bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of an Intensive Multi-Modal Intervention for Attention-Deficit Hyperactivity Disorder (ADHD) on Equity in Children’s Health and Educational Outcomes
Authors: Smith Mark , Chateau Dan , Enns Jennifer , Randall Jason , Bolton James , Katz Laurence , Burland Elaine , Katz Alan , Brownell Marni , Raymond Collette
Published: April 2017

ABSTRACTObjectivesTo determine whether an intensive multi-modal ADHD intervention for children and teens resulted in improved long-term health and educational outcomes and in reduced inequity in these outcomes across the socioeconomic gradient.

ApproachWe used administrative data from the healthcare and education sectors in the Population Health Data Repository at the Manitoba Centre for Health Policy. We identified children and teens aged 5-17 who had 3+ visits to the ADHD intervention program between 2007 and 2012. A matched control group was constructed, and confounders were controlled using inverse probability of treatment weights. We examined rates of hospital episodes, emergency department visits, psychostimulant use and adherence, contact with child and family services, and whether the children were in the school grade appropriate to their age. We calculated concentration indices to measure changes in inequity.

ResultsThere were 485 children in the ADHD intervention group and 1,884 controls. Children who received the intervention were more likely to be prescribed medication (patients with 1+ prescription(s), rate ratio [RR] 1.21, 95% CI 1.08-1.36) and be adherent to their medication (RR 1.42, 95% CI 1.03-1.96). They were also more likely to be in their age-appropriate grade (RR 1.33, 95% CI 1.09-1.63) compared to controls. Moreover, the intervention was associated with reduced inequity in these outcomes across income deciles. No difference in the rates of hospital episodes or emergency department visits was found, nor in rates of contact with child and family services.

ConclusionsA multi-modal ADHD intervention program was associated with increased use and adherence to medication, and may boost academic achievement for vulnerable children and teens. It contributed to closing the equity gap between children from low- and high-income families. ADHD interventions that combine approaches may be more effective than medication alone.
Using administrative and claims data in the GNC-study – how to overcome legal restrictions
Authors: Powietzka Janett , Stallmann Christoph , Swart Enno
Published: April 2017

ABSTRACT

ObjectivesThe German GNC-Health Study (GNC) will have duration of at least ten years and will compile medical examinations, biomaterials and computer assisted interviews of intended 200.000 participants (funding code: 01ER1301A). For the first time, this data collection will be supplemented with a multitude of administrative and claims data such as data of statutory health insurance funds, statutory pension funds as well as the Federal Employment Agency. The GNC extends this field of research to private health insurance funds, epidemiologic and clinical cancer and mortality registers. This supplementary use of claims data is strictly regulated by legal requirements. The challenges and solutions for scientific use of such data in Germany will be described.

ApproachThe Social Security Code and data protection rules govern the scientific use of administrative data. These rules include requirements for the wording of important documents such as informed consent, release from confidentiality, participants’ information, data protection concept etc. and often an authorization process by the supervisory authority of the data owner. These complex tasks, which are time consuming costly and labour intensive, are tied into the GNC-Competence Network for secondary and registry data (CNSRD).

ResultsThe GNC-CNSRD has helped to formulate legal informed consent for each data source, which describes the use of the information provided by the participants, as well as the period and limitation of its retro- and prospective use. Furthermore, only the GNC-trust agency is allowed to save the social security number but not the local study center. The modular consent process and the IT- and data protection concept of the GNC is a prototype to enable the large scale use of administrative and claims data of future epidemiologic studies in Germany.

ConclusionUnfortunately, one of the biggest obstacles for the scientific use of administrative and claims data still remains unsolved. The application for data use at the local supervisory authority of the data owner requires the description and limitation of the research question and the period of use of this data. This is in conflict with the modern longitudinal design of GNC because it wants to establish a research structure and data base in order to answer a variety of future and unspecified research questions. Hence, current legal requirements in Germany prevent the full utilization of the potential of administrative and claims data. Therefore, the German Federal Commissioner for Data Protection and Freedom of Information recommended an amendment to the social law.
Exploring local variation in the use of out-of-home care in England using linked administrative data
Authors: Mc Grath-Lone Louise , Harron Katie , Dearden Lorraine , Nasim Bilal , Gilbert Ruth
Published: April 2017

ABSTRACT

ObjectivesIn England, approximately one in thirty children spend time in out-of-home care (OHC) by age 18.Use of OHC is known to vary across the country, which may be explained in part by ethnic group differences in the risk of being placed in OHC. This study uses linked administrative data to determine whether local variation in the cumulative proportion of children placed in OHC is explained by differences in the ethnic distribution of the local populations.

Approach Administrative social care records from January 1, 1992 to December 31, 2012 for a one-third sample of children were linked to publicly-available local authority population estimates. Two artificial birth cohorts were selected for analysis; 1992-94 and 2009-11. The cumulative proportion of children who entered OHC was calculated for each of the current 150 local authorities (the local government bodies who deliver children’s social care services). Funnel plots were used to identify local authorities with higher or lower than expected rates of entry to OHC, taking into account the size of their child population and its ethnic distribution.

