives (2012-2022)’ indicates that people with a learning disability (LD) represent one of the most vulnerable and disadvantaged groups in Northern Ireland (NI). Individuals with a LD are more likely to experience major illnesses, to develop them earlier, and die of them sooner, than the general population. Furthermore, the LD population is less likely to get some of the evidence-based annual health checks and treatments they need, and continue to face real barriers in accessing services. At present there is no central register detailing the actual number of individuals with LD in NI.

Study aimsThe study is based on research funded by the ESRC SDAI (ES/P002293/1). It involves the analysis of Northern Ireland Mortality Study (NIMS) data to:

Establish the socio-demographic characteristics of the LD population;

Profile morbidity and comorbidity of health care problems among individuals with LD; and

Explore the causes of death among the NI LD community.

Results and ConclusionsPreliminary study findings will be available by June 2018. Findings will be of particular interest to a range of government departments, trusts and learning disability support groups.
Social-determinants of self-reported multi-morbidity among adults in Northern Ireland: a census-based administrative data study
Authors: Ferry Fiona , Rosato Michael , Leavey Gerry , Curran Emma , De Cock Paul , O'Reilly Dermot
Published: June 2018

BackgroundA combination of increased life expectancy and improvements in childhood survival rates has resulted in a persistent increase in the population at risk of chronic conditions and multimorbidity (WHO, 2016). Relatively little is known about levels of multi-morbidity, combinations of multi-morbid disorders or risk factors among the Northern Ireland (NI) population.

ObjectivesThis study aims to estimate rates of multi-morbidity among adults aged 25 and over in the NI population and examine the association of multi-morbidity and combinations of multimorbid conditions with a range of social determinants.

MethodsAnalyses are based on 1,123,604 individuals enumerated in the 2011 NI census, aged 25-64 and 65 plus. Descriptive statistics report prevalence rates and logistic regression examined the association between social determinants and multi-morbidity.

ResultsOverall, 40.08% reported at least one health condition, while 19.23% reported multi-morbidity. Results confirm a clear social gradient and association between age and multi-morbidity. Multi-morbidity was more likely among females aged 25- 64 (OR=1.09), but less likely among females aged 65 plus (OR=0.93). Marriage was protective among those aged 25- 64, while those who were never married had lower risk among those aged 65 plus (OR=0.64). Further analyses exploring social determinants of morbidity profiles present a complex array of associations. Among 25-64 year olds, while females were more likely to report single mental and less likely to report single physical problems, they were less likely to report multiple mental conditions and more likely to report combined physical/mental conditions.

ConclusionsResults suggest that multi-morbidity is common among the NI adult population and is a public health issue across the lifespan. While studies assessing the validity of self-reported health conditions within census are required, findings provide tentative evidence of the complex nature of associations between social determinants and multi-morbidity and how these vary among younger and older adults.
The Mental Health of Migrants in Northern Ireland
Authors: Patel Kishan , Kouvonen Anne , Bosqui Tania , Vannanen Ari , O'Reilly Dermot
Published: June 2018

BackgroundResearch has shown that the health of migrants can vary dramatically from the health of the settled population of their countries. Whilst migrant health has been studied in other areas of the UK, it is especially important to research the mental health of migrants in Northern Ireland specifically, due to the country’s unique mental health situation.

ObjectivesThis study aims to assess the mental health of migrants in Northern Ireland as compared to the settled majority population, both by way of reported poor mental health, and psychotropic prescription medication uptake.

MethodsThis study uses a cohort of 1,019,769 people in Northern Ireland, taken from the 2011 Census of Northern Ireland and the BSO Enhanced Prescribing Dataset (2011-2014). The migrant population of Northern Ireland is described in terms of demographic and socioeconomic factors, and logistic regression models are used to analyse the relative risks of reporting poor mental health and uptake of psychotropic medication within the migrant population as compared to the settled population.

FindingsThe results show that migrants were significantly less likely to report poor mental health than the settled population of Northern Ireland, when adjusted for demographic characteristics, socioeconomic factors, and reported poor physical health. Migrants were also significantly less likely to use any form of psychotropic prescription medication than the settled population.

