Welshman Research Articles

The OBS UK Dashboard: an interactive tool for representative trial site selection to facilitate equality and diversity in maternity research

BackgroundObstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. Traditionally, decisions regarding site selection are based on desire to complete trials on target in ‘tried and tested’ research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK.MethodUsing routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard.ResultsThe dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented.ConclusionThe NIHR equality, diversity and inclusion strategy states studies must widen participation, facilitating individuals from all backgrounds to engage. The development of this novel interactive dashboard demonstrates an innovative way of achieving this. National Health Service (NHS) maternity researchers should consider using this tool to enhance diversity in research, address health disparities and improve generalisability of findings. This approach could be applied to healthcare settings beyond maternity care and across different global populations.Trial registrationISRCTN 17679951. Registered on August 30, 2023.

Daryl Leeworthy. Causes in Common: Welsh Women and the Struggle for Social Democracy Cardiff: University of Wales Press, 2022. Pp. 192. £11.99 (paper).

Daryl Leeworthy. Causes in Common: Welsh Women and the Struggle for Social Democracy Cardiff: University of Wales Press, 2022. Pp. 192. £11.99 (paper).

Inequalities in severe COVID-19 outcomes in Wales, UK

ObjectiveResearch evidence shows that COVID-19 has disproportionately affected people from more deprived backgrounds. In Wales (UK), there is strong evidence of a socioeconomic gradient in total hospitalisations, critical care admissions and deaths. This study focussed on a cohort of the Welsh population using anonymised individual-level linked population-scale data in the SAIL Databank. ApproachThis analysis examines the impact of confounding/mediating factors on severe health outcomes. We used logistic regression, considering the Welsh Index of Multiple Deprivation (WIMD) 2019 as a predictor, to investigate how the coefficient for WIMD is changed when other variables (such as comorbidities, smoking status, Body Mass Index) are added, aiming to understand whether inequalities are mediated by observed characteristics or related to other unobserved factors. ResultsInitial findings show that age-standardised rates of hospital admissions, Intensive Care Unit (ICU) admissions and deaths were roughly twice as high in the most deprived vs least deprived WIMD quintile in Wales. We estimated Years of Life Lost per 1,000 due to COVID-19 as 28.9, with variation between WIMD quintiles of 38.4 for the most deprived and 22.2 for the least deprived. The project also produced regression formulas to evaluate the contribution of the different confounding factors. ConclusionThis study built on existing research findings and further explored the potential reasons for known socioeconomic inequalities in relation to COVID-19 outcomes. Insights from this study have broadened the knowledge around the impact of mediating factors and may contribute to future pandemic preparedness and the formation of future policies.

Clostridioides difficile infection following COVID-19: A nationwide analysis using routine surveillance data in Wales

CDI incidence has increased in Wales from summer 2020 and has remained elevated. There is evidence of poorer outcomes from concurrent CDI and COVID-19 infections, but it is not clear if infection with COVID-19 directly impacts likelihood of CDI infection. We investigated the relationship between CDI and COVID-19 and the impact of secondary infections. We conducted two analytical studies using routine surveillance data: i) population level ecological case control study comparing CDI cases in the Welsh population by SARS-COV-2 exposure in the previous 90 days, ii) cohort study of COVID-19 cases by secondary infection presence, investigating CDI development within 90 days. Case control: 12% (196/1645) of CDI cases had prior COVID-19 and were twice as likely to have had COVID-19 compared to general population controls, when controlling for other infection history (OR 2.1, CI 1.8-2.5, p<0.0001). CDI cases were 8 times more likely to have had other infections, independent of COVID-19 history (OR 8.0, CI 7.0-9.0, p<0.001). 2% (2,255/137,620)) of the COVID-19 cohort developed >1 secondary infection, and <1% (185/137620) developed CDI within 90 days. CDI risk was four times higher in those with secondary infections, after age and sex adjustment (RR 4.6, CI 3.1 - 6.1, p<0.001). CDI risk increased with age and did not differ by sex. Findings suggest a relationship between COVID-19 and CDI. However, incidence of CDI following COVID-19 was a rare outcome generally, suggesting other factors are likely contributing to the increased rates of CDI observed since 2020.

