Diverse early-life family trajectories and young children's mental health in the UK

Authors gratefully acknowledge funding from the Economic and Social Research Council (ESRC); grant number 2460061.Past research suggests that children from two-parent married families fare better than children from other families on many outcomes. Only fragmented evidence on diverse family trajectories in association with child mental health is available. Using multi-channel sequence analysis and data from the UK Household Longitudinal Study, we jointly capture maternal partnership trajectories and type of father co-residence between birth and age 5. We then assess the association between these family trajectories and child mental health at age 5 and 8 using random effects regression. Children whose trajectories include the entrance of a non-biological father or parental separation have the lowest levels of mental health. However, children of never partnered mothers and those who repartner with the biological father have comparable mental health to children of stably married biological parents. Thus, not all types of family complexity or instability appear to be equally detrimental to children’s mental health.Peer reviewe

Implementation of a Nurse-Led Family Centered Engagement Intervention for Caregivers of Extremely Premature Infants in the Neonatal Intensive Care Unit

Objective: The objective of this feasibility study was to examine the implementation and usefulness of an intervention for extremely premature infant (EPI) caregivers. Results: One caregiver and five nurses provided feedback with a mean score of 4.4 out of 5 pertaining to helpfulness. Conclusions: Implementation of the Caregiver’s Guide was feasible and was positively received by NICU nurses and caregivers. We recommend implementing a revised version of this tool based on nurse and caregiver feedback. The delivery of education should be divided between dayshift and nightshift nurses so that one nurse is not responsible for providing all the information. The education should be categorized by gestational age and day of life and only given when it is pertinent to the care of the child. A section should be added to include a quick reference guide for the medical jargon used in the NICU

Customising Best Practice In Studies Advice For Undergraduate Engineering Students

The attrition rates from undergraduate engineering programmes in the UK remains stubbornly high, despite the best efforts of course teams to engage and support students on their learning journeys. It is generally accepted that there is no single reason for attrition rates from engineering programmes being higher than from other vocational-type university programmes, but many academics believe that an effective Studies Advice system that works for students and staff, could lead to reduced numbers of disengaging and/or failing students. Much has been written on effective approaches to the provision of Studies Advice at University, but it is not clear if the implementation of discipline specific approaches would yield better outcomes. This practice paper describes work that is currently underway at Ulster University to examine engineering students’ perspectives on the Studies Advice approach and to explore how best practice in the university sector might be effectively customised for engineering students. The work describes an initial scoping study, a co-creation exercise with students to establish their baseline understanding of the current system and their ‘wish-list’, and a follow-up focus group session where a number of discipline-specific interventions were explored. Preliminary findings indicate that professional support departments could be more effectively integrated with academic support to provide a wrap-around or ‘single contact point’ for Studies Advice, that formal organised studies advice sessions should be explicit on programme schedules and that an informal ‘buddy or mentor’ student-to-student support system would be beneficial in addressing the UK engineering student attrition issue

Customising Best Practice In Studies Advice For Undergraduate Engineering Students

The attrition rates from undergraduate engineering programmes in the UK remains stubbornly high, despite the best efforts of course teams to engage and support students on their learning journeys. It is generally accepted that there is no single reason for attrition rates from engineering programmes being higher than from other vocational-type university programmes, but many academics believe that an effective Studies Advice system that works for students and staff, could lead to reduced numbers of disengaging and/or failing students. Much has been written on effective approaches to the provision of Studies Advice at University, but it is not clear if the implementation of discipline specific approaches would yield better outcomes. This practice paper describes work that is currently underway at Ulster University to examine engineering students’ perspectives on the Studies Advice approach and to explore how best practice in the university sector might be effectively customised for engineering students. The work describes an initial scoping study, a co-creation exercise with students to establish their baseline understanding of the current system and their ‘wish-list’, and a follow-up focus group session where a number of discipline-specific interventions were explored. Preliminary findings indicate that professional support departments could be more effectively integrated with academic support to provide a wrap-around or ‘single contact point’ for Studies Advice, that formal organised studies advice sessions should be explicit on programme schedules and that an informal ‘buddy or mentor’ student-to-student support system would be beneficial in addressing the UK engineering student attrition issue

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation