scholarly journals Self-harm presentation across healthcare settings by sex in young people

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Amanda Marchant ◽  
Samantha Turner ◽  
Lloyd Balbuena ◽  
Evyn Peters ◽  
Dave Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Linked Data ◽  
Hospital Admissions ◽  
Population Level ◽  
Population Based ◽  
Service Planning ◽  
Individual Level ◽  
Healthcare Data ◽  
Healthcare Settings ◽  
Self Harm

BackgroundAccurate data on self-harm is crucial to suicide prevention efforts. It has been previously found that around twice as many people who self-harm seek help in primary care than in secondary care. Little is known about how contacts for self-harm differ across settings at a population level. This study utilised individual-level linked data across GP, Emergency Departments (ED), outpatients and hospital admissions examining contacts across settings and time by sex for self-harm in 10-24 year olds. MethodsA whole-population based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented. ResultsA total of 937,697 individuals aged 10-24 years contributed 5,369,794 person years of data from the 01.01.2003-30.09.2015. There were differences in self-harm contacts by demographic variables particularly with regards to sex and admissions to hospital following ED attendance. ConclusionThis is the first study to compare self-harm in people aged 10-24 years across primary care, EDs, and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention. Understanding patterns of presentation will inform service planning and configuration for follow-up care and could inform tailored support, for example for males in ED. Linked data provides important evidence to support the development of interventions across healthcare settings.

scholarly journals Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK

2019 ◽  
Vol 105 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Amanda Marchant ◽  
Samantha Turner ◽  
Lloyd Balbuena ◽  
Evyn Peters ◽  
Dave Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hospital Admissions ◽  
Population Based ◽  
Age Group ◽  
Individual Level ◽  
Healthcare Data ◽  
Self Harm ◽  
The Uk ◽  
Over Time

BackgroundThis study used individual-level linked data across general practice, emergency departments (EDs), outpatients and hospital admissions to examine contacts across settings and time by sex for self-harm in individuals aged 10–24 years old in Wales, UK.MethodsA whole population-based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented.ResultsA total of 937 697 individuals aged 10–24 years contributed 5 369 794 person years of data from 1 January 2003 to 30 September 2015. Self-harm incidence was highest in primary care but remained stable over time (incident rate ratio (IRR)=1.0; 95% CI 0.9 to 1.1). Incidence of ED attendance increased over time (IRR=1.3; 95% CI 1.2 to 1.5) as did hospital admissions (IRR=1.4; 95% CI 1.1 to 1.6). Incidence in the 15–19 years age group was the highest across all settings. The largest increases were seen in the youngest age group. There were increases in ED attendances for both sexes; however, females are more likely than males to be admitted following this. This was most evident in individuals 10–15 years old, where 76% of females were admitted compared with just 49% of males. The majority of associated outpatient appointments were under a mental health specialty.ConclusionsThis is the first study to compare self-harm in people aged 10–24 years across primary care, EDs and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention.

scholarly journals Healthcare presentations with self-harm and the association with COVID-19: an e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016 - March 2021

2021 ◽  
Author(s):  
Marcos del Pozo Banos ◽  
Sze Chim Lee ◽  
Yasmin Friedmann ◽  
Ashley Akbari ◽  
Fatemeh Tobari ◽  
...  
Keyword(s):  
Healthcare Service ◽  
Hospital Admissions ◽  
Healthcare Services ◽  
Population Based ◽  
Population Based Study ◽  
Individual Level ◽  
Healthcare Data ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
Self Harm