ConclusionsThese findings are in concordance with most research conducted in other countries. The roles of the healthy migrant effect, the salmon bias, stigma, and lack of access to healthcare are discussed as possible reasons for the percieved migrant mental health advantage. However, such a dramatic difference between the health of migrants and the settled population of Northern Ireland may be due, in part, to certain limitations of the datasets used.
Better to stay or go? A longitudinal study of mobility over the educational life course
Authors: Sweet Amy , Harris Richard , Manley David
Published: June 2018

BackgroundThere has been substantial discussion in the literature about where you grow up and if whether or not you experience social and spatial mobility during childhood has substantial bearing upon later life achievement (Pribesh and Downey, 1999; Gasper et al, 2010; Sharkey and Elwert, 2011).

ObjectivesThis paper utilises data from the National Pupil Database (NPD) and a quantitative framework to explore the impact of residential mobility on educational outcomes. Many previous studies of neighbourhood mobility have used point in time measures when studying inequality, which means that an individual’s neighbourhood trajectory is overlooked.

Data/MethodsWe follow a single cohort of pupils’ over an eleven year time period to analyse their mobility along with their individual characteristics to provide a clear understanding of who is moving and the impact this has on them in terms of educational attainment. We also use the index of multiple deprivation as a measure of neighbourhood wealth to determine to what extent children are able to ’trade up’ in terms of neighbourhood.

FindingsOur findings show that moving home has a negative impact on educational attainment compared to those that stay in the same location throughout the educational life cycle. Those that ‘trade up’ in terms of quality of neighbourhood still do not achieve the same educational outcomes as their peers who live in a lower deprived neighbourhood throughout their schooling.

ConclusionResidential mobility between deprived areas, as shown in this paper, has more of an impact than just being ‘stuck in place’. It is not purely a case of where you live determining your outcomes, but also how often you move home in childhood and adolescence.
Evaluating the impacts on health outcomes ofWelsh Government funded schemes designed to improve the energy efficiency of the homes of low income households: A comparison of individual level and area based schemes.
Authors: Morrison-Rees Sian , Lowe Sarah
Published: June 2018

BackgroundTo reduce fuel poverty and its adverse health effects in Wales the Welsh Government developed programmes to improve the energy efficiency of homes. This includes the fuel poverty scheme: ‘Warm Homes Nest‘. The scheme was available to low income and vulnerable households in Wales from 2011 to 2015, and provided energy efficiency measures e.g. insulation and heating upgrades such as a more efficient boiler, aimed to maintain warmer homes.

ObjectivesThe overall aim was to evaluate the health impacts of Welsh Government funded schemes designed to reduce fuel poverty through the use of existing data linked to the routine health records held in the SAIL Databank at Swansea University.

MethodWe created a longitudinal dataset of individuals living in residential dwellings in receipt of home energy efficiency improvements, then linked to their health records to create a summary of their health utilization measures.

We used difference-in-difference (DID) estimations to compare any changes in recipient health before and after intervention against any concurrent change in health in those yet to receive the intervention.

FindingsWe have built upon our previous work presented at the ADRN 2017 conference where we reported a positive impact of the Nest scheme on the respiratory health of recipients. We will show a significant impact on respiratory conditions leading to a change to the eligibility criteria for the successor scheme. We will discuss our ongoing work analysing the impacts of the Nest scheme on mental health outcomes. This will include the findings from the literature search demonstrating the need for more evidence using objective outcome measures, and on selecting and utilizing validated codes developed for administrative data to investigate any changes in common mental health issues such as depression and anxiety.

ConclusionsProviding home energy efficiency interventions has the potential to benefit population health. Our findings will inform more effectively-focussed home energy efficiency schemes and potentially thus improve the health of people living in Wales.
Creation and analysis of a ‘national’ homelessness prevention programme dataset – The Supporting People Data Linkage Study
Authors: Johnson Rhodri , Lowe Sarah , Jones Ian , Morrison-Rees Sian
Published: June 2018

BackgroundWelsh Government (WG) invests over £120m annually in housing related support to help prevent and tackle homelessness under the Supporting People (SP) Programme.

A 2016 data-linkage Feasibility Study for two Local Authorities (LAs) indicated health-service utilisation reductions post-intervention, and led to a four-year ADRC-Wales project to create a national, all-Wales dataset to provide robust statistical results.

ObjectivesEstablish data sharing agreements and acquire anonymised individual level data into the SAIL (Secure Anonymised Information Linkage) databank to create a national, all-Wales, longitudinal SP dataset.

Create control groups and carry out statistical analysis to investigate how the Supporting People Programme may help service users and the effects on other public services.

Methods (including data)Intervention data for Supporting People service users was collected from individual LAs and imported into the SAIL databank using a split file process to maintain anonymity.

