scholarly journals Estimating the effect of the 2005 change in BCG policy in England: A retrospective cohort study

2019 ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Nicky Welton ◽  
Ellen Brooks-Pollock
Keyword(s):  
High Risk ◽  
Negative Binomial ◽  
Labour Force ◽  
Incidence Rates ◽  
School Age Children ◽  
List Type ◽  
School Age ◽  
Bcg Vaccination ◽  
The Uk ◽  
The Impact

ABSTRACTBackgroundIn 2005, England changed from universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children to targeted BCG vaccination of high-risk children at birth.MethodsWe combined notification data from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts of individuals in England relevant to both the universal, and targeted vaccination programmes between Jan 1, 2000 and Dec 31, 2010. For each cohort, we estimated incidence rates over a 5 year follow-up period and used Poisson and Negative Binomial regression models in order to estimate the impact of the change in policy on TB.ResultsIn the non-UK born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age IRR: 0.74 (95%CI 0.61, 0.88), neonatal IRR: 0.62 (95%CI 0.44, 0.88)). We found some evidence that the change in BCG policy was associated with a increase in incidence rates in the UK born school-age population (IRR: 1.08 (95%CI 0.97, 1.19)) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96 (95%CI 0.82, 1.14)). Overall, we found that the change in BCG policy was associated with directly preventing 385 (95% CI −105, 881) TB cases.ConclusionsWithdrawing universal vaccination at school-age and targeting BCG vaccination towards high-risk neonates was associated with reduced incidence of TB in England. This was largely driven by reductions in the non-UK born. There was a slight increase in UK born school-age cases.Key MessagesThere is little existing literature on the impact of withdrawing universal school-age BCG vaccination and introducing high-risk neonatal BCG vaccination on TB incidence rates in the populations directly affected by the vaccination programmes.There was strong evidence that the change in policy was associated with a decrease in TB incidence rates in non-UK born neonates and school-age children. In the UK born individuals, there was some evidence that the change in policy was associated with an increase in TB incidence rates in those relevant to the universal school-age scheme, with little evidence of a decrease in incidence rates in those relevant to the high-risk neonatal vaccination scheme.Overall the change in vaccination policy was associated with preventing TB cases, mainly in the non-UK born.These results provide an important evaluation of the direct effects of both withdrawing and implementing a BCG vaccination programme in a low incidence, high income, country and are relevant to several other countries that have made similar changes to their vaccination programmes.

scholarly journals Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015

2019 ◽  
Vol 24 (49) ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Nicky J. Welton ◽  
Ellen Brooks-Pollock
Keyword(s):  
High Risk ◽  
Labour Force ◽  
Demographic Data ◽  
Credible Interval ◽  
Incidence Rates ◽  
School Age Children ◽  
School Age ◽  
Bcg Vaccination ◽  
The Uk ◽  
The Impact

Background In 2005 in England, universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates. Aim Estimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England. Methods We conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB. Results In the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: −105 to 881) cases. Conclusions Withdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.

scholarly journals Reassessing the Evidence for Universal School-age Bacillus Calmette Guerin (BCG) Vaccination in England and Wales

2019 ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Ellen Brooks-Pollock
Keyword(s):  
Parameter Uncertainty ◽  
Incidence Rates ◽  
School Age Children ◽  
List Type ◽  
School Age ◽  
Bacillus Calmette Guerin ◽  
England And Wales ◽  
Bcg Vaccination ◽  
Notification Data ◽  
The Impact

