Poverty, Opportunity, and Well-Being in the United States

Economic opportunity varies dramatically across the United States. In this study the Opportunity to Flourish Index (OFI) is created to determine the level of opportunity United States cities afford those at the bottom of the income distribution. Indicators within the index measure disposable income, access to financial services, diet, educational attainment, unemployment, physical well-being, and family structure. The OFI’s relationship with standard measures of economic growth and economic mobility is also evaluated. The OFI is not correlated with measures of income and population growth, suggesting, that in the short-run growth and opportunity are not necessarily complementary. The OFI is strongly correlated with intergenerational economic mobility. Individuals that live in cities which have higher levels of opportunity are more likely to have children that move up the income distribution. The OFI provides stakeholders in poverty alleviation a means to evaluate and promote equality of opportunity in United States cities

Picture books and critical literacy:using multimodal interaction analysis to examine children’s engagements with a picture book about war and child refugees

In this paper, we explore how a group of 10 and 11-year-old primary school children engage with a picture book about a refugee boy from Somalia. As we examine in some detail a video-recording of the children’s discussion, we suggest that the children’s emotional engagement with the story was pivotal to not only their making sense of the book but to their critical discussion of the issues the story raised. The discussion we report on here was part of a wider project to examine the use of picture books for critical literacy in schools. Critical literacy is often discussed as a rational endeavour, where children are invited to ask analytical questions about the message a text seeks to communicate and the means by which this is achieved. Following others, for example Anwarrudin (2016), who have challenged this focus on rationalism, we explore the role of emotions in our session. Our data shows that the children’s critical-analytical discussions of the story were closely connected with their emotional engagement. We use Norris’(2004) multimodal interaction analysis to examine the children’s emotional and embodied engagement with the book and its story. This analysis of the children’s words, gestures, posture, gaze and voice quality reveals the complexity of their reactions to the book and specifically the role of ‘emotional collisions’ (Kuby 2012, p. 35) in provoking embodied and affective reactions but also intellectual curiosity and ‘critical engagement’ (Johnson and Vasudevan 2012, p. 35). With regards to the role of picture books in critical literacy pedagogy, our paper offers teachers new insights into what processes of thinking, feeling and communicating they can expect to be part of critical literacy lessons

Investigating the association between opioid analgesics and the risk of bone fracture

Background Opioids have been increasingly prescribed to people with pain; despite limited evidence to support their effectiveness and safety in the long-term. Opioids may increase the risk of bone fracture due to effects on the central nervous system (CNS) and on bone mineral density (BMD). The aim of this research was to examine the utilisation of opioids in the UK and to explore the relationship between opioids and fractures. Methods A systematic review was conducted to identify observational studies relating to opioids and fractures. Methodological approaches were appraised, and pooled risk estimates were synthesised by meta-analysis. People prescribed opioids were identified in the Clinical Practice Research Datalink (CPRD) and opioid prescription records were prepared to generate a time-varying measure of opioid exposure and dose. A repeat cross-sectional study and a retrospective cohort study of people prescribed opioids was conducted to describe population- and patient-level trends in opioid utilisation. Fracture events among new users of opioids were identified in the CPRD and Hospital Episode Statistics (HES) databases to estimate the incidence rate of fractures. Finally, a self-controlled case series (SCCS) study was conducted to compare the incidence of fractures during opioid exposure and non-exposure; assessing the effects of opioid duration and dose. Results Prior opioid-fracture association studies A total of 26 studies were included in the systematic review; these varied by study design, population, exposure definitions and potential for confounding. Of these, 21 studies that compared opioid use to non-use were meta-analysed; pooled hazard ratios (HRs) showed that opioids significantly increased the risk of fracture (pooled HR: 1.39; 95% confidence interval (CI): 1.20, 1.62). Trends in opioid utilisation 1,790,046 people registered in the CPRD were prescribed opioids between 2008 and 2017. The proportion of CPRD registrants prescribed opioids increased from 14.5% to 15.9%, and the proportion of strong opioid users doubled from 3.0% to 6.6%. In 2008, strong opioid users were prescribed a median oral morphine equivalent (OMEQ) dose of 60mg/day for a median duration of 155 days, whereas weak opioid users were prescribed 18mg/day for 30 days. Of 957,664 new opioid users, most (97.5%) were initiated on weak opioids and were prescribed opioids for short durations; half discontinued opioids within 16 days. A small proportion (4.1%) of people were persistent users within one year of initiation. Fracture incidence in people prescribed opioids Of 539,369 new opioid users who had linkage to the HES database, 67,622 sustained ≥1 fracture. The overall rate of fracture in the cohort was 218 per 10,000 person-years; double that of the general UK population. Risk of fracture during opioid use 67,622 people with fractures were included in the SCCS study. Opioid use was associated with a significant increase in the risk of fracture compared to non-exposure (incidence rate ratio (IRR): 3.9; 95%CI: 3.8, 4.0). The risk of fracture was greatest in the first week of use (IRR: 7.8; 95%CI: 7.4, 8.3) and declined with increasing duration of use. Re-starting opioids increased the risk of fracture and fracture-risk was greater when the OMEQ dose was ≥50mg/day compared to when the OMEQ dose was <50mg/day. Conclusions Opioid prescribing has increased in the UK, and a greater proportion of people were prescribed strong opioids. Although most people are prescribed weak opioids for short durations, they remain at an increased risk of fracture; the risk is greatest during the first week of use. This research complements existing evidence to suggest a causal association between opioids and fracture. Policy makers and healthcare providers need to be aware of the potential for opioids to increase the risk of fracture, particularly at initiation

Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 COVID-19 pandemic

Objectives: To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods: We conducted a cohort study in Hospital Episode Statistics for England from 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results: We included 168 691 people with a recorded diagnosis of RAIRD alive on 1 March 2020. Their median age was 61.7 (IQR 41.5-75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. A total of 1815 (1.1%) participants died during March and April 2020. The age-standardized mortality rate (ASMR) among people with RAIRD (3669.3; 95% CI: 3500.4, 3838.1 per 100 000 person-years) was 1.44 (95% CI: 1.42, 1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion: The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to health-care services

Validation of methods to identify people with idiopathic inflammatory myopathies using hospital episode statistics

ObjectiveHospital episode statistics (HES) are routinely recorded at every hospital admission within the National Health Service (NHS) in England. This study validates diagnostic ICD-10 codes within HES as a method of identifying cases of idiopathic inflammatory myopathies (IIMs).MethodsAll inpatient admissions at one NHS Trust between 2010 and 2020 with relevant diagnostic ICD-10 codes were extracted from HES. Hospital databases were used to identify all outpatients with IIM, and electronic care records were reviewed to confirm coding accuracy. Total hospital admissions were calculated from NHS Digital reports. The sensitivity and specificity of each code and code combinations were calculated to develop an optimal algorithm. The optimal algorithm was tested in a sample of admissions at another NHS Trust.ResultsOf the 672 individuals identified by HES, 510 were confirmed to have IIM. Overall, the positive predictive value (PPV) was 76% and sensitivity 89%. Combination algorithms achieved PPVs between 89 and 94%. HES can also predict the presence of IIM-associated interstitial lung disease (ILD) with a PPV of 79% and sensitivity of 71%. The optimal algorithm excluded children (except JDM code M33.0), combined M33.0, M33.1, M33.9, M36.0, G72.4, M60.8 and M33.2, and included M60.9 only if it occurred alongside an ILD code (J84.1, J84.9 or J99.1). This produced a PPV of 88.9% and sensitivity of 84.2%. Retesting this algorithm at another NHS Trust confirmed a high PPV (94.4%).ConclusionIIM ICD-10 code combinations in HES have high PPVs and sensitivities. Algorithms tested in this study could be applied across all NHS Trusts to enable robust and cost-effective whole-population research into the epidemiology of IIM

The incidence of Kawasaki disease using hospital admissions data for England 2006-2021

