Suchergebnisse

ObjectivesSpinal pain predisposes patients to a more sedentary lifestyle, a major risk factor for cardiovascular disease and other comorbidities. There is little recent evidence of the current prevalence of spinal pain and associated risk factors in Wales. This analysis addresses this gap in knowledge.
ApproachThis retrospective e-cohort study used linked National Survey for Wales (NSW) data and Welsh Demographic Services data held in the Secure Anonymised Information Linkage (SAIL) Databank. All years of the annual NSW data from 2016 to 2020 (N = 34,123) were used to determine the prevalence of spinal pain in Wales. The likelihood of developing spinal pain was quantified by multivariate regression cross-sectional analysis, adjusting for the presence of the same person in multiple years of the survey data. Predictors included socio-demographic and health status, including mental health and cardiovascular disease.
ResultsSpinal pain affected 5% of people who took part in the NSW. This analysis also shows that spinal pain disproportionally affects some sub-populations of Wales. Factors associated with a greater likelihood of spinal pain were cardiovascular disease, presence of at least one mental health condition, living in a more deprived area, and education level. This is especially pertinent as the burden of cardiovascular risk is disproportionately elevated in the Welsh population and Wales represents a distinctive demographic, characterised by geographical constraints and low socio-economic status. These factors will be presented and discussed in detail.
ConclusionThe prevalence of spinal pain and associated risk factors in Wales was quantified. This work will help inform public health action to encourage interventional and prevention strategies to improve the quality of life for those suffering with spinal pain across Wales.

ObjectiveWhen an infant is identified as having suffered or is at risk of suffering significant harm from parents or caregivers, section 31 care and supervision proceedings (s.31, Children Act 1989) may be issued. We examined the healthcare use of infants under one year old subject to these proceedings in Wales.
ApproachA retrospective e-cohort study utilising data held in the Secure Anonymised Information Linkage (SAIL) Databank. General Practice records, emergency department attendances, and hospital admissions (non-elective and elective) were linked with family justice (Cafcass Cymru) data between 2011–2020 for all s.31 proceedings (n = 920). By comparing to the infant population not undergoing family law proceedings (n = 18179), regression models examined the incidence and rate of healthcare events between birth and the court proceeding application date. Wider determinants of health were sequentially added (infant perinatal factors, maternal mental health, sex, area-level deprivation). Reasons for healthcare events were also investigated.
ResultsThese models showed that infants who were subject to s.31 care and supervision proceedings were more likely to have required healthcare prior to proceedings than the comparison group. A similar pattern was shown for the rate of healthcare events. Even when wider determinants of health were included in the models, this difference was especially pronounced for incidence and event rate ratios for emergency department attendances, [incidence RR = 1.73, CI = 1.52–1.96; event RR = 2.08, CI = 1.82–2.38] and non-elective inpatient admissions [incidence RR = 2.91, CI = 2.57–3.28; event RR = 3.84, CI = 3.31–4.45]. Infants in s.31 proceedings were more likely to require healthcare for injury and poisoning, and other external causes.
ConclusionThis is the first population-wide evidence on the health of infants subject to s.31 care and supervision proceedings in Wales. These findings highlight the increased healthcare utilisation for this population. The study helps to build a better understanding of the needs and vulnerabilities of infants in the family justice system.

IntroductionWhen a child has suffered, or is at risk of suffering, significant harm from parents or caregivers, the local authority may issue Section 31 (s.31) Care and Supervision proceedings under the Children Act (1989).
ObjectivesWe compared the healthcare use of infants less than one year old subject to s.31 proceedings in Wales (n = 1,332),to that of a comparison group of infants not subject to s.31 proceedings (n = 204,417), between January 2011 and February 2020.
MethodsPopulation-based e-cohort study utilising data held in the Secure Anonymised Information Linkage (SAIL) Databank. Infants in s.31 proceedings were identified using the Children and Family Court Advisory and Support Service dataset. This was linked to demographic and healthcare datasets, to identify General Practice (GP) visits, emergency department (ED) attendances, and hospital admissions (emergency and elective); before the study end date or the child's first birthday for the comparison group, orbefore the s.31 application date.Regression analysis calculated event rate ratios [RR] and incidence rate ratios [IRR] for healthcare events, adjusting for widerdeterminants of health (e.g. perinatal factors, maternal mental health, deprivation), and investigated reasons for healthcare use.
ResultsInfants in s.31 proceedings had ahigher number and incidence of healthcare events compared with the comparison group, across all healthcare settings. Differences were greatest for emergency hospital admissions (IRR = 4.03, 95% confidence interval [CI] = 3.53 - 4.59; RR = 4.60, CI = 3.90 - 5.41). "Injury and poisoning" was the main reason for emergency admissions amongst infants in s.31 proceedings. For ED presentations, emergency hospital admissions, and GP visits, there were proportionally more events for these infants across all top ten reasons for healthcare.
ConclusionsFindings highlight greater healthcare utilisation for infants involved in s.31 proceedings in Wales, helping to build a better understanding of their needs and vulnerabilities.