Comparative risk of cerebral venous sinus thrombosis (CVST) following COVID-19 vaccination or infection: A national cohort study using linked electronic health records

To inform the public and policy makers, we investigated and compared the risk of cerebral venous sinus thrombosis (CVST) after SARS-Cov-2 vaccination or infection using a national cohort of 2,643,699 individuals aged 17 y and above, alive, and resident in Wales on 1 January 2020 followed up through multiple linked data sources until 28 March 2021. Exposures were first dose of Oxford-ChAdOx1 or Pfizer-BioNTech vaccine or polymerase chain reaction (PCR)-confirmed SARS-Cov-2 infection. The outcome was an incident record of CVST. Hazard ratios (HR) were calculated using multivariable Cox regression, adjusted for confounders. HR from SARS-Cov-2 infection was compared with that for SARS-Cov-2 vaccination. We identified 910,556 (34.4%) records of first SARS-Cov-2 vaccination and 165,862 (6.3%) of SARS-Cov-2 infection. A total of 1,372 CVST events were recorded during the study period, of which 52 (3.8%) and 48 (3.5%) occurred within 28 d after vaccination and infection, respectively. We observed slight non-significant risk of CVST within 28 d of vaccination [aHR: 1.34, 95% CI: 0.95-1.90], which remained after stratifying by vaccine [BNT162b2, aHR: 1.18 (95% CI: 0.63-2.21); ChAdOx1, aHR: 1.40 (95% CI: 0.95-2.05)]. Three times the number of CVST events is observed within 28 d of a positive SARS-Cov-2 test [aHR: 3.02 (95% CI: 2.17-4.21)]. The risk of CVST following SARS-Cov-2 infection is 2.3 times that following SARS-Cov-2 vaccine. This is important information both for those designing COVID-19 vaccination programs and for individuals making their own informed decisions on the risk-benefit of vaccination. This record-linkage approach will be useful in monitoring the safety of future vaccine programs

An exploration of the lived experiences of men who have an eating disorder in the guise of anorexia or a-typical anorexia/EDNOS

Background: In the United Kingdom (UK) the number of males with Eating Disorders (ED) admitted to hospital has risen by 70% since 2000. Taking account of under-reporting and misdiagnosis, men are now thought to represent 25% of those diagnosed with anorexia. To date, within academic literature, there has been a strong focus on EDs in women, perpetuating and maintaining stereotypical ideas of anorexia and the existent social stigma. Whilst there has been a plethora of quantitative studies regarding anorexia per se, with some specifically relating to men, there is a dearth of qualitative studies, with only two studies examining the experiences of men with EDs accessing services identified within the literature review. In adding to such a limited body of knowledge, this study was undertaken with the purpose of exploring the lived experiences of men who had an ED, namely anorexia, and/or an eating disorder not otherwise specified. Methodology: Qualitative research, adopting a narrative approach was used, in order to promote the hearing of the participants’ own constructed stories. Data was collected via narrative interviews with seven men aged 23-34 years old. In the first instance narrative analysis was used for each man’s story, with thematic analysis being used to explore commonalities and difference across all seven interviews. Findings: The interviews highlighted the need for male stories of anorexia to be researched and voiced. The men shared many background similarities, experiencing a range of negative consequences during their everyday living; from discriminatory health care, to problems with employment and isolation. Four major themes emerged from the cross-narrative analysis: (1)The final John Doe, (2)Masculinity – The beast in me; (3)Not working 9-5; and (4)Help, I need somebody – Bedlam revisited. Conclusions: If men experiencing eating disorders are to receive appropriate and supportive health care, further research is needed to ensure better understanding and acceptance on the part of society, service providers and employers

Direct and indirect effects of the COVID-19 pandemic on mortality: an individual-level population-scale analysis.

Objectives The COVID-19 pandemic has had a detrimental impact on healthcare utilisation, resulting in increased mortality both directly and indirectly associated with COVID-19. We aimed to assess the impact of the COVID-19 pandemic on all-cause and disease-specific mortality and further explore the impact of potential inequalities, deprivation status and ethnicity. Approach Population-scale, individual-level, anonymised linked, routinely-collected electronic health records from demographic and administrative sources were used for two cohorts: i) C19-COHORT16 included individuals alive and resident in Wales on the 1st January 2016 with follow-up until death, break-in Welsh residency, or 31st December 2019; ii) C19-COHORT20 included individuals alive and resident in Wales on 1st January 2020 with follow-up until death, break-in Welsh residency, or study end. We used time-series analysis to investigate trends in mortality over time. We fitted negative binomial models to estimate expected all-cause and disease-specific mortality and compared these estimates to observed mortality in C19-COHORT20. Results Excess all-cause and COVID19-related deaths were higher during the period where the alpha variant was dominant. The trend in deaths decreased during the omicron dominant period. The Asian population had increased mortality during the period where the delta variant was dominant. Mortality was increased for most deprived groups compared to least deprived groups, however, the magnitude of this effect remained unchanged during the pandemic. COVID-19 indirectly affected cancer, circulatory, trauma, digestive and mental health related deaths, with a higher than expected mortality. The majority of trauma related deaths occurred early on in the pandemic, where a higher than expected number of deaths occurred outside of an NHS establishment. Mortality associated with respiratory disease (unrelated to COVID-19) was significantly lower than expected during the COVID-19 pandemic. Conclusion Increased all-cause and disease-specific mortality was observed during the COVID-19 pandemic. Excess deaths may be a result of reduced healthcare utilisation, delayed investigation and/or treatment of chronic diseases. As healthcare systems recover from COVID-19, investigation of mortality trends will play a central role in healthcare planning, utilisation and resource use

