Scotland Research Research Articles

Creating a longitudinal dataset of care experienced children in Scotland – Administrative Data Research Scotland.

To create a dataset which describes the care experience of children in Scotland data. To share with analysts in a safe setting to allow linkage, and provide information on the strengths and weaknesses. To gather feedback on its use to inform future collections and improve experience of future users. The dataset was created by combining 11 years of data provided to Scottish Government by local authorities. The resulting longitudinal dataset includes details of the children, the periods of care including the type of care setting, along with the legal basis for this care, and information on the destination of the child following care. Detailed information about the dataset is provided along with a background document in how the dataset was constructed. Data quality flags are provided to highlight situations where there may be inconsistences, and code is shared to create a cleaned dataset for analysis. A longitudinal dataset has been created covering the period 2009 to 2019. This covers almost 60,000 children with details of the care setting and legal basis. The dataset has been indexed to a population spine, which enables it to be linked to other data. Additional derived variables have been added, and improvements made to data quality where possible. In other situations data quality is highlighted with guidance provided on how to deal with these issues. The results have been shared extensively with the data providers, and previous users providing valuable input. This has resulted in improved understanding of the data, and informed the practice of gathering data in future years, and plans for official statistics on health outcomes of care experienced children. This project has created an enduring resource which will improve evidence for policy making by allowing analysis to consider patterns of care experience and link it to outcomes. This is particularly relevant given a review of care experience in Scotland, and the commitment by Scottish Government to keep the Promise.

Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise—CISCO-21

BackgroundCoronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection.MethodsA two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID.Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea.DiscussionEthical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals.Trial registrationClinicialTrials.gov NCT04900961. Prospectively registered on 25 May 2021

Premature mortality in people affected by co-occurring homelessness, justice involvement, opioid dependence, and psychosis: a retrospective cohort study using linked administrative data

SummaryBackgroundHomelessness, opioid dependence, justice involvement, and psychosis are each associated with an increased risk of poor health and commonly co-occur in the same individuals. Most existing studies of mortality associated with this co-occurrence rely on active follow-up methods prone to selection and retention bias, and focus on a limited set of specific exposures rather than taking a population-based approach. To address these limitations, we did a retrospective cohort study using linked administrative data.MethodsIn this retrospective cohort study, we linked a population register of adults resident in Glasgow, UK, to administrative datasets from homelessness and criminal justice services; community pharmacies; and a clinical psychosis registry with data from April 1, 2010 to March 31, 2014. Linkage to death registrations from April 1, 2014 to March 31, 2019 provided follow-up data on premature mortality (age <75 years) from all causes, non-communicable diseases, and causes considered potentially avoidable through health-care or public health intervention. We estimated hazard ratios (HR) using Poisson regression, adjusting for age, gender, socioeconomic deprivation, and calendar time.FindingsOf 536 653 cohort members, 11 484 (2·1%) died during follow-up. All-cause premature mortality was significantly higher among people with multiple exposures than among people with single exposures, and among people with any exposure than among people with none (eg, homelessness plus other exposures vs no exposures: HR 8·4 [95% CI 7·3–9·5]; homelessness alone vs no exposures: HR 2·2 [1·9–2·5]). Avoidable premature mortality was highest among those with multiple exposures (eg, imprisonment plus other exposures vs no exposures: HR 10·5 [9·1–12·3]; imprisonment alone vs no exposures: HR 3·8 [3·0–4·8]). Premature mortality from non-communicable disease was higher among those with any exposures than among those with none, despite accounting for a lower proportion of deaths in the exposed group; although in some cases there was little difference between estimates for single versus multiple exposures.InterpretationThe co-occurrence of at least two of homelessness, opioid dependence, justice involvement, or psychosis is associated with very high rates of premature mortality, particularly from avoidable causes of death, including non-communicable disease. Responding to these findings demands wide-ranging efforts across health-care provision, public health, and social policy. Future work should examine the timing and sequencing of exposures to better understand the causal pathways underlying excess mortality.FundingChief Scientist Office, Medical Research Council, NHS Research Scotland.

