Birth outcomes for African and Caribbean babies in England and Wales: retrospective analysis of routinely collected data

Objectives: To compare mean birth weights, gestational ages and odds of preterm birth and low birth weight of live singleton babies of black African or Caribbean ethnicity born in 2005 or 2006 by mother's country of birth. Design: Secondary analysis of data from linked birth registration and NHS Numbers for Babies data set. Setting: Births to women in England and Wales in 2005 and 2006. Participants: Babies of African and Caribbean ethnicity born in England and Wales in 2005–2006, whose mothers were born in African and Caribbean countries or the UK. Birth outcomes for 51 599 singleton births were analysed. Main outcome measures: Gestational age and birth weight. Results: Mothers born in Eastern or Northern Africa had babies at higher mean gestational ages (39.38 and 39.41 weeks, respectively) and lower odds of preterm birth (OR=0.80 and 0.65, respectively) compared with 39.00 weeks for babies with mothers born in the UK. Babies of African ethnicity whose mothers were born in Middle or Western Africa had mean birth weights of 3327 and 3311 g, respectively. These were significantly higher than the mean birth weight of 3257 g for babies of the UK-born mothers. Their odds of low birth weight (OR=0.75 and 0.72, respectively) were significantly lower. Babies of Caribbean ethnicity whose mothers were born in the Caribbean had higher mean birth weight and lower odds of low birth weight than those whose mothers were born in the UK. Conclusions: The study shows that in babies of African and Caribbean ethnicity, rates of low birth weight and preterm birth varied by mothers' countries of birth. Ethnicity and country of birth are important factors associated with perinatal health, but assessing them singly can mask important heterogeneity in birth outcomes within categories particularly in relation to African ethnicity. These differences should be explored further

Linking maternity data for England 2007: methods and data quality

Maternity Hospital Episode Statistics (HES) data for 2007 were linked to birth registration and NHS Numbers for Babies (NN4B) data to bring together some key demographic and clinical data items not otherwise available at a national level. This extended the time period 2005-06, for which data had previously been linked and reported

Linkage of Maternity Hospital Episode Statistics data to birth registration and notification records for births in England 2005-2014: methods. A population-based birth cohort study.

INTRODUCTION: Maternity Hospital Episode Statistics (HES) data for 2005-2014 were linked to birth registration and birth notification data (previously known as NHS Numbers for Babies or NN4B) to bring together some key demographic and clinical data items not otherwise available at a national level. The linkage algorithm that was previously used to link 2005-2007 data was revised to improve the linkage rate and reduce the number of duplicate HES records. METHODS: Birth registration and notification linked records from the Office for National Statistics ('ONS birth records') were further linked to Maternity HES delivery and birth records using the NHS Number and other direct identifiers if the NHS Number was missing. RESULTS: For the period 2005-2014, over 94% of birth registration and notification records were correctly linked to HES delivery records. Two per cent of the ONS birth records were incorrectly linked to the HES delivery record and 5% of ONS birth records were linked to more than one HES delivery record. Therefore, a considerable amount of time was spent in quality assuring these files. CONCLUSION: The linkage rate for birth registration and notification records to HES delivery records steadily improved from 2005 to 2014 due to improvement in the quality and completeness of patient identifiers in both HES and birth notification data