ResultsOverall 3.3% of children in England born 1992-94 had entered OHC by age 18. Rates varied considerably by local authority from this national average, ranging from just 1.0% in Rutland to 6.9% in Manchester (both p<0.001). Local authority variation in rates of entry to OHC was also evident among the most recent birth cohort: while 0.8% of children born 2009-11 had entered OHC by age one, this figure varied from 0.2% in Rutland to 2.7% in Blackpool (p<0.05 and p<0.001 respectively). Indirect standardisation of rates for ethnicity did not appreciably change the cumulative percentage of children entering care in each local authority or the relative rankings of local authorities.

Conclusion There is considerable, persistent variation between local authorities in England in the rate of entry into OHC during childhood which cannot be attributed to differences in ethnic composition. Further linkage of administrative social care data to area-level data (for example, related to social care spending or indicators of social deprivation) would be useful for understanding local variation in thresholds for placing a child in OHC.
Causes of death in the decade after hospitalisation for injury during adolescence: a study using linked hospital admissions and death registrations data
Authors: Herbert Annie , Gilbert Ruth , Cottrell David J , Gonzalez-Izquierdo Arturo , Li Leah
Published: April 2017

ABSTRACT

ObjectivesTo quantify risks of cause-specific death up to ten years after discharge from an emergency admission to hospital for violent, self-inflicted, or drug/alcohol-related injury, during adolescence. To compare these risks by type of original injury, and with risks after accident-related injury.

ApproachWe used admissions data for England linked to death registrations from 1997 to 2012. We identified emergency admissions for injury in 10-19y olds and categorised type of injury as either violent, self-inflicted, drug/alcohol-related, or accident-related (no record of violent, self-inflicted, or drug/alcohol-related injury, but record of an accident), using ICD-10 codes in admission records. We categorised causes of death as homicide, suicide, drug/alcohol-related, accidental (excluding drug/alcohol-related accidents), or ‘other’ (remaining causes), using ICD-9 and ICD-10 codes from death registration records. We estimated cumulative risks of cause-specific death in the ten years after discharge, by sex and type of original injury. We used time-to-event regression models to estimate risks of cause-specific death, after violent, self-inflicted or drug/alcohol-related injury (relative to those after accident-related injury), adjusted for age-group (10-15, 16-17, 18-19y) and chronic condition status (yes/no; indicated by ICD-10 codes in past year admission records), and stratified by sex.

ResultsThere were 333,009 adolescents admitted for violent, self-inflicted, or drug/alcohol-related injury (girls 181,926, boys 181,053), and 649,818 for accident-related injury (girls 166,462, boys 483,356). There were 4,782 deaths in the ten years after discharge: 2,415 after violent, self-inflicted or drug/alcohol-related injury (girls 873, boys 1,542) and 2,367 after accident-related injury (girls 439, boys 1,928). Deaths after violent, self-inflicted or drug/alcohol-related injury injury were mostly accounted for by suicide (girls 35.8% of all deaths, boys 34.2%) or drug/alcohol-related death (girls 31.7%, boys 35.6%). Risks of suicide were similar to those for drug/alcohol-related death, regardless of the type of original injury. Adjusted risks of death were 1.4 to 6.8 times greater than after accident-related injury (by cause and sex).

ConclusionAdolescent girls and boys discharged after violent, self-inflicted, or drug/alcohol-related injury had similar risks of suicide and drug/alcohol related death, regardless of the category of the original injury. These adolescents also had increased risks of cause-specific deaths compared to those discharged after accident-related injury. Current practice to assess and reduce risks of future harm after self-inflicted injury should be extended to adolescents discharged after violent or drug/alcohol-related injury. Preventive strategies should address risks of drug/alcohol-related death as well as risks of suicide.
Investigating the incidence of youth mental health problem by merging person register and school level class room survey data
Authors: Merikukka Marko , Ristikari Tiina , Paananen Reija , Gissler Mika
Published: April 2017

ABSTRACT

ObjectivesAim of the study is to investigate the incidence of youth mental health problems by merging two different types of datasets; a person register, the 1987 Finnish Birth Cohort and school level class room survey data, Finnish School Health Promotion study.

ApproachThe 1987 Finnish Birth Cohort is a longitudinal nationwide follow-up data including a complete census of children born in a single year 1987. Children have been followed subsequently over time from the prenatal period through the year 2012, using official registers collected by Finnish authorities. Register data includes forms of documentation of children’s own and their parents’ health status and social circumstances from the perinatal period into early adulthood.

Finnish School Health Promotion study is a cross-sectional classroom survey that has been carried out in the Finnish lower secondary schools nationally every other year since 1996. Depending on the geographical location of the school, half of the age group (born in 1987) voluntarily responded to the survey on their health and lifestyle habits in 8th grade (2002) and other half in 9th grade (2003).