Motor Neuron Disease Systematic Multi-Arm Adaptive Randomised Trial (MND-SMART): a multi-arm, multi-stage, adaptive, platform, phase III randomised, double-blind, placebo-controlled trial of repurposed drugs in motor neuron disease

IntroductionMotor neuron disease (MND) is a rapidly fatal neurodegenerative disease. Despite decades of research and clinical trials there remains no cure and only one globally approved drug, riluzole, which prolongs...

Evaluation of two electronic-rehabilitation programmes for persistent knee pain: protocol for a randomised feasibility trial

IntroductionPersistent, knee pain is a common cause of disability. Education and exercise treatment are advocated in all clinical guidelines; however, the increasing prevalence of persistent knee pain presents challenges for...

Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-Pall): a qualitative interview study protocol

IntroductionMore people are living with multimorbidity, defined as two or more long-term physical or mental health conditions. Multimorbidity is associated with poor quality of life and high treatment burden. Palliative...

Designing and evaluating a patient decision aid for patients with locally advanced or locally recurrent rectal cancer: a national multicentre mixed methods study protocol

IntroductionApproximately 5%–10% of new rectal cancers are locally advanced (locally advanced rectal cancer (LARC)) at presentation with 4%–8% recurring (locally recurrent rectal cancer (LRRC)) after initial treatment. Patients with potentially...

Rationale and Design for the LOnger-term effects of SARS-CoV-2 INfection on blood Vessels And blood pRessure (LOCHINVAR): an observational phenotyping study

IntroductionCOVID-19 may lead to long-term endothelial consequences including hypertension, stroke and myocardial infarction. A pilot study ‘COVID-19 blood pressure endothelium interaction study’, which found that patients with normal blood pressure...

Longitudinal variation in SARS-CoV-2 antibody levels and emergence of viral variants: a serological analysis

BackgroundSerological assays are being used to monitor antibody responses in individuals who had SARS-CoV-2 infection and those who received a COVID-19 vaccine. We aimed to determine whether such assays can predict neutralising antibody titres as antibody levels wane and viral variants emerge.MethodsWe measured antibody levels in serum samples from a cohort of 112 participants with SARS-CoV-2 infection using ten high-throughput serological tests and functional neutralisation assays. Serum samples were taken at baseline and at up to four subsequent visits. We assessed the effects of time and spike protein sequence variation on the performance and predictive value of the various assays. We did correlation analyses for individual timepoints using non-parametric Spearman correlation, and differences between timepoints were determined by use of a two-tailed Wilcoxon matched-pairs signed rank test.FindingsNeutralising antibody titres decreased over the first few months post-infection but stabilised thereafter, at about 30% of the level observed shortly after infection. Serological assays commonly used to measure antibodies against SARS-CoV-2 displayed a range of sensitivities that declined to varying extents over time. Quantitative measurements generated by serological assays based on the spike protein were better at predicting neutralising antibody titres than those based on nucleocapsid, but performance was variable, and manufacturer positivity thresholds were not able to predict the presence or absence of detectable neutralising activity. Although we observed some deterioration in correlation between serological measurements and functional neutralisation activity, some assays maintained an ability to predict neutralising titres, even against variants of concern.InterpretationThe ability of high-throughput serological assays to predict neutralising antibody titres is likely to be crucial for evaluation of immunity at the population scale. These data can facilitate the selection of the most suitable assays as surrogates of functional neutralising activity and suggest that such measurements might be useful in clinical practice.FundingUS National Institutes of Health and National Health Service Research Scotland BioResource.

Association of gamma-glutamyltransferase levels with total mortality, liver-related and cardiovascular outcomes: A prospective cohort study in the UK Biobank