To describe the incidence of Kawasaki Disease (kDa) between 2006 and 2021 in England. We identified all cases in hospital episode statistics with an ICD-10 diagnostic code M303 (for kDa) between 1 April 2006 - 31 March 2021. We validated 83 diagnoses using hospital medical records and found >97% accuracy. We calculated incidence rate ratios (IRRs) using Poisson regression and assessed the influence of age, sex, ethnicity, and index of multiple deprivation (IMD). We used Office for National Statistics population estimates for England as the denominator. We identified a total of 5908 cases of kDa in all children under the age of 16 (mean age 3.8, SD = 3.2, 95% CI: 3.7-3.9). Incidence in children aged <5 years was 8.9 (95% CI: 8.6-9.2)/100 000 person-years; in children aged 5-9, 2.4 (95% CI: 2.3-2.6)/100 000 person-years; and in children aged 10-15, 0.6 (95% CI: 0.6-0.7). Male: female ratio was 1.5:1. Incidence was higher among non-White than White ethnicities (adjusted IRR 2.1 (2.0-2.2) for Asian, 3.0 (2.8-3.3) for Black and 4.5 (4.2-4.8) for other ethnicities). The incidence increased with socioeconomic deprivation; the adjusted IRR of the least deprived IMD quintile compared with the most deprived quintile was 0.81 (0.77-0.84). Incidence rates of kDa derived from hospital admission data in England were higher than in studies relying on clinician reporting. We confirm previous findings on the influence of sex, and ethnicity on kDa incidence and observe that there was a higher incidence of kDa within more deprived socioeconomic groups

Sarcoptic mange: An emerging panzootic in wildlife

Sarcoptic mange, a skin infestation caused by the mite Sarcoptes scabiei, is an emerging disease for some species of wildlife, potentially jeopardizing their welfare and conservation. Sarcoptes scabiei has a near-global distribution facilitated by its forms of transmission and use of a large diversity of host species (many of those with broad geographic distribution). In this review, we synthesize the current knowledge concerning the geographic and host taxonomic distribution of mange in wildlife, the epidemiological connections between species, and the potential threat of sarcoptic mange for wildlife conservation. Recent sarcoptic mange outbreaks in wildlife appear to demonstrate ongoing geographic spread, increase in the number of hosts and increased virulence. Sarcoptic mange has been reported in at least 12 orders, 39 families and 148 species of domestic and wild mammals, making it one of the most generalist ectoparasites of mammals. Taxonomically, the orders with most species found infested so far include Perissodactyla (67% species from the entire order), Artiodactyla (47%), and Diprotodontia (67% from this order). This suggests that new species from these mammal orders are likely to suffer cross-species transmission and be reported positive to sarcoptic mange as surveillance improves. We propose a new agenda for the study of sarcoptic mange in wildlife, including the study of the global phylogeography of S. scabiei, linkages between ecological host traits and sarcoptic mange susceptibility, immunology of individuals and species, development of control strategies in wildlife outbreaks and the effects of global environmental change in the sarcoptic mange system. The ongoing transmission globally and sustained spread among areas and wildlife species make sarcoptic mange an emerging panzootic in wildlife. A better understanding of sarcoptic mange could illuminate the aspects of ecological and evolutionary drivers in cross-species transmission for many emerging diseases.This research was supported by the Australian Research Council Linkage Program (LP180101251) to Scott Carver. Luis Escobar was supported by the Global Change Center and the Center for Emerging, Zoonotic, and Arthropod-borne Pathogens at Virginia Tech. Any use of trade, firm or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government.Peer reviewe

Mental health literacy practices: an exploration of how students with mental health conditions use literacy to navigate support systems, manage their mental health, and engage with being a student.

As mental health is a growing concern in universities and beyond, mental health literacy has become a focus of interest for researchers. Addressing gaps in the current dominant conceptualisations, a social practice approach to mental health literacy is proposed in this thesis, based on previous social practice theories of literacy and health literacy. In combination with an innovative methodology, where remote video-calling interviews were used with 11 student participants with mental health conditions at one university over the course of an academic year, this approach to mental health literacy facilitated the capture of individual students’ complex and nuanced real experiences. From these experiences, detailed accounts are presented of the ways that the students managed their mental health, navigated support systems, and engaged with being a student through their mental health literacy practices. The study shows that mental health literacy practices play a role in how the students obtained institutional recognition of their mental health condition, how they accessed support and treatment, their experiences in participating in that support or treatment and how they cared for and managed their own mental health. The students’ accounts highlight the complexity in the relationship between mental health, literacy, and assessment. These accounts further show the important role of the specific institutional contexts, which often position the students as relatively powerless whilst expecting them to be responsible and active in managing their mental health and support. Mental health literacy practices are also shown to involve emotions and to have a link with identity, with literacy and texts mediating many of the actions involved with managing mental health and navigating support systems. The study contributes to a deeper understanding of the situated practice nature of mental health literacy and how students use such practices to successfully cope with their mental health condition