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ABSTRACTObjectiveWomen with a diagnosis of non-affective psychosis have a lower fertility rate than the general population. However, perinatal outcomes in mothers with non-affective psychosis are under-researched. What is the general fertility rate (GFR) of women with a lifetime diagnosis of non-affective psychosis in Scotland? Does such a diagnosis affect the outcome of pregnancy?
ApproachAn 'exposed' cohort with non-affective psychosis and at least one pregnancy was established using a combined dataset derived via data linkage in local safe havens of routine psychiatric and maternity data from two Scottish regions:•NHS Grampian (NHSGr): Aberdeen Maternity and Neonatal Databank (AMND); psychiatric casenotes•NHS Greater Glasgow and Clyde (NHSGG&C): SMR02; PsyCIS bespoke psychiatric databaseExposed women were matched to women without a diagnosis of non-affective psychosis, by maternal age (NHSGG&C only), year of first birth, parity and deprivation, sourced from AMND/SMR02 in a 3:1 unexposed:exposed ratio.
Demographics and pregnancy outcomes of exposed versus unexposed women were analysed to describe effect of psychosis on pregnancy.
ResultsMany challenges were encountered in terms of having legal agreements in place between institutions and safe havens, constructing cohorts and datasets within each study site and joining the data to analyse the overall cohort. Challenges with the data itself included discrepancies between the variables measured in datasets in different sites and missing information within patient records, particularly in earlier years. Preliminary results for the NHSGG&C region show that the average GFR for exposed women aged 15-44 from 2005 to 2014 was 14.38 compared to the general population rate of 55.26. The number of women ever having a miscarriage was significantly higher in the exposed group (23.4% vs 9.9%; p-value <0.001). However during the study period (1996 to 2014), more unexposed women had miscarriages (0.5% vs 4.7%; p-value = 0.002). There were no significant differences in pregnancy complications for the study period. The mean birthweight of babies was lower (3.23kg vs 3.35kg; p-value = 0.029) and more babies were admitted to neonatal units (17.5% vs 9.8%; p-value = 0.004) in the exposed group. Results for the NHSGr region and the combined dataset will also be reported.
ConclusionThis work highlights that there remain hurdles to linking data across sites, despite availability of rich datasets within Scotland. Women with non-affective psychosis within NHSGG&C region had a lower fertility rate on average than the general population and some poorer outcomes, such as birthweight and rate of admission to neonatal units.

Funding: the study was funded by the Greater Glasgow Health Board, the Scottish Government via the Scottish Learning Disabilities Observatory and the UK Medical Research Council (grant number: MC_PC_17217). ; Objective: To investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses. DESIGN: Comparison of cross-sectional data in 2002-2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data. SETTING: General community. PARTICIPANTS: 1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data. Main Outcome Measures: Encashed regular and as-required psychotropic prescriptions. Results: 50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001). Conclusions: Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews. ; Publisher PDF ; Peer reviewed

Funding: UK Medical Research Council, grant number: MC_PC_17217), and the Scottish Government via the Scottish Learning Disabilities Observatory. ; Objectives To investigate mortality in adults with intellectual disabilities: rates, causes, place, demographic and clinical predictors. Design Cohort study with record linkage to death data. Setting General community. Participants 961/1023 (94%) adults (16–83 years; mean=44.1 years; 54.6% male) with intellectual disabilities, clinically examined in 2001–2004; subsequently record-linked to their National Health Service number, allowing linkage to death certificate data, 2018. Outcome measures Standardised mortality ratios (SMRs), underlying and all contributing causes of death, avoidable deaths, place, and demographic and clinical predictors of death. Results 294/961 (30.6%) had died; 64/179 (35.8%) with Down syndrome, 230/783 (29.4%) without Down syndrome. SMR overall=2.24 (1.98, 2.49); Down syndrome adults=5.28 (3.98, 6.57), adults without Down syndrome=1.93 (1.68, 2.18); male=1.69 (1.42, 1.95), female=3.48 (2.90, 4.06). SMRs decreased as age increased. More severe intellectual disabilities increased SMR, but ability was not retained in the multivariable model. SMRs were higher for most International Statistical Classification of Diseases and Related Health Problems, 10th Revision chapters. For adults without Down syndrome, aspiration/reflux/choking and respiratory infection were the the most common underlying causes of mortality; for Down syndrome adults 'Down syndrome', and dementia were most common. Amenable deaths (29.8%) were double that in the general population (14%); 60.3% died in hospital. Mortality risk related to percutaneous endoscopic gastrostomy/tube fed, Down syndrome, diabetes, lower respiratory tract infection at cohort-entry, smoking, epilepsy, hearing impairment, increasing number of prescribed drugs, increasing age. Bowel incontinence reduced mortality risk. Conclusions Adults with intellectual disabilities with and without Down syndrome have different SMRs and causes of death which should be separately reported. Both die younger, from different causes than other people. Some mortality risks are similar to other people, with earlier mortality reflecting more multimorbidity; amenable deaths are also common. This should inform actions to reduce early mortality, for example, training to avoid aspiration/choking, pain identification to address problems before they are advanced, and reasonable adjustments to improve healthcare quality. ; Publisher PDF ; Peer reviewed