The 1987 Birth Cohort data includes a unique numeric code regarding the school the cohort members attended in 2003. The Finnish School Health Promotion study dataset also includes the same unique school code from the year 2003 through which it’s possible to merge datasets. The linked data can be analyzed both at school and municipality level.

ResultsThere were 59 476 children in the 1987 Finnish Birth Cohort, of whom 57 620 (96.9 %) had school code. School health survey was filled by 48 146 of the 1987 age group. There was positive correlation between self-reported help from home and F-diagnoses F40-F49 (correlation: 0.137, p-value: 0.011). Also self-reported depression score correlated with F-diagnoses F10-F19 (correlation: 0.152, p-value: 0.005) in municipality level.

ConclusionIt is possible to merge datasets from school level to an individual level register data. The merged big data offers new possibilities to study questions related to the prevalence of mental health problems. The new linked data can be further analyzed to hierarchical model.
Data linkage in social care: a pilot project
Authors: Orrell Alison , Heaven Martin , Seddon Diane , Robinson Catherine
Published: April 2017

ABSTRACT

BackgroundTo build the complete picture of service provision there is a need to broaden the linked data available to include health, social service provision by Local Authorities, and provision of support by third sector organisations. Data Linkage in Social Care is a pilot project to test the feasibility of linking datasets from a local authority, the NHS and third sector organisations. The focus of this work is individual level data from adults who are referred to social services in order to avoid admission to hospital or to facilitate their discharge from hospital. The data linkage will include data from statutory and third sector organisations and services which provide interventions and support in community settings.

ObjectivesThe main aims of this research are to:1. Test the feasibility of linking datasets from Local Authority, the NHS and third sector organisations.2. Build a more complete picture of service provision using adults who have been referred to social services in order to avoid admission to hospital or to facilitate their discharge from hospital.3. Assess the range and quality of data available in each of the relevant organisations providing services to those individuals.

The research outcome is a better understanding of the utility of data linkage across statutory and third party organisations.

ApproachA Bangor University led research team partnered with the Gwynedd Local authority to explore the Governance Issues and practicalities of providing an anonymised dataset to the SAIL databank at Swansea. Two third sector agencies were also approached. With the various required Service Level Agreements in place, data were put through the tried and trusted SAIL process for analysis.

Results Data relating to well over 20,000 referrals generated by 17,000+ social services clients in Gwynedd Local Authority from the period 2008 to 2015 were anonymised into the SAIL databank in Swansea, and linked to records from primary and secondary care. We will present results on the success of this process and on the emerging findings from the linked datasets.
Understanding NHS hospital admissions in England, Scotland and Wales: data linkage to the King’s College Military Cohort Study
Authors: Leightley Daniel , Chui Zoe , Goodwin Laura
Published: April 2017

ABSTRACT

ObjectiveSecondary health systems in the United Kingdom (UK) are unique for recording Outpatient, Inpatient and Accident & Emergency (A&E) visits in the form of electronic health (eHealth) records. Linking regional healthcare datasets is a problematic, further challenging when linking externally, such as to the King’s College Military Cohort Study (KCMCS). We introduce our methodology used for eRecord linkage.

ApproacheHealth records from England, Scotland and Wales offer a variety of parameters such as admission/discharge date, diagnosis, treatment/procedure undertaken and the cost of treatment. To acquire eHealth records, unique patient identifiers: NHS number, forename, surname, sex and date of birth extracted from KCMCS were provided to each region. The KCMCS contains self-reported questionnaire results for 9,990 serving/ex-serving military personal, 8,602 participants consented to linkage. eHealth records prepared for linkage in two stages. First, admission and discharge date were checked to ensure a valid date. Second, episodes were checked for consistency, ensuring that no records for individual participants were duplicated. Data available varied based on the region, this disparity between regions can result in data type variation. Hence, linkage was performed on mutual variables to ensure a uniform admission history. Creation of the linked dataset was as follows. First, records and episodes relating to an individual were brought together, to create a personal admission history. Secondly, personal admission history were linked to the KCMCS.

ResultsLinking to regional health datasets is not without its challenges. England, Scotland and Wales obtain, store and process eHealth records using different methodologies. A total of 6,336 (76.66%) participants were matched by regional health providers, with a total of 61,558 eHealth records. A total of 187 eHealth records were identified and discounted from linkage due to failure to meet criteria listed above. Verifying diagnoses completeness, Inpatient admissions were consistently code, with full completeness. Conversely, Outpatient admissions were poorly coded with 98% lacking any type of diagnosis. In addition, A&E records were sparsely coded; we identified four different regional and local coding systems to identify reason for admission. The eHealth records show promise for identifying health traits of the military. However, further work is required to identify synergy and overcome regional variations.

