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Association between paediatric antibiotic prescribing and socioeconomic deprivation: insights from a pilot project in West Yorkshire, United Kingdom
Get PDFBackground
Inappropriate antibiotic use in settings including human and veterinary medicine and a lack of novel therapies have contributed to a global antimicrobial resistance (AMR) crisis. In January 2025, the UK Health Security Agency revised the UK Access, Watch, Reserve (AWaRe) antibiotic list to guide prescribing of 90 antibiotics. This pilot study investigated relationships between socioeconomic deprivation and paediatric antibiotic prescribing in secondary care in the Mid Yorkshire Teaching NHS Trust region, UK.
Methods
Retrospective antibiotic prescribing data was obtained from the NHS Trust’s electronic prescribing system for patients aged 0–2 years prescribed systemic antibiotics between April 2022 and January 2025, the start of the Born and Bred in Wakefield (BaBi) Wakefield project. Demographic data retrieved from electronic clinical and management information system included ethnicity, admission and discharge date, ICD-10 diagnostic codes, and IMD decile, converted to quintile for statistical analysis. Quasi-Poisson count regression approach was used to explore the relationship between the rate of antibiotic prescription, socioeconomic deprivation, and region.
Results
A total of 780 patients and 2204 antibiotic prescriptions were identified from hospital prescribing report. Adjusted models identified four key findings. Firstly, length of stay (LOS) in hospital and number of diagnostic codes were highest in the most deprived group (Q1). Secondly, the number of unique antibiotics prescribed (adjusted per admission) was highest in the least deprived group(Q5) although this relationship was not statistically significant. Thirdly, the number of unique antibiotics (adjusted per LOS) was highest in Q5, and this was statistically significant (p = xxx). Finally, in contrast with other studies in the UK, ethnicity was not significantly associated with the use of systemic antibiotics.
Conclusion
Our findings suggest that children from more deprived areas with more comorbidities/ diagnosis received less antibiotics in secondary care settings compared with their peers from least deprived areas. The LOS and number of diagnostic codes also decreased from Q1 to Q5. Future prescribing trends among children aged 0-2years should account for contextual factors to ensure that children from the most deprived communities are not disproportionately exposed to less antibiotics despite of suffering more comorbidities
Morning serum cortisol predicts short synacthen test response during glucocorticoid weaning in children and adults
No full textSocioeconomic and ethnic disparities in major lower limb amputation related to peripheral arterial disease in England
Get PDFBackground
Amputation is a treatment of last resort for peripheral arterial disease. This study examined associations between socioeconomic deprivation, ethnicity, above-knee amputation (AKA) and below-knee amputation (BKA) rates, and post-amputation survival in England.
Methods
Hospital Episode Statistics data identified patients aged ≥25 years who underwent an AKA or BKA related to peripheral arterial disease in 2006-2018. Data on ethnicity, comorbidity and socioeconomic deprivation was recorded. An ecological study design, based on population-level data, analysed amputation rates (Poisson regression), and a cohort study design investigated mortality subsequent to amputation (Cox regression).
Results
Within a population of 35.7 million people aged ≥25 years, 47 249 patients underwent peripheral arterial disease-related major amputation over 12 years (94.1% White, 1.9% Black, and 1.6% Asian ethnicity). AKA : BKA ratios were 1.03, 0.73, and 0.80 for White, Black, and Asian ethnicities respectively. Amputation rates increased with increasing socioeconomic deprivation. The amputation rate ratio for the most relative to the least deprived category varied with age, ranging from 4.94 (95% confidence interval 4.24 to 5.75) for age 45–54 years to 1.35 (1.21 to 1.49) for age ≥85 years for AKA, and from 3.88 (3.44 to 4.37) to 1.12 (0.97 to 1.29) for BKA. Post-amputation mortality hazard ratios also increased with increasing socioeconomic deprivation, ranging from 1.26 (1.04 to 1.53) for age 25–54 years to 1.11 (1.03 to 1.19) for age ≥75 years for AKA, and from 1.25 (1.08 to 1.46) to 1.17 (1.08 to 1.27) for BKA. Over 12 years, amputation rates decreased in all socioeconomic categories in the population aged ≥65 years, but there was little change in the population aged 25–64 years. Black ethnicity was associated with lower adjusted AKA and BKA rate ratios relative to White ethnicity in those aged 25–64 years, and similar AKA but higher BKA rate ratios in those aged ≥65 years. Black ethnicity was also associated with lower post-amputation mortality, except in those aged 25–54 years within 90 days of BKA. Asian ethnicity was associated with lower AKA and BKA rate ratios relative to White ethnicity, but similar post-amputation mortality with some exceptions.