Assessing public health implications of free trade agreements: The comprehensive and progressive Trans‐Pacific Partnership Agreement

AbstractIn 2016, the United Kingdom voted to exit the European Union, which was surrounded by political and social uncertainty. The United Kingdom now negotiates its own trade agreements, and in March 2023, it agreed to join the Comprehensive and Progressive Trans‐Pacific Partnership Agreement (CPTPP). A health impact assessment (HIA) was undertaken in 2022–23 to predict the potential impact of the CPTPP on the health and well‐being of the Welsh Population. This paper explores the HIA findings and highlights the value of the approach in engaging with stakeholders and informing policymakers. This HIA followed a standard five‐step approach which involved a literature review to identify potential health impacts, qualitative interviews with cross‐sectoral stakeholders and the development of a community health profile. The HIA identified potential impacts across the wider determinants of health and specific vulnerable population groups. Investor state dispute settlement mechanisms, economic uncertainty and loss of regulatory policy space were identified as key pathways for health impacts. The findings have been beneficial in informing decision‐makers to prepare for the CPTPP in Wales using an evidence‐informed approach. This work has demonstrated the value of a HIA approach that uses a transparent process to mobilise a wide range of evidence, resulting in transferrable learning.

Epilepsy and the risk of COVID-19-related hospitalization and death: A population study.

People with epilepsy (PWE) may be at an increased risk of severe COVID-19. It is important to characterize this risk to inform PWE and for future health and care planning. We assessed whether PWE were at higher risk of being hospitalized with, or dying from, COVID-19. We performed a retrospective cohort study using linked, population-scale, anonymized electronic health records from the SAIL (Secure Anonymised Information Linkage) databank. This includes hospital admission and demographic data for the complete Welsh population (3.1 million) and primary care records for 86% of the population. We identified 27 279 PWE living in Wales during the study period (March 1, 2020 to June 30, 2021). Controls were identified using exact 5:1 matching (sex, age, and socioeconomic status). We defined COVID-19 deaths as having International Classification of Diseases, 10th Revision (ICD-10) codes for COVID-19 on death certificates or occurring within 28 days of a positive SARS-CoV-2 polymerase chain reaction (PCR) test. COVID-19 hospitalizations were defined as having a COVID-19 ICD-10 code for the reason for admission or occurring within 28 days of a positive SARS-CoV-2 PCR test. We recorded COVID-19 vaccinations and comorbidities known to increase the risk of COVID-19 hospitalization and death. We used Cox proportional hazard models to calculate hazard ratios. There were 158 (.58%) COVID-19 deaths and 933 (3.4%) COVID-19 hospitalizations in PWE, and 370 (.27%) deaths and 1871 (1.4%) hospitalizations in controls. Hazard ratios for COVID-19 death and hospitalization in PWE compared to controls were 2.15 (95% confidence interval [CI] = 1.78-2.59) and 2.15 (95% CI = 1.94-2.37), respectively. Adjusted hazard ratios (adjusted for comorbidities) for death and hospitalization were 1.32 (95% CI = 1.08-1.62) and 1.60 (95% CI = 1.44-1.78). PWE are at increased risk of being hospitalized with, and dying from, COVID-19 when compared to age-, sex-, and deprivation-matched controls, even when adjusting for comorbidities. This may have implications for prioritizing future COVID-19 treatments and vaccinations for PWE.

