Suchergebnisse

Acknowledgments: We are very grateful to David Fone for help in the concept of the study. SP received a Translational Health Research Platform Award from the National Institute for Social Care and Health Research (grant reference: TPR08- 15 006) for the development of WECC.JD was supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. SP was an applicant in the Centre for the Improvement of Population Health through E-records Research (CIPHER), one of four UK e-health Informatics Research Centres funded by a joint investment from: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council,the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (Grant reference: 7 MR/K006525/1). ; Peer reviewed

Background Heavy alcohol consumption by mothers during pregnancy is associated with developmental problems in their children. However, the impact of light to moderate consumption on the long-term health and educational attainment up to adolescence has not been established.
Main Aim To investigate the association between mother's alcohol use during pregnancy and health and educational attainment of their children up to age 14 years.
Methods Millennium Cohort Study (MCS) children in Wales (1,838), with parental consent, were record-linked to emergency hospital admission data between birth and 14 years (1,795) and National Curriculum Key Stage-Three (KS3) (1,645) records within the Secure Anonymised Information Linkage (SAIL) Databank. Mother's self-reported alcohol use during pregnancy was classified into a) abstain; b) light (1 - 2 units per week/occasion, 1 unit = 8g ethanol)); c) moderate (3 - 6 units per week/3-5 units per occasion) and d) heavy (> 6, dropped due to a paucity of data). Cox regression estimated the risk of emergency hospital admission and multivariate linear regression models estimated the difference in KS3 scores by exposure group.
Results 71% of mothers abstained, 24% were light drinkers and 5% moderate. Light drinking was associated with children's lower risk of emergency hospital admission (HR = 0.85, 95% CI 0.75 - 0.97) and better KS3 scores (β = 0.14, 95% CI 0.05 - 0.23) by age 14 years, when compared to abstaining mothers. Children of mothers who drank moderately had a comparable risk of emergency hospital admission (HR = 1.07, 95% CI 0.79 - 1.46) and a better KS3 score (β = 0.30, 95% CI 0.11 - 0.49), compared to abstaining mothers.
Conclusion Consumption during pregnancy of 1-2 units of alcohol per week/occasion was neither associated with an increased risk of emergency hospital admission nor poor academic attainment in children up to 14 years of age.

IntroductionEarly alcohol use has significant association with poor health outcomes. Individual risk factors around early alcohol use have been identified, but a holistic, data-driven investigation into health and household environmental factors on early alcohol use is yet to be undertaken.
ObjectivesThis study aims to investigate the relationship between preceding health events, household exposures and early alcohol use during adolescence using a two-stage data-driven approach.
MethodsIn stage one, a study population (N=1,072) were derived from the Millennium Cohort Study (MCS) Wales (born between 2000-2002). MCS data were first linked with electronic-health records. Factors associated with early (<= eleven years old) alcohol use were identified using feature selection and stepwise logistic regression. In stage two, analogous risk factors from MCS were recreated for whole population (N=59,231) of children (born between 1998-2002 in the Welsh Demographic Service Dataset) using routine data to predict the alcohol-related health events in hospital or GP records.
ResultsSignificant risk factors from stage two included poor maternal mental (adjusted odds ratio [aOR]=1.31) and physical health (aOR=1.25), living with someone with alcohol-related problem (aOR=2.16), single-adult household (aOR=1.45), ever in deprivation (aOR=1.66), child's high hyperactivity (aOR=3.57), and conduct disorder (aOR= 3.26). Children with health events, whose health needs are supported (e.g., are taken to the doctor), are at lower risk of early alcohol use.
ConclusionHealth events of the family members and the child can act as modifiable exposures and may therefore inform the development of prevention initiatives. Families with known alcohol problems, living in deprivation, experiencing child behavioural problems and those who are not taken to the doctor are at higher risk of early drinking behaviour and should be prioritised for early years support and interventions to target problem drinking in young people.