Linking maternity data for Wales, 2005-07: methods and data quality

Background: This work formed part of a project to link data recorded routinely at birth in England and Wales to bring together socio-demographic data and data about care at birth. Birth registration data for England and Wales had already been linked to the National Health Service (NHS) Numbers for Babies’ data (NN4B) recorded when an NHS number is issued to a new baby. The data for babies born between 2005 and 2007 to mothers resident in England were then further linked to their records in the Maternity Hospital Episode Statistics (HES). This paper describes the linkage of linked birth registration and NN4B records for babies of mothers resident in Wales for 2005 to 2007 to the Patient Episode Database for Wales (PEDW) and the National Community Child Health Database (NCCHD) records. Methods: Birth registration and NN4B records were first linked to NCCHD records, which contains data about the children born. This dataset was further linked to PEDW to obtain maternity records relating to their delivery. The linkage was carried out using pre-defined linkage algorithms. The quality of the Welsh data was assessed in terms of completeness of data and concordance of common data items in relation to birth registration wherever possible. NN4B data were used for data items not collected at birth registration, such as gestational age for live births. Results: Around 92 per cent of registration/NN4B records for the three years could be linked to NCCHD and PEDW records. Different data fields were provided from each of the two Welsh data sources, with the common and key data items, such as birth weight and gestational age, coming from NCCHD. Overall the percentage of missing data in NCCHD was minimal, with the exception of ethnicity which was missing from 13 per cent of records in NCCHD in 2005 but from fewer records in subsequent years. For births in 2005 and 2006, over 30 per cent of NN4B records linked to registration did not have the mother’s NHS number compared with less than 1.1 per cent of NCCHD records. There was excellent agreement between the data items in linked birth registration and NN4B files and the data from NCCHD with over 95 per cent concordance in common data items. Around 99 per cent of the linked records had the same ethnic group which is not surprising as records on the child health system databases and NN4B are derived from a common data source. Conclusion: The linkage rate for maternity data in Wales was similar to that obtained in linking registration/NN4B linked data to the Maternity HES records for England but the data were of higher quality and were more complete. Therefore, NCCHD linked to PEDW could be used to analyse birth outcomes for Wales without the need to link to birth registration and NN4B data. Nevertheless data items such as mother’s country of birth and socio-economic status are recorded only at birth registration so linkage to the birth registration/NN4B dataset can generate a much fuller set of data items and enable analyses of birth outcomes by factors such as ethnicity, socio-economic status and parents’ country of birth

Linking maternity data for England, 2005-06: methods and data quality

Maternity Hospital Episode Statistics (HES) data were linked to birth registration and NHS Numbers for Babies (NN4B) data to bring together some key demographic and clinical data items not otherwise available at a national level. This project added to earlier work involving linkage of birth registration records to NN4B records

Endocrine morbidity in midline brain defects: Differences between septo-optic dysplasia and related disorders

Background Septo-optic dysplasia (SOD) is a heterogeneous congenital condition. The aim of this study was to investigate the clinical phenotypes of a large cohort of children with SOD, Multiple Pituitary Hormone Deficiency (MPHD) and Optic Nerve Hypoplasia (ONH), with a focus on endocrine testing. Methods Retrospective single-centre longitudinal study of children with SOD (n:171), MPHD (n:53) and ONH (n:35). SOD+ and SOD- indicate patients with or without hypopituitarism, respectively. Findings All deficits were more frequent and occurred earlier in MPHD than SOD+ [Hazard Ratios (HR): 0·63(0·45,0·89) for GH, 0·48(0·34,0·69) for TSH, 0·55(0·38,0·80) for ACTH, 0·28(0·11,0·68) for gonadotropins], except Diabetes Insipidus (DI) [HR: 2·27(0·88,5·9)]. Severe hypothalamo-pituitary (H-P) abnormalities were more frequent in MPHD [80·0% vs 41·6%, p<0·0001 for Ectopic Posterior Pituitary (EPP)]. Stalk and PP abnormalities were associated with more severe endocrine phenotypes and placed a subgroup of SOD+ at risk of developing deficits earlier. SOD and ONH shared heterogeneous phenotypes ranging from pubertal delay to precocity and from leanness to extreme obesity, whilst MPHD had GnD and obesity only. Mortality was recorded in 4·2% (6/144) SOD and 3·2% (1/31) ONH, and only in patients with multisystem phenotypes. Interpretation More than a single disease, SOD represents a spectrum of malformative conditions involving different brain structures and characterised by a dynamic and sequential nature of endocrine. In contrast, MPHD displays a more homogeneous phenotype of (mainly) anterior pituitary early-onset failure. Stalk and PP abnormalities place a subgroup of SOD+ at a higher risk of early-onset deficits. Additionally, there are striking differences between the SOD and MPHD cohorts in terms of pubertal progression. The shared phenotypes between ONH and SOD could be partly explained by common hypothalamic dysfunction. The differences between the cohorts are important as they may aid in planning management and preventing morbidity by dictating earlier interventions

Towards a feasible implementation of quantum neural networks using quantum dots

We propose an implementation of quantum neural networks using an array of quantum dots with dipole-dipole interactions. We demonstrate that this implementation is both feasible and versatile by studying it within the framework of GaAs based quantum dot qubits coupled to a reservoir of acoustic phonons. Using numerically exact Feynman integral calculations, we have found that the quantum coherence in our neural networks survive for over a hundred ps even at liquid nitrogen temperatures (77 K), which is three orders of magnitude higher than current implementations which are based on SQUID-based systems operating at temperatures in the mK range.Comment: revtex, 5 pages, 2 eps figure

Clinical management of nausea and vomiting in pregnancy and hyperemesis gravidarum across primary and secondary care: a population based study

Objectives: To assess how nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) are managed and treated across primary and secondary care.Design: Population-based pregnancy cohortSetting: Medical records (CPRD-GOLD) from EnglandPopulation: 417,028 pregnancies, during 1998-2014 Methods: Proportions of pregnancies with recorded NVP/HG diagnoses, primary care treatment and hospital admissions were calculated. Multinomial logistic regression was employed to estimate adjusted relative risk ratios (aRRRs) with 99% confidence intervals (CIs) for the association between NVP/HG management paths and maternal characteristics.Main Outcome Measures: NVP/HG diagnoses, treatments and hospital admissions. Results: Overall prevalence of clinically recorded NVP/HG was 9.1%: 2.1% had hospital admissions, 3.4% were treated with antiemetics in primary care only, and 3.6% had only recorded diagnoses. Hospital admissions and antiemetic prescribing increased continuously during 1998-2013 (trend p less than 0.001). Younger age, deprivation, Black/Asian/Mixed ethnicity, multiple-pregnancy were associated with NVP/HG generally across all levels, but associations were strongest for hospital admissions. Most comorbidities had patterns of association with NVP/HG levels. Among women with NVP/HG who had no hospital admissions, 49% were prescribed antiemetics, mainly from first line treatment (21% prochlorperazine, 15% promethazine, 13% cyclizine) and metoclopramide (10%). Of those admitted, 38% had prior antiemetic prescriptions (34% first-line, 9% second-line, 1% third-line treatment).Conclusion: Previous focus on hospital admissions has greatly underestimated the NVP/HG burden. Although primary care prescribing has increased, most women admitted to hospital have no antiemetics prescribed before this. An urgent call is made to assess whether admissions could be prevented with better primary care recognition and timely treatment

Cardiovascular Risk Reduction is Important for Improving Patient and Graft Survival After Ligation and Bypass Surgery for Popliteal Artery Aneurysm

OBJECTIVES: To report outcomes following ligation and bypass (LGB) surgery for popliteal artery aneurysm (PAA) and study factors influencing patient and graft survival. MATERIALS AND METHODS: A retrospective review of patients undergoing LGB surgery for PAA between September 1999 and August 2012 at a tertiary referral vascular unit was performed. Primary graft patency (PGP), primary-assisted graft patency (PAGP), and secondary graft patency (SGP) rates were calculated using survival analyses. Patient, graft aneurysm-free survival (GAFS), aneurysm reperfusion-free survival (ARFS), and amputation-free survival (AFS) rates were also calculated. Log-rank testing and Cox proportional hazards modeling were used to perform univariate and multivariate analysis of influencing factors, respectively. RESULTS: Eighty-four LGB repairs in 69 patients (mean age 71.3 years, 68 males) were available for study. The 5-year PGP, PAGP, SGP, and patient survival rates were 58.1%, 84.4%, 85.2%, and 81.1%, respectively. On multivariate analysis, the principal determinants of PGP were urgency of operation ( P = .009) and smoking status ( P = .019). The principal determinants of PAGP were hyperlipidemia status ( P = .048) and of SGP were hyperlipidemia ( P = .042) and cerebrovascular disease (CVD) status ( P = .045). The principal determinants of patient survival were previous myocardial infarction ( P = .004) and CVD ( P = .001). The 5-year GAFS, ARFS, and AFS rates were 87.9%, 91.6%, and 96.1%, respectively. CONCLUSION: This study has shown that traditional cardiovascular risk factors, such as a smoking and ischemic heart disease, are the most important predictors of early graft failure and patient death following LGB surgery for PAA