AbstractBackgroundIn 2005, England and Wales switched from universal BCG vaccination against tuberculosis (TB) disease for school-age children to targeted vaccination of neonates. We assessed the quantitative evidence that informed this policy change.MethodsWe recreated a previous approach for estimating the impact of ending the BCG schools’ scheme in England and Wales, updating the model with parameter uncertainty. We investigated scenarios considered by the UK’s Joint Committee on Vaccination and Immunisation, and explored new approaches using notification data. We estimated the number of vaccines needed to prevent a single notification, and the average annual additional notifications caused by ending the BCG schools’ scheme.ResultsWe found a 1.9% annual decrease in TB incidence rates best matched notification data. We estimate that 1600 (2.5-97.5% Quantiles (Q): 1300 - 2100) vaccines would have been required to prevent a single notification in 2004. If the scheme had ended in 2001, 302 (2.5-97.5% Q: 238 - 369) additional annual notifications would have occurred compared to if the scheme had continued. If the scheme ended in 2016, 120 (2.5-97.5% Q: 88 - 155) additional annual notifications would have occurred.ConclusionsOur estimates of the impact of ending the BCG schools’ scheme were highly sensitive to the annual decrease in incidence rates. The impact of ending the BCG schools’ scheme was found to be greater than previously thought when parameter values were updated and notification data were used. Our results highlight the importance of including uncertainty when forecasting the impact of changes in vaccination policy.What is already known on this subjectTargeted Bacillus Calmette Guerin (BCG) vaccination against TB is recommended in low incidence countries over universal vaccination.The impact of replacing universal BCG vaccination in England and Wales with a targeted programme in 2005 was assessed under the assumption of static declines in TB rates.The BCG Guerin vaccine was shown to be effective in the UK born in England, regardless of the age at which it was given. School-age vaccination maybe more beneficial in this population than in other settings.What this study addsUsing notification data from England and Wales from 1973 to 2015, we estimate that the ending the BCG schools’ scheme likely resulted in more additional cases than was predicted.The inclusion of parameter uncertainty, and measurement error, allowed the uncertainty in the final estimates to be presented. Previously published estimates may have been spuriously precise.This study highlights the need for a more detailed evaluation of the 2005 change in BCG policy. In particular, the impact of including the introduction of targeted neonatal vaccination and capturing the long term, indirect, effects needs further study.

scholarly journals How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043397
Author(s):  
Austen El-Osta ◽  
Aos Alaa ◽  
Iman Webber ◽  
Eva Riboli Sasco ◽  
Emmanouil Bagkeris ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Social Isolation ◽  
Online Survey ◽  
Female Gender ◽  
School Age Children ◽  
School Age ◽  
Cross Sectional ◽  
The Uk ◽  
The Impact

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.DesignCross-sectional online survey of parents of primary and secondary school-age children.SettingCommunity setting.Participants1214 parents of school-age children in the UK.MethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.Main outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.ResultsHalf of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

scholarly journals Reassessing the evidence for universal school-age BCG vaccination in England and Wales: re-evaluating and updating a modelling study

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e031573
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Ellen Brooks-Pollock
Keyword(s):  
Policy Change ◽  
Parameter Uncertainty ◽  
Incidence Rates ◽  
Parameter Estimates ◽  
School Age ◽  
England And Wales ◽  
Bcg Vaccination ◽  
Methodological Flaw ◽  
Notification Data ◽  
The Impact

ObjectivesIn 2005, England and Wales switched from universal BCG vaccination against tuberculosis (TB) disease for school-age children to targeted vaccination of neonates. We aimed to recreate and re-evaluate a previously published model, the results of which informed this policy change.DesignWe recreated an approach for estimating the impact of ending the BCG schools scheme, correcting a methodological flaw in the model, updating the model with parameter uncertainty and improving parameter estimates where possible. We investigated scenarios for the assumed annual decrease in TB incidence rates considered by the UK’s Joint Committee on Vaccination and Immunisation and explored alternative scenarios using notification data.SettingEngland and Wales.Outcome measuresThe number of vaccines needed to prevent a single notification and the average annual additional notifications caused by ending the policy change.ResultsThe previously published model was found to contain a methodological flaw and to be spuriously precise. It greatly underestimated the impact of ending school-age vaccination compared with our updated, corrected model. The updated model produced predictions with wide CIs when parameter uncertainty was included. Model estimates based on an assumption of an annual decrease in TB incidence rates of 1.9% were closest to those estimated using notification data. Using this assumption, we estimate that 1600 (2.5; 97.5% quantiles: 1300, 2000) vaccines would have been required to prevent a single notification in 2004.ConclusionsThe impact of ending the BCG schools scheme was found to be greater than previously thought when notification data were used. Our results highlight the importance of independent evaluations of modelling evidence, including uncertainty, and evaluating multiple scenarios when forecasting the impact of changes in vaccination policy.

scholarly journals Observational study to estimate the changes in the effectiveness of bacillus Calmette–Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

2017 ◽  
Vol 21 (39) ◽  
pp. 1-54 ◽  
Author(s):  
Punam Mangtani ◽  
Patrick Nguipdop-Djomo ◽  
Ruth H Keogh ◽  
Lucy Trinder ◽  
Peter G Smith ◽  
...  
Keyword(s):  
High Risk ◽  
Research Council ◽  
Vaccination Status ◽  
School Age ◽  
Bacillus Calmette Guerin ◽  
Bcg Vaccination ◽  
Record Data ◽  
The Uk ◽  
Duration Of Protection ◽  
Minority Ethnic

