scholarly journals Antipsychotic and antidepressant prescribing for 704 297 children and young people with and without intellectual disabilities: record linkage study

2020 ◽  
Vol 218 (1) ◽  
pp. 58-62
Author(s):  
Angela Henderson ◽  
Deborah Kinnear ◽  
Michael Fleming ◽  
Bethany Stanley ◽  
Nicola Greenlaw ◽  
...  
Keyword(s):  
Young People ◽  
Intellectual Disabilities ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Linkage Study ◽  
Children And Young People ◽  
Prescribing Trends ◽  
Antidepressant Use ◽  
The Difference ◽  
Over Time

BackgroundPsychotropics are overprescribed for adults with intellectual disabilities; there are few studies in children and young people.AimsTo investigate antipsychotic and antidepressant prescribing in children and young people with and without intellectual disabilities, and prescribing trends.MethodScotland's annual Pupil Census, which identifies pupils with and without intellectual disabilities, was record-linked to the Prescribing Information System. Antidepressant and antipsychotic data were extracted. Logistic regression was used to analyse prescribing between 2010 and 2013.ResultsOf the 704 297 pupils, 16 142 (2.29%) had a record of intellectual disabilities. Antipsychotic and antidepressant use increased over time, and was higher in older pupils; antipsychotic use was higher in boys, and antidepressant use was higher in girls. Overall, antipsychotics were prescribed to 281 (1.74%) pupils with intellectual disabilities and 802 (0.12%) without (adjusted odds ratio 16.85, 95% CI 15.29–18.56). The higher use among those with intellectual disabilities fell each year (adjusted odds ratio 20.19 in 2010 v. 14.24 in 2013). Overall, 191 (1.18%) pupils with intellectual disabilities and 4561 (0.66%) without were prescribed antidepressants (adjusted odds ratio 2.28, 95% CI 2.03–2.56). The difference decreased each year (adjusted odds ratio 3.10 in 2010 v. 2.02 in 2013).ConclusionsSignificantly more pupils with intellectual disabilities are prescribed antipsychotics and antidepressants than are other pupils. Prescribing overall increased over time, but less so for pupils with intellectual disabilities; either they are not receiving the same treatment advances as other pupils, or possible overprescribing in the past is changing. More longitudinal data are required.

scholarly journals Predictors of emergency department attendance following NHS 111 calls for children and young people: analysis of linked data

2018 ◽  
Author(s):  
Arne Wolters ◽  
Cicely Robinson ◽  
Dougal Hargreaves ◽  
Rebecca Pope ◽  
Ian Maconochie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Young People ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Patient Characteristics ◽  
Health Needs ◽  
Out Of Hours ◽  
Children And Young People ◽  
Emergency Department Attendance ◽  
At Home

ABSTRACTObjectivesTo assess whether clinical input during calls to the NHS 111 telephone-based advice service is associated with lower rates of subsequent emergency department attendance and hospital admission.DesignAlthough NHS 111 largely employs non-clinical call handling staff to triage calls using computerised clinical decision support software, some support is available from clinical supervisors, and additionally some calls are referred to out-of-hours General Practitioners (GP). We used linked data sets to examine GP and secondary care activity following calls to NHS 111, adjusting for the patient characteristics, signs and symptoms recorded during the NHS 111 call.SettingOut-of-hours care in three areas of North West London that have an integrated approach to delivering NHS 111 and out-of-hours GP care.ParticipantsNHS 111 calls for children and young people aged 15 years or under. We excluded calls that were diverted to the emergency (‘999’) service or where patients were advised to go to an emergency department. This left callers who were either referred to a GP or advised to manage their health needs at home.Primary and secondary outcome measuresThe percentage of callers attending any emergency departments, major emergency department, or minor injury unit within ten hours of the NHS 111 call, and the percentage admitted to hospital following visits to emergency departments.ResultsOf the 10,356 callers, 2,898 (28.0%) were advised by NHS 111 to manage their health needs at home, with an appointment with an out-of-hours GP made for the remaining 7,458 (72.0%). 14.9% (432/2,898) of the callers who were advised by NHS 111 to manage their health needs at home attended an emergency department with ten hours, compared with 16% (1,207/7,458) of callers who had an out-of-hours appointment with an out-of-hours GP. After adjusting for patient characteristics, GP out-of-hours appointment was associated with lower rates of emergency department attendance (adjusted odds ratio, 0.86, 95% CI, 0.75-0.99),). When we subset emergency department types, a GP out-of-hours appointment was associated with lower rates of minor injury unit attendance (adjusted odds ratio, 0.32, 95% CI, 0.23 - 0.44) but not major emergency department attendance (adjusted odds ratio 1.06, 95% CI 0.90-1.24). There was no association with hospital admission. Review by an NHS 111 clinical supervisor was associated with fewer emergency department attendances (adjusted OR 0.77, 95% CI, 0.62-0.97).ConclusionsClinical input during or following out-of-hours calls to NHS 111 was associated with lower rates of emergency department utilisation for children and young people, though the reduction may be concentrated in lower intensity care settings. Thus, there may be potential to reduce the use of emergency care by providing access to clinical advice or out-of-hour services in other settings through the NHS 111 telephone service.

