Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD

Abstract Background: 50% of Malagasy children have moderate to severe stunting. In 2016, a new 10-year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016. Methods: The data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a population-representative cohort study begun in 2014). We interviewed women ages 15-49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were >1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level. Results: Of 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had >=4 stimulation activities in past 3 days. Greater paternal engagement (OR 1.59(1.13, 2.21)) was associated with increased delay vs. international norms. Adolescent motherhood (OR3.89 (1.32, 11.48)) decreased children’s development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR(95%CI =0.76 (0.61, 0.93) & 0.28(0.16, 0.50) respectively). Stunting was not associated with delay risk (1.33 (0.83, 2.14) or low development (0.91(0.47, 1.74)) when controlling for other factors. Conclusions: In this setting of high child malnutrition, stunting is not independently associated with developmental risk. A low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. Stimulation from non-parent adults is associated with lower odds of delay

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Factors associated with wide variation in clinical litigation rates across acute NHS trusts in England: a cross-sectional analysis

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa141 ◽

2020 ◽

Author(s):

Beverley Griggs ◽

Tristan Childs ◽

Jamie Birkinshaw ◽

Padmanabhan Badrinath

Keyword(s):

Routine Data ◽

Organizational Factors ◽

Hospital Level ◽

Cross Sectional ◽

Level Indicator ◽

Factors Associated ◽

Cross Sectional Analysis ◽

The North ◽

Bed Days ◽

Sectional Analysis

Abstract Objective Identify organizational factors associated with high clinical litigation rates among acute National Health Service (NHS) trusts in England. Design Cross-sectional analysis using routine data. Setting NHS trusts in England. Participants A total of 235 NHS trusts used the NHS Clinical Negligence Scheme in 2016–17. Ninety-seven trusts (41.3%) with no maternity services, 2 (0.9%) providing specialized services and 3 (1.2%) without clinical negligence claims were excluded. Hence, the remaining 133 trusts (56.6%) were included. Intervention(s) None. Main Outcome Measures Rate of clinical litigation by trust per 100 000 occupied bed days. Results The mean rate of clinical litigation was 25.4 per 100 000 occupied bed days. In univariable analyses, higher values of summary hospital-level mortality indictor, staff sickness, written complaints, patient safety incidents and being in the North of England led to increased clinical litigation rates. Conversely, higher patient admissions, NHS Staff Survey overall engagement score and occupied bed days led to decreased clinical litigation rates. In the multivariable model, factors associated with increased clinical litigation rates were as follows: summary mortality hospital-level indicator (SHMI) (0.9 increase in litigation rate per 0.05 increase in SHMI; P = 0.012); new written complaints (0.62 increase per 50 complaints higher; P < 0.001); located in the North of England compared to London (5.22 higher; P < 0.001). Conversely, a higher number of occupied bed days (−0.64 change per 50 000 days higher; P = 0.007) was associated with lower clinical litigation rates. Conclusions This study identified organizational factors associated with clinical litigation, which will be of interest to clinicians and the NHS. This research also highlights areas for further investigation.

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