Acknowledgements This research has been carried out as part of the ADR Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government's national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). This work was also supported by and the National Centre for Population Health and Well-Being Research (NCPHWR). The research was supported by DECIPHer, a UKCRC Public Health Research Centre of Excellence, which receives funding from the British Heart Foundation, Cancer Research UK, Medical Research Council, the Welsh Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration. This work was supported by Health Data Research UK which receives its funding from HDR UK Ltd (NIWA1) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Welcome Trust. The authors are grateful to the Centre for Longitudinal Studies, UCL Institute of Education and the UK Data Service. The co-operation of the participating Cohort families is also gratefully acknowledged. This work uses data provided by patients and collected by the NHS as part of their care and support. This ...

Acknowledgement We thank the SAIL databank for assisting in the statistical disclosure process. Declarations and Funding Data is collected routinely and access to this was granted via the SAIL databank. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication. The data sets generated and analysed during the current study are available in the SAIL databank repository, https://saildatabank.com/. This work was supported by funds from the Economic and Social Research Council, the Medical Research Council, and Alcohol Research UK to the ELAStiC Project (ESL015471/1) and Public Health Wales. The views expressed are those of the authors and should not be assumed to be of the funding body. The research was also supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. The funders had no role in designing the study, data collection, analysis, or interpretation, or in writing the report; MAB's role in the design, analysis, and writing was independent of the funding from Public Health Wales. SP, SL and MAB had the original idea for this study. SP, AE, RA, EL and RD designed the study and developed the analysis plan. AJ provided advice on the mental health codes used in this analysis. AB extracted the data and prepared data sets for analysis. EM, AE and RA analysed the data. EM and RA wrote the first draft of the paper. All authors were involved in interpreting the findings, revising drafts and agreeing the final version. ; Peer reviewed ; Publisher PDF

BackgroundHarmonisation of different data sources from various electronic health records (EHRs) across systems enhances the potential scope and granularity of data available to health data research.
ObjectiveTo describe data harmonisation of routine electronic healthcare records in Wales and Scotland linked to a UK longitudinal birth cohort, the Millennium Cohort Study (MCS).
MethodsComparable secondary care data was linked, with parental consent, to MCS information for 1838 and 1431 children participating in MCS and residing in Wales and Scotland, by assigning, respectively, unique Anonymised Linkage Fields to personbased records in the privacy protecting Secure Anonymised Information Linkage (SAIL) databank at Swansea University, and by the National Health Service (NHS) Information Standards Division. Survey and non-response weights were created to account for the clustered sample, sample attrition and consent to linkage. Heterogeneous variables from the Patient Episode Dataset for Wales, Emergency Department Data Set for Wales, Scottish Medical Record 01 and Accident and Emergency dataset for Scotland were harmonised enabling data to be pooled and standardised for research.
FindingsOverall linkage to harmonised health care data was achieved for 98.9% (99.9% for Wales and 97.6% for Scotland) of consented MCS participants. 66% of children experienced at least one hospital admission (total 5747 hospital admissions) up totheir 14th birthday, while 60% attended A&E departments at least once (total 5221 attendances) between their 9th and 14th birthday. We managed date granularity by generating random dates of birth, standardising periods of data collection,identifying inconsistencies and then mapping and bridging differences in definitions of periods of care across countries and datasets.
ConclusionsCombining and harmonising data from multiple sources and linking them to information from a longitudinal cohort create useful resources for population health research. These methods are reproducible and can be utilised by other researchersand projects.

ObjectiveThe UK Government increasingly emphasises a comprehensive, multi-agency approach to tackling crime. This pilot study explores the feasibility of integrating police data with routine health data to develop a holistic understanding of the predictors of domestic abuse (DA).
ApproachThe study encompasses three work-packages a) coding the narrative data from Domestic Abuse, Stalking and Harassment (DASH) risk assessment report from Public Protection Notifications (PPNs), which are information-sharing documents recording safeguarding concerns and shared with partner agencies b) exploring to identify what works to harmonise different software systems within police data-sharing approach, c) constructing a case study by linking PPN DASH data with routine health and administrative records. These efforts illustrate the potential of national data-sharing initiatives.
Results
a) Text mining methods successfully identified and coded (with over 95% accuracy) 17 refereed/involved agencies from the PPN DASH data.
b) Barriers to data sharing were attributed to a lack of clarity and consensus regarding appropriate information sharing, rather than technical obstacles. This barrier can be overcome by an unambiguous framework, endorsed at an elevated level, highlighting which data should be shared.
c) The data-linkage study revealed that victims of DA had prior interactions with healthcare services before their initial PPN, and younger pregnant victims had higher risk of future healthcare emergency visits.
Conclusion and ImplicationPolice and health data integration enhances evidence-based prevention and early identification of vulnerable individuals by both law enforcement and public health services.