AbstractBackgroundQuality of primary healthcare impacts on health outcomes. This study aimed to quantify trends in good practice and the healthcare inequalities gap.MethodIndicators of best‐practice management of long‐term conditions and health promotion were extracted from primary healthcare records on 721 adults with intellectual disabilities in 2007–2010, and 3638 in 2014. They were compared over time, and with the general population in 2014, using Fisher's Exact test and ordinal regression.ResultsManagement improved for adults with intellectual disabilities over time (OR = 5.32; CI = 2.69–10.55), but not for the general population (OR = 0.74; CI = 0.34–1.64). However, it remained poorer, but to a lesser extent, compared with the general population (OR = 0.38; CI = 0.20–0.73 in 2014, and OR = 0.05; CI = 0.02–0.12 in 2007–2010). In 2014, health care was comparable to the general population on 49/78 (62.8%) indicators.ConclusionsThe extent of the healthcare inequality gap reduced over this period, but remaining inequalities highlight that further action is still necessary.

AbstractBackgroundIn the UK, general practitioners/family physicians receive pay for performance on management of long‐term conditions, according to best‐practice indicators.MethodManagement of long‐term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long‐term conditions was determined, and associated factors were investigated via logistic regression analyses.ResultsAdults with intellectual disabilities received significantly poorer management of all long‐term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%–100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation.ConclusionsAdults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care.

IntroductionPopulation-based screening has been shown to reduce cancer specific mortality. Within Scotland, three national screening programmes exist: breast, cervical and bowel. Despite being a common and preventable form of cancer, the uptake for bowel cancer screening among women lags behind that for breast and cervical cancer.
Objectives and ApproachSince the benefits of screening accrue with participation, it is important to understand why differences in screening uptake exist. In this study, data on women aged 24-74 in the Greater Glasgow and Clyde Health Board, invited to take part in one or more screening programme during the period 2009-2013, were linked to demographic and medical data. Uptake was determined based on the presence of a screening attendance or result; the impact of age, deprivation and co-morbidity on uptake was determined using logistic regression for each individual programme, and for the cohort of women invited to participate in all three programmes.
ResultsOverall, 430,591 women were invited to take part in one or more screening programme during the study period. The uptake for bowel screening was, at 61.7%, lower than that seen in either the breast (72.6%) or cervical (80.7%) programme. Despite these differences, the same demographic factors were associated with uptake of each individual screening programme: older women and those living in affluent areas were most likely to attend. Medical factors did differentially influence uptake, those with multi-morbid illness being less likely to participate in breast and bowel, but not the cervical programme. For the 68,324 women invited to participate in all programmes, 52.1% took part in all three while 7.2% participated in none.
Conclusion/ImplicationsUptake of bowel screening was confirmed as lower than uptake of other programmes, although all were similarly impacted by demographic, clinical and socioeconomic factors. Individuals were more likely to complete bowel screening if they participate in another programme, suggesting these may serve as a vehicle for improving bowel screening uptake.