Mortality from head injury over four decades in Scotland

Although the causes of head injury, the population at risk and approaches to prevention and treatment are continually evolving, there is little information about how these are reflected in patterns of mortality over time. We used population based comprehensive data uniquely available in Scotland to investigate changes in the total numbers of deaths from 1974 to 2012, as well as the rates of head injury death, from different causes, overall and in relation to age and gender. Total mortality fell from an annual average of 503 to 339 with a corresponding annual decrease in rate from 9.6 to 6.4 per 100,000 population, the decline substantially occurring between 1974 and 1990. Deaths in children fell strikingly but rose in older people. Deaths in males fell to a greater extent than females but remained at a higher rate overall. Initially, a transport accident accounted for most deaths but these fell by 80%, from 325 per year to 65 per year over the 39 year period. Deaths from falling and all other causes did not decline, coming to outnumber transport accident deaths by 1998, which accounts for the overall absence of change in total mortality in recent years. In order to reduce mortality in the future, more effective measures to prevent falls are needed and these strategies will vary in younger adults (where alcohol is often a factor), and in older adults where infirmity can be a cause. In addition, measures to sustain reductions in transport accidents need to be maintained and further developed

Helping to Support CPC+ Initiative to Integrate Behavioral Health Within Primary Care: A Team-Based Approach to Improving Depression Management

AIM: The objective of this project is to increase the rate of documented successful treatment of depression for both new and established diagnoses of depression at Jefferson Internal Medicine Associates (JIMA) from 29% to 50% over 12 months.https://jdc.jefferson.edu/patientsafetyposters/1027/thumbnail.jp

Why Teach? Exploring the Motivations and Expectations of First-year, Alternatively Certified Agriscience Teachers

School-Based agricultural education increasingly depends upon alternatively certified (AC) teachers to teach agriculture across the United States. Understanding why these individuals become teachers is an important step to better recruit and retain educators who do not complete traditional preparation programs. The purpose of our study was to explore the backgrounds, motivations, and expectations of AC agriscience teachers joining the profession. Our study was guided by the social cognitive career theory and utilized a qualitative phenomenological approach. We interviewed seven AC agriscience teachers in Florida during their first-year teaching to explore their journey into teaching agricultural education. Six major themes were found, including background and interest in agriculture, positive teaching self-efficacy expectations, positive teaching outcome expectations, right location and right time, exciting but challenging, and more than expected. We recommend providing support programs tailored for AC agriscience teachers that are guided by the similar backgrounds, motivations, and expectations of AC teachers

Applying the integrated trans-contextual model to mathematics activities in the classroom and homework behavior and attainment

The aim of the present study was to test hypotheses of the trans-contextual model. We predicted relations between perceived autonomy support, autonomous motivation toward mathematics learning activities in an educational context, autonomous motivation toward mathematics homework in an out-of-school context, social-cognitive variables and intentions for future engagement in mathematics homework, and mathematics homework outcomes. Secondary school students completed measures of perceived autonomy support from teachers and autonomous motivation for in-class mathematics activities; measures of autonomous motivation, social-cognitive variables, and intentions for out-of-school mathematics homework; and follow-up measures of students' mathematics homework outcomes: self-reported homework engagement and actual homework grades. Perceived autonomy support was related to autonomous motivation toward in-class mathematics activities. There were trans-contextual effects of autonomous motivation across educational and out-of-school contexts, and relations between out-of-school autonomous motivation, intentions, and mathematics homework outcomes. Findings support trans-contextual effects of autonomous motivation toward mathematics activities across educational and out-of-school contexts and homework outcomes

Are routinely collected NHS administrative records suitable for endpoint identification in clinical trials? Evidence from the West of Scotland coronary prevention study

Background: Routinely collected electronic patient records are already widely used in epidemiological research. In this work we investigated the potential for using them to identify endpoints in clinical trials.<p></p> Methods: The events recorded in the West of Scotland Coronary Prevention Study (WOSCOPS), a large clinical trial of pravastatin in middle-aged hypercholesterolaemic men in the 1990s, were compared with those in the record-linked deaths and hospitalisations records routinely collected in Scotland.<p></p> Results: We matched 99% of fatal study events by date. We showed excellent matching (97%) of the causes of fatal endpoint events and good matching (.80% for first events) of the causes of nonfatal endpoint events with a slightly lower rate of mismatching of record linkage than study events (19% of first study myocardial infarctions (MI) and 4% of first record linkage MIs not matched as MI). We also investigated the matching of non-endpoint events and showed a good level of matching, with .78% of first stroke/TIA events being matched as stroke/TIA. The primary reasons for mismatches were record linkage data recording readmissions for procedures or previous events, differences between the diagnoses in the routinely collected data and the conclusions of the clinical trial expert adjudication committee, events occurring outside Scotland and therefore being missed by record linkage data, miscoding of cardiac events in hospitalisations data as ‘unspecified chest pain’, some general miscoding in the record linkage data and some record linkage errors.<p></p> Conclusions: We conclude that routinely collected data could be used for recording cardiovascular endpoints in clinical trials and would give very similar results to rigorously collected clinical trial data, in countries with unified health systems such as Scotland. The endpoint types would need to be carefully thought through and an expert endpoint adjudication committee should be involved.<p></p&gt