A Welsh Vision of Empire? Welsh Imperialists and the Indian Empire

Neither Welsh history nor imperial history has given much attention to the Welsh connection with empire. While English, Scottish, and Irish imperial history have been developed in recent decades, Wales has been largely ignored. In relation to India, there have been projects on missionaries and the East India Company, but little that focuses on Welsh imperialists during the period of Crown Rule. Despite having a smaller presence than other British nationalities, the Welsh were present in India between 1858–1947, and interacted with imperialism in ways which were distinctly Welsh. This research will explore the Welsh in India during this period and how their Welsh identity interacted with the empire to create a unique Welsh conception of imperialism. Constructed in the domestic press, it emphasised Welsh understanding of indigenous peoples through their own experience of being a minority within the UK and attached itself to a strong sense of Britishness manifested in loyalty to the empire. This ideology, however, had limited impact on the ground in India, with Welsh imperialists generally conforming to the racial and class norms of British India. Welsh imperialism remained a prism through which the Welsh thought about themselves rather than a method of action. Examining this experience adds new dimensions to imperial thinking, especially in relation to how faith and language were transported, reimagined, and contested in the colonial sphere. It demonstrates how the British exported their national and regional ideological baggage which continued to influence their thinking, despite being removed from the physical landscape in which they were forged. Welsh people like Sir Lawrence Jenkins and the missionaries of the Northeast of India had tangible impacts on the colonial space which were fundamentally inspired by their Welshness. This greatly adds to our understanding of how British imperialism operated and has implications far beyond India.

Transnational Memory and Y Ffydd Ddi-ffuant

This article re-assesses Y Ffydd Ddi-ffuant ['The Unfeigned Faith'] (1667; 1671; 1677), written by Charles Edwards, a seventeenthcentury Welsh Presbyterian. It analyses the first part of the Ffydd, which consists of the history of the Christian faith, as cultural memory for the Welsh people, meaning that it is a past that belongs to them, defines them and is meditated through culture. This cultural memory was transnational and defined the Welsh as a people connected to other nations through a shared Protestant faith. The discussion begins with an outline of key concepts including transnationalism and cultural memory. Following this, the article assesses how the Christianity espoused by Edwards, 'the unfeigned faith', was remembered in a Euro-Mediterranean cultural space by analysing the memory of transnational martyrs from shortly after the Fall to the Reformation. The history of Christianity among the Welsh is also studied as a transnational memory that came to Britain from the Euro-Mediterranean world. The article closes by considering the transnational relationship between the Welsh and the English as outlined in the Ffydd.

Profiles of tobacco smokers and ex-smokers in a large-scale random sample survey across Wales: an unsupervised machine-learning cluster analysis

BackgroundThe Welsh government recently set a target to be smoke-free by 2030, which means reducing the prevalence of tobacco smoking in adults to 5% by then. The goal is to improve health and population life expectancy. To support this strategy, we identified profile groups with different sets of socioeconomic and demographic characteristics within the population of smokers. We compared these profiles to those identified in the ex-smoker population to provide a broader understanding of smokers and inform targeting of interventions and policy. MethodsWe did a cross-sectional study using data from the National Survey for Wales. This survey is a random sample telephone survey of individuals aged 16 years and older across Wales carried out from Sept 1, 2021 to Jan 31, 2022, weighted to be representative of the Welsh population. For the smoking subgroup, we did a weighted hierarchical cluster analysis with multiple imputation to impute missing data and repeated it for ex-smokers. In total, 63 survey variables were used in the analysis. These variables included smoking history, e-cigarette use, sociodemographics, lifestyle factors, individual-level deprivation, general health and long-term conditions, mental health, and wellbeing. FindingsAmong the 6407 respondents (weighted proportions: 49% male, 51% female; 28% aged 16–34 years, 46% aged 35–44 years, 26% aged ≥65 years; 95% white, 5% other ethnicity), 841 (13%) smoked and 2136 (33%) were ex-smokers. Four distinctive profiles of smokers were identified, the groups were of relatively comparable size and characterised by similarities described as (1) high-risk alcohol drinkers and without children; (2) single, mostly in social housing, and poor health and mental health; (3) mostly single, younger, tried e-cigarettes, and poor mental health; (4) older couples and poor health; when comparing the groups with each other. Cluster quality and validation statistics were considered fair: silhouette coefficient=0·09, Dunn index (Dunn2)=1·06. Generally, ex-smoker clusters differed from smoking clusters because of themes related to increased sickness, better affluence, employment, and older age (≥75 years). InterpretationThis study suggests that not all smokers are the same, and they do not fall into one coherent group. Smoking cessation interventions to improve the health of ageing populations might need a different approach to consider a wider context or motivations to inform targeted quitting. It is acknowledged that smoking might be underreported because of perceived social unacceptability. FundingPublic Health Wales.

