Objectives
Traumatic brain injury (TBI) is a leading cause of death and disability among young children and adolescents and the effects can be lifelong and wide-reaching. This study aimed to compare the educational and employment outcomes of Scottish schoolchildren previously hospitalised for TBI with their peers.
Methods
A retrospective, record-linkage population cohort study was conducted using linkage of health and education administrative records. The cohort comprised all 766,244 singleton children born in Scotland and aged between 4 and 18 years who attended Scottish schools at some point between 2009 and 2013. Outcomes included special educational need (SEN), examination attainment, school absence and exclusion, and unemployment. Logistic regression models and generalised estimating equation (GEE) models were run unadjusted and then adjusted for sociodemographic and maternity confounders.
Results
Of the 766,244 children in the cohort, 4,788 (0.6%) had a history of hospitalisation for TBI. Following adjustment for potential confounders, previous TBI was associated with SEN (OR 1.28, CI 1.18 to 1.39, p < 0.001), absenteeism (IRR 1.09, CI 1.06 to 1.12, p < 0.001), exclusion (IRR 1.33, CI 1.15 to 1.55, p < 0.001), and low attainment (OR 1.30, CI 1.11 to 1.51, p < 0.001). There was no significant association with unemployment 6 months after leaving school (OR 1.03, CI 0.92 to 1.16, p = 0.61). Excluding hospitalisations coded as concussion strengthened the associations.
Conclusion
Childhood TBI, sufficiently severe to warrant hospitalisation, was associated with a range of adverse educational outcomes. These findings reinforce the importance of preventing TBI where possible. Where not possible, children with a history of TBI should be supported to minimise the adverse impacts on their education.
The conference was organized as a hybrid event by the Institute of Economic Sciences in Belgrade and the Public Policy Research Center, a Belgrade-based think tank. It was held under the auspices of COST Action CA21118 - Platform Work Inclusion Living Lab (P-WILL). The conference addressed the challenges and opportunities associated with digital platform work and explored ways to ensure fair and inclusive practices within this emerging sector.
The conference had several primary objectives. Firstly, it aimed to increase awareness regarding the rights and working conditions of individuals involved in digital platform work. Secondly, it sought to analyze the influence of digital platforms on both the labor market and the broader economy. Additionally, the conference aimed to facilitate discussions surrounding regulatory frameworks and policy choices that can ensure equitable and inclusive conditions for digital platform workers. Lastly, it aimed to promote dialogue among policymakers, researchers, industry representatives, and civil society organizations on these crucial issues.
Rosanna Hildersley, Jayati Das-Munshi, Peter Schofield
et al.
Objectives
UK cities show higher incidence of psychotic disorders, but the reasons remain unclear. This case-control study uses data from one of the first and largest person-level data linkages between mental health records and the UK census to explore associations previously only assessed using ecological or smaller studies in England.
Methods
The SocioEconomic Predictors of Mental Disorders (SEP-MD) project dataset comprises of data extracted from electronic health records (EHR) from the South London and Maudsley NHS Foundation trust (SLaM). These EHRs were linked to the 2011 UK census as a collaboration between SLaM, the ONS and King’s College London.
Cases with clinical diagnoses of non-affective (schizophrenia-spectrum) and affective psychoses (bipolar disorder, depression with psychosis) were identified. Population controls were sampled from the locality.
Logistic regression models were used to calculate weighted adjusted (age and sex) odds ratios (waOR) to assess associations. Robust standard errors were used to account for clustering.
Results
16,863 linked cases with psychosis (affective n=5,694; non-affective n=11,169) were identified alongside 596,125 population controls.
Cases with psychosis were more likely to live in areas with the highest population density (waOR 1.17 (1.05, 1.30)) when comparing the lowest quintile to the highest. Non-affective disorders showed the highest association with population density.
Being born within the UK was associated with a higher risk of psychosis, and migrants living in the country for longer were at a significantly higher risk than those living in the UK for less time. Socioeconomic predictors, including education, occupation and tenure, were all associated with higher psychosis risk. Racialised minorities were at higher risk of specifically non-affective psychoses. Indicators of isolation (marital status and living alone) were highly associated with psychosis risk.