Background Until recently, evidence that protection from the bacillus Calmette–Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK’s universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. Objectives To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. Methods Two case–control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0–19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10–29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case–cohort analysis based on Cox regression. Results In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [< 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5–10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10–15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10–15 years after vaccination and 57% (95% CI 33% to 72%) 15–20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. Limitations The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination > 10 years after vaccination. Conclusions Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading. Funding The National Institute for Health Research Health Technology Assessment programme. During the conduct of the study, Jonathan Sterne, Ibrahim Abubakar and Laura C Rodrigues received other funding from NIHR; Ibrahim Abubakar and Laura C Rodrigues have also received funding from the Medical Research Council. Punam Mangtani received funding from the Biotechnology and Biological Sciences Research Council.

scholarly journals CoMix: Changes in social contacts as measured by the contact survey during the 1 COVID-19 pandemic in England between March 2020 and March 2021

2021 ◽  
Author(s):  
Amy Gimma ◽  
James D Munday ◽  
Kerry LM Wong ◽  
Pietro Coletti ◽  
Kevin van Zandvoort ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Virus Transmission ◽  
School Age Children ◽  
Data Set ◽  
Social Contacts ◽  
Contact Patterns ◽  
The Mean ◽  
The Government ◽  
The Uk ◽  
The Impact

Background: During the COVID-19 pandemic, the UK government imposed public health policies in England to reduce social contacts in hopes of curbing virus transmission. We measured contact patterns weekly from March 2020 to March 2021 to estimate the impact of these policies, covering three national lockdowns interspersed by periods of lower restrictions. Methods: Data were collected using online surveys of representative samples of the UK population by age and gender. We calculated the mean daily contacts reported using a (clustered) bootstrap and fitted a censored negative binomial model to estimate age-stratified contact matrices and estimate proportional changes to the basic reproduction number under controlled conditions using the change in contacts as a scaling factor. Results: The survey recorded 101,350 observations from 19,914 participants who reported 466,710 contacts over 53 weeks. Contact patterns changed over time and by participants' age, personal risk factors, and perception of risk. The mean of reported contacts among adults have reduced compared to previous surveys with adults aged 18 to 59 reporting a mean of 2.39 (95% CI 2.20 - 2.60) contacts to 4.93 (95% CI 4.65 - 5.19) contacts, and the mean contacts for school-age children was 3.07 (95% CI 2.89 - 3.27) to 15.11 (95% CI 13.87 - 16.41). The use of face coverings outside the home has remained high since the government mandated use in some settings in July 2020. Conclusions: The CoMix survey provides a unique longitudinal data set for a full year since the first lockdown for use in statistical analyses and mathematical modelling of COVID-19 and other diseases. Recorded contacts reduced dramatically compared to pre-pandemic levels, with changes correlated to government interventions throughout the pandemic. Despite easing of restrictions in the summer of 2020, mean reported contacts only returned to about half of that observed pre-pandemic.

scholarly journals The Impact of the Covid-19 Pandemic on Uptake of Influenza Vaccine: A UK-Wide Observational Study

2020 ◽  
Author(s):  
Patrik Bachtiger ◽  
Alex Adamson ◽  
Ji-Jian Chow ◽  
Rupa Sisodia ◽  
Jennifer K Quint ◽  
...  
Keyword(s):  
Public Health ◽  
Influenza Vaccination ◽  
Vaccination Rate ◽  
School Age Children ◽  
School Age ◽  
Flu Vaccination ◽  
Flu Vaccine ◽  
The Uk ◽  
The Impact ◽  
To Receive

