1792 Predictors of healthcare utilisation in children: a population segmentation approach in North West London

Objective: Nearly one-third of adults in New York City (NYC) have high blood pressure and many social, economic, and behavioral factors may influence nonadherence to antihypertensive medication. The objective of this study is to identify profiles of adults who are not taking antihypertensive medications despite being advised to do so. Methods: We used a machine learning–based population segmentation approach to identify population profiles related to nonadherence to antihypertensive medication. We used data from the 2016 NYC Community Health Survey to identify and segment adults into subgroups according to their level of nonadherence to antihypertensive medications. Results: We found that more than 10% of adults in NYC were not taking antihypertensive medications despite being advised to do so by their health care providers. We identified age, neighborhood poverty, diabetes, household income, health insurance coverage, and race/ethnicity as important characteristics that can be used to predict nonadherence behaviors as well as used to segment adults with hypertension into 10 subgroups. Conclusions: Identifying segments of adults who do not adhere to hypertensive medications has practical implications as this knowledge can be used to develop targeted interventions to address this population health management challenge and reduce health disparities.

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Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review

BMC Medical Research Methodology ◽

10.1186/s12874-021-01209-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jun Jie Benjamin Seng ◽

Amelia Yuting Monteiro ◽

Yu Heng Kwan ◽

Sueziani Binte Zainudin ◽

Chuen Seng Tan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Scoping Review ◽

Clinical Applications ◽

Data Driven ◽

Population Segmentation ◽

Wide Range ◽

Segmentation Approach

Abstract Background Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients. Methods The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed. Results Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients’ race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies. Conclusions Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients.

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Burden and impact of chronic cough in UK primary care: a dataset analysis

BMJ Open ◽

10.1136/bmjopen-2021-054832 ◽

2021 ◽

Vol 11 (12) ◽

pp. e054832

Author(s):

James H Hull ◽

Haya Langerman ◽

Zia Ul-Haq ◽

Tahereh Kamalati ◽

Amanda Lucas ◽

...

Keyword(s):

Primary Care ◽

Chronic Cough ◽

Index Date ◽

Healthcare Utilisation ◽

Chronic Obstructive ◽

Service Utilisation ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

North West ◽

Before And After

ObjectiveChronic cough (CC) is a debilitating respiratory symptom, now increasingly recognised as a discrete disease entity. This study evaluated the burden of CC in a primary care setting.DesignCross-sectional, retrospective cohort study.SettingDiscover dataset from North West London, which links coded data from primary and secondary care. The index date depicted CC persisting for ≥8 weeks and was taken as a surrogate for date of CC diagnosis.ParticipantsData were extracted for individuals aged ≥18 years with a cough persisting ≥8 weeks or cough remedy prescription, between Jan 2015 and Sep 2019.Main outcome measuresDemographic characteristics, comorbidities and service utilisation cost, including investigations performed and treatments prescribed were determined.ResultsCC was identified in 43 453 patients from a total cohort of 2 109 430 (2%). Median (IQR) age was 64 years (41–87). Among the cohort, 31% had no recorded comorbidities, 26% had been given a diagnosis of asthma, 17% chronic obstructive pulmonary disease, 12% rhinitis and 15% reflux. Prevalence of CC was greater in women (57%) and highest in the 65–74 year age range. There was an increase in the number of all investigations performed in the 12 months before and after the index date of CC diagnosis, and in particular for primary care chest X-ray and spirometry which increased from 6535 to 12 880 and from 5791 to 8720, respectively. This was accompanied by an increase in CC-associated healthcare utilisation costs.ConclusionOne-third of individuals had CC in the absence of associated comorbidities, highlighting the importance of recognising CC as a condition in its own right. Overall outpatient costs increased in the year after the CC index date for all comorbidities, but varied significantly with age. Linked primary-care datasets may enable earlier detection of individuals with CC for specialist clinic referral and targeted treatment.