Comparison of data characterizing the clinical effectiveness of the fluocinolone intravitreal implant (ILUVIEN) in patients with diabetic macular edema from the real world, non-interventional ICE-UK study and the FAME randomized controlled trials

Objective: To compare the effectiveness and safety of the fluocinolone acetonide (FAc) intravitreal implant between the observational Iluvien Clinical Evidence study in the United Kingdom (ICE-UK) and the Fluocinolone Acetonide in Diabetic Macular Edema (FAME) randomized controlled trials (RCTs) in people with diabetic macular edema (DME). Clinical Trials Registration: NCT00344968. Methods: This study selected patients randomized to receive 0.2 µg/day FAc insert (FAc treated eyes) or sham injection (control eyes) from the FAME RCTs, and patients’ first FAc treated eye and non-FAc treated fellow (control) eye from the ICE-UK study. Outcomes included change in visual acuity (VA), central foveal thickness (CFT), and intraocular pressure (IOP). Results: After 12 months follow-up, mean change in VA was 5.0 letters improvement (p < .001) and 1.6 letters improvement (p = .003) in FAME FAc treated and control eyes, and 3.8 letters (p = .012) and –2.1 letters (p = .056) in ICE-UK FAc treated and control eyes, respectively. Mean change in CFT was –144 µm (p < .001) vs –72 µm (p < .001) in FAME FAc treated and control eyes and –113 µm (p < .001) vs –13 µm (p < .001) in ICE-UK FAc treated and control eyes. For eyes with a follow-up of 12 months, 77 (22.3%) and 15 (8.6%) FAME FAc treated and control eyes and 25 (18.7%) and six (4.3%) ICE-UK FAc treated and control eyes required emergent IOP-lowering therapy. Conclusions: Statistically significant improvements in VA 12 months after FAc implantation were observed in both the real-world study and in the RCTs. The improvement in VA and CFT in the RCTs was marginally greater than in the real-world study; however, recruits in the real-world study had more severe visual morbidity at baseline. Whilst there were many changes in the care of people with DME over this time, these data all support the value of treatment with FAc intravitreal implant

Time From First Intercourse to First Sexually Transmitted Infection Diagnosis Among Adolescent Women

Objective To determine the time between first intercourse and first sexually transmitted infection (STI) with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis and time between repeated infections. Design Observational study. Setting Three adolescent medicine clinics. Participants A cohort of 386 urban young women aged 14 to 17 years at enrollment. Main Outcome Measures Age at first intercourse; organism-specific interval between first intercourse and first STI diagnosis; interval between repeated infections; and age at first STI test prior to study participation. Results Participants had first intercourse at a young age (first, second, and third quartiles were 13, 14, and 15 years of age, respectively). By age 15 years, 25% of the women acquired their first STI, most often C trachomatis. Median interval between first intercourse and first STI diagnosis was 2 years. Within 1 year of first intercourse, 25% had their first C trachomatis infection. Repeated infections were common; within 3.6, 6, and 4.8 months, 25% of the women with prior C trachomatis, N gonorrhoeae, and T vaginalis infection were reinfected with the respective organisms. Considerable delay in STI testing was found for those who began sex at a younger age. The median interval between first sex and first test were 4.9, 3.5, 2.1, 1.8, and 1.2 years for those who had first sex at ages 10, 11, 12, 13, and 14 years, respectively. Conclusions Timely screening and treatment are important for prevention of STI sequelae. For urban adolescent women, STI screening (especially for C trachomatis) should begin within a year after first intercourse and infected individuals should be retested every 3 to 4 months

Power analysis for generalized linear mixed models in ecology and evolution

Power analysis for generalized linear mixed models in ecology and evolution. Methods in Ecology and Evolution, 6(2 University of Basel, Petersplatz 1, Basel CH-4003, Switzerland Summary 1. &apos;Will my study answer my research question?&apos; is the most fundamental question a researcher can ask when designing a study, yet when phrased in statistical terms -&apos;What is the power of my study?&apos; or &apos;How precise will my parameter estimate be?&apos; -few researchers in ecology and evolution (EE) try to answer it, despite the detrimental consequences of performing under-or over-powered research. We suggest that this reluctance is due in large part to the unsuitability of simple methods of power analysis (broadly defined as any attempt to quantify prospectively the &apos;informativeness&apos; of a study) for the complex models commonly used in EE research. With the aim of encouraging the use of power analysis, we present simulation from generalized linear mixed models (GLMMs) as a flexible and accessible approach to power analysis that can account for random effects, overdispersion and diverse response distributions. 2. We illustrate the benefits of simulation-based power analysis in two research scenarios: estimating the precision of a survey to estimate tick burdens on grouse chicks and estimating the power of a trial to compare the efficacy of insecticide-treated nets in malaria mosquito control. We provide a freely available R function, sim.glmm, for simulating from GLMMs. 3. Analysis of simulated data revealed that the effects of accounting for realistic levels of random effects and overdispersion on power and precision estimates were substantial, with correspondingly severe implications for study design in the form of up to fivefold increases in sampling effort. We also show the utility of simulations for identifying scenarios where GLMM-fitting methods can perform poorly. 4. These results illustrate the inadequacy of standard analytical power analysis methods and the flexibility of simulation-based power analysis for GLMMs. The wider use of these methods should contribute to improving the quality of study design in EE

'Reaching the hard to reach' - lessons learned from the VCS (voluntary and community Sector). A qualitative study.

Background The notion 'hard to reach' is a contested and ambiguous term that is commonly used within the spheres of social care and health, especially in discourse around health and social inequalities. There is a need to address health inequalities and to engage in services the marginalized and socially excluded sectors of society. Methods This paper describes a pilot study involving interviews with representatives from eight Voluntary and Community Sector (VCS) organisations . The purpose of the study was to explore the notion of 'hard to reach' and perceptions of the barriers and facilitators to accessing services for 'hard to reach' groups from a voluntary and community sector perspective. Results The 'hard to reach' may include drug users, people living with HIV, people from sexual minority communities, asylum seekers, refugees, people from black and ethnic minority communities, and homeless people although defining the notion of the 'hard to reach' is not straight forward. It may be that certain groups resist engaging in treatment services and are deemed hard to reach by a particular service or from a societal stance. There are a number of potential barriers for people who may try and access services, including people having bad experiences in the past; location and opening times of services and how services are funded and managed. A number of areas of commonality are found in terms of how access to services for 'hard to reach' individuals and groups could be improved including: respectful treatment of service users, establishing trust with service users, offering service flexibility, partnership working with other organisations and harnessing service user involvement. Conclusions: If health services are to engage with groups that are deemed 'hard to reach' and marginalised from mainstream health services, the experiences and practices for engagement from within the VCS may serve as useful lessons for service improvement for statutory health services

Mapping geographic trends in early childhood social emotional, and behavioural difficulties in Glasgow : 2010–2017

Measuring variation in childhood mental health supports the development of local early intervention strategies. The methodological approach used to investigate mental health trends (often determined by the availability of individual level data) can affect decision making. We apply two approaches to identify geographic trends in childhood social, emotional, and behavioural difficulties using the Strengths and Difficulties Questionnaire (SDQ). SDQ forms were analysed for 35 171 children aged 4–6 years old across 180 preschools in Glasgow, UK, between 2010 and 2017 as part of routine monitoring. The number of children in each electoral ward and year with a high SDQ total difficulties score (≥15), indicating a high risk of psychopathology, was modelled using a disease mapping model. The total difficulties score for an individual child nested in their preschool and electoral ward was modelled using a multilevel model. For each approach, linear time trends and unstructured spatial random effects were estimated. The disease mapping model estimated a yearly rise in the relative rate (RR) of high scores of 1.5–5.0%. The multilevel model estimated an RR increase of 0.3–1.2% in average total scores across the years, with higher variation between preschools than between electoral wards. Rising temporal trends may indicate worsening social, emotional, and behavioural difficulties over time, with a faster rate for the proportion with high scores than for the average total scores. Preschool and ward variation, although minimal, highlight potential priority areas for local service provision. Both methodological approaches have utility in estimating and predicting children's difficulties and local areas requiring greater intervention