scholarly journals Association between Preferred Language and Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children in the United States

2021 ◽  
Author(s):  
William R. Otto ◽  
Robert W. Grundmeier ◽  
Diana Montoya-Williams ◽  
Wanjikũ F. M. Njoroge ◽  
Kate E. Wallis ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
The United States ◽  
Predicted Probability ◽  
Increased Risk ◽  
English Speaking ◽  
The Difference ◽  
Second Wave ◽  
Over Time

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a disproportionate impact on Black, Hispanic, and other individuals of color, although data on the effect of a person’s language on SARS-CoV-2 infection are limited. Considering the barriers suffered by immigrants and non-English-speaking families, we tested whether children with a preferred language other than English was associated with SARS-CoV-2 infection. Children from families with a preferred language other than English had a higher predicted probability of SARS-CoV-2 test positivity (adjusted odds ratio, 3.76; 95% CI, 2.07–6.67) during the first wave of the pandemic. This discrepancy continued into the second wave (adjusted odds ratio, 1.64; 95% CI, 1.10–2.41), although the difference compared with families who prefer to speak English decreased over time. These findings suggest that children from non-English-speaking families are at increased risk of SARS-CoV-2 infection, and efforts to reverse systemic inequities causing this increased risk are needed.

scholarly journals Access and participation: What factors influence the provision and utilisation of health care services by children with learning disabilities?

2017 ◽  
Vol 41 (S1) ◽  
pp. S452-S452
Author(s):  
A. Rebowska
Keyword(s):  
Health Care ◽  
Learning Disabilities ◽  
Young People ◽  
Intellectual Disabilities ◽  
Health Care Services ◽  
Healthcare Services ◽  
Children And Young People ◽  
Care Services ◽  
Healthcare Needs ◽  
Wide Range

AimsThe aim of this literature review is to explore the range of factors that influence the degree of access to health care services by children and young people with learning disabilities.BackgroundChildren with learning disabilities are at increased risk of a wide range of health conditions comparing with their peers. However, recent reports by UK government as well as independent charities working with children and young people with learning disabilities demonstrated that they are at risk of poor health outcomes as a result of barriers preventing them from accessing most appropriate services.MethodsComprehensive searches were conducted in six databases. Articles were also obtained through review of references, a search of the grey literature, and contacting experts in the field. The inclusion criteria were for studies evaluating access to healthcare services, identification and communication of health needs, organisational aspects impacting on access and utilisation, staff attitudes where they impacted on access, barriers, discrimination in patients with intellectual disabilities age 0–18. The literature search identified a sample of 36 papers. The marked heterogeneity of studies excluded conducting a meta-analysis.ResultsBarriers to access included problems with identification of healthcare needs by carers and healthcare professionals, communication difficulties, the inadequacy of facilities, geographical and physical barriers, organisational factors such as inflexible appointment times, attitudes and poor knowledge base of healthcare staff.ConclusionThe factors identified can serve as a guide for managers and clinicians aiming to improve access to their healthcare services for children and young people with intellectual disabilities.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction

2020 ◽  
pp. 1-18
Author(s):  
Elaine Chase ◽  
Jennifer Allsopp
Keyword(s):  
Young People ◽  
Social Care ◽  
Immigration Policies ◽  
Children And Young People ◽  
Unaccompanied Children ◽  
Youth Migration ◽  
The Uk ◽  
The Impact ◽  
Over Time