Conclusions
Our findings regarding urbanicity, ethnicity, migration socioeconomic position and social circumstances both confirm and provide further depth to previously identified associations. Novel findings relating to migration and interactions with ethnicity will require further investigation.
These insights will provide valuable information for future public health and policy development.
This study contributes to the growing literature on the repercussions of the COVID- 19 pandemic for family functioning, with a special focus on couples’ relationship quality. We advance an analytical model that emphasizes the role of three main stressors of relationship quality during the pandemic: namely, emotional, paid work-related and organizational stressors. To outline such an approach, we analyze whether the onset of the pandemic – and the home confinement that followed – has reduced relationship quality in France, Italy and Spain using survey data collected in April 2020.We show that relationship quality decreased for a non-negligible part of the population, and that this result was driven mostly by the emotional stressor. These negative effects on relationship quality appeared to be relatively stable across genders, different levels of network support and countries; which suggests that the severity of the lockdown measures outweighed the traditional moderating factors usually accounted for in family research.
Objectives
Physical inactivity directly contributes to the global issue of obesity. Small-scale garden-based interventions have positively impacted on children’s physical activity levels. However, no studies have objectively measured household gardens and assessed associations with childhood obesity on a population scale. We linked garden measures with administrative data for a national population.
Approach
Our cross-sectional study examined the relationship between garden size and BMI in 154,444 children aged 5 years living in Wales between 2013-2019. We linked garden size at the home location with individual-level BMI measurements and socio-demographic data in the SAIL databank; a secure research environment. BMI measures were derived from the Child Measurement Programme and were standardised using the LMS method. We calculated descriptive statistics for our cohort and used Generalised Additive Models to investigate associations between garden size and BMI. Our results include adjustment for confounding variables such as deprivation. We stratified our analysis by gender and rurality.
Results
Our cohort consisted of 52% male and 49% females. 18% lived in the most affluent quintile and 28% lived in the most deprived quintile. 74% of the cohort lived in urban areas whilst 26% lived in rural areas. Average garden size was 176m2 and the mean number of individuals living in the home was 4. We found a non-linear statistically significant negative association between garden size and BMI (edf = 2.37, p < 0.01). When we stratified our analysis by gender, for males we found a linear statistically significant negative association between garden size and BMI (edf = 1, p < 0.01). For females we found a non-linear statistically significant association between garden size and BMI (edf = 2.67, p < 0.05).
Conclusion
Our study is the first to link routinely measured objective household variables with BMI data for a national cohort. Our results suggest that garden-based interventions could be focussed on to increase physical activity in children. Further research is required to investigate the pathways between garden, physical activity and reducing obesity.
Nicole L De La Mata, Grace Macleod, Patrick J Kelly
et al.
Introduction
Female life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to biological differences or healthcare inequities.
Objectives and Approach
We aimed to explore sex differences in mortality among people with end-stage kidney disease (ESKD). T he entire ESKD population in Australia, 1980-2013, and New Zealand,1988-2012, were included from the Australian and New Zealand Dialysis and Transplant Registry. Data linkage to national death registers was undertaken to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), relative survival and expected life years lost, using general population data to account for background mortality, adjusting for country, age, sex and year.
Results
Of 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Mortality sex differences within the ESKD population were minor, but once compared to the general population, female ESKD patients had more excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Females had 11.5 SMR (95%CI:11.3-11.7) and males had 6.7 SMR (95%CI:6.7-6.8), with greater disparity among younger ages and from certain causes. Relative survival was consistently lower in females, with adjusted excess mortality 9% higher (95%CI:7-12%) in ESKD females. Average life years lost was 4-5 years greater in ESKD females compared to males across all ages. Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42) and average life years lost reduced to 3-4 years for females.
Conclusion / Implications
The impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.
