Despite a growing acceptance of egalitarian gender attitudes, there is no empirical evidence about the division of roles between wives and husbands and its variation across their family life in the Islamic Republic of Iran (IRI). This paper uses data from the 2014 to 2015 Time Use Survey, representing urban areas of the IRI, to examine the dynamics of the spouses' division of roles across their family life. The findings confirm a gender division of roles. The mapping of the spouses' role behaviours during their family life provides a combination of gender similarities and differences. Role configurations (or role variations across family life) clearly differ between spouses but the pathways (or life-course variations in role behaviours) are quite similar in some roles (i.e., community, individual and parental roles) and different in others (i.e., occupational and domestic roles). To the extent that the existing gender patterns are perceived as unjustified, they can be consequential not only for marital satisfaction and quality, but also for marriage and childbearing decisions.
Despite a growing acceptance of egalitarian gender attitudes, there is no empirical evidence about the division of roles between wives and husbands and its variation across their family life in the Islamic Republic of Iran (IRI). This paper uses data from the 2014 to 2015 Time Use Survey, representing urban areas of the IRI, to examine the dynamics of the spouses' division of roles across their family life. The findings confirm a gender division of roles. The mapping of the spouses' role behaviours during their family life provides a combination of gender similarities and differences. Role configurations (or role variations across family life) clearly differ between spouses but the pathways (or life-course variations in role behaviours) are quite similar in some roles (i.e., community, individual and parental roles) and different in others (i.e., occupational and domestic roles). To the extent that the existing gender patterns are perceived as unjustified, they can be consequential not only for marital satisfaction and quality, but also for marriage and childbearing decisions.
SummaryIt is anticipated that the demand for contraceptives in Iran will increase in the near future as the number of women of reproductive age increases and with women wanting smaller families. The aim of this paper was to study the demand for long-acting and permanent contraceptive methods (LAPCMs), and its determinants, among Kurdish women in Mahabad city, Iran. Data were taken from the Mahabad Fertility Survey (MFS) conducted on a sample of over 700 households in April 2012. The results show that the demand for LAPCMs was 71.35% at the time of survey, although only 27.7% of women were using these methods. Thus, the number of unintended pregnancies is likely to increase in the future if this gap is not reduced. The multivariate analysis showed significant impacts on the dependent variables of the number of children ever born, perceived contraceptive costs and childbearing intentions. Moreover, women at the end of their reproductive lives and those with higher education were more likely to desire LAPCMs. It is concluded that despite a growing use of contraceptive methods in Iran in recent decades, the development of reproductive health services and promotion of the quality of family planning services remains a necessity.
IntroductionMonitoring social wellbeing and its relationship to health service utilisation by means of appropriate measurement tools can potentially provide a complementary view for influencing service development. Aspects of wellbeing have been collected in the Welsh Health Survey (WHS) while routine health data captures health service utilisation.
Objectives and ApproachWHS was used to link self-reported wellbeing to health outcomes, prior to linking to routinely collected data. Initially, a measure for personal wellbeing was developed using the four personal wellbeing questions defined by The Office of National Statistics (ONS), included in national surveys from 2011 onward. We conducted regression analysis to identify potential predictors of personal wellbeing scores our model included self-reported lifestyle behaviour, self-reported health, education, work, household and general demographics. Links to primary care, hospital and emergency department datasets are being developed to provide insight into the relationship between wellbeing, multi-morbidity and health service utilisation.
ResultsFour wellbeing questions had similar scoring patterns across age groups which is different to most health indicators that tend to show a marked health decline with increasing age. There is a difference between mean wellbeing score for males and females. Our finding showed that self-reported of 'excellent' or 'very good' general health has the largest positive effect on wellbeing while positive viewpoint on self-health has the second largest effect on our model. In addition, being retired from a paid job, eating at least one or 5+ portion of fruit and vegetables and giving up smoking have positive impact on population wellbeing. In contrast, not being able to work, intermediate household occupancy, consuming alcohol in last 12-months, having long-standing illness, showed a negative impact on wellbeing.
Conclusion/ImplicationsThis project established robust methodology on utilizing survey and routine health data for monitoring and evaluation purposes. We also evaluated the linkability of survey data The latest release of National Survey for Wales (NSW) will cover a combination of self-reported health measures and aims for a higher linkage consent rate.
BackgroundMonitoring social wellbeing and its relationship to health service utilisation by means of appropriate measurement tools can provide a complementary view towards service development. Welsh Health Survey (WHS) collects aspects of wellbeing while routine health data captures details around health service utilisation.
ObjectiveThe aim of this project was to evaluate the linkage ability of routine health data with survey data and establish a methodology for utilizing survey data as a measure for self-reported health outcomes.
MethodWe used WHS data from UK data archive to link self-reported wellbeing to health outcomes, a measure for personal wellbeing was developed using the personal wellbeing questions defined by Office of National Statistics (ONS), included in national surveys from 2011 onward. WHS was then linked to routine health data using SAIL Databank. We conducted regression analysis to identify potential predictors of personal wellbeing by linking primary care, hospital and emergency department datasets, to develop and provide insight into the relationship between wellbeing, multi-morbidity and health service utilisation.