ConclusionLinkage techniques provide new opportunities for exploring the health of serving and veteran population. However, quality of identifier and linkage error are still of major concern. Further, record completeness, diagnoses accuracy and data cleaning impact the data quality.
Treating heterogeneity and uncertainty in data integration: study on Brazilian healthcare databases.
Authors: Barreto Marcos , Denaxas Spiros
Published: April 2017

ABSTRACTBackgroundData integration comprises methods and tools to aggregate data from disparate sources to various purposes. Heterogeneity and uncertainty are technical challenges in this field. The first involves different data representation or meaning, while the second refers to incomplete data or the expectancy that a data item exists in a data source. Our goal is to design and validate a data integration model and computing tools able to address both problems. Such model and tools will support the setup of a population-based cohort comprised by 100 million individuals and the generation of data marts (domain-specific data) to be used in epidemiological studies within an ongoing cooperation Brazil-UK. Such studies will assess the impact of a conditional cash transfer programme (PBF – Bolsa Família) on the occurrence, severity and mortality of several diseases and health problems (hospitalization, mortality, child health etc) over this cohort.

ApproachWe propose a three-dimensional data model to aggregate information on the cohort, exposition (payments received during the observed period) and health outcomes. We treat heterogeneity based on our existing probabilistic linkage pipeline that provides data quality assessment, data conditioning (standardization, cleansing, blocking, and anonymization), two methods for probabilistic record matching, and accuracy assessment. Through this pipeline, we are able to probabilistically link records from PBF, CadastroÚnico (CADU - socioeconomic information) and healthcare databases from the Unified Health System (SUS). Uncertainty is modeled through “possible worlds”, which represent a data instance (record) with a corresponding probability. There exist 2^records possible worlds with the probability distribution being the product of record probabilities. We map the most probable relationships between all the databases involved and create some simulation scenarios in order to validate them. We are seeking for a good balance between the set of possible worlds, not overextending the possibilities, and their proximity to a real scenario.

ResultsThe current implementation comprises the linkage of the 2011 extraction of CADU and healthcare databases to populate the proposed model. Such linkage provides timely execution (up to 9 hours depending on the databases) with high accurate data marts (over 95% of true positive matched pairs) for samples with increasing size (from 1,447,512 to 12,036,010 records).

ConclusionOur model is able to treat heterogeneity aspects present in huge databases. Our tools provide timely execution of probabilistic linkage with high accuracy. We started to model uncertainty in order to perform simulations and decide how to incorporate it in our model.
Trajectories through child protection and education: Patterns, timing and causality
Authors: Maclean Miriam , Taylor Catherine , O'Donnell Melissa
Published: April 2017

ABSTRACTObjectives1) To examine the reading trajectories of children with different levels of child protection involvement from Year 3-9 of school 2) To estimate the ‘effects’ of entering care on Year 9 reading achievement, attendance and suspensions among children with substantiated maltreatment

ApproachRecord-linkage of population data was used to investigate educational outcomes for children born in Western Australia from 1990-2010. Data from the Departments of Health, Child Protection and Family Support, Education, and Disability Services were used. Multi-level modelling was used to assess children’s reading trajectories from Year 3-9, and identify child, family, neighbourhood and child protection factors associated with reading achievement over time. Educational outcomes for maltreated children placed in out-of-home care were compared to a propensity-matched comparison group of children that remained at home using regression analyses.

ResultsChild protection involved children most often showed a stable pattern of low achievement from Year 3-9. Of those with mid-level Year 3 scores, 45%-50% showed declining achievement with scores in the lowest third of their Year 9 cohort. Particularly low achievement in Year 3 and 9 was found among children with early unsubstantiated maltreatment followed by older-aged entry to care. Propensity matched analysis showed that after controlling for maltreatment, child, family, and neighbourhood characteristics, maltreated children did not significantly differ by placement status on reading or suspensions. Absences were significantly lower among children that entered care versus those remaining at home (OR=0.36,95%CI[0.15, 0.91).

ConclusionFindings suggest that poor educational outcomes for children that have entered care are not primarily caused by out-of-home care, but reflect prior disadvantage and maltreatment. Child protection involved children are more likely to show stable low and declining patterns of achievement than other children, highlighting a need not only for early intervention, but also for interventions to address academic problems that arise later in childhood.
Integrating text analytics and statistical modelling to analyse kidney transplant immune suppression medication in registry data
Authors: Alfattni Ghada , Peek Niels , Nenadic Goran , Caskey Fergus
Published: April 2017

ABSTRACT

ObjectivesElectronic Health Records (EHRs) contain a wealth of routinely-collected data that could potentially be used to inform clinical decisions such as the choice between competing treatment regimens. Apart from structured data about diagnoses and biomarkers, these records often include unstructured data such as free-text medication prescriptions. Disjoint toolsets exist for structured and unstructured data, making it difficult to analyse datasets that comprise both structured and unstructured data. Representing free-text items in a structured and standardised format would enable their statistical analysis. The aim of this study was to develop a generic, analytical pipeline that integrates different tools for text analytics and statistical modelling, and to apply it to data from the UK Renal Registry (UKRR) to answer specific clinical and epidemiological questions on kidney transplant immune suppression.

ApproachThe UKRR database comprises data from all renal units in England, Wales and Northern Ireland and consists of both structured and semi-structured data. Our workflow starts by using rules to extract medication regimen from free-text prescriptions, which is then automatically combined with structured patient's record. The data is then analysed for patterns of transplant immune suppression prescribing by specific centres across the UK.

ResultsWe have developed an analytical pipeline for improving concordance between unstructured and structured medical records, combining new and established text analysis and subsequence analysis tools. Results of the study are underway and will be presented at the conference.

ConclusionsWe have developed new framework that integrates tools for text analytics and statistical modelling, to facilitate the analysis of mixed structured and unstructured data. Our analysis of the UKRR data will help to compare immune suppressive treatment regimens, identify best practice, and explore the associations between transplant medication and transplant outcomes.
Balancing Privacy and Utility in Secondary Data Use to Inform Policy
Authors: Cui Xinjie , Blackadar Robyn
Published: April 2017

ABSTRACT

ObjectivesUsing existing data for research can generate new knowledge and evidence for policy with relatively little cost. Privacy concerns are paramount in such secondary usage of data collected on human subjects. Information privacy protection and data security are critical considerations in reuse and repurposing of data especially linked data, longitudinal data, and large amounts of data. Data sharing and privacy protection are both in the public interest and we need to assess the risk of “doing” (sharing) as well as the risk of “not doing” (not sharing or not protecting). 

 

ApproachThe Alberta Centre for Child Family and Community Research (the Centre) establishes the Child Youth Data Lab that links and analyzes administrative data from multiple provincial ministries and the Child Data Centre of Alberta that repurposes research data and manages its access for reuse. The Centre partners with provincial Office of the Information Privacy Commissioner, Research Ethics Boards and leaders in the research communities and technology industry to design and develop measures to enable secondary use while safeguarding the data, and to explore and adopt best practices on data sharing processes, governance, and technologies.

ResultsIn principle current privacy laws and regulations provide good guidance in collection, use, and disclosure of data, however there is a lack of consistency in the interpretation of these laws at the operational level with regard to secondary data use. The experiences of establishing different data sharing models at the Centre through multiple initiatives are discussed. Cross-sectoral broad partnership brings understanding and builds trusting relationships, which are crucial to establishing data sharing processes. The recognition of the significance of secondary data use to provide direction for policy and program development at the executive level provides commitment for data sharing initiatives. Strong governance structure consists multi-level ministry and multiple stakeholder involvement ensures ongoing support and engagement. The highest data security standards and anonymous solution for data linkage enables the sharing of data with good privacy protection.

ConclusionSecondary use of data to improve system performance and contributing to scientific discovery has been broadly recognized. A balance between utility and privacy can be realized through broad partnership in building proper governance, technology, processes and policies.
Effect of short interdelivery interval between the first and second pregnancies in adolescence on low birth weight.
Authors: Vieira Claudia , Coeli Claudia , Aguiar Fernanda , Camargo Kenneth , Pinheiro Rejane , Flores Patricia
Published: April 2017

ABSTRACTObjectiveTo estimate the effect of short interdelivery interval between the first and second pregnancies in adolescence on low birth weight. ApproachA non-concurrent cohort study was carried out employing a probabilistic duplicate detection technique of the Brazilian Live Birth Information System (N=2,774,373 records). We evaluated 3,146 linked records of singleton live-born infants delivered between 1999 and 2009 in Rio de Janeiro City (Brazil), who were the second child of teenage mothers born in 1989. We estimated the association between short interdelivery interval (less than 24 months) and low birth weight (<2,500 g) using a logistic regression model, adjusting for low birth weight on the first pregnancy, adequacy of prenatal on the first pregnancy, mother's age and schooling. Covariates were assessed for inclusion using a directed acyclic graph. ResultsBy the time of the second birth, the mothers' median age was 18 years (interquartile range 17-19 years). Almost half of the second children born to these teenage mothers (N=1,481; 47.1%) were born within less than 24 months of a previous birth. The prevalence of low birth weight in this group was 9.1% (confidence interval [CI] 95% 7.6 to 10.5), whereas in the group of children born within 24 months or more of a previous birth the prevalence was 6.5% (CI 95% 5.3 to 7.7) (adjusted odds ratio=1.4; CI 95% 1.1 to 1.9). ConclusionThis study suggests that a short interdelivery interval between the first and second pregnancies in adolescence has an independent effect on low birth weight.
Phenotyping congenital anomalies in England and Scotland: a comparison of three coding clusters using retrospective hospital data
Authors: Wijlaars Linda , Zylbersztejn Ania , Verfürden Maximiliane , Gilbert Ruth , Hardelid Pia
Published: April 2017

ABSTRACT

ObjectivesWe aimed to compare prevalence rates of complex congenital anomalies (CCAs) in the first two years of life in England and Scotland using two published CCA diagnosis code lists (phenotypes) developed to identify children who require high levels of healthcare.

ApproachWe developed birth cohorts of singleton, hospital live births between 1998-2011 using birth registration, hospitalisation and mortality register datasets from England (n=8,157,213) and from Scotland (n=731,377) from. Children were followed up until 2 years of age.