<b>Background</b>: Reducing domestic violence and increasing contraceptive use are two ways to improve women's health in developing countries. Social scientists debate whether women's experiences of intimate partner violence influence contraceptive use. The empirical evidence evaluating the relationship yields inconsistent results. These contradictory findings might be due to specific regional conditions that moderate the relationship. <b>Methods</b>: Using 30 panels of DHS data from 17 developing countries, this study examines the relationship between intimate partner violence and contraceptive use in a cross-national comparison and assesses whether this relationship is moderated by macro contextual factors, including the presence or absence of legal regulations against domestic violence and the national level of female empowerment. <b>Results</b>: Experience of either physical or sexual violence is associated with an increase in contraceptive use, and is statistically significant in a cross-national setting. The magnitude of the positive relationship between physical and sexual violence and contraceptive use decreases in the presence of legal regulations against domestic violence. The positive association of sexual violence with contraceptive use decreases in contexts with higher levels of women's empowerment. However, there is no change in the positive association between physical violence and contraceptive use in contexts with higher levels of women's empowerment. These results are robust to additional sensitivity tests. <b>Contribution</b>: This study demonstrates how macro contexts moderate the relationship between intimate partner violence and contraceptive use. The results inform and reconcile previous findings by demonstrating that the positive relationship between women's experience of violence by an intimate partner and contraceptive use can be attenuated when structural conditions change - namely, adoption of legal protections and improved women's empowerment.
Previous studies have documented an increasing heterogeneity in first-birth timing in countries experiencing the postponement transition. Sobotka (2004), for instance, showed a rising dispersion in age at first birth in developed countries, particularly in the United Kingdom and the United States, where the timing polarisation between more and less advantaged women is most evident. However, these studies have included few countries outside Europe and North America, and lack a thorough interpretation of the rising dispersion in first births.
Our aim is to compare the evolution of dispersion in age at first birth in countries in Europe, East Asia, North America and South America.
Using data from the Human Fertility Database and the Human Fertility Collection, we describe the evolution of the period mean age at first birth and its variance for 21 countries since 1970.
In line with previous studies, our results show a widespread pattern of increasing heterogeneity in age at first birth after the onset of the postponement transition, although with marked differences among regions and countries. The greatest heterogeneity can be found in countries where timing of family formation varies greatly among women with different socioeconomic status. Chile and Uruguay, in particular, exhibit the highest heterogeneity even though they are at the beginning of the postponement transition. There is no general explanation of why dispersion increased as the mean age at first birth rose. Further studies in this area should investigate causes and interpretations of this trend, and develop measures for studying heterogeneity in fertility timing.
Urban groups. The city. Urban sociology, City population. Including children in cities, immigration
Isabel Stockton, Annette Bergemann, Stephan Brunow
Background
Better estimates of workers' willingness to pay to reduce commutes can help evaluate transport policy as well as innovations in workplace organisation implemented by firms (such as telecommuting). These measures could facilitate the employment of workers with care responsibilities by reducing commuting cost.
Objectives
We estimate female workers' marginal willingness to pay to reduce commuting distance in Germany in a partial-equilibrium model of job search with non-wage job attributes. We consider heterogeneity by parenthood, regional structure and part-time status of workers and are moreover able to explore the role of housing cost, childcare and intra-household interactions for subsamples of the data.
Methods and Data
We use national insurance data based on a 10\% sample of the German labour force including daily information on job spells, personal and job characteristics and residential and workplace post codes between 2000 and 2013 (a customised version of the ``Integrated Employment Biographies'' provided by the Institute of Employment Research, IAB). Taking advantage of the longitudinal structure of the data, our analysis uses a stratified Cox model to take better account of unobserved individual heterogeneity than the previous literature has been able to do. We control for housing costs using additional data on rents at the county level.
Findings
We find a substantial gender gap in marginal willingness to pay for reduced commuting distance between men and women which is not explained by individual unobserved heterogeneity. When women have their first child, their willingness to pay increases further. Preliminary results suggest that heterogeneity between urban, conurbational and rural areas in Germany plays a minor role in determining women's willingness to pay.
Conclusions
Substantial gender and motherhood gaps in implicit commuting cost provide an important link between the household and labour market in understanding gender and job choice, with implications for gender-sensitive labour market policy.
Introduction
All bits of clinical information acquire meaning against a backdrop of longitudinal engagement with a potentially large constellation of services. Full cross-continuum transactional data will be refractory to analysis unless the full continuum of service locations can be rendered in a form that is transparent with regard to target populations.