IntroductionHarmonization of different data sources from various electronic health records across systems enhances the potential scope and granularity of data available to health data research, providing more opportunities for research by improving the generalizability and effective sample size of a range of outcome metrics.
Objectives and ApproachThis study describes data harmonisation for a UK longitudinal birth cohort, the Millennium Cohort Study (MCS) which was linked to routine inpatient and emergency department, and, where available, general practice and child health records for 1838 Welsh and 1431 Scottish consenting MCS participants. Datasets requiring harmonisation were: from Wales, Patient Episode Dataset for Wales (PEDW) and Emergency Department Data Set (EDDS) data and from Scotland, Scottish Medical Record 01 (SMR01) and Accident and Emergency dataset (A&E2). Heterogeneous variables were created by transforming variable names, concepts, codes to improve scope for analysis.
ResultsA harmonized dataset of 2166 participants and 5747 hospital admissions were derived of cohort members who had at least 1 hospital inpatient or A&E event before their 14th birthday. Harmonisation included: dealing with date granularity by generating random dates of birth; standardising periods of data collection; identifying inconsistencies and then mapping and bridging differences in definitions of periods of care and levels of diagnostic and operational coding across countries and datasets.
Conclusion/ImplicationsHeterogeneous variables from different data sources were pooled and converted into standardised data for research, extending existing harmonisation work, including curation of a population based anonymously linkable longitudinal cohort. [AA1] These methods are reproducible and can be utilised by other researchers and projects applying to use these routine data sources.

Funding Economic and Social Research Council, Medical Research Council, Alcohol Research UK, Public Health Wales. Acknowledgments This work was supported by funds from the Economic and Social Research Council, the Medical Research Council, and Alcohol Research UK to the ELAStiC Project (ES/L015471/1) and Public Health Wales. The views expressed are entirely those of the authors and should not be assumed to be the same as those of the funding body. The research was also supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, a UK Clinical Research Collaboration Public Health Research Centre of Excellence, and The Centre for the Improvement of Population Health through E-records Research (CIPHER). CIPHER is funded by: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government), and the Wellcome Trust (Grant reference: MR/K006525/1). Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (grant RES-590-28-0005), Medical Research Council, the Welsh Government, and the Wellcome Trust (grant WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. ; Peer reviewed ; Publisher PDF

IntroductionPrimary care electronic health records (pcEHRs) are a valuable resource for life course research, however loss to follow up due to changing practices has received little attention. We investigated factors associated with changes in registration and record continuity in the Secure Anonymised Information Linkage (SAIL) databank, with ~80% practice coverage.
Objectives and ApproachWe analysed linked pcEHRs for 1834 (882 girls) Millennium Cohort Study (MCS) participants, resident in Wales and with parental consent to health record linkage at the age seven MCS interview. We studied time from first to next general practice (GP) registration in Wales by fitting Cox proportional hazards models, and estimated mutually-adjusted hazard ratios (aHRs) for the following factors: child (sex, ethnicity, mode of delivery, gestation, birthweight, neonatal illness, wheeze, longstanding illness); maternal (age, education, lone parent status); household (income, housing tenure, residential mobility, urban/rural residence); GP type (SAIL-contributing/-non-contributing). Analyses were weighted for survey design (Stata: Release 15; StataCorp LP).
ResultsThere were 3065 Welsh GP registrations for 1834 children. By age 5 years, 25% of children changed GP at least once, with 1070 (58.3%), 477 (26.0%) and 287 (15.7%) registered with 1, 2, 3+ GPs respectively up to 14 years of age. Children with older mothers (aHRs; 95% CI: 0.96; 0.95, 0.98; per year) or those residing in rural areas (0.75;0.56,0.99) were less likely, and those whose first registration was not with a SAIL contributing GP (2.16;1.60,2.93), whose mothers had no educational qualifications (1.40;1.15,1.71), or had recently changed address (1.62;1.21,2.16) more likely, to change GP. 305 (16.6%) children had never registered with a SAIL-contributing GP. Of 403 children initially registered with a SAIL contributing GP who then changed GP, 66.7% re-registered with a SAIL contributing GP.
Conclusion/ImplicationsGeographically contiguous primary care databanks, such as the SAIL databank, enable a high proportion of children to be reliably followed over time despite changing GP. Similar analyses of databases based on geographically disparate volunteer GPs are needed to quality assure their suitability for life course epidemiology research.