Conclusion
The main policy and practice implications relate to socioeconomic inequalities. Greater efforts are needed in disadvantaged areas to prevent and manage peripheral arterial disease and reduce amputation
The ways that external and internal dynamics influence intermediaries in the climate policy process
Get PDF“Climate intermediaries” are important for climate governance, as they can strengthen mitigation efforts by drawing enable diverse insights into the policy process. However, actors wishing to intermediate may be stymied from assuming such a role; hence, there is a need for a greater understanding of whether and how, organizations can act as climate intermediaries. We investigate in what ways external governance dynamics surrounding an organization can influence their intermediation, and further, in what ways these external dynamics produce internal dynamics that influence intermediation still further. We find that externally, the presence of funding limitations, competition between intermediaries, and unwilling or inappropriate intermediation partners can influence nongovernmental organizations (NGOs’) pursuit of intermediation. Moreover, by examining internal dynamics, we see that these external dynamics challenge NGOs’ strategy-making, staff well-being, and maintenance of expertise, which impact their organization’s intermediation still further. Resultantly, we propose that despite intermediaries being a crucial component of the post-Paris Agreement climate policymaking process, the governance arrangements that surround NGOs impact their ability to assume this role, with attendant implications for limiting the diversity of insights into the policy process
New upper limits for β -delayed fission probabilities of Fr 230,232 and Ac 230,232,234
Get PDFThe process of β-delayed fission (βDF) of Fr230,232 and Ac230,232,234 was studied in an experiment performed at the ISOLDE facility at CERN. As no fission fragments were observed for any of the nuclei investigated, upper limits for their βDF probability (PβDF) were determined. The experimental results were compared with theoretical calculations that were first benchmarked on Tl178,180PβDF experimental values. The PβDF values were calculated using the code TALYS to which β-strength functions obtained from the D1M Gogny parametrization and from the Skyrme functional SKO' were given as input together with fission paths obtained with BSkG3 and BSk14 models. Sensitivity studies of different β-strength functions, and fission paths scaling on the PβDF values were conducted, suggesting a stronger dependence of the PβDF on the fission paths rather than on the β-strength function used
What is media literacy and why does it matter? Perspectives of Senegalese media professionals
Get PDFLike other West African countries, Senegal has not been spared from the adverse political, social, cultural and economic effects of misinformation. Although the country stands out as a pioneer in West Africa for introducing media literacy education within the school system in the early 1960s, it has not yet established a national strategy for promoting media literacy. At the same time, media literacy has been touted as one way to address misinformation. This study surveys media professionals to capture their understanding of ‘media literacy’ and explores their views on implementing a national media literacy policy. A thematic analysis of 22 in-depth interviews shows that although media professionals are not particularly knowledgeable about media literacy, they view the Senegalese government, the media and opinion leaders as potential agents of change in promoting media literacy in schools, mosques, markets and other public spaces where information circulates
Defining and measuring acceptability of surgical interventions: a scoping review
Get PDFBackground Acceptability, in the context of healthcare interventions is a frequently used term, including in evaluations of surgical interventions. This reflects the importance of the concept to all stakeholders and significance to designing, implementing and evaluating interventions. Despite this, definitions and measurement of acceptability are not standardised, and acceptability is often poorly conceptualised. The aim of this scoping review was to identify how studies define, measure and report the acceptability of a surgical intervention. Methods A scoping review was conducted adhering to the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A comprehensive search of MEDLINE; Embase:APA PsycInfo; EBHealth-KSR Evidence; Cochrane Central Register of Controlled Trials; International HTA database; ClinicalTrials.gov and WHO International Clinical Trials Registry Platform was conducted for the period January 2000 to November 2023. No language limits were applied. Results Sixty-seven studies from 25 countries were included. The majority of studies (n=60; 90%) did not provide a definition of acceptability. Various methods were used to collect data on acceptability, most frequently a questionnaire (n=36; 54%), followed by qualitative interviews (n=16; 24%). Thirty-three studies (49%) reported acceptability of the surgical intervention received to patients, nine (13%) reported hypothetical acceptability of the surgical intervention to patients, five (7%) reported acceptability to both patients and surgeons, and three studies (4%) the acceptability to surgeons. Conclusion Studies assessing acceptability of a surgical intervention tended not to provide a definition of acceptability and demonstrated a lack of clarity in the use of acceptability in the context of surgical interventions. There was substantial variability in how and when acceptability was measured and from which perspective. Further research is required to explore the most appropriate approaches to address variability and promote a more consistent conceptualisation and accurate measurement of acceptability in evaluations of surgical interventions
Convolutional neural networks to characterise particle suspensions from ultrasonic backscatter
Get PDFUltrasonic backscatter has been used extensively across many applications to characterise suspended particles. It is of particular interest in nuclear decommissioning, as it allows online characterisation without the need to sample, or even contact the suspension in some cases. Industrial processes often utilise dynamic changes to suspended particle concentrations and particle size distributions (PSDs), and as such, characterisation of both simultaneously would be advantageous. At present, there is limited scope within existing analytical methods to achieve this, where the concentration or PSD of the target system must be known to calculate the other. Machine learning (ML) is a method that when trained on representative data, can use non-linear multi-variable minimisations to estimate both concentration and PSD simultaneously and, as such, this study aims to demonstrate that an artificial neural network (ANN) and convolutional neural network (CNN) can accomplish this. A training library of nine spherical glass bead suspension systems, comprising of variable median particle size and coefficient of variation, across six concentrations was compiled using a commercial backscatter instrument at 2 and 4 MHz. The hyperparameters of an ANN and CNN were optimised on these acoustic profiles, before being used to predict median particle size, coefficient of variation, and concentration from acoustic profiles at 2 and 4 MHz of two “unknown” suspensions. While neither the ANN or CNN predictions proved to be successful for estimating the coefficient of variation, moderate agreement between predicted and true values were found for median particle size and concentration from the ANN, while the CNN achieved good agreement for median particle size and very good agreement when predicting particle concentration. Consequently, this study was able to successfully determine that a CNN could simultaneously estimate a median particle size and concentration using ultrasonic backscatter data gathered on an “unknown” suspension
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