Suchergebnisse

Main AimThe Digital Health Survey was the first nationally representative survey in Wales aiming to understand the extent to which people use social media, disclose personal health related information through social media sites and different user patterns across population groups.
MethodsA nationally representative household sample (n=1,252) was identified by a probabilistic sampling approach. One individual, aged 16 years and older, per household was randomly invited to complete a face-to-face questionnaire between April and June 2018. The survey collected quantitative information on use of social media platforms, perception of sharing personal health information on social media platforms, health status and socio-demographic characteristics. We tested the relationships among use, user type, demographics and health status using Chi-squared test or Fisher's exact test correspondingly. Using estimated marginal means (and 95% confidence intervals), adjusted proportions of people who reported their use on social media platforms was calculated by adjusted mean, controlling for confounders.
Results76.9% of the Welsh population engaged with social media, including 64.7% who used one or more form of social media platform on a daily basis. The most frequently used (i.e. daily) social media platform was Facebook (50.6% of the Welsh population including 23.4% used several times a day). Within the population sampled, controlling for confounders, significant higher proportion of women (91%) users were found compared to men (86%). 99.6% of 16-29 years old used social media with significant lower proportions for older age groups (i.e. 75.6% for 60-69 and 59.8% for 70+). No significant differences were found between social media engagement and deprivation quintiles. 9.6% shared personal health information on social media with friends and family, while only 2.7% shared health information with people they did not know.
ConclusionPatterns in social media use are an important consideration for health promotion. The absence of a difference by deprivation groups suggests this approach may reach population more traditional routes have not. However, continued reduction in a digital divide and development of effective solutions for health via social media remains a priority.

Background Public Health Wales developed its long-term strategy with the purpose of 'Working to Achieve a Healthier Future for Wales'. This study is motivated by one of the strategic priorities, 'Influencing the wider determinants of health' with an emphasis on homelessness prevention.
Main AimTo understand health needs of homeless health service users from routinely collected health data in Wales. To quantify the corresponding differences from general population.
MethodsScoping work has completed collaborating with academic researchers, third sectors, clinical professionals, Office for National Statistics, and housing stats of Welsh Government. To construct study cohort, we will perform linkage exercise among Annual District Death Extract, Emergency Department Data Set, Outpatient Dataset for Wales, Patient Episode Database for Wales, Substance Misuse Data Set and Welsh Longitudinal General Practice dataset (from 2007 to 2018) stored in Secure Anonymised Information Linkage (SAIL) Databank. Study cohort includes all patients with an indication (i.e. clinical codes) of homelessness in their registration information and/or health records. We propose to adapt propensity score matching to construct matched case and control groups. This method will assign each homeless individual to individual without homeless flag with same or similar propensity score. We will then proceed to test for the significance of the homelessness and each health and wellbeing indicators (i.e. physical health, mental wellbeing and substance misuse) in the presence of confounders, and estimate the effects of homelessness on these indicators.
ResultsThis study will demonstrate how linked data provide a more comprehensive review of the health needs of a vulnerable population, the homeless groups in Wales, and be able to explore changes over time.
ConclusionThe relationship between homelessness and health issues is bi-directional. Findings from this study will have implications for health, housing, social, and homelessness policy at both local and national level; as well as contributing to the ability to providing tailored health services to targeted homeless populations groups.

Abstract
Na+/K+-ATPase, which creates transmembrane electrochemical gradients by exchanging 3 Na+ for 2 K+, is central to the pathogenesis of neurological diseases such as alternating hemiplegia of childhood. Although Na+/K+-ATPase has 3 distinct ion binding sites I–III, the difficulty of distinguishing ion binding events at each site from the others hinders kinetic study of these transitions. Here, we show that binding of Na+ at each site in the human α3 Na+/K+-ATPase can be resolved using extracellular Na+-mediated transient currents. When Na+/K+-ATPase is constrained to bind and release only Na+, three kinetic components: fast, medium, and slow, can be isolated, presumably corresponding to the protein dynamics associated with the binding (or release depending on the voltage step direction) and the occlusion (or deocclusion) of each of the 3 Na+. Patient-derived mutations of residues which coordinate Na+ at site III exclusively impact the slow component, demonstrating that site III is crucial for deocclusion and release of the first Na+ into the extracellular milieu. These results advance understanding of Na+/K+-ATPase mutation pathogenesis and provide a foundation for study of individual ions' binding kinetics.