Background Databanks of primary care electronic health records (pcEHRs) are a valuable resource for life course research, however loss to follow up due to changing general practice has received little attention.
ObjectiveWe investigated factors associated with changing general practice (GP) in early life and continuity of participation in the Secure Anonymised Information Linkage (SAIL) databank, to which approximately 80% of Welsh practices contribute.
MethodsWe analysed linked pcEHRs for 1834 (882 girls) Millennium Cohort Study participants, resident in Wales, with consent to health record linkage. We studied time from first to next practice registration using Cox proportional hazards models, and estimated mutually-adjusted hazard ratios (aHRs) for child, household and practice factors.
FindingsThere were 3065 Welsh GP registrations for 1834 children. By age 5 years, 25% changed practice at least once, with 1070 (58.3%), 477 (26.0%), 287 (15.7%) registered with 1, 2, or 3+ GPs respectively by age 14 years. Changing practice was related to maternal age (aHRs; 95% CI: 0.96; 0.95,0.98), living in rural areas (0.75;0.56,0.99), initial registration with a non-SAIL-practice (2.16;1.60,2.93), recent address change (1.62;1.21,2.16), and no maternal educational qualifications (1.40;1.15,1.71). Overall, 305 (16.6%) children had never registered with a SAIL practice. Of 403 children initially registered with a SAIL practice who then changed practice, 66.7% re-registered with a SAIL practice.
ConclusionsIn a nationally representative sample of Welsh children, the majority remained registered with the same practice up to age 14 years, with change in practice varying by maternal and household factors. Continuity of participation in the Welsh SAIL databank over early life is high, reflecting the high proportion of practices contributing, and the high proportion of children registered with them. Geographically contiguous primary care databanks, such as SAIL, enable a high proportion of children to be followed over time despite changing general practice.

BackgroundIn longitudinal health research, combining the richness of cohort data to the extensiveness of routine data opens up new possibilities, providing information not available from one data source alone. In this study, we set out to extend information from a longitudinal birth cohort study by linking to the cohort child's routine primary and secondary health care data. The resulting linked datasets will be used to examine health outcomes and patterns of health service utilisation for a set of common childhood health problems. We describe the experiences and challenges of acquiring and linking electronic health records for participants in a national longitudinal study, the UK Millennium Cohort Study (MCS).
MethodWritten parental consent to link routine health data to survey responses of the MCS cohort member, mother and her partner was obtained for 90.7% of respondents when interviews took place at age seven years in the MCS. Probabilistic and deterministic linkage was used to link MCS cohort members to multiple routinely-collected health data sources in Wales and Scotland.
ResultsOverall linkage rates for the consented population using country-specific health service data sources were 97.6% for Scotland and 99.9% for Wales. Linkage rates between different health data sources ranged from 65.3% to 99.6%. Issues relating to acquisition and linkage of data sources are discussed.
ConclusionsLinking longitudinal cohort participants with routine data sources is becoming increasingly popular in population data research. Our results suggest that this is a valid method to enhance information held in both sources of data.