FindingsWellbeing questions had similar scoring patterns across age groups which is different to most health indicators that tend to show a marked health decline with increasing age. Our findings showed that self-reported of 'excellent' or 'very good'general health has the largest positive effect on wellbeing while positive viewpoint on self-health has the second largest effect.
ConclusionsCombining and harmonising data from multiple sources and linking them to information from a longitudinal cohort create useful resources for population health research. These methods are reproducible and can be utilised by other researchersand projects.
AbstractBackgroundMany of the 35 million women and girls aged 15–49 requiring humanitarian assistance have inadequate access to the sexual and reproductive health (SRH) services to which they are entitled. Ensuring accountability is critical to realizing their SRH and reproductive rights (RR).ObjectivesThis scoping review examines the extent and nature of existing evidence on accountability strategies for SRH in humanitarian settings in different geographical scopes/contexts, and contextualizes these findings in the larger thematic literature. This review seeks to answer the following questions: What accountability strategies are employed to address the availability, accessibility, acceptability, and quality of SRH in humanitarian settings? What do we know about the successes and challenges of the given strategies? What are the implications for practice?MethodsWe consulted public health, social science, and legal databases including SCOPUS, PubMed, ProQuest, and LexisNexis for peer-reviewed articles, as well as Google Advanced search for grey literature; the search was conducted in March 2019. We searched for relevant articles and documents relating to accountability, humanitarian, and SRH and/or RR. To identify key challenges not reflected in the literature and additional grey literature, 18 key informants from international NGOs, local government bodies, academia, and donor agencies were interviewed from March–June 2019.ResultsA total of 209 papers and documents were identified via our literature searches and interviews for review. We identified three categories of approaches to accountability in our background reading, and we then applied these to the papers reviewed a priori.We created a fourth category based on our findings. The categories include: (1) humanitarian principles, codes of conduct, and legal instruments; (2) technical, performance, and impact standards; (3) efforts to solicit and address the rights and needs of the affected populations, or "listening and responding," and, (4) accountability demands made by affected populations themselves. Almost all papers identified referred to challenges to realizing accountability in humanitarian contexts. There are promising accountability approaches – some specific to SRH and some not - such as open-ended feedback from affected populations, quality improvement, and practical application of standards. Reflecting a largely top down orientation, papers concentrate on accountability mechanisms within humanitarian work, with much less focus on supporting affected populations to deepen their understanding of structural causes of their position, understand their entitlements, or access justice.ConclusionIn the last 20 years, there has been increasing standard and guideline development and program experiences related to accountability in humanitarian settings. Yet, the emphasis is on tools or mechanisms for accountability with less attention to changing norms regarding SRH and RR within affected communities, and to a lesser extent, among implementers of humanitarian programs or to institutionalizing community participation.
BackgroundTrusted Research Environments provide a legitimate basis for data access along with a set of technologies to support implementation of the "five-safes" framework for privacy protection. Lack of standard approaches in achieving compliance with the "five-safes" framework results in a diversity of approaches across different TREs. Data access and analysis across multiple TREs has a range of benefits including improved precision of analysis due to larger sample sizes and broader availability of out-of-sample records, particularly in the study of rare conditions. Knowledge of governance approaches used across UK-TREs is limited. ObjectiveTo document key governance features in major UK-TRE contributing to UK wide analysis and to identify elements that would directly facilitate multi TRE collaborations and federated analysis in future. MethodWe summarised three main characteristics across 15 major UK-based TREs: 1) data access environment; 2) data access requests and disclosure control procedures; and 3) governance models. We undertook case studies of collaborative analyses conducted in more than one TRE. We identified an array of TREs operating on an equivalent level of governance. We further identify commonly governed TREs with architectural considerations for achieving an equivalent level of information security management system standards to facilitate multi TRE functionality and federated analytics. ResultsAll 15 UK-TREs allow pooling and analysis of aggregated research outputs only when they have passed human-operated disclosure control checks. Data access requests procedures are unique to each TRE. We also observed a variability in disclosure control procedures across various TREs with no or minimal researcher guidance on best practices for file out request procedures. In 2023, six TREs (40.0%) held ISO 20071 accreditation, while 9 TREs (56.2%) participated in four-nation analyses. ConclusionSecure analysis of individual-level data from multiple TREs is possible through existing technical solutions but requires development of a well-established governance framework meeting all stakeholder requirements and addressing public and patient concerns. Formation of a standard model could act as the catalyst for evolution of current TREs governance models to a multi TRE ecosystem within the UK and beyond.
ObjectivesThe COVID-19 pandemic has had a detrimental impact on healthcare utilisation, resulting in increased mortality both directly and indirectly associated with COVID-19. We aimed to assess the impact of the COVID-19 pandemic on all-cause and disease-specific mortality and further explore the impact of potential inequalities, deprivation status and ethnicity.