We compared prevalence rates of congenital anomalies using two code lists developed to identify CCAs: a UK chronic condition code list developed by Hardelid et al. and a US medical complexity code list developed by Feudtner et al. Children were classified as having a CCA if a diagnosis code was included in any admission during follow-up as a primary or subsidiary diagnosis.

To assess the level of healthcare attention required, we compared the proportion of children who had at least one re-admission to hospital in the first two years of life.

ResultsRates of CCAs in England and Scotland were higher using the Hardelid phenotype (2.8% for both countries) than when using the Feudtner phenotype (1.8% in England and 1.5% in Scotland). Rates of CCAs increased in both England and Scotland between 1998 and 2011. The increase was more notable using the Hardelid phenotype (37.2% and 20.2%, in England and Scotland, respectively) compared to the Feudtner phenotype (35.6% and 13.0%). Prevalence rates using the Hardelid phenotype were similar to EUROCAT figures. The proportion of children with at least one re-admission to hospital was higher in the Feudtner code list (69.2% in England and 84.8% in Scotland), than for Hardelid’s code list (67.9% and 72.0% in England and Scotland, respectively). The proportions of children with any of the CCA phenotypes were higher than compared to children without CCAs (24.4% in England and 25.8% in Scotland).

ConclusionPrevalence of CCAs and associated hospital use vary depending on choice of CCA code list. Our findings suggest that Feudtner’s code list identifies children with higher level of healthcare needs. The impact of coding methods for defining CCAs in administrative hospital records should be explored and externally validated when comparing prevalence of CCAs and associated hospital use between countries.

The impact of coding method for defining CCAs in administrative hospital records should be explored and externally validated when comparing prevalence and admission rates between countries.
Improving the Accuracy of Length of stay Risk Adjustment Models using Linked Data
Authors: Sajobi Tolulope , Lu Mingshan , Jiang Jason , Quan Hude
Published: April 2017

ABSTRACT

BackgroundHospital length of stay (LOS) is a widely used measure for assessing cross-jurisdiction health system performance and informs resource allocation decisions. However, the accuracy of existing LOS risk adjustment models are limited, because they are mostly derived from administrative data, which mostly contain clinical/diagnostic information but lack detailed information on relevant demographic, socio-economic (SES), and self-reported health-related quality of life (HRQOL) risk factors, which have been shown to improve the accuracy of LOS risk adjustment models. The study investigates the relative contribution of demographic, socio-economic, and health status risk factors derived through data linkage in improving the accuracy of LOS risk adjustment models.

MethodsPopulation-based data on 8000 individuals hospitalized for coronary heart disease were obtained from Alberta Provincial Project on Outcomes Assessment in Coronary Heart Disease (APPROACH) registry and linked to Alberta Discharge Abstract Database (DAD). SES was measured using multi-domain measure of SES derived from area-level census information, while the health-related quality of life outcome was measured using the Seattle Angina Questionnaire. LOS risk adjustment model based on hierarchical logistic regression models was developed to assess relative impact of each SES measure and HRQOL measure improving the predictive accuracy of LOS adjustment models. The relative impact of each predictor was assessed by its adjusted odds ratio (OR) and improvement over the predictive accuracy of a reference model that included patients’ clinical risk factors only. 

ResultMore than 80% of the hospitalized individuals had prolonged LOS more than 10 days. The HRQOL and single-domain measures of SES had significant impact in accurately predicting LOS. But the inclusion of the multi-domain measure SES did not significantly improve the accuracy of LOS risk adjustment models

ConclusionUsing large population-based Canadian data, our study suggests that the inclusion of patients’ SES and health status information through data linkage can improve the accuracy of LOS risk adjustment models. The development of more accurate risk adjustment models can aid the identification of individuals at risk of prolonged LOS and comparison of health system performance across several cross-jurisdictions.
Measuring medication adherence: standardized definitions are needed to allow for comparisons
Authors: Tang Karen , Quan Hude , Rabi Doreen
Published: April 2017

ABSTRACTObjectivesThough pharmacy claims data are commonly used to study medication adherence, there remains no standard operational definition for adherence especially for patients on multiple medications. Even when studies use the same terminology, the actual methods of calculating adherence can differ drastically. It is unclear whether the use of different definitions results in different conclusions regarding adherence and associated outcomes. The objective of our study was to compare adherence rates and associations with mortality using different operational definitions of adherence, and using various methods of handling concurrent medication use.

ApproachWe conducted a cohort study of patients aged ≥65 years from Manitoba, Canada, with incident hypertension diagnosed in 2004 and followed to 2009. We calculated adherence rates to anti-hypertensive medications using different operational definitions of medication adherence (including interval and prescription based medication possession ratios [MPR] and proportion of days covered [PDC]). For those on concurrent medications, we calculated adherence rates using the different methods of handling concurrent medication use, for each definition. We used logistic regression to determine the association between adherence and mortality for each operational definition.