Objectives and Approach
The work entailed two streams of activity: (1) building a six-dimensional framework (Clinical Context Coding Scheme - CCCS) that is layered directly onto the full array of secondary and tertiary service locations to render transparent the clinical function of the services; and (2) developing tools that work from that framework to reduce very large numbers of granular service entities down to a smaller number of clinically-functionally homogeneous entities. This solution serves both to supply the data in an analyzable form, and to address problems of small cell sizes and associated challenges around risk for re-identification of high-dimensional longitudinal data sets.
Results
The CCCS consists of an extensible array of meta-data categories (currently six) that are layered onto each of the 1700 service locations extracted from the location build in Island Health’s deployment of the Cerner EHR. This scheme was linked to the large body of longitudinal encounter data in Island Health. Service encounters, classified and aggregated using this CCCS scheme, were used to perform the following functions: (a) supply a base longitudinal encounter layer onto which other data sets could be superimposed (linked); (b) generate within-person-over-time visualizations of individual patients that reflects full secondary and tertiary cross-continuum service utilization; (c) generate cohort definitions reflecting patterns of service utilization, and (d) generate aggregate level reports that summarize full cross-continuum service utilization for cohorts.
Conclusion/Implications
The CCCS produces views of patients that are more complete and/or quite different from those created with the “usual datasets” (e.g., Acute Care + ER). Applying the scheme to diverse populations (e.g. addictions; stroke patients) illustrates the scheme’s viability – and the consequences/costs of NOT bring the full continuum into focus.
Alysha Crocker, Susan Anderes, Linda Verbeek
et al.
Introduction
Each year in Alberta, over 2,300 women are affected by breast cancer. In Alberta, a multi-year Breast Health Initiative is underway to improve breast cancer care; reduce wait times, coordinate care, and enhance patient experience. Patient reported experience measurements are important to inform and advance patient and family-centred care.
Objectives and Approach
The aim is to assess breast cancer patients’ experiences at two survey points; after surgeon consult and after breast surgery. Patients meeting inclusion criteria; highly suspicious of cancer on imaging result (i.e. BI-RADS 5), referral to Calgary or Edmonton breast program, English speaking, and having an email address are recruited by RN coordinators or nurse navigators. Automated survey invitations from REDCap are used. Seven days after the surgeon consult the first survey is sent and seven days after breast surgery the second survey is sent.
Results
Patient recruitment began November 27, 2017 and January 2, 2018 for Edmonton and Calgary, respectively. As of February, 2018, 45 patients had been recruited. Of these, the first survey was sent to 34 (i.e. seven days post surgeon consult) and 19 (56%) had completed the survey. All those eligible (18) agreed to participate in the upcoming second survey. Of those, six had provided their surgery date and the second survey which both were completed. Recruitment is ongoing until the conference, at that time there will be sufficient numbers to report findings.
Conclusion/Implications
Patient and family-centred care is an element of high-quality healthcare which AHS has identified as a priority. These results will report on the breast cancer patients’ perspectives and generate important information for clinicians and administrators to use for decision making and quality improvement of health services.
ABSTRACT
Background
Research into General Practitioner (GP) records is relatively straightforward when it comes to establishing the prescribing of a particular drug or a specific disease group, but what if you want to use it to make more general inferences about health service utilisation?
Supporting People is a project that is examining GP recorded activity for a cohort of people around a known crisis point in their lives – a time when they were at risk of becoming homeless. Examining GP recorded data prior to and post this crisis point revealed a definite pattern in the volume of recording activity by the GPs. Records increased over the year leading up to the crisis date and then reduced in the year following the crisis date.
Objectives
To understand what we were observing in this group of patients required a much deeper understanding of the GP event database available in the SAIL Databank at Swansea University. What is included and what do the associated dates relate to? Were some categories of GP recording, such as prescribing, tests, diagnostics, or signs and symptom recordings, more stable than others in establishing the time trend, and could we identify and eliminate noise? Can a suitable control population be constructed from the data, and if so, how?
