English indices of deprivation 2010 : technical report

The English indices of deprivation 2010 is the third release in a series of statistics produced to measure multiple forms of deprivation at the small spatial scale. It updates the indices of deprivation 2007 and 2004, retaining broadly the same methodology, domains and indicators. This report outlines the conceptualisation underpinning the model of multiple deprivation used and describes the indicators and domains that make up the indices

Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis : a record linkage analysis of Scottish healthcare databases

This study was commissioned by GSK through the Farr Institute/SHIP/eDRIS single portal. DJM is a Clinician Scientist Fellow funded by the Health Foundation/Academy of Medical Sciences.Objectives: Acute pancreatitis (AP) can initiate systemic complications that require support in critical care (CC). Our objective was to use the unified national health record to define the epidemiology of AP in Scotland, with a specific focus on deterministic and prognostic factors for CC admission in AP. Setting: Health boards in Scotland (n=4). Participants: We included all individuals in a retrospective observational cohort with at least one episode of AP (ICD10 code K85) occurring in Scotland from 1 April 2009 to 31 March 2012. 3340 individuals were coded as AP. Methods: Data from 16 sources, spanning general practice, community prescribing, Accident and Emergency attendances, hospital in-patient, CC and mortality registries, were linked by a unique patient identifier in a national safe haven. Logistic regression and gamma models were used to define independent predictive factors for severe AP (sAP) requiring CC admission or leading to death. Results: 2053 individuals (61.5% (95% CI 59.8% to 63.2%)) met the definition for true AP (tAP). 368 patients (17.9% of tAP (95% CI 16.2% to 19.6%)) were admitted to CC. Predictors of sAP were pre-existing angina or hypertension, hypocalcaemia and age 30-39 years, if type 2 diabetes mellitus was present. The risk of sAP was lower in patients with multiple previous episodes of AP. In-hospital mortality in tAP was 5.0% (95% CI 4.1% to 5.9%) overall and 21.7% (95% CI 19.9% to 23.5%) in those with tAP necessitating CC admission. Conclusions: National record-linkage analysis of routinely collected data constitutes a powerful resource to model CC admission and prognosticate death during AP. Mortality in patients with AP who require CC admission remains high.Publisher PDFPeer reviewe

Protocol for the insight study: a randomised controlled trial of single-dose tocilizumab in patients with depression and low-grade inflammation.

INTRODUCTION: Observational studies indicate a potentially causal role for interleukin 6 (IL-6), a proinflammatory cytokine, in pathogenesis of depression, but interventional studies based on patients with depression have not been conducted. Tocilizumab, anti-inflammatory drug, is a humanised monoclonal antibody that inhibits IL-6 signalling and is licensed in the UK for treatment of rheumatoid arthritis. The main objectives of this study are to test whether IL-6 contributes to the pathogenesis of depression and to examine potential mechanisms by which IL-6 affects mood and cognition. A secondary objective is to compare depressed participants with and without evidence of low-grade systemic inflammation. METHODS AND ANALYSIS: This is a proof-of-concept, randomised, parallel-group, double-blind, placebo-controlled clinical trial. Approximately 50 participants with International Classification of Diseases 10th revision (ICD-10) diagnosis of depression who have evidence of low-grade inflammation, defined as serum high-sensitivity C reactive protein (hs-CRP) level ≥3 mg/L, will receive either a single intravenous infusion of tocilizumab or normal saline. Blood samples, behavioural and cognitive measures will be collected at baseline and after infusion around day 7, 14 and 28. The primary outcome is somatic symptoms score around day 14 postinfusion. In addition, approximately, 50 depressed participants without low-grade inflammation (serum hs-CRP level <3 mg/L) will complete the same baseline assessments as the randomised cohort. ETHICS AND DISSEMINATION: The study has been approved by the South Central-Oxford B Research Ethics Committee (REC) (Reference: 18/SC/0118). Study findings will be published in peer-review journals. Findings will be also disseminated by conference/departmental presentations and by social and traditional media. TRIAL REGISTRATION NUMBER: ISRCTN16942542; Pre-results

Social prescribing in cardiology : rediscovering the nature of and within us

Personalised care is integral to the delivery of the NHSE Long Term Plan. Enabling choice and supporting patients to make decisions predicated on what matters to them, rather than what is the matter with them, is a fundamental part of the NHS vision. Social prescribing uses nonmedical, asset based, salutogenic approaches to promote this personalised paradigm, and places the patient central to decision making. We discuss how Personalised care can be used to help people with Cardiovascular Disease (CVD) using socially prescribed ‘nature-based’ interventions to support the prehabilitation and rehabilitation of patients with CVD. The concept of Personalised care outlined and the significance of salutogenic principles as complementary approach to the pathogenic model is discussed. We argue that this seemingly novel approach to using nature-based interventions can help promote wellbeing for people with CVD as part of the wider personalised agenda