ABSTRACT
ObjectivesThe aim of this project is to address important issues relevant to children's health This will be done by enhancing information collected in the longitudinal, UK-wide Millennium Cohort Study (MCS) by linking participating children to their routine health records. These issues include: health service implications of early life onset of obesity and overweight; timeliness of immunisations; association of infections with asthma and allergic disorders in childhood; and burden of disease due to childhood injuries.
ApproachThe MCS comprises information on the social, economic and health-related circumstances of children surveyed at ages 9 months, 3, 5, 7, 11 and 14 years. At the age 7 interview, 12517 (89.1%) of the 14043 adults with parental responsibility consented for information from their child's routine heath records to be released to the MCS (a).
Routine health records have been requested for Wales, England and Scotland to be linked to MCS responses within the Secure Anonymised Information Linkage Databank at Swansea University. Data will be analysed using weights for non-response, non-consent and non-linkage and the linkage reported according to the RECORD guidelines (b).
ResultsTo date, all 1881 MCS children with valid consent who live or have lived in Wales have been linked by assigning an Anonymous Linking Field (ALF) to each individual which can be mapped across multiple datasets without risk of identification (c). Of these children, 1365 (72.3%) had experienced at least one hospital admission by the age of 14 years. Risk of admission by each of the survey ages for boys and girls separately will be calculated adjusting for non-response at different sweeps. These children have also been linked to their immunisation records (n = 1872), Emergency Department attendances (n = 1276), and available GP records (n = 1151) to enable analyses in fulfilment of the project objectives.
ConclusionsRoutine health records are a potentially valuable enhancement to longitudinal studies, allowing evaluation of questions of relevance to public health and health services, and the completeness and consistency of records from these different sources to be addressed.
Referencesa. Shepherd, P. (2013) Consent to linkage to child health data ISBN 978-1-906929-59-6b. Benchimol, E.I. et al (2015) DOI: 10.1371/journal.pmed.1001885 c. Ford, D.V. et al (2009) DOI: 10.1186/1472-6963-9-157

ABSTRACT
ObjectivesThe ELAStiC (Electronic Longitudinal Alcohol Study in Communities) project was established to determine factors that predict pathways into alcohol misuse and the life-course effects of alcohol use and misuse on health and well-being. This is achieved through accessing existing longitudinal data that are key sources of evidence for social and health policy, developing statistical methods and modelling techniques from a diverse range of disciplines, working with stakeholders in both policy, practice and the third sector to bring relevance to the work, and to bring together a diverse team of experts to collaborate and facilitate learning across diverse fields.
ApproachThe project will link data that include cohort studies such as; UK Biobank, ALSPAC (Avon Longitudinal Study of Parents and Children), Millennium Cohort Study, British Household Panel Survey, Understanding Society, E_CATALyST (Caerphilly Health and Social Needs Electronic Cohort Study) and WECC (Wales Electronic Cohort for Children). These data will be linked with routine data from primary and secondary healthcare in England, Scotland and Wales. Additional data from education and police data source will also be linked as part of the project.
The main work packages for the project are:
Methodological InnovationsMethodological developments in mechanisms for correcting bias in reporting alcohol consumption and for combining routine data with cohort data; the application of Markov models for examining the extent to which past behaviour influences future behaviour, and econometric hedonic pricing methods for providing insights into the costs of alcohol-related harm.
Pathways into HarmDo family structure, household composition, youngsters' previous ill-health and educational attainment predict their use of alcohol and what socio-economic factors and household transitions contribute to hazardous alcohol consumption in adults?
Secondary HarmsWhat is the effect on children's health and educational achievement of living in households in which one or more adults has experienced alcohol-related harm?
Mental Health & Well-BeingWhat is the relationship between alcohol consumption, hospital admission and mental health in adults and children?
ResultsThe results of the data linkage between the multiple cohorts and health, education and police data will be reported. The challenges of linking cohort and other data types from different nations will be discussed.
ConclusionsOur project will aim to provide evidence that informs the UK Government's commitment to "radically reshape the approach to alcohol and reduce the number of people drinking to excess", by working with existing longitudinal data collected in the UK to inform policy and practice.