The Haunted Island: Medieval History and the Old English Elegies in Brenda Chamberlain’s Tide-race (1962)

Abstract This article explores the relationship between Tide-race, a 1962 memoir by the Welsh poet and artist Brenda Chamberlain, and medieval culture and literature on Ynys Enlli. Written in the decades after the Second World War when Chamberlain had left mainland Wales, Tide-race is a memoir of the artist’s time on Enlli living with its small community of fishermen and farmers. In contrast to other works of twentieth-century island literature, I argue, Chamberlain rejected dominant, medieval patriarchal histories of Enlli, refusing to read the island as a male monastic site, or as a Welsh nationalist or cultural space. Tide-race is a medieval modern text that is deeply ambivalent about what medieval culture means for modern conceptions of identity, specifically Welshness and womanhood. Chamberlain’s late modernist work has been neglected because of her status as a Welsh woman writer working outside of the centres of modernism, and she has never been considered in the context of Medievalism Studies. By bringing archival material from the Brenda Chamberlain papers at the National Library of Wales together with the published memoir, this article brings to light an unremarked upon interest in Old English literature and traces the development of Chamberlain’s medievalism in the post-war period. Although her use of the Old English elegies—The Wanderer, The Seafarer and The Wife’s Lament—has remained unnoticed by Chamberlain’s critics, these early medieval poems are translated and adapted in her prose in ways that allow her to exorcize old grudges and challenge masculine ideals.

What impact does informal caring have on Mental Wellbeing? A cross-sectional analysis of survey data

Abstract Background It is estimated that 1 in 8 of the English &amp; Welsh population are unpaid informal carers. There is an upward trend in the number of carers in a growing and ageing population. This study aimed to quantify the mental wellbeing of informal carers as compared to the English general population. Methods The study drew from secondary analysis of the Health Survey for England, including 10,300 participants of all ages. The outcome measure was the Warwick Edinburgh mental wellbeing scale (WEMWBS) a 14-item validated survey which measures subjective well-being and psychological function with higher scores denoting greater wellbeing. Derived caring status, age &amp; sex were explanatory variables. Multiple linear regression was employed to estimate associations. Results Of the 7,297 eligible adult participants, 1,244 were carers. The adjusted mean difference in WEMBS for men compared to women was 0.53 (0.10 to 0.96, P = 0.016). When including caring status, the mean difference for carers compared to non-carers was -1.71 (-2.29 to -1.13, p &amp;lt; 0.001) adjusted for age and sex. In sub groups of age, (&amp;lt;25, 25-64, and &amp;gt;65) there was evidence that caring was associated with lower wellbeing for ages &amp;lt;64 but no evidence of difference in &amp;gt; 65 years. Conclusions There is compelling evidence that informal carers have a lower WEMWBS score, indicating poorer mental wellbeing. However, this does impact all age groups equally as there was only evidence of carers &amp;lt;64 having a lower WEMWBS. This is one of the first studies to quantify the mental wellbeing of carers, and could lead to further studies to identify a causal link, and better support carers. Key messages • Informal unpaid carers &amp;lt;64 years, have quantifiably reduced mental wellbeing, compared to the wider population. Further research is needed to reduce the disparity. • In an ageing population, and with increasing numbers of people informally caring, policy should support them in caring, and to also improve their own health.

Declining territory occupancy and productivity in a Welsh Red-billed Chough Pyrrhocorax pyrrhocorax population