Approach
To establish this we explored just over 1 billion unique Read coded records generated in the time period 1999 to 2015 by GP practices participating in the provision of anonymised records to SAIL, aligning, filtering and summarising the data in a series of observational exercises to generate hypotheses related to the capture and recording of the data.
Results
A fascinating journey through 1 billion GP practice generated pieces of information, embarked upon to aid interpretation of our Supporting People results, and providing insights into the patterns of recording within GP data.
This article aims to critically assess the economic growth paradigm, which typically underlies most approaches to regional policymaking for demographic change. While population losses, ageing and outmigration – i.e. phenomena that are addressed as demographic change – have become a matter of urgency for many European regions, most regional economic development theories remain silent about the population decline affecting the economic growth and development prospects of regions. Consequently, regional policies usually rely on the concept of economic growth, yet neglect the complexity and importance of demographic change and how it relates to the economic sphere. Due to this lack in nuance, we argue that regional policymaking fails to design adequate policy support for regions facing persistent demographic change and economic stagnation or decline as a result. Based on these observations, the paper examines a selection of regional economic development theories in search for alternative concepts of growth and development in the context of demographic change. To this aim, globalisation peripheries are introduced as a fruitful conceptual point of reference and, in combination with endogenous regional development theories, discussed as an alternative approach for regional policymaking.
Urban groups. The city. Urban sociology, City population. Including children in cities, immigration
El artículo pretende identificar elementos que puedan señalarse como los primeros signos del descenso de la mortalidad. Para ello estudia el comportamiento de la mortalidad en Montevideo, desde el período colonial hasta la segunda mitad del siglo xix. Se analizan las crisis de mortalidad y la mortalidad en períodos de normalidad, y se hace un análisis de la mortalidad por causas. Se plantea un análisis desde el punto de vista epidemiológico, homologando las listas de causas de muerte a una clasificación que permita su interpretación en el marco de la transición epidemiológica. El trabajo combina fuentes cuantitativas y cualitativas: padrones de población, registros parroquiales, documentación del Cabildo, Juntas de Higiene Pública y bibliografía médica de la época. Los resultados encontrados concuerdan con lo esperado: un elevado nivel de la mortalidad con las fluctuaciones características de la mortalidad pretransicional. Sin embargo, aspectos relativos al cambio de la viruela de enfermedad epidémica a endémica y al incremento en el peso relativo de las enfermedades infecciosas no epidémicas permiten discutir la pertinencia de la pregunta que titula el trabajo.
Social Sciences, Demography. Population. Vital events
Este artigo tem por objetivo analisar alguns resultados empíricos derivados de um survey aplicado na cidade do Recife para estimar os efeitos da política de transferência de renda mais importante do governo federal, o Programa Bolsa Família, sobre a autonomia das mulheres pobres. Pretende-se analisar os efeitos do programa no ambiente familiar, nas relações de gênero e nas oportunidades de inserção ocupacional da população adulta feminina. Com base em logits, vamos estimar probabilidades distintas para mulheres beneficiárias e não-beneficiárias contra um conjunto importante de fatores que determinam a autonomia das mulheres. Busca-se inferir se receber o benefício do Bolsa Família, entregue às mulheres, amplia seu grau de autonomia no âmbito das relações de gênero. Este artigo não pretende proceder a uma revisão da literatura de gênero sobre autonomia feminina, mas tão somente proceder a uma análise empírica.
Social Sciences, Demography. Population. Vital events
M. Georgina Rivas, Austreberta Nazar, Erin Jane Estrada
et al.
Este estudio es parte de una investigación cualitativa que se realizó en San Cristóbal de Las Casas, Chiapas, México. Con base en entrevistas a mujeres indígenas inmigrantes, se hacen evidentes la influencia del entorno de marginación social así como el abuso de poder de los varones en el origen del embarazo no deseado. La sobrevaloración de los saberes masculinos, la expectativa de formar una unión como mandato social y como estrategia de sobrevivencia, así como la violencia que sufren las mujeres a lo largo de su ciclo de vida, condicionan su aceptación de relaciones sexuales con escasa protección anticonceptiva.
Human settlements. Communities, Demography. Population. Vital events