Anonymised service users data were linked at the individual level to demographic and health data records for in excess of 40,000 individuals, with outcome measures created based on emergency hospital admissions, accident and emergency visits and General Practice events.

Several control group creation methods were examined: 1) Internal Intervention Programme Data; 2) Matched controls using the SAIL databank; 3) Healthcare-Utilisation Patterns; 4) External Data Sources (Housing Options and Substance Misuse datasets).

FindingsData sharing agreements and data acquisition complete for nineteen of twenty-two LAs, discussions ongoing for remaining LAs.

Health data-linkage complete, other public service data acquisition ongoing.

Annual progress reports published, main statistical analysis underway and due for 2018 publication.

ConclusionsWe discuss challenges and opportunities around acquiring multi-sourced administrative data, methods of creating meaningful control groups and planned statistical analysis.
Predicting psychosis admission rates in Wales using neighbourhood deprivation
Authors: Jones Leah , Jackson Mike , Saville Christopher WN
Published: June 2018

BackgroundSocioeconomic deprivation has been identified as a risk factor for psychosis and admission rates for psychosis are higher in deprived areas than more affluent areas. However, social gradients exist in many mental health conditions and it is unclear if this relationship is particularly important for psychosis.

ObjectivesThe present study assesses whether there is a stronger relationship between the socioeconomic deprivation of an area and its rate of psychiatric admissions for psychosis than there is for other mental health diagnoses.

MethodsWe linked a large dataset of routinely recorded psychiatric admissions from the Welsh National Health Service to small area indices of socio-economic deprivation (the Welsh Index of Multiple Deprivation). Poisson generalised linear mixed effects models were applied to stratified admission count data to test whether the relationship between deprivation and admission rates was stronger for psychosis admissions than for non-psychosis admissions. Data from Betsi Cadwaladr University Health Board (19,437 patients) were used as a discovery sample and an analysis protocol was pre-registered before being applied to data from the rest of Wales (116,641 patients).

FindingsIn both samples, admission rates were higher in more deprived areas. In the discovery sample, this relationship was stronger for psychosis admissions than for other types of admission. However, in the larger replication dataset, this was not the case and the social gradient in admissions was equivalently steep for the two diagnosis categories.

ConclusionsAlthough socio-economic deprivation was a risk factor for admission with psychosis, it is not a stronger risk factor for psychosis than for other psychiatric categories. Theoretical accounts of the relationship between psychosis and poverty should focus on factors common across mental health, rather than factors specific to psychosis.
El turismo de reuniones en comunidades indígenas como estrategia de reproducción familiar en Cuetzalan, Puebla / Congress tourism in indigenous communities as a family reproduction strategia in Cuetzalan, Puebla
Authors: Ortiz-Rodríguez Ma. Teresa Tonantzin , López-Guevara Víctor Manuel , Sandoval-Quintero Mayra Antonieta
Published: June 2018

En este artículo se ofrece un debate sobre cómo el agente comunitario (individual o grupal) es protagonista del desarrollo turístico desde su lógica de reproducción familiar, establecida cultural, social e históricamente. Para ello, se ha realizado un estudio de caso, específicamente a una familia de origen indígena, cuya historia de vida los condujo a tomar la decisión de dedicarse al turismo de reuniones. El análisis de esta información se hizo mediante la propuesta del ciclo reproductivo de las unidades domésticas campesinas como estructurantes y estructuradas. En las conclusiones se ofrece una nueva propuesta para definir y clasificar el turismo de reuniones a partir de la experiencia familiar en contextos interculturales.
The length of the hydraulic jump on the basis of physical and numerical modeling
Authors: Urbański Janusz , Siwicki Piotr , Kiczko Adam , Kozioł Adam , Krukowski Marcin
Published: June 2018

The outcomes of physical and numerical modeling of the sluice gate outflow are presented. The measured velocity distributions in verticals of a physical model were compared with results of numerical modeling, obtained using ANSYS Fluent software. The research goal was verification of suitability of the computational fluid dynamic (CFD) approach in determination of the hydraulic jump length at the outflow of the flow control structure. Studies were performed for the model of the sluice gate and stilling basin with two setups of baffle blocks: in one and two rows. The jump lengths were estimated by an analysis of vertical velocity profiles at the outflow. Two rows of baffle blocks in the stilling basin allowed to reduce the length of the hydraulic jump by 5–10%, comparing to the length with the single row of blocks. The computational fluid dynamic approach underestimated the length of the hydraulic jump by 4–7%, comparing to the physical model.