ABSTRACT Capsule Much of the UK’s largest population of Red-billed Chough Pyrrhocorax pyrrhocorax shows long-term decline in territory occupancy and productivity. Underlying mechanisms need urgent study to improve conservation delivery for this species in Wales. Aims Periodic census data have shown a localized decline of Red-billed Choughs in Wales, which supported 66% of the UK breeding population in 2014. The aim is to explore the nature of this decline using long-term study data to search for patterns in territory occupancy and breeding performance. Methods Data from annual monitoring of breeding territories in mid- and north Wales, across 25 years and representing 74% of the Welsh population, were analysed to test for variation in occupancy and breeding metrics in relation to territory type, geographic region, and protection status. Results Most territories were coastal, where occupancy fell by 12%. Occupancy of inland territories fell by 72%, accounting for just 24% of territories by 2019. The number of chicks fledged per occupied territory fell by 25% across all territories, but the brood size of successful pairs only fell 9% with neither varying by territory type. Nest success rate fell 17% on the coast but 33% inland. Trends in occupancy and breeding metrics showed little variation between geographic regions and protection status. Conclusion The severe decline of inland nesting Red-billed Choughs could lead to rapid local extinction, but the slower decline in the coastal population is also of concern. Declining breeding performance is a plausible driver of population decline. As current conservation delivery appears ineffective, the mechanism of decline needs urgent study to identify necessary protection measures.

English and Welsh men's domestic cricket injury risk by activity and cricket type: A retrospective cohort study from 2010 to 2019

ObjectivesExplore whether injury profiles and mechanisms differ between red (First-Class multi-day) ball cricket and white (One-Day and Twenty20 limited over) ball cricket in elite men's domestic cricket from 2010 to 2019. DesignRetrospective cohort analysis. MethodsInjury incidence calculated according to the updated international consensus statement on injury surveillance in cricket, along with seasonal days lost and injury severity descriptive statistics. ResultsAcross both cricket types, bowling resulted in the most seasonal days lost (mean 1942, 95 % confidence interval: 1799–2096) and highest mean injury severity (30 days, 95 % confidence interval: 28–33), with the lumbar spine the body region with the most seasonal days lost (mean 432 seasonal days; 95 % confidence interval: 355–525) from bowling. Injury incidence was higher in white ball compared to red ball cricket (per unit of time), with bowling (and its various phases) the most frequently occurring mechanism in both cricket types (white ball: 67.0 injuries per 1000 days of play [95 % confidence interval: 59.6–75.3]; red ball: 32.4 injuries per 1000 days of play [95 % confidence interval: 29.1–36.1]). When bowling, the abdomen and thigh were the body regions most injured from white (13.4 injuries per 1000 days of play [95 % confidence interval: 10.3–17.4]), and red ball (6.4 injuries per 1000 days of play [95 % confidence interval: 5.0–8.2]) cricket respectively. Overall, clear differences emerged in the nature and mechanism of injuries between red ball cricket and white ball cricket. ConclusionsBowling presents the highest injury risk (across both cricket types), as well as highlighting the increased risk of injuries from diving during fielding and running between the wickets when batting, in shorter white ball cricket.

The extent of anticholinergic burden across an older Welsh population living with frailty: cross-sectional analysis of general practice records.

Anticholinergic medicines are associated with adverse outcomes for older people. However, little is known about their use in frailty. The objectives were to (i) investigate the prevalence of anticholinergic prescribing for older patients, and (ii) examine anticholinergic burden according to frailty status. Cross-sectional analysis of Welsh primary care data from the Secure Anonymised Information Linkage databank including patients aged ≥65 at their first GP consultation between 1 January and 31 December 2018. Frailty was identified using the electronic Frailty Index and anticholinergic burden using the Anticholinergic Cognitive Burden (ACB) scale. Descriptive analysis and logistic regression were conducted to (i) describe the type and frequency of anticholinergics prescribed; and (ii) to estimate the association between frailty and cumulative ACB score (ACB-Sum). In this study of 529,095 patients, 47.4% of patients receiving any prescription medications were prescribed at least one anticholinergic medicine. Adjusted regression analysis showed that patients with increasing frailty had higher odds of having an ACB-Sum of >3 compared with patients who were fit (mild frailty, adj OR 1.062 (95%CI 1.061-1.064), moderate frailty, adj OR 1.134 (95%CI 1.131-1.136), severe frailty, adj OR 1.208 (95%CI 1.203-1.213)). Anticholinergic prescribing was high in this older population. Older people with advancing frailty are exposed to the highest anticholinergic burden despite being the most vulnerable to the associated adverse effects. Older people with advancing frailty should be considered for medicines review to prevent overaccumulation of anticholinergic medications, given the risks of functional and cognitive decline that frailty presents.