ResultsAmong 2199 patients, 24.1% to 90.5% and 71.2% to 92.7% were considered adherent when using fixed interval and prescription-based interval medication possession ratios [MPRi and MPRp] respectively, depending on how concurrent medications were handled. Adherence was inversely associated with death, with the strongest association for MPRp measures. This association was significant only when considering adherence to any hypertensive [aOR 0.70, 95% CI 0.51, 0.97], or when the mean of the class-specific MPRp’s [adjusted OR 0.71, 95% CI 0.53, 0.95] was used. No significant association existed when the highest or lowest class-specific MPRp was used as the adherence estimate.

ConclusionThe range of adherence estimates varies widely depending on the operational definition used. Given less variation in adherence rates and their stronger association against mortality, we recommend using prescription-based MPR’s to define medication adherence.
Discharge Communication and Patient Involvement are Associated with Unplanned Hospital Readmissions: Results from a Validated Hospital Experience Survey
Authors: Kemp Kyle , Santana Maria , Jolley Rachel , Southern Danielle , Quan Hude
Published: April 2017

ABSTRACTObjectivesUnplanned hospital readmissions are an indicator of quality of care, and are associated with significant costs to healthcare systems. Previous research has shown that poor communication and discharge experiences are associated with higher readmission rates. This, however, has only been examined in the short-term, and in many instances, at the hospital-level. The purpose of the study was to examine the relationship between aspects of inpatient communication and discharge instructions and unplanned readmissions at the individual-level up to one-year post-discharge.

ApproachThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) telephone survey was completed by patients within 6 weeks of hospital discharge in Alberta, Canada. Survey data were linked to corresponding inpatient records using personal health number, discharge date, and facility codes. Unplanned readmissions (yes vs. no; all causes) from 43 to 365 days post-hospital discharge comprised the outcome variable. Independent variables included selected demographic characteristics, clinical variables, and five survey questions: a) patient involvement in their care decisions, b) receiving written information at discharge, c) understanding the purpose of taking medications, d) understanding responsibility for one’s health, and e) discussing help needed when returning home. Multivariate logistic regression was used to examine each question in the presence of the other predictors. Odds ratios and 95% confidence intervals were calculated.

ResultsFrom April 2011 to March 2014, 24,868 patients completed a survey which was successfully linked to the corresponding inpatient record. The cohort had a mean age of 52.8±19.8 years of age (range=18-100), and was predominantly female (65.4%). 18.6% of patients (n=4,620) experienced an unplanned hospital readmission within 43 to 365 days post-discharge. Patients who felt that they were not involved in their care decisions were more likely to be readmitted (OR=1.79; 95%CI: 1.59-2.01), as were patients who did not receive written information at discharge (OR=1.96; 95%CI: 1.83-2.11). Odds of unplanned readmissions did not differ according to understanding of medications (OR=1.08; 95%CI: 0.90-1.30), understanding responsibility for one’s health (OR=1.02; 95%CI: 0.86-1.20), or discussion of help needed when returning home (OR=1.03; 95%CI: 0.93-1.14).

ConclusionOur results demonstrate that a lack of patient involvement in their care and not receiving written information at discharge is associated with increased unplanned readmission rate up to one-year post-discharge. This present study provides an example of how patient-reported measures may be linked to individual-level administrative data to drive healthcare improvements. Future research examining patient-reported hospital experience and other health system measures is warranted.
Using probabilistically linked data to investigate the burden of Respiratory Syncytial Virus (RSV) in children <5 years of age on secondary care in England
Authors: Reeves Rachel , Hardelid Pia , Gilbert Ruth , Panagiotopoulos Nikolaos , Minaji Mehdi , Pebody Richard
Published: April 2017

ABSTRACTObjectivesThis study aims to describe the burden of respiratory syncytial virus (RSV) in children <5 years of age on secondary care in England using linked laboratory surveillance and hospital admissions databases. We will compare our results with previous estimates of the burden of RSV in secondary care based on statistical modelling techniques.

ApproachNational laboratory surveillance data was probabilistically linked to the Hospital Episode Statistics (HES) database for children aged <5 years in England from 01/08/2010 to 31/07/2012. Linkage was based on NHS and hospital number, date of birth, sex and post code. Only records where the laboratory test was within one week of hospital admission were included. Using the linked data, we estimated the probability of a respiratory hospital admission being related to RSV based on patient characteristics, calendar week and diagnostic coding. We used these probabilities to estimate the national incidence of RSV-associated hospital admissions. Admission rates were calculated by age group (<1 year, 1-4 years) using Office for National Statistics (ONS) mid-year population estimates.

ResultsThere was an average of 11,289 RSV-positive laboratory records per year during the study period. Preliminary results indicate that 75% of RSV-positive laboratory records linked to a hospital admission. 92% of linked hospital admissions occurred between November and March each year. 76% of the linked hospital admissions were in children aged <1 year. There were significant differences in coding of RSV-associated hospital admissions by age, and over two-thirds of RSV-associated hospital admissions did not have a primary diagnosis indicating RSV as the cause of disease. We will present results on the number of linked hospital admissions, unlinked hospital admissions potentially caused by RSV and the total estimated number of RSV-associated hospital admissions, stratified by age, calendar week and primary diagnosis.