ABSTRACTObjectivesThe objective of this study was to measure the impact of the Covid-19 pandemic on acceptance of flu vaccination in the 2020-21 season, including for those newly eligible for the UK National Health Service (NHS) free vaccination programme, extended this year to include an estimated 32.4 million (48.8%) of the UK population. Knowing intended uptake is essential to inform supply and steer public health messaging to maximise vaccination given the combined threats of both flu and Covid-19 — the unknown impact of which on both attitudes and the need for mass uptake yet again create the threat of ill-informed planning resulting in failure to meet necessary public health demand.MethodsAn online questionnaire posing question items on influenza vaccination was administered to registrants of the Care Information Exchange (CIE), the NHS’s largest patient electronic personal health record. This was part of a longitudinal study initiated during the Covid-19 pandemic lockdown. This analysis was limited to those who, in line with established NHS criteria, were previously or newly eligible but had not routinely received seasonal influenza vaccination in the past. Groups were stratified by response (yes/no) to intending to receive flu vaccination in 2020-21: Group 1.) Previously eligible now responding ‘yes’, 2.) Previously eligible still responding ‘no’, 3.) Newly eligible responding ‘yes’, and 4.) Newly eligible responding ‘no’. Within these groups, response by health worker status and each group’s inclination to vaccinate school age children was also measured. Summary statistics were reported alongside univariate and multivariable regression. Lastly, a network analysis visualised the frequency and co-occurrence of reasons qualifying response for or against influenza vaccination in 2020/21.FindingsAmong 6,641 respondents, 4,040 (61.1%) had previously routinely received the flu vaccination. 1,624 (24.5%) had been either previously eligible but not vaccinated (945, 58.2%) or newly eligible (679, 41.8%). Among the previously eligible participants who had not routinely received influenza vaccination 536 (56.7%) responded they would in 2020-21, increasing the vaccination rate in the entire previously eligible cohort from 79.6% to 91.2%, and 466 (68.6%) in the newly eligible.Multivariable logistic regression resulted in few substantial changes to effect estimates, with the exception of age, for which all estimates showed a stronger association with intention to receive the flu vaccine. In those who became newly eligible to receive the flu vaccine, there was an association between intention to receive the flu vaccine and increased age (OR = 1.07, 95% CI 1.03 to 1.12), IMD quintile, and considering oneself at high risk from Covid-19 (OR = 1.80, 95% CI 1.22 to 2.70).Network analysis showed the most frequent themes for previously eligible unvaccinated and newly eligible participants accepting vaccination in 2020/21 were: ‘precaution for myself’ (41.2% and 46.1%) and ‘Covid-19’ (27.4% and 27.1%), where the former was qualified by the latter in 36% and 29.1% of responses. Among the previously and newly eligible not intending to receive vaccination in 2020/21, misinformed themes of ‘makes me unwell’, ‘gives me flu’ and ‘vaccine doesn’t work’ were present across 37.4% and 21.9% of responses, respectively.Among participants with school age children, of those previously eligible who now intend to be vaccinated themselves, 82.5% also intend to vaccinate their children in 2020/21 compared to 25.8% of those who would not accept the influenza vaccine for themselves. Among the newly eligible respondents this was 82.1% and 43.5%, respectively. 49.9% of the previously unvaccinated healthcare workers would continue to decline the vaccine in 2020/21.InterpretationIn this UK-wide observational study, Covid-19 has increased acceptance of flu vaccination in 2020/21 from 79.6% to 91.2% in those previously eligible, and for the 69% of those newly eligible. This high anticipated vaccination rate (to 26 million (80%) of the UK population) requires appropriate planning, but can be further increased with effective messaging campaigns to address negative misconceptions about flu vaccination, which may also help in preparation for future Covid-19 vaccination. It remains of concern that 50% of healthcare professionals who refused it previously still do not intend to have the flu vaccine.

Mother's Employment and Child Health Care

1992 ◽  
Vol 21 (3) ◽  
pp. 375-393 ◽  
Author(s):  
Therese Dowswell ◽  
Jenny Hewison
Keyword(s):  
Women Workers ◽  
Labour Force ◽  
Policy Implications ◽  
School Age Children ◽  
Child Health Care ◽  
School Age ◽  
Care Needs ◽  
Childhood Illnesses ◽  
The Uk ◽  
And Child Health

ABSTRACTA decline in the number of young people entering the UK labour force has led to growing interest in the recruitment and retention of women workers. As yet the child care needs of school age children have not been addressed. Using interview data the strategies mothers employ to meet their work commitments outside of school hours and during childhood illnesses are described. Although mothers remained the main carers of their children, they frequently depended on unpaid help from relatives. These informal arrangements were sometimes complicated and potentially vulnerable. This dependence on informal support networks has a range of policy implications.

scholarly journals Estimating the burden of hyperkalaemia in the UK in high-risk patient populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P McEwan ◽  
L Hoskin ◽  
K Badora ◽  
D Sugrue ◽  
G James ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Patient Outcomes ◽  
Real World ◽  
High Risk Patient ◽  
Incidence Rates ◽  
Funding Source ◽  
Eligible Population ◽  
Increased Risk ◽  
The Uk