IntroductionNew non-vitamin K Target Specific Oral Anticoagulants (TSOACs) have a favourable risk-benefit profile and debatable cost effectiveness. Large numbers and data from multiple countries in a European study are required to investigate safety issue of TSOACs in subgroups, e.g. people with an intracranial haemorrhage.
Objectives and ApproachWe developed an approach to rapidly replicate data and analyses to support cross-country distributed research within the UK/EU using Electronic Health Records (EHRs). This project was conceptualised and initialled by linking relevant datasets held in multiple data warehouses, in Scotland with the Scottish National Data Safe Haven, and in Wales through the Secure Anonymised Information Linkage (SAIL) databank. Analysts in Edinburgh and Swansea had remote access to each other's datasets and worked collaboratively to harmonise variables and analysis scripts. . A common R code script has been produced to harmonise individual data as well as the outputs from the study.
ResultsThe study screened data on 8M people to develop a cohort that included pseudonymised information of 4,153 individuals in Scotland and 2,676 individuals in Wales, 6,829 individuals in total. Standardised risk analyses were completed in both settings with ongoing work in combining the analyses. In Wales, 39.5% of the patients in the cohort had been admitted to hospitals due to serious vascular events or died caused by these events, after intracranial haemorrhage. Incident rates for male and female are 0.63 and 0.7 respectively. Within the cohort, 0.5% were prescribed with TSOACs and 3% with Warfarin (included as reference). The project is also in the process of including other European jurisdictions.
Conclusion/ImplicationsThe adopted approach was the simplest, yet most efficient and cost-effective method to ensure consistency in analysis and coherence with currently available governance systems of both safe havens. It can also be considered as an initialisation of developing infrastructure to support research using EHRs across the UK and EU.

IntroductionThe Inverse Care Law (ICL) programme in Wales was piloted in Aneurin Bevan (AB) and Cwm Taf (CT) University Health Boards, chosen due to being located in areas of Wales which experience some of the most significant health inequalities and lower life expectancy and potential to effect change.
Objectives and ApproachThe programme is aiming to address inequalities in health outcomes between the most and least deprived communities in Wales and implement targeted interventions towards lifestyle risk factors, such as poor diet, physical inactivity, smoking and high alcohol intake. The project collaborated with multiple stakeholders within the Health Boards, Swansea and Cardiff University and Public Health Wales to ensure the correct outcomes were identified and measured. The Welsh Longitudinal General Practice (WLGP) data held in Secure Anonymised Information Linkage (SAIL) databank was used to extract clinically relevant information for evaluation, with the Welsh Demographic Service Dataset (WDSD) providing demographic characteristics.
ResultsBetween AB and CT University Health Boards, from February 2015 to November 2016, over 7000 people who were offered a health check completed one at a participating General Practice. 96% of these were in the three most deprived Welsh Index of Multiple Deprivation (WIMD) quintiles. 51% were referred within primary care for follow up based on their health check results, 71% were overweight/obese, and 20% were identified as current smoker of within which 28% were referred to smoking sensation services. Alchohol usage and other health issues have also been investigated. For example, 20% of those tested for blood pressure had an elevated result and 24% were subsequently prescribed anti-hypertensive medication.
Conclusion/ImplicationsResults showed risks have been identified from health checks and targeted interventions were introduced based on the results. Repeated analysis in future should be used to further evaluate the effectiveness of the interventions longitudinally. Outcomes are reported back on a scheduled basis to monitor and improve the implementation across Wales.