Background Multi-setting population-based studies on healthcare service presentations with self-harm covering the first 12 months of the COVID-19 pandemic are yet to be published. Aims Ascertain changes across settings in healthcare service presentations with self-harm during Waves 1 and 2 of the COVID-19 pandemic. Method E-cohort study using individual-level linked routine healthcare data from Wales, UK, 2016-March 2021. We measured weekly proportion of self-harm contacts and people who self-harmed in contact with general practice (GP), emergency department (ED) and hospital admissions. We modelled weekly trends using linear regression and generalised estimated equations, quantifying time differences using difference-in-difference (DiD). Results We included 3,552,210 Welsh residents aged ≥10 years. Counts of self-harm presentations across settings was at a minimum at the start of stay-at-home restrictions during both waves and recovered compared to previous years in 3-5 months. Those who self-harmed in April 2020 were more likely to be seen in GP compared to other settings and previous years - mean rate of OR=1.2, although actual numbers fell. The proportion of self-harm ED contacts admitted to hospital dropped from June 2020 (1.9 [1.5-2.3] pp/month). Self-harm and COVID-19 infection had a bidirectional effect - self-harm history had OR=1.4 [1.2-1.6] and incidence had DiD=1.1 [0.8-1.4]. Conclusions Those that self-harmed and sought help during the COVID-19 pandemic potentially encountered stringent criteria for hospitalisation, particularly in Wave 2, while in Wave 1 they preferentially presented to GP. Reductions in contacts likely resulted in unmet healthcare needs which may later emerge placing further burden on individuals and healthcare services.

scholarly journals Cohort profile: CROSS-TRACKS: a population-based open cohort across healthcare sectors in Denmark

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039996
Author(s):  
Anders Hammerich Riis ◽  
Pia Kjær Kristensen ◽  
Matilde Grøndahl Petersen ◽  
Ninna Hinchely Ebdrup ◽  
Simon Meyer Lauritsen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Hospital Admissions ◽  
Smoking Status ◽  
Population Based ◽  
Fertility Treatment ◽  
Study Patient ◽  
Transfer Payment ◽  
Sociodemographic Characteristics ◽  
Patient Pathways

PurposeThis paper describes the open cohort CROSS-TRACKS, which comprises population-based data from primary care, secondary care and national registries to study patient pathways and transitions across sectors while adjusting for sociodemographic characteristics.ParticipantsA total of 221 283 individuals resided in the four Danish municipalities that constituted the catchment area of Horsens Regional Hospital in 2012–2018. A total of 96% of the population used primary care, 35% received at least one transfer payment and 66% was in contact with a hospital at least once in the period. Additional clinical information is available for hospital contacts (eg, alcohol intake, smoking status, body mass index and blood pressure). A total of 23% (n=8191) of individuals aged ≥65 years had at least one potentially preventable hospital admission, and 73% (n=5941) of these individuals had more than one.Findings to dateThe cohort is currently used for research projects in epidemiology and artificial intelligence. These projects comprise a prediction model for potentially preventable hospital admissions, a clinical decision support system based on artificial intelligence, prevention of medication errors in the transition between sectors, health behaviour and sociodemographic characteristics of men and women prior to fertility treatment, and a recently published study applying machine learning methods for early detection of sepsis.Future plansThe CROSS-TRACKS cohort will be expanded to comprise the entire Central Denmark Region consisting of 1.3 million residents. The cohort can provide new knowledge on how to best organise interventions across healthcare sectors and prevent potentially preventable hospital admissions. Such knowledge would benefit both the individual citizen and society as a whole.

Risk factor intervention at the population level

ESC CardioMed ◽  
2018 ◽  
pp. 873-882
Author(s):  
Eva Prescott ◽  
Torben Jørgensen ◽  
Maja-Lisa Løchen ◽  
Jonathan Pearson-Stuttard ◽  
Simon Capewell
Keyword(s):  
Cardiovascular Health ◽  
Environmental Changes ◽  
Population Level ◽  
Population Based ◽  
Entire Life ◽  
Individual Level ◽  
Convenience Stores ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Unhealthy Diet

Great health benefits can be achieved if preventive efforts are focused on whole populations rather than mainly on high-risk individuals. Tobacco smoking, unhealthy diet, physical inactivity, alcohol abuse, and air pollution are responsible for a large proportion of global deaths and loss of disability-adjusted life years and there are documented effects of interventions at the population level on all of these factors. Population-based strategies include fiscal measures (i.e. taxation and subsidies), international, national, and regional policy regulations and legislation (e.g. smoke-free policies, rules for marketing, food production), and environmental changes (e.g. access to recreational areas, convenience stores), and have the advantages of addressing cardiovascular health over the entire life course, reducing health inequalities and saving costs when compared to individual-level interventions.