SummaryBackgroundGamma-glutamyltransferase (GGT) levels in the blood can be a sensitive marker of liver injury but the extent to which they give insight into risk across multiple outcomes in a clinically useful way remains uncertain.MethodsUsing data from 293,667 UK Biobank participants, the relationship of GGT concentrations to self-reported alcohol intake and adiposity markers were investigated. We next investigated whether GGT predicted liver-related, cardiovascular (CV) or all-cause mortality, and potentially improved CV risk prediction.FindingsHigher alcohol intake and greater waist circumference (WC) were associated with higher GGT; the association was stronger for alcohol with evidence of a synergistic effect of WC. Higher GGT concentrations were associated with multiple outcomes. Compared to a GGT of 14.5 U/L (lowest decile), values of 48 U/L for women and 60 U/L for men (common upper limits of ‘normal’) had hazard ratios (HRs) for liver-related mortality of 1.83 (95% CI 1.60–2.11) and 3.25 (95% CI 2.38–4.42) respectively, for CV mortality of 1.21 (95% CI 1.14–1.28) and 1.43 (95% CI 1.27–1.60) and for all-cause mortality of 1.15 (95% CI 1.12–1.18) and 1.31 (95% CI 1.24–1.38). Adding GGT to a risk algorithm for CV mortality reclassified an additional 1.24% (95% CI 0.14–2.34) of participants across a binary 5% 10-year risk threshold.InterpretationOur study suggests that a modest elevation in GGT levels should trigger a discussion with the individual to review diet and lifestyle including alcohol intake and consideration of formal liver disease and CV risk assessment if not previously done.FundingBritish Heart Foundation Centre of Research Excellence Grant (grant number RE/18/6/34217), NHS Research Scotland (grant number SCAF/15/02), the Medical Research Council (grant number MC_UU_00022/2); and the Scottish Government Chief Scientist Office (grant number SPHSU17).

Multicentre, randomised controlled feasibility study to compare a 10-week physiotherapy programme using an interactive exercise training device to improve walking and balance, to usual care of children with cerebral palsy aged 4–18 years: the ACCEPT study protocol

IntroductionChildren with cerebral palsy (CP) frequently undertake physiotherapy programmes to improve walking and balance. They often require adult support to exercise in a functional position. A novel interactive exercise trainer...

Seen and Heard: The Long-Term Impact of Arts Projects on Young People Living in Poverty

This article presents unique findings from research in Scotland of the long-term impact of arts projects on young people living in poverty. Through the support of creative skilled practitioners sensitive to their challenges, these initiatives provided spaces of inspiration for young people to feel seen and heard, and their area not completely forgotten. Crucially, this promoted bridging social capital or access to opportunities outside of their local environment. The young people, reflecting more than five years on from their engagement, reported that it had increased their wellbeing, confidence, hopes for the future, reduced isolation, and for some, had opened up career pathways, thus mediating against some of the effects of poverty. In an increasingly challenging funding environment and uncertain times, it is vital that the impact of the arts is understood in policy contexts, and these are accessible to young people, from all walks of life as a right.

Combining low-frequency oscillometry and spirometry measurements in relation to asthma control and exacerbations in moderate-to-severe asthma

Combining low-frequency oscillometry and spirometry measurements in relation to asthma control and exacerbations in moderate-to-severe asthma

DEPEND study protocol: early detection of patients with pancreatic cancer – a pilot study to evaluate the utility of faecal elastase-1 and 13C-mixed triglyceride breath test as screening tools in high-risk individuals

IntroductionPancreatic cancer (PC) is the fifth leading cause of cancer-related death in the UK. The incidence of PC is increasing, with little or no improvement in overall survival and the...

Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

IntroductionA growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant variation in its implementation in community stroke care...

ACCEPTANCE: protocol for a feasibility study of a multicomponent physical activity intervention following treatment for cervical cancer

IntroductionCervical cancer treatment can have life changing sequelae and be associated with poor short-term and long-term quality of life. Physical activity (PA; that is, bodily movement) is known to improve...

Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study protocol : a randomised controlled trial comparing primary unassisted patency at 1 year of primary arteriovenous fistulae created under regional compared to local anaesthesia

IntroductionArteriovenous fistulae (AVF) are the ‘gold standard’ vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre studies have demonstrated better early...

Evaluating Diuretics in Normal Care (EVIDENCE): protocol of a cluster randomised controlled equivalence trial of prescribing policy to compare the effectiveness of thiazide-type diuretics in hypertension

IntroductionHealthcare systems must use treatments that are effective and safe. Regulators licensed many currently used older medications before introducing the stringent evidential requirements imposed on modern treatments. Also, there has been little encouragement to carry out within-class, head-to-head comparisons of licensed medicines. For commonly prescribed drugs, even small differences in effectiveness or safety could have significant public health implications. However, conventional clinical trials that randomise individual subjects are costly and unwieldy. Such trials are also often criticised as having low external validity. We describe an approach to rapidly generate externally valid evidence of comparative safety and effectiveness using the example of two widely used diuretics for the management of hypertension.Methods and analysisThe EVIDENCE (Evaluating Diuretics in Normal Care) study has a prospective, cluster-randomised, open-label, blinded end-point design. By randomising prescribing policy in primary care practices, the study compares the safety and effectiveness of commonly used diuretics in treating hypertension. Participating practices are randomised 1:1 to a policy of prescribing either indapamide or bendroflumethiazide when clinically indicated. Suitable patients who are not already taking the policy diuretic are switched accordingly. All patients taking the study medications are written to explaining the rationale for changing the prescribing policy and notifying them they can opt-out of any switch. The prescribing policies’ effectiveness and safety will be compared using rates of major adverse cardiovascular events (hospitalisation with myocardial infarction, heart failure or stroke or cardiovascular death), routinely collected in national healthcare administrative datasets. The study will seek to recruit 250 practices to provide a study population of approximately 50,000 individuals with a mean follow-up time of two years. A primary intention-to-treat time-to-event analysis will be used to estimate the relative effect of the two policies.Ethics and disseminationEVIDENCE has been approved by the East of Scotland Research Ethics Service (17/ES/0016, current approved protocol version 5, 26 August 2021). The results will be disseminated widely in peer reviewed journals, guideline committees, National Health Service (NHS) organisations and patient groups.Trial registrationISRCTN46635087. Registered on 11 August 2017 (pre-recruitment).

Correction to: ‘Networks of reliable reputations and cooperation: a review’

Open AccessMoreSectionsView PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditEmail Cite this article Takács Károly, Gross Jörg, Testori Martina, Letina Srebrenka, Kenny Adam R., Power Eleanor A. and Wittek Rafael P. M. 2022Correction to: ‘Networks of reliable reputations and cooperation: a review’Phil. Trans. R. Soc. B3772021046720210467http://doi.org/10.1098/rstb.2021.0467SectionOpen AccessCorrectionsCorrection to: ‘Networks of reliable reputations and cooperation: a review’ Károly Takács Károly Takács Google Scholar Find this author on PubMed Search for more papers by this author , Jörg Gross Jörg Gross Google Scholar Find this author on PubMed Search for more papers by this author , Martina Testori Martina Testori Google Scholar Find this author on PubMed Search for more papers by this author , Srebrenka Letina Srebrenka Letina Google Scholar Find this author on PubMed Search for more papers by this author , Adam R. Kenny Adam R. Kenny Google Scholar Find this author on PubMed Search for more papers by this author , Eleanor A. Power Eleanor A. Power Google Scholar Find this author on PubMed Search for more papers by this author and Rafael P. M. Wittek Rafael P. M. Wittek Google Scholar Find this author on PubMed Search for more papers by this author Károly Takács Károly Takács Google Scholar Find this author on PubMed Search for more papers by this author , Jörg Gross Jörg Gross Google Scholar Find this author on PubMed Search for more papers by this author , Martina Testori Martina Testori Google Scholar Find this author on PubMed Search for more papers by this author , Srebrenka Letina Srebrenka Letina Google Scholar Find this author on PubMed Search for more papers by this author , Adam R. Kenny Adam R. Kenny Google Scholar Find this author on PubMed Search for more papers by this author , Eleanor A. Power Eleanor A. Power Google Scholar Find this author on PubMed Search for more papers by this author and Rafael P. M. Wittek Rafael P. M. Wittek Google Scholar Find this author on PubMed Search for more papers by this author Published:15 November 2021https://doi.org/10.1098/rstb.2021.0467This article corrects the followingReview ArticleNetworks of reliable reputations and cooperation: a reviewhttps://doi.org/10.1098/rstb.2020.0297 Károly Takács, Jörg Gross, Martina Testori, Srebrenka Letina, Adam R. Kenny, Eleanor A. Power and Rafael P. M. Wittek volume 376issue 1838journalTitle Philosophical Transactions of the Royal Society B: Biological Sciences04 October 2021Phil. Trans. R. Soc. B376, 20200297. (Published 4 October 2021). (doi:10.1098/rstb.2020.0297)Funding information for one author was omitted from the funding statement.S.L. is part of the relationship programme supported by The Medical Research Council and Scotland's Chief Scientist Office (grant no. MC_UU_00022/3) and with CSO funding of the Relationships programme (grant no. SPHSU18).This has been updated on the publisher's website. Previous Article FiguresRelatedReferencesDetailsRelated articlesNetworks of reliable reputations and cooperation: a review04 October 2021Philosophical Transactions of the Royal Society B: Biological Sciences This Issue03 January 2022Volume 377Issue 1841Theme issue ‘Voice modulation: from origin and mechanism to social impact (Part II)’ compiled and edited by Juan David Leongómez, Katarzyna Pisanski, David Reby, Disa Sauter, Nadine Lavan, Marcus Perlman and Jaroslava Varella Valentova Article InformationDOI:https://doi.org/10.1098/rstb.2021.0467PubMed:34775829Published by:Royal SocietyPrint ISSN:0962-8436Online ISSN:1471-2970History: Published online15/11/2021Published in print03/01/2022 License:© 2021 The Authors.Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited. Citations and impact PDF Download Subjectsbehaviour