Embodying Indigeneity in the Mountains: Creating Inclusive Adventure Spaces for Welsh Women, UK

Summary This case study examines an intersecting legacy of exclusion in the Welsh mountains, UK, and how this is challenged by Welsh women’s participation in outdoor adventure courses. The research critically appraised how Indigenous Welsh women 1 navigate gender, class, and racial landscapes in mountain leisure to create inclusive spaces. Facilitated by a National Charitable Organization (NCO) that engages Indigenous Welsh communities in mountain adventure, we explored women’s embodied experiences through mobile video ethnography. Methodologically embodiment facilitated a way of capturing bodily sensations and experiences, which provided a language to express those ideas through reflexive analysis ( Ellingson, 2017 ). The findings highlight how women embody cultural identity in the mountains, which contributes to understanding issues of exclusion/inclusion in adventure spaces. Information © The Authors 2023

Differences in trends in blood pressure and lipid assessment in patients with and without depression with atherosclerotic cardiovascular disease

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation. Background Patients who have atherosclerotic cardiovascular disease (aCVD) and depression are at increased risk of future CVD events compared to those without depression. The reasons for this are not fully understood. Appropriate management of aCVD risk factors (RF) including blood pressure (BP) and Lipids are essential for secondary prevention. Aim To explore BP and lipid assessment over time in patients with aCVD with and without depression, in the Welsh population. Methods A retrospective observational cohort study of patients with aCVD was conducted using individual level linked electronic health record data between 2009 &amp; 2019 using the all-Wales SAIL databank. Clinical codes were used to identify aCVD and depression diagnoses, and BP and lipid assessments from GP data. Numbers having assessment of BP and/or lipids during each calendar year were documented. Results In 2009, the cohort consisted of 183,275 (F=44.2%, mean age= 69.6 (SD=12.3)). 58.5% of patients had both BP and lipid assessments in that year, with 15.1% having BP only, 2.8% lipid only and 23.6% with neither. Over the subsequent 10y, the proportion with neither BP or lipid checks (23.6% 2009 vs 31.7% 2019, Fig 1.A) and the proportion with only one or neither RF checked increased (Fig 1.A). When comparing those with a history of depression to those without, the worsening trend over time was similar, but patients without depression were more likely to have neither RF checked (13.6% in those with depression vs 26.4% in those without in 2009 and 22.3% vs 35.7% respectively in 2019 Fig 1.B). Conclusion These data show a concerning trend for BP and lipids to be checked less rigorously for secondary prevention of aCVD. Although historically aCVD patients with a history of depression are more likely to have a worse outcome, RF assessment is more comprehensive in these patients in Wales. Whether differences in RF control may contribute to variation in outcomes between those with and without depression remains to be determined.

Unravelling the Clinical Co-Morbidity and Risk Factors Associated with Agenesis of the Corpus Callosum.

Agenesis of the Corpus Callosum (ACC) can result in multiple neurological deficits including social and behavioural issues. However, the underlying aetiology, clinical co-morbidity and the contributing risk factors remain elusive, resulting in inaccurate prognosis and delayed therapy. The main objective of this study was to comprehensively describe the epidemiology and clinical co-morbidity associated with patients diagnosed with ACC. The secondary objective was to identify the factors that contribute towards increased risk for ACC. For this, we analysed 22 years (1998-2020) of clinical data across the whole of Wales, UK collected through the Congenital Anomaly Register & Information Service (CARIS) and Public Health Wales (PHW). Our results demonstrate that complete ACC (84.1%) was the prevalent subtype, in comparison to partial ACC. Further, ventriculomegaly/hydrocephalus (26.37%) and ventricular septal defect (21.92%) were identified to be the most prevalent neural malformation (NM) and congenital heart disorder (CHD) in our cohort. Although 12.7% of subjects with ACC had both an NM and CHD, we found no significant association between them (χ2 (1, n = 220) = 3.84, p = 0.33). We found socioeconomic deprivation and increased maternal age contributed towards an increased risk for ACC. To the best of our knowledge, this study for the first time defines the clinical phenotypes and the factors that contribute to ACC within the Welsh population. These findings will be of value to both patients and healthcare professionals, who may take preventative or remedial measures.

Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018

BackgroundThere is variance in the incidence of lower extremity amputation across and within countries including within the UK. National data shows up to a fourfold variance in the amputation rate throughout the regions of England and differences in amputation incidence have been reported in Scotland and Ireland. Lower extremity amputation rate has yet to be documented within Wales. The aim of this cohort study was to examine trends in diabetes and non-diabetes related lower extremity amputation incidence within the Welsh population and to examine the influence of diabetes on the relative risk of amputation. Materials and MethodsAll first-time amputations between 2008-2018 were extracted from SAIL, a repository of all routine medical data of residents of Wales. People with diabetes were identified using an algorithm utilising data from several clinical and non-clinical sources. Crude and direct age and sex adjusted incidences were estimated over time. ResultsOver the period 3505 major amputations and 4335 minor amputations occurred. The diabetes population greater than 17 years of age increased by 29.4% from 143,595 in 2008 to 206,818 in 2018. There was a statistically significant rate reduction in major amputation in both populations. In the diabetes population the number of major amputations reduced from 6.9 [5.5–8.5]/10 000 person years (PY) in 2008 to 4.9 [5.4–6.2]/10 000 PY in 2018. However, for major amputation, the risk of incident amputation in people with diabetes was 7.3 fold higher [7.1–7.5] than those without diabetes. The relative risk of minor amputation for those with diabetes was higher at 11.9 [11.8 –1.01]. There was no reduction in this risk over the period. ConclusionThis study found that rates of major amputation decreased over the study period but the risk of amputation for persons with diabetes remained substantial. As the population with diabetes increases so do crude rates of amputation, providing a substantial financial and societal cost to the Welsh Population.

COVID-19 vaccination uptake in people with epilepsy in wales

PurposePeople with epilepsy (PWE) are at increased risk of severe COVID-19. Assessing COVID-19 vaccine uptake is therefore important. We compared COVID-19 vaccination uptake for PWE in Wales with a matched control cohort. MethodsWe performed a retrospective, population, cohort study using linked, anonymised, Welsh electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank (Welsh population=3.1 million).We identified PWE in Wales between 1st March 2020 and 31st December 2021 and created a control cohort using exact 5:1 matching (sex, age and socioeconomic status). We recorded 1st, 2nd and booster COVID-19 vaccinations. ResultsThere were 25,404 adults with epilepsy (127,020 controls). 23,454 (92.3%) had a first vaccination, 22,826 (89.9%) a second, and 17,797 (70.1%) a booster. Comparative figures for controls were: 112,334 (87.8%), 109,057 (85.2%) and 79,980 (62.4%).PWE had higher vaccination rates in all age, sex and socioeconomic subgroups apart from booster uptake in older subgroups. Vaccination rates were higher in older subgroups, women and less deprived areas for both cohorts. People with intellectual disability and epilepsy had higher vaccination rates when compared with controls with intellectual disability. ConclusionsCOVID-19 vaccination uptake for PWE in Wales was higher than that for a matched control group.

The economic impact of COVID-19 on the creative industries: a sub-regional input–output approach

The creative industries are a strategically important sector for the Cardiff Capital Region (CCR) which houses large public sector broadcasters and an ecosystem of IT and software businesses. The CCR is an administrative boundary in Wales which captures just under half of the Welsh population but over half of the Welsh economy. The pandemic and resultant lockdown restrictions have had profound impacts on the creative industries, a sector which depends heavily on in-person interaction. The creative industries are not one homogenous sector, but a collection of different activities some of which faced different supply and demand conditions due to the COVID-19 shock. To understand the impact of the shock in fine inter-industry detail and at a sub-regional scale an input–output table for the Cardiff Capital Region (the CCRC-IO) is utilized. The CCRC-IO estimates that the direct, indirect, and induced impacts of the shock see output fall by £457 m (0.53% of CCR output), GVA by £147 m (0.58% of CCR GVA) and FTE employment by 2416 (0.58% of CCR FTE). The paper finds that the economic impact of the COVID-19 shock varies considerably by both geography and sub-sector.