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Retrospective analysis of North West London healthcare utilisation by children during the COVID-19 pandemic

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001363 ◽

2022 ◽

Vol 6 (1) ◽

pp. e001363

Author(s):

Rohan Mongru ◽

Danielle F Rose ◽

Ceire Costelloe ◽

Aubrey Cunnington ◽

Ruud G Nijman

Keyword(s):

Primary Care ◽

Retrospective Analysis ◽

Hospital Admissions ◽

Healthcare Utilisation ◽

Care Practice ◽

North West ◽

Classification Of Diseases ◽

International Statistical Classification ◽

The Impact

ObjectiveTo explore the impact of the measures taken to combat COVID-19 on the patterns of acute illness in children presenting to primary and secondary care for North West London.Design/setting/participantsRetrospective analysis of 8 309 358 primary and secondary healthcare episodes of children <16 years registered with a North West London primary care practice between 2015 and 2021.Main outcome measuresNumbers of primary care consultations, emergency department (ED) attendances and emergency admissions during the pandemic were compared with those in the preceding 5 years. Trends were examined by age and for International Statistical Classification of Diseases and Related Health Problems 10th Revision-coded diagnoses of: infectious diseases, and injuries and poisonings for admitted children.ResultsComparing 2020 to the 2015–2019 mean, primary care consultations were 22% lower, ED attendances were 38% lower and admissions 35% lower. Following the first national lockdown in April 2020, primary care consultations were 39% lower compared with the April 2015–2019 mean, ED attendances were 72% lower and unscheduled hospital admissions were 63% lower. Admissions >48 hours were on average 13% lower overall during 2020, and 36% lower during April 2020. The reduction in admissions for infections (61% lower than 2015–2019 mean) between April and August 2020 was greater than for injuries (31% lower).ConclusionThe COVID-19 pandemic was associated with an overall reduction in childhood illness presentations to health services in North West London, most prominent during periods of national lockdown, and with a greater impact on infections than injuries. These reductions demonstrate the impact on children of measures taken to combat COVID-19 across the health system.

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CORRIGENDUM to Decoding Nonadherence to Hypertensive Medication in New York City: A Population Segmentation Approach

Journal of Primary Care & Community Health ◽

10.1177/21501327211011299 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110112

Keyword(s):

New York ◽

New York City ◽

York City ◽

Population Segmentation ◽

Segmentation Approach

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Electron Microscopic Examination of a Transplantable Rat Mammary Carcinoma

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100099842 ◽

1968 ◽

Vol 26 ◽

pp. 20-21

Author(s):

S. Shirahama ◽

G. C. Engle ◽

R. M. Dutcher

Keyword(s):

Electron Microscope ◽

Osmium Tetroxide ◽

Electron Microscopic Examination ◽

Undifferentiated Carcinoma ◽

Uranyl Acetate ◽

Sprague Dawley ◽

Electron Microscopic ◽

North West ◽

X Irradiation ◽

Tissue Specimens

A transplantable carcinoma was established in North West Sprague Dawley (NWSD) rats by use of X-irradiation by Engle and Spencer. The tumor was passaged through 63 generations over a period of 32 months. The original tumor, an adenocarcinoma, changed into an undifferentiated carcinoma following the 19th transplant. The tumor grew well in NWSD rats of either sex at various ages. It was invariably fatal, causing death of the host within 15 to 35 days following transplantation.Tumor, thymus, spleen, and plasma from 7 rats receiving transplants of tumor at 3 to 9 weeks of age were examined with an electron microscope at intervals of 8, 15, 22 and 30 days after transplantation. Four normal control rats of the same age were also examined. The tissues were fixed in glutaraldehyde, postfixed in osmium tetroxide and embedded in Epon. The plasma was separated from heparanized blood and processed as previously described for the tissue specimens. Sections were stained with uranyl acetate followed by lead citrate and examined with an RCA EMU-3G electron microscope.

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SEM and TEM observations of sperm development in the testis of the freshwater fish Oreochromis mossambicus

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100157838 ◽

1990 ◽

Vol 48 (3) ◽

pp. 58-59

Author(s):

Daryl A. Cornish ◽

George L. Smit

Keyword(s):

Morphological Characteristics ◽

Oreochromis Mossambicus ◽

Breeding Cycle ◽

Limited Information ◽

North West ◽

The North ◽

Sem And Tem ◽

Sperm Development ◽

Ultrastructural Characteristics ◽

The University

Oreochromis mossambicus is currently receiving much attention as a candidater species for aquaculture programs within Southern Africa. This has stimulated interest in its breeding cycle as well as the morphological characteristics of the gonads. Limited information is available on SEM and TEM observations of the male gonads. It is known that the testis of O. mossambicus is a paired, intra-abdominal structure of the lobular type, although further details of its characteristics are not known. Current investigations have shown that spermatids reach full maturity some two months after the female becomes gravid. Throughout the year, the testes contain spermatids at various stages of development although spermiogenesis appears to be maximal during November when spawning occurs. This paper describes the morphological and ultrastructural characteristics of the testes and spermatids.Specimens of this fish were collected at Syferkuil Dam, 8 km north- west of the University of the North over a twelve month period, sacrificed and the testes excised.

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