Facilitating hospital discharge through housing support: a mixed-methods evaluation of a housing association support service in two UK hospitals

BackgroundAppropriate transfer of care from the hospital to the home is vital for improved patient outcomes, but evidence on the effect of housing-based interventions developed to facilitate timely hospital discharge is scarce. We aimed to explore the effect of a housing support coordinator on service users' health and housing outcomes, hospital costs, and hospital discharge processes. MethodsWe did a mixed-methods process evaluation of a housing association service aimed at improving hospital discharge in two hospitals in Yorkshire, UK, from Nov 26, 2020, to Dec 31, 2021. Patients for whom suitable housing was anticipated to be a barrier to timely discharge were referred to the housing service by health-care professionals while in hospital. We undertook interviews with service users and hospital and housing staff, administered a questionnaire to all eligible service users, conducted a secondary analysis of routine data (information on demographics, housing issues, support provided, and housing outcomes collected between April 1, 2018, and May 31, 2021), and did an economic evaluation to assess costs. Service users completed questionnaires at the start and after finishing the service. Questionnaires were also sent to all services users already discharged from the service. Interviewees were recruited via telephone and email. We did a thematic analysis using NVivo 10 software to assess interviews and survey data and statistical analysis for routinely collected data and questionnaire data using SPSS-27. We also did a before-and-after study to compare economic costs. We used a following-the-thread technique to integrate the different methods. Informed consent (both written and verbal, depending on the mode of data collection) was obtained from participants. Ethical approval for this project was granted by North of Scotland Research Ethics committee and the Health Research Authority (REC reference: 20/NS/0050). Findings489 people were supported by the service the majority of whom were male (321 [66%]). Five service users, seven hospital staff, and four housing staff completed interviews, and 31 service users completed a questionnaire (14 prospectively and 17 retrospectively). Service users faced different housing barriers: 136 (28%) of 481 experienced homelessness and a further 80 (17%) of 481 faced challenges with their accommodation no longer meeting their physical needs. Service users found the support useful. Hospital staff at all levels felt the service facilitated discharge, reducing pressure on health-care services. Having skilled housing officers embedded within the patient's care team was valued, with both the questionnaire and routine data highlighting that the housing officers provided support ranging from organising repairs, arranging new accommodation, accessing financial help, and referring to additional services. The service was constrained by the unavailability of appropriate housing stock and wider support systems for service users after discharge. As this study is ongoing, available routine data are currently insufficient to allow reliable quantification of economic impact. InterpretationThe evaluation has shown the benefits of housing discharge services and will inform future commissioning decisions on funding services to facilitate discharge. We recommended that other hospitals with housing-related barriers to discharge might want to adopt a similar model. FundingNational Institute for Health Research (NIHR) School for Public Health Research