scholarly journals Differences in hospital admissions practices following self-harm and their influence on population-level comparisons of self-harm rates in South London: an observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032906
Author(s):  
C Polling ◽  
Ioannis Bakolis ◽  
Matthew Hotopf ◽  
Stephani L. Hatch
Keyword(s):  
Hospital Admissions ◽  
Population Level ◽  
City Centre ◽  
Spatial Patterning ◽  
Patient Demographics ◽  
Admission Data ◽  
Self Harm ◽  
Hospital Practices ◽  
The Impact ◽  
The City

ObjectivesTo compare the proportions of emergency department (ED) attendances following self-harm that result in admission between hospitals, examine whether differences are explained by severity of harm and examine the impact on spatial variation in self-harm rates of using ED attendance data versus admissions data.SettingA dataset of ED attendances and admissions with self-harm to four hospitals in South East London, 2009–2016 was created using linked electronic patient record data and administrative Hospital Episode Statistics.DesignProportions admitted following ED attendance and length of stay were compared. Variation and spatial patterning of age and sex standardised, spatially smoothed, self-harm rates by small area using attendance and admission data were compared and the association with distance travelled to hospital tested.ResultsThere were 20 750 ED attendances with self-harm, 7614 (37%) resulted in admission. Proportion admitted varied substantially between hospitals with a risk ratio of 2.45 (95% CI 2.30 to 2.61) comparing most and least likely to admit. This was not altered by adjustment for patient demographics, deprivation and type of self-harm. Hospitals which admitted more had a higher proportion of admissions lasting less than 24 hours (54% of all admissions at highest admitting hospital vs 35% at lowest). A previously demonstrated pattern of lower rates of self-harm admission closer to the city centre was reduced when ED attendance rates were used to represent self-harm. This was not altered when distance travelled to hospital was adjusted for.ConclusionsHospitals vary substantially in likelihood of admission after ED presentation with self-harm and this is likely due to the differences in hospital practices rather than in the patient population or severity of self-harm seen. Public health policy that directs resources based on self-harm admissions data could exacerbate existing health inequalities in inner-city areas where these data may underestimate rates relative to other areas.

scholarly journals Cystic fibrosis carriers are at increased risk for a wide range of cystic fibrosis-related conditions

2019 ◽  
Vol 117 (3) ◽  
pp. 1621-1627 ◽  
Author(s):  
Aaron C. Miller ◽  
Alejandro P. Comellas ◽  
Douglas B. Hornick ◽  
David A. Stoltz ◽  
Joseph E. Cavanaugh ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Failure To Thrive ◽  
Population Level ◽  
Population Based ◽  
Carrier State ◽  
Individual Level ◽  
Relative Odds ◽  
Increased Risk ◽  
Wide Range ◽  
Autosomal Recessive Diseases

Autosomal recessive diseases, such as cystic fibrosis (CF), require inheritance of 2 mutated genes. However, some studies indicate that CF carriers are at increased risk for some conditions associated with CF. These investigations focused on single conditions and included small numbers of subjects. Our goal was to determine whether CF carriers are at increased risk for a range of CF-related conditions. Using the Truven Health MarketScan Commercial Claims database (2001–2017), we performed a population-based retrospective matched-cohort study. We identified 19,802 CF carriers and matched each carrier with 5 controls. The prevalence of 59 CF-related diagnostic conditions was evaluated in each cohort. Odds ratios for each condition were computed for CF carriers relative to controls. All 59 CF-related conditions were more prevalent among carriers compared with controls, with significantly increased risk (P < 0.05) for 57 conditions. Risk was increased for some conditions previously linked to CF carriers (e.g., pancreatitis, male infertility, bronchiectasis), as well as some conditions not previously reported (e.g., diabetes, constipation, cholelithiasis, short stature, failure to thrive). We compared our results with 23,557 subjects with CF, who were also matched with controls; as the relative odds of a given condition increased among subjects with CF, so did the corresponding relative odds for carriers (P < 0.001). Although individual-level risk remained low for most conditions, because there are more than 10 million carriers in the US, population-level morbidity attributable to the CF carrier state is likely substantial. Genetic testing may inform prevention, diagnosis, and treatment for a broad range of CF carrier-related conditions.

scholarly journals Private Religious or Spiritual Activities and its Impact on Life Satisfaction: A Population-based Study

2019 ◽  
Author(s):  
Sameer Desai
Keyword(s):  
Life Satisfaction ◽  
Multinomial Logistic Regression ◽  
Population Level ◽  
Well Being ◽  
Canadian Community Health Survey ◽  
Population Based ◽  
Multinomial Logistic Regression Analysis ◽  
Individual Level ◽  
High Satisfaction ◽  
The Impact