IntroductionThe Inverse Care Law (ICL) programme in Wales was setup to identify people in deprived communities at risk of cardiovascular disease (CVD) through a health check; offering lifestyle and medical intervention as appropriate. Evaluation of this programme to tackle health inequalities ensuring services are available is vital.
Objectives and ApproachTo evaluate the uptake and long term outcomes of the programme, using longitudinal evidence-based results, it was necessary to develop an efficient and cost effective approach with a readily available source of data. To achieve this, the Welsh Longitudinal General Practice (WLGP) data held in Secure Anonymised Information Linkage (SAIL) databank was utilised, with programme-specific code deployed within primary care at the point of the health check, which identified the intervention, potential CVD risks, referrals and any follow-up. Lifestyle risk factors could be evaluated such as poor diet, physical inactivity, smoking and high alcohol intake.
ResultsUtilising routine data sources and reproducible SQL (Standard Query Language), we evaluated the programme initialisation between February 2015 and November 2016, and found of 55 General Practices who participated, 31 of 35 in Aneurin Bevan (AB) and 17 of 20 in Cwm Taf (CT) University Health Boards, providing data which allowed identification of the health check and associated outcomes of interest in the routine data, with 3 (2 AB, 1 CT) since delivering. There are ongoing evaluations on the various risk factors longitudinally as well as the overall implementation of the programme itself, with this collaborative approach succeeding in utilising existing powerful data linkage within the SAIL databank to identify our intervention and facilitate long-term follow-up at an individual level using robust information governance mechanisms.
Conclusion/ImplicationsLessons learned and challenges encountered are being fed back as part of our evaluation, with further work assessing the long term population level outcomes and impact of the health check and services provided across these deprivation groups, informing and refining programme delivery of similar work across Wales in the future.

BackgroundThe Inverse Care Law (ICL) programme was set up in South Wales valleys and aiming to achieve a measurable closing of the gap in health outcomes between the most and least deprived areas.
ObjectivesPeople in deprived communities in Wales were invited for health checks to identify risks of cardiovascular disease followed by targeted interventions towards lifestyle risk factors, e.g. poor diet, physical inactivity, smoking and high alcohol intake, under the ICL programme piloted in Aneurin Bevan (AB) and Cwm Taf (CT) University Health Boards.
MethodsWelsh Longitudinal General Practice (WLGP) data held in Secure Anonymised Information Linkage (SAIL) databank was utilised to evaluate outcomes through project-specified clinical codes and uptake of the programme, linked with the Welsh Demographic Service Dataset (WDSD) providing demographic characteristics.
FindingsThere were 7,094 people completing health checks in AB and CT University Health Boards between February 2015 and November 2016. 96% of these were in the three most deprived Welsh Index of Multiple Deprivation (WIMD) quintiles. 51% were referred within primary care for follow-up based on their health check results, 71% were overweight/obese, and 20% were identified as current smokers of within which 28% were referred to smoking sensation services, with further analyses to follow.
ConclusionsImplementations and effectiveness of the interventions and impact of health checks will be evaluated longitudinally on a scheduled basis with repeated analyses. Challenges and results will help refining the programme to be delivered across Wales.