Abstract Background Patients with chronic kidney disease (CKD), heart failure (HF), resistant hypertension (RHTN) and diabetes are at an increased risk of hyperkalaemia (HK) which can be potentially life-threatening, as a result of cardiac arrhythmias, cardiac arrest leading to sudden death. In these patients, renin-angiotensin-aldosterone system inhibitors (RAASi), are used to manage several cardiovascular and renal conditions, and are associated with an increased risk of HK. Assessing the burden of HK in real-world clinical practice may concentrate relevant care on those patients most in need, potentially improving patient outcomes and efficiency of the healthcare system. Purpose To assess the burden of HK in a real-world population of UK patients with at least one of: RHTN, Type I or II diabetes, CKD stage 3+, dialysis, HF, or in receipt of a prescription for RAASi. Methods Primary and secondary care data for this retrospective study were obtained from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES). Eligible patients were identified using READ codes defining the relevant diagnosis, receipt of indication-specific medication, or, in the case of CKD, an estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73m2 within the study period (01 January 2008 to 30 June 2018) or in the five-year lookback period (2003–2007). The index date was defined as 01 January 2008 or first diagnosis of an eligible condition or RAASi prescription, whichever occurred latest. HK was defined as K+ ≥5.0 mmol/L; thresholds of ≥5.5 mmol/L and ≥6.0 mmol/L were explored as sensitivity analyses. Incidence rates of HK were calculated with 95% confidence intervals (CI). Results The total eligible population across all cohorts was 931,460 patients. RHTN was the most prevalent comorbidity (n=317,135; 34.0%) and dialysis the least prevalent (n=4,415; 0.5%). The majority of the eligible population were prescribed RAASi during follow-up (n=754,523; 81.0%). At a K+ threshold of ≥5.0 mmol/L, the dialysis cohort had the highest rate of HK (501.0 events per 1,000 patient-years), followed by HF (490.9), CKD (410.9), diabetes (355.0), RHTN (261.4) and the RAASi cohort (211.2) (Figure 1). This pattern was still observed at alternative threshold definitions of HK. Conclusion This large real-world study of UK patients demonstrates the burden of hyperkalaemia in high-risk patient populations from the UK. There is a need for effective prevention and treatment of HK, particularly in patients with CKD, dialysis or HF where increased incidence rates are observed which in turn will improve patient outcomes and healthcare resource usage. Figure 1. Rates of HK by condition Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

The impact of an unconditional parental benefit on employment of mothers

2017 ◽  
Vol 37 (1/2) ◽  
pp. 33-50 ◽  
Author(s):  
Anna Kurowska
Keyword(s):  
Maternal Employment ◽  
Parental Leave ◽  
School Age Children ◽  
Employment Rate ◽  
School Age ◽  
Older Children ◽  
Cultural Economic ◽  
Similar System ◽  
Content Type ◽  
The Impact

Purpose The purpose of this paper is to solve the puzzle of the disproportionately lower employment rate of mothers of toddlers with relation to the employment rate of mothers of preschool and school-age children in Estonia. Design/methodology/approach The research is based on the Most Similar System Design and compares Estonia with Lithuania. The applied methods include inferential statistics and microsimulation techniques, employing the OECD Benefits and Wages Calculator, the OECD Family Support Calculator and EUROMOD – the European tax-benefit microsimulation model. Findings The comparison revealed that the overwhelming majority of the crucial aspects of socio-cultural, economic and institutional conditions were more favourable for maternal employment in Estonia than in Lithuania. This explains the higher maternal employment rates both for mothers of pre-schoolers and school-age children in Estonia. However, one particular element of the institutional context targeted to the mothers of toddlers – the unconditional parental benefit – had an entirely opposite character. This particular feature of the parental leave scheme was the only factor that could explain why the employment rate of mothers of toddlers is disproportionately lower than the employment rate of mothers of older children in Estonia and much lower than the employment of mothers of toddlers in Lithuania. Originality/value This study complements previous research by providing evidence on the relative importance of universal parental benefit schemes in the context of other country-specific conditions for maternal employment, including the availability of institutional childcare. Furthermore, the results presented show that childcare regime typologies, at least those that characterise Eastern European countries, should be more sensitive to children’s age.

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