Background: Life satisfaction is considered a valid population-based indicator of health and well-being. Recently, many advances in life satisfaction and well-being have been made by improving social and health policies. However, several countries continue to report low levels of life satisfaction, even among many modern industrialized nations. The purpose of this study was to investigate the impact of private religious or spiritual activities (PRS) as a possible modifiable, individual-level factor to increase life satisfaction, with population-level health implications.Methods: The analytic sample included 9,627 respondents to the 2011-2012 Canadian Community Health Survey. Multinomial logistic regression analysis was conducted to examine the relationship between self-reported PRS activities and life satisfaction, adjusted for confounders.Results: After adjusting for the confounders, daily PRS activities was associated with an increased odds of high satisfaction (AOR=1.22, 95% CI: 0.84, 1.78) compared to low satisfaction. Engaging in weekly PRS activities was also associated with an increased odds of high satisfaction (AOR = AOR=1.33, 95% CI: 0.87, 2.02) compared to low satisfaction. Monthly engagement in PRS activities was not associated with increases in life satisfaction. Conclusions: There is a moderate association between the odds of high satisfaction and engaging in PRS activities on a daily or weekly basis. The variability in the CIs of the AORs indicates imprecision in the data; however, the majority of the possible range of effects are beneficial. Countries and other relevant organizations should be cognizant of the possible role that religious and spiritual values may have on life satisfaction, as another factor to explore further for population-level health benefits.

Sleep and pain

2018 ◽  
Author(s):  
Nicole K. Y. Tang ◽  
Esther F. Afolalu ◽  
Fatanah Ramlee
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Population Level ◽  
Population Based ◽  
Future Research ◽  
Long Term Conditions ◽  
Treatment Development ◽  
The Individual ◽  
The Relationship

Pain and sleeplessness are two of the commonest reasons for primary care appointments. The prevalence of each problem alone is high, and to add to the complexity, pain and insomnia frequently co-occur, with pain interrupting sleep and pain being further aggravated following a poor night’s sleep. Sleep and pain management are increasingly recognized as important to public health. In particular, insomnia and chronic pain are long-term conditions that actively contribute to morbidity, disability, economic burden to society, and suffering to the individual and immediate family. This chapter examines the interrelationship between the two at the population level. Specifically, evidence from population-based studies regarding the co-occurrence and temporal link of pain and sleep is reviewed, with moderators and mediators of the relationship highlighted. Possible directions for future research and treatment development are also outlined.

scholarly journals Offering nicotine patches to all households in a community with high smoking rates: Pilot test of a population-based approach to promote tobacco cessation

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
John A Cunningham ◽  
Scott T Leatherdale ◽  
Michael Chaiton ◽  
Rachel Tyndale ◽  
Christina Schell ◽  
...  
Keyword(s):  
Tobacco Cessation ◽  
Public Health Intervention ◽  
Population Level ◽  
Population Based ◽  
Smoking Rate ◽  
Small Community ◽  
Individual Level ◽  
Nicotine Patches ◽  
High Smoking Rate ◽  
Target Community

BackgroundThe objective of this project is to determine the effectiveness of targeting a community with a high smoking rate with the distribution of free-of-charge nicotine patches in order to promote tobacco cessation. Methods/DesignOne small community with an elevated smoking rate (compared to national and provincial averages) has been identified. All households in the community will be sent a letter offering one smoker (18 years or older; 10 or more cigarettes per day) in the household a free-of-charge mailed five-week supply of nicotine patches (up to a total of 800 five-week kits will be available for distribution). Participants receiving nicotine patches will be asked to complete a six-month follow-up survey assessing tobacco cessation defined as 30-day point prevalence abstinence. In addition, attempts will be made to employ ongoing national population surveys containing cigarette smoking variables to compare changes in smoking prevalence in the target community to other communities with similar characteristics. DiscussionWe will examine whether the concentrated distribution of mailed nicotine patches will result in a measurable reduction in smoking rates in the target community. If demonstrated, this would provide support for the targeted population-level distribution of an effective individual-level public health intervention. Clinical Trials registrationNCT04534231

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