Validating the QCOVID risk prediction algorithm for risk of mortality from COVID-19 in the adult population in Wales, UK.

IntroductionCOVID-19 risk prediction algorithms can be used to identify at-risk individuals from short-term serious adverse COVID-19 outcomes such as hospitalisation and death. It is important to validate these algorithms in different and diverse populations to help guide risk management decisions and target vaccination and treatment programs to the most vulnerable individuals in society.ObjectivesTo validate externally the QCOVID risk prediction algorithm that predicts mortality outcomes from COVID-19 in the adult population of Wales, UK.MethodsWe conducted a retrospective cohort study using routinely collected individual-level data held in the Secure Anonymised Information Linkage (SAIL) Databank. The cohort included individuals aged between 19 and 100 years, living in Wales on 24th January 2020, registered with a SAIL-providing general practice, and followed-up to death or study end (28th July 2020). Demographic, primary and secondary healthcare, and dispensing data were used to derive all the predictor variables used to develop the published QCOVID algorithm. Mortality data were used to define time to confirmed or suspected COVID-19 death. Performance metrics, including R2 values (explained variation), Brier scores, and measures of discrimination and calibration were calculated for two periods (24th January–30th April 2020 and 1st May–28th July 2020) to assess algorithm performance.Results1,956,760 individuals were included. 1,192 (0.06%) and 610 (0.03%) COVID-19 deaths occurred in the first and second time periods, respectively. The algorithms fitted the Welsh data and population well, explaining 68.8% (95% CI: 66.9-70.4) of the variation in time to death, Harrell’s C statistic: 0.929 (95% CI: 0.921-0.937) and D statistic: 3.036 (95% CI: 2.913-3.159) for males in the first period. Similar results were found for females and in the second time period for both sexes.ConclusionsThe QCOVID algorithm developed in England can be used for public health risk management for the adult Welsh population

A Tale of Two Stories: A Narrative of Bulimia in a Research Study of Anorexia, and the Dilemmas of a Novice Researcher.

The purpose of this paper is two-fold: Firstly, it reports on one man's experience of bulimia. After being interviewed it became evident that he did not meet the inclusion criteria for the study, which was focussed on anorexia in men. Secondly, the paper explores the implications for a novice researcher of including someone in a study who does not meet the inclusion criteria. The researcher's story reflects upon the implications of self-doubt when embarking upon sensitive research, and the morality of holding onto a rogue participant's story. It offers others an opportunity to consider and learn from this experience

Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales

Background: Evidence suggests living in greener areas, or close to green blue spaces (GBS; parks, lakes, or beaches) benefits mental health, but longitudinal evidence when GBS exposures precede outcomes is limited. We aimed to analyse the impact of living in greener areas, or close to GBS over time on subsequent adult mental health, explicitly considering health inequalities, and disentangling the mental health benefits of potentially accessing GBS from living in greener areas.Methods; A cohort of the adults in Wales, UK (>16 years; n=2,341,591) was constructed from electronic health record (EHR) data sources, 2008-2019, comprising 19,141,896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index, EVI), access to GBS (counts, distance to nearest); and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression (treated or untreated in the preceding one-year period), or treatment of historical diagnosis(es) frombefore the ‘current’ cohort (up to 8 years prior, to 2000), where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out-of-Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation.Findings: After adjustment, exposure to greater ambient greenness over time (+0.1 increased EVI on a 0-1 scale) was associated with lower odds of subsequent CMD (Adjusted Odds Ratio (AOR) = 0.80, 95% CI: 0.80, 0.81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding one-year period), or treatments). Ten percentile points more access to GBS was associated with lower odds of a later CMD (AOR = 0.93 95% CI 0.93, 0.93). Every additional 360m to the nearest GBS was associated with higher odds of CMD (AOR = 1.05, 95% CI 1.04, 1.05). We found differences across deprivation quintiles. Interpretation Ambient exposure is associated with the greatest reduced risk of CMD, particularly for adults who live in deprived communities. Findings support authorities responsible for GBS who are attempting to engage planners and policy makers, to ensure GBS meets resident needs