ApproachPopulation-scale, individual-level, anonymised linked, routinely-collected electronic health records from demographic and administrative sources were used for two cohorts: i) C19-COHORT16 included individuals alive and resident in Wales on the 1st January 2016 with follow-up until death, break-in Welsh residency, or 31st December 2019; ii) C19-COHORT20 included individuals alive and resident in Wales on 1st January 2020 with follow-up until death, break-in Welsh residency, or study end. We used time-series analysis to investigate trends in mortality over time. We fitted negative binomial models to estimate expected all-cause and disease-specific mortality and compared these estimates to observed mortality in C19-COHORT20.
ResultsExcess all-cause and COVID19-related deaths were higher during the period where the alpha variant was dominant. The trend in deaths decreased during the omicron dominant period. The Asian population had increased mortality during the period where the delta variant was dominant. Mortality was increased for most deprived groups compared to least deprived groups, however, the magnitude of this effect remained unchanged during the pandemic. COVID-19 indirectly affected cancer, circulatory, trauma, digestive and mental health related deaths, with a higher than expected mortality. The majority of trauma related deaths occurred early on in the pandemic, where a higher than expected number of deaths occurred outside of an NHS establishment. Mortality associated with respiratory disease (unrelated to COVID-19) was significantly lower than expected during the COVID-19 pandemic.
ConclusionIncreased all-cause and disease-specific mortality was observed during the COVID-19 pandemic. Excess deaths may be a result of reduced healthcare utilisation, delayed investigation and/or treatment of chronic diseases. As healthcare systems recover from COVID-19, investigation of mortality trends will play a central role in healthcare planning, utilisation and resource use.
IntroductionAtrial Fibrillation (AF) is a common abnormal heart rhythm that is associated with five times the risk of stroke and twice the risk of death. However, this risk can be reduced by approximately two thirds through the appropriate use of anticoagulation (AC).
Objectives and ApproachReducing the incidence of stroke through effective management of AF is a priority recognised by Abertawe Bro Morgannwg University Health Board (ABMUHB), in Wales, UK. An understanding of how closely services follow appropriate clinical guidelines for stroke prevention allows identification of opportunities to improve stroke outcomes and service efficiency. This study was commissioned to describe the nature of antithrombotic drug prescribing in ABMUHB patients with AF according to thromboembolic and bleeding risk status, and the numbers of non-anticoagulated patients with AF presenting with stroke. This study was completed using linked data held in the Secure Anonymised Information Linkage (SAIL) databank.
ResultsAF was identified in 12,778 ABMUHB patients (approximately 3% of the population), with 97% providing linked primary care records for our required period of follow-up. Of the AF patients with linked prescribing data, 60.5% were prescribed anticoagulants, 15.8% were prescribed antiplatelet agents and 23.7% received no antithrombotic medication. Notably, the thromboembolic risk and bleeding risk profiles (characterised by modified CHA2DS2-VASc and HAS-BLED scores respectively, implemented within the SAIL databank data) were remarkably similar in those receiving and those not receiving AC. 965 patients were admitted to ABMUHB hospitals with a stroke during 2015. AF was previously diagnosed in 18% of these patients, of whom just over half (50.3%) were not being prescribed AC during the 3 months prior to their stroke.
Conclusion/ImplicationsThis study demonstrates under prescribing of AC in patients with AF, which is not explained by stroke risk or bleeding scores. ABMUHB colleagues are developing strategies for service improvements, with plans for further sequential analysis to evaluate the effectiveness of implemented measures for outcome monitoring and reporting purposes.
IntroductionCritical Care is a specialty in medicine providing a service for severely ill and high-risk patients who, due to the nature of their condition, may require long periods recovering after discharge. Consequently, focus on the routine data collection carried out in Intensive Care Units (ICUs) leads to reporting that is confined to the critical care episode and is typically insensitive to variation in individual patient pathways through critical care to recovery. A resource which facilitates efficient research into interactions with healthcare services surrounding critical admissions, capturing the complete patient's healthcare trajectory from primary care to non-acute hospital care prior to ICU, would provide an important longer-term perspective for critical care research. ObjectiveTo describe and apply a reproducible methodology that demonstrates how both routine administrative and clinically rich critical care data sources can be integrated with primary and secondary healthcare data to create a single dataset that captures a broader view of patient care. MethodTo demonstrate the INTEGRATE methodology, it was applied to routine administrative and clinical healthcare data sources in the Secure Anonymised Data Linking (SAIL) Databank to create a dataset of patients' complete healthcare trajectory prior to critical care admission. SAIL is a national, data safe haven of anonymised linkable datasets about the population of Wales. ResultsWhen applying the INTEGRATE methodology in SAIL, between 2010 and 2019 we observed 91,582 critical admissions for 76,019 patients. Of these, 90,632 (99%) had an associated non-acute hospital admission, 48,979 (53%) hadan emergency admission, and 64,832 (71%) a primary care interaction in the week prior to the critical care admission. ConclusionThis methodology, at population scale, integrates two critical care data sources into a single dataset together with data sources on healthcare prior to critical admission, thus providing a key research asset to study critical care pathways.