This introductory chapter provides an overview of youth migration. Youth migration needs to be understood in relation to its negative drivers of persecution, violence, and unsustainable lives in countries of origin, factors that motivated the flights of many young people. But at the same time, there is a need to recognize that such adversity also fuels individual and collective dreams and aspirations for better lives. Without acknowledging this, politicians will struggle to formulate meaningful and workable asylum and immigration policies. The chapter then briefly outlines the differing journeys that young people took in order to arrive in Europe. The chapter explains that the book focuses on how asylum, immigration, and social care procedures are operationalized once unaccompanied children and young people arrive in the UK and Italy, and the impact that these bureaucratic processes have on them over time.

scholarly journals Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage in Cesarean Deliveries: A Retrospective Study of Two Consecutive Periods

2020 ◽  
Vol 10 (03) ◽  
pp. e241-e246
Author(s):  
Pierre Delorme ◽  
Gilles Kayem ◽  
Hélène Legardeur ◽  
Louise Anne Roux-Dessarps ◽  
Guillaume Girard ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Regression Analysis ◽  
Cohort Study ◽  
Postpartum Hemorrhage ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Single Injection ◽  
Single Center ◽  
Cesarean Deliveries ◽  
The Difference

Abstract Objective The aim of the study is to investigate whether carbetocin prevents postpartum hemorrhage (PPH) more effectively than oxytocin Methods This historical retrospective single-center cohort study compares women who underwent cesarean deliveries during two periods. During period A, oxytocin was used as a 10-unit bolus immediately after delivery, with 20 units thereafter infused for 24 hours. During period B, carbetocin in a single 100-µg injection replaced this protocol. The main outcome was PPH, defined as a decline in hemoglobin of more than 2 g/dL after the cesarean. The analysis was performed on the overall population and then stratified by the timing of the cesareans (before or during labor). A logistic regression analysis was performed. Results This study included 1,796 women, 52% of whom had a cesarean before labor; 15% had a PPH. The crude PPH rate was lower in period B than in period A (13 vs. 17%, respectively, odds ratio 0.75, 95% confidence interval [CI]: 0.58–0.98). The difference was no longer significant in the multivariate analysis (adjusted odds ratio: 0.81, 95% CI 0.61–1.06). Results were similar when stratified by the timing of the cesareans (before or during labor). Conclusion Carbetocin is not superior to oxytocin in preventing PPH. However, it does provide the advantage of requiring a single injection.

scholarly journals Qualitative study: patients’ and parents’ views on brain tumour MRIs

2019 ◽  
pp. archdischild-2019-317306 ◽  
Author(s):  
Natalie Tyldesley-Marshall ◽  
Sheila Greenfield ◽  
Susan Neilson ◽  
Martin English ◽  
Jenny Adamski ◽  
...  
Keyword(s):  
Young People ◽  
Brain Tumour ◽  
No Value ◽  
Brain Tumours ◽  
Emotional Responses ◽  
Working Relationships ◽  
Structured Interviews ◽  
Children And Young People ◽  
Parent Preferences ◽  
Over Time

BackgroundMRI is essential to the clinical management of children and young people with brain tumours. Advances in technology have made images more complicated to interpret, yet more easily available digitally. It is common practice to show these to patients and families, but how they emotionally respond to, understand and value, seeing brain tumour MRIs has not been formally studied.MethodsQualitative semi-structured interviews were undertaken with 14 families (8 patients, 15 parents) purposively sampled from paediatric patients (0 to 18 years) attending a large UK children’s hospital for treatment or monitoring of a brain tumour. Transcripts were analysed thematically using the Framework Method.ResultsFour themes were identified: Receiving results (waiting for results, getting results back, preferences to see images), Emotional responses to MRIs, Understanding of images (what they can show, what they cannot show, confusion) and Value of MRIs (aesthetics, aiding understanding, contextualised knowledge/emotional benefits, enhanced control, enhanced working relationships, no value). All families found value in seeing MRIs, including reassurance, hope, improved understanding and enhanced feeling of control over the condition. However emotional responses varied enormously.ConclusionsClinical teams should always explain MRIs after ‘framing’ the information. This should minimise participant confusion around meaning, periodically evident even after many years. Patient and parent preferences for being shown MRIs varied, and often changed over time, therefore clinicians should identify, record and update these preferences. Time between scanning and receiving the result was stressful causing ‘scanxiety’, but most prioritised accuracy over speed of receiving results.

scholarly journals Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 203-212
Author(s):  
Tomoyuki Ohara ◽  
Bijoy K. Menon ◽  
Fahad S. Al-Ajlan ◽  
MacKenzie Horn ◽  
Mohamed Najm ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Intravenous Alteplase ◽  
Over Time

Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.

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