Determinants of occupational mobility: the importance of place of work

The LSCS is supported by the Economic and Social Research Council (ESRC)/JISC, the Scottish Funding Council, the Chief Scientist’s Office, and the Scottish government.This research focuses on individual and place-based determinants of occupational mobility in Scotland over the period 2001–11. Its originality relates to the importance of workplace location, rather than residential locations, on occupational mobility, and in questioning the idea that spatial mobility accelerates occupational mobility. The findings also indicate that skill level and employment in ‘knowledge-intensive’ sectors are key determinants of career progression. Urban career escalator effects are found to be particularly evident for higher-skilled workers. The findings point to the importance of spatial sophistication and sectoral sensitivity in understandings of occupational mobility.PostprintPeer reviewe

Institutional legacies and HRM: similarities and differences in HRM practices in Portugal and Mozambique

This is a study of institutional change and continuity, comparing the trajectories followed by Mozambique and its formal colonial power Portugal in HRM, based on two surveys of firm level practices. The colonial power sought to extend the institutions of the metropole in the closing years of its rule, and despite all the adjustments and shocks that have accompanied Mozambique’s post-independence years, the country continues to retain institutional features and associated practices from the past. This suggests that there is a post-colonial impact on human resource management. The implications for HRM theory are that ambitious attempts at institutional substitution may have less dramatic effects than is commonly assumed. Indeed, we encountered remarkable similarities between the two countries in HRM practices, implying that features of supposedly fluid or less mature institutional frameworks (whether in Africa or the Mediterranean world) may be sustained for protracted periods of time, pressures to reform notwithstanding. This highlights the complexities of continuities which transcend formal rules; as post-colonial theories alert us, informal conventions and embedded discourse may result in the persistence of informal power and subordination, despite political and legal changes

Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality

Background: Information is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long-term mortality in an elderly hypertensive population. Methods and Results: We used data from a subset of participants in the Second Australian National Blood Pressure study (n=496) aged ≥65 years who had 24-hour ambulatory blood pressure recordings at study entry (baseline) and then after a median of 2 years while on treatment (follow-up). Weighted day-night systolic BPV was calculated for both baseline and follow-up as a weighted mean of daytime and nighttime blood pressure standard deviations. The annual rate of change in BPV over time was calculated from these BPV estimates. Furthermore, we classified both BPV estimates as high and low based on the baseline median BPV value and then classified BPV changes into stable: low BPV, stable: high BPV, decline: high to low, and increase: low to high. We observed an annual decline (mean±SD: −0.37±1.95; 95% CI, −0.54 to −0.19; P<0.001) in weighted day-night systolic BPV between baseline and follow-up. Having constant stable: high BPV was associated with an increase in all-cause mortality (hazard ratio: 3.03; 95% CI, 1.67–5.52) and cardiovascular mortality (hazard ratio: 3.70; 95% CI, 1.62–8.47) in relation to the stable: low BPV group over a median 8.6 years after the follow-up ambulatory blood pressure monitoring. Similarly, higher risk was observed in the decline: high to low group. Conclusions: Our results demonstrate that in elderly hypertensive patients, average BPV declined over 2 years of follow-up after initiation of antihypertensive therapy, and having higher BPV (regardless of any change) was associated with increased long-term mortality

Linking Scottish vital event records using family groups

Funding: This work was supported by ESRC Grants ES/K00574X/2 “Digitising Scotland” and ES/L007487/1 “Administrative Data Research Centre – Scotland.”The reconstitution of populations through linkage of historical records is a powerful approach to generate longitudinal historical microdata resources of interest to researchers in various fields. Here we consider automated linking of the vital events recorded in the civil registers of birth, death and marriage compiled in Scotland, to bring together the various records associated with the demographic events in the life course of each individual in the population. From the histories, the genealogical structure of the population can then be built up. Rather than apply standard linkage techniques to link the individuals on the available certificates, we explore an alternative approach, inspired by the family reconstitution techniques adopted by historical demographers, in which the births of siblings are first linked to form family groups, after which intergenerational links between families can be established. We report a small-scale evaluation of this approach, using two district-level data sets from Scotland in the late nineteenth century, for which sibling links have already been created by demographers. We show that quality measures of up to 83% can be achieved on these data sets (using F-Measure, a combination of precision and recall). In the future, we intend to compare the results with a standard linkage approach and to investigate how these various methods may be used in a project which aims to link the entire Scottish population from 1856 to 1973.PostprintPeer reviewe