ConclusionThis study is the first to link laboratory and hospital data for RSV in England, and therefore the first to describe laboratory-confirmed RSV-associated hospital admissions on a national scale. Our approach to estimate the national incidence of admissions based on developing probability weights from a smaller, linked sample has applications not just for RSV but for other seasonal infections. In addition, with a World Health Organization (WHO) consultation last year estimating that an RSV vaccine will be available commercially within 5-10 years, the results of this study can be used in mathematical models of potential vaccine strategy, contributing to the identification of optimal target groups for a potential licensed vaccine.
Riesgo coronario en la hipertensión arterial sistólica asociada a factores de riesgo prevalentes. Hospital Nacional PNP "Luis N. Saenz"
Authors: Reyes Tamara Daniel , Geldres Echeverria Arnaldo , Rivera Vizcarra Juan
Published: April 2017

Estimar el riesgo de padecer una enfermedad coronaria es posible con el uso de herramientas como el score Framingham. La hipertensión arterial sistólica de acuerdo a los lineamientos de las Guías de Práctica Clínica vigentes constituye un punto inicial valido para la investigación de enfermedad coronaria asociada a sus factores de riesgo prevalentes como son diabetes Mellitus, dislipidemia y tabaquismo. El objetivo de esta investigación fue determinar el riesgo coronario en la población con hipertensión arterial sistólica aislada o asociada a factores de riesgo cardiovasculares prevalentes. Se recolectaron los datos pertinentes de 1469 usuarios del Departamento de Cardiología del Hospital Nacional PNP “Luis N. Sáenz” durante el año 2012-2013, estimando la probabilidad de enfermedad coronaria e identificando el perfil de riesgo intermedio alto. De 1469 usuarios, 706 (48.06%) de género masculino y 763 (51.94%) de género femenino; el 65.49% se ubica entre los 60 y 79 años. La diabetes Mellitus tipo 2 se identificó en 365 (24.85%) pacientes, obesidad en 387 (26.34%), dislipidemia en 768 (52.28%). El riesgo coronario según el score Framingham, resultó en bajo riesgo en 36.76%, moderado en 30.50% y alto y muy alto en 32.74%. El riesgo coronario alto y muy alto tiene mayor frecuencia entre los 70 y 79 años de edad. La hipertensión arterial sola o asociada con otros factores de riesgo cardiovasculares incrementa el riesgo coronario. Otros factores asociados a riesgo alto son la enfermedad renal crónica e infarto cerebral previo. El score Framingham tiene utilidad demostrada en el cálculo del riesgo coronario.Palabras clave: riesgo coronario, hipertensión arterial sistólica, score Framingham
Estilos de vida en estudiantes de una universidad pública
Authors: Olivero Pacheco Nancy , Benites Vega Juan Carlos , García Casique Alfredo , Bello Vidal Catalina
Published: April 2017

El objetivo fue describir los estilos de vida en estudiantes de una universidad pública. La muestra se constituyó con 611 estudiantes, de las carreras profesionales de Sociología, Economía, Educación, Odontología, Contabilidad y Psicología que registraron matricula regular en el año 2015; a quienes se aplicó una encuesta válida y confiable. Fueron divididos en grupos de primero – segundo año y tercero – cuarto año de estudios. Encontramos que las dimensiones de la promoción de la salud, tales como: importancia de la salud, higiene corporal y la alimentación, basada en el consumo de frutas, verduras y pescado, acompañadas de actividad física, principalmente caminar y realizar actividades grupales, como pasear e ir al cine, determinan comportamientos de bajo riesgo en la salud. La gran mayoría de estudiantes tienen una visión clara de su Proyecto de Vida (68.74%), controla sus situaciones de estrés y no tienen problemas con su sexualidad (70.54%). Sin embargo, un alto porcentaje de estudiantes manifestaron tendencia a cuadros de ansiedad, depresión, o ambos. Y 43.3% tendrían un cuadro de depresión que requeriría tratamiento.Palabras claves: estilos de vida, estrés, proyecto de vida y salud
Implementación de una metodología toxicológica para la rápida determinación del CL50 del sulfato de cobre en peces Cebra(Danio rerio) a 24, 48, 72, 96 y 120 horas de exposición
Authors: Scotto Espinoza Carlos
Published: April 2017

Los bioensayos han sido el método tradicional para documentar la presencia de diversos contaminantes en el agua. Se implementó un sistema para determinar la Concentración Letal Media (CL50) del sulfato de cobre en los peces Cebra (Danio rerio). Para ello se realizaron ensayos a diferentes tiempos de exposición (24, 48, 72, 96 y 120 horas). Se determinó que la CL50 fue de 0.1875 mg/L a las 96 horas de exposición.