IntroductionDue to various regulatory barriers, it is increasingly difficult to move pseudonymised routine health data across platforms and among jurisdictions. To tackle this challenge, we summarized five approaches considered to support a scientific research project focused on the risk of the new non-vitamin K Target Specific Oral Anticoagulants (TSOACs) and collaborated between the Farr institute in Wales and Scotland.
ApproachIn Wales, routinely collected health records held in the Secure Anonymous Information Linkage (SAIL) Databank were used to identify the study cohort. In Scotland, data was extracted from national dataset resources administered by the eData Research & Innovation Service (eDRIS) and stored in the Scottish National Data Safe Haven. We adopted a federated data and multiple analysts approach, but arranged simultaneous accesses for Welsh and Scottish analysts to generate study cohorts separately by implementing the same algorithm. Our study cohort across two countries was boosted to 6,829 patients towards risk analysis. Source datasets and data types applied to generate cohorts were reviewed and compared by analysts based on both sites to ensure the consistency and harmonised output.
DiscussionThis project used a fusion of two approaches among five considered. The approach we adopted is a simple, yet efficient and cost-effective method to ensure consistency in analysis and coherence with multiple governance systems. It has limitations and potentials of extending and scaling. It can also be considered as an initialisation of a developing infrastructure to support a distributed team science approach to research using Electronic Health Records (EHRs) across the UK and more widely.
KeywordsTeam science, cross-jurisdictional data linkage, electronic health records

Background Disasters such as the COVID-19 pandemic pose an overwhelming demand on resources that cannot always be met by official organisations. Limited resources and human response to crises can lead members of local communities to turn to one another to fulfil immediate needs. This spontaneous citizen-led response can be crucial to a community's ability to cope in a crisis. It is thus essential to understand the scope of such initiatives so that support can be provided where it is most needed. Nevertheless, quickly developing situations and varying definitions can make the community response challenging to measure.
Aim To create an accessible interactive map of the citizen-led community response to need during the COVID-19 pandemic in Wales, UK that combines information gathered from multiple data providers to reflect different interpretations of need and support.
Approach We gathered data from a combination of official data providers and community-generated sources to create 14 variables representative of need and support. These variables are derived by a reproducible data pipeline that enables flexible integration of new data. The interactive tool is available online (www.covidresponsemap.wales) and can map available data at two geographic resolutions. Users choose their variables of interest, and interpretation of the map is aided by a linked bee-swarm plot.
Discussion The novel approach we developed enables people at all levels of community response to explore and analyse the distribution of need and support across Wales. While there can be limitations to the accuracy of community-generated data, we demonstrate that they can be effectively used alongside traditional data sources to maximise the understanding of community action. This adds to our overall aim to measure community response and resilience, as well as to make complex population health data accessible to a range of audiences. Future developments include the integration of other factors such as well-being.

IntroductionGreen-blue spaces (GBS), such as parks, woodlands, and beaches, may be beneficial for population mental health and wellbeing. However, there are few longitudinal studies on the association between GBS and mental health and wellbeing, and few that incorporate network analysis as opposed to simple Euclidian proximity.
Objectives and ApproachWe are examining the association between the availability of GBS with wellbeing and common mental health disorders. We will use geographic information systems (GIS) to create quarterly household level GBS availability data using digital map and satellite data (2008-2018) for over 1 million homes in Wales, United Kingdom. We will link GBS availability to individual level mental health (1.7 million people with General Practitioner (GP) data) and data from the National Survey for Wales (n = 24,000) on wellbeing (Warwick Edinburgh Mental Wellbeing Scale (WEMWBS)) using the Secure Anonymised Information Linkage (SAIL) databank.
ResultsWe created an historic dataset of GBS availability using road network and path data to create quarterly household level GBS exposures (2008-2018). We tested Residential Anonymised Linking Fields (RALFs) and accurately linked 97\% of individuals and their health data to their home and GBS exposure. The 1.65 million exposure-health data pairs, updated quarterly, will enable a longitudinal panel study to be built. Using GP recorded data on treatments, diagnoses, symptoms and prescriptions for mental health problems we identified 35,000 people had a common mental health disorder in 2016, and 24,000 people answered the National Survey for Wales questions about their wellbeing and use of GBS. We will explore how house moves, and visits to GBS change the association between GBS availability and outcomes.
Conclusion/ImplicationsThis study fills the gap in the evidence base around environmental planning policy to shape living environments to benefit health. It will inform the planning and management of GBS in urban and rural environments and contribute to international work on impacts of the built environment on mental health and wellbeing.