27 research outputs found
The overlooked challenges facing Out-of-Hours primary care in the NHS:a missed opportunity in policy
No full text[No abstract
Inequality in uptake of bowel cancer screening by deprivation, ethnicity and smoking status: cross-sectional study in 86 850 citizens
No full textBackgroundSurvival from colorectal cancer depends on stage at detection. In England, bowel cancer mortality has historically been highest in deprived areas. During the initial stages of the COVID-19 pandemic, it was necessary to temporarily halt many screening programmes, which may have led to inequalities in uptake since screening restarted.MethodsCross-sectional data from the Bristol, North Somerset and South Gloucestershire Systemwide Dataset were analyzed. Associations of baseline characteristics with uptake of bowel screening were examined using logistic regression.ResultsAmongst 86 850 eligible adults aged 60–74 years, 5261 had no screening record. There was little evidence of association between no screening and sex (adjusted odds ratio 0.95 (95% confidence interval 0.90, 1.02)). Absence of screening record was associated with deprivation (1.26 (1.14, 1.40) for the most compared with the least deprived groups), smoking (1.11 (1.04, 1.18)) compared with no smoking record and black (1.36 (1.09, 1.70)) and mixed (1.08 (1.01, 1.15)) ethnicity compared with white ethnicity.ConclusionsIn a data set covering a whole NHS Integrated Care Board, there was evidence of lower uptake of bowel cancer screening in adults living in more deprived areas, of minority ethnic groups and who smoked. These findings may help focus community engagement work and inform research aimed at reducing inequalities
Why can't my child see 3D television?
No full textA child encountering difficulty in watching three-dimensional (3D) stereoscopic displays could have an underlying ocular disorder. It is therefore valuable to understand the differential diagnoses and so conduct an appropriate clinical assessment to address concerns about poor 3D vision.</p
The range of peripapillary retinal nerve fibre layer and optic disc parameters in children aged up to but not including 18 years of age, as measured by optical coherence tomography:protocol for a systematic review
No full textBackgroundThe parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in at-risk children. There is no standardised reference for the normal parameters of the optic disc and pRNFL in children; however, there are a large number of small individual studies that have been undertaken to look at these measures.MethodsA systematic review of current literature on the range of pRNFL and optic disc parameters in children aged less than 18 years will be performed. Studies will be considered for review if they report numerical data on optic disc and pRNFL parameters, measured using optical coherence tomography. Outcome measures will include mean pRNFL thickness and cup-disc ratio. The bibliographic databases Medline, CINAHL, EMBASE, Scopus and Web of Science will be systematically searched from 1991. Screening of search results will be conducted by two authors working independently, as will extraction of primary and secondary outcome data. Ten per cent of all other data extraction will be checked by a second author. Results will be compiled and presented in evidence tables. Where possible and appropriate, study-specific estimates will be combined to obtain an overall summary estimate of pRNFL thickness and cup-disc ratio across studies and results will be presented by age of population. Subgroup analyses will be undertaken for children of different ethnicities.DiscussionThis review aims to provide an overview of the parameters of the optic disc and pRNFL in children of different ages in order to identify gaps in knowledge and to improve understanding of what might be considered within/outside the range of normality. The findings will be presented in peer-reviewed journals and will be presented at conferences.Systematic review registrationPROSPERO CRD4201603306
Pseudo-Papilledema Detection and Prevalence
No full textPapilledema, caused by raised intracranial pressure, must be distinguished from pseudo-swelling when the optic disc appears swollen but is not. Anecdotally, pseudo-papilledema referrals are often based on abnormal disc appearances on fundus imaging and may precipitate unnecessary invasive investigations. The prevalence of pseudo-papilledema is not reported. We aimed to: (1), determine the population-prevalence of pseudo-papilledema (2), determine the sensitivity and specificity for papilledema detection on fundus imaging
Ophthalmic abnormalities in children with Developmental Coordination Disorder: Data from the ALSPAC
No full textDynamics of public health messaging and healthcare activity in children during the 2022 iGAS surge:an observational study in England
No full textBackgroundPublic health messaging during infectious disease outbreaks can influence healthcare demand. The winter 2022 surge in Group A Streptococcus (GAS) in England provided an opportunity to examine the relationship between communications and National Health Service (NHS) activity, informing future strategies for resilience and risk communication.MethodsThis observational study analysed UK Health Security Agency (UKHSA) invasive GAS (iGAS) notifications, NHS 111, General Practice (GP), and emergency department (ED) surveillance data, prescription records, internet searches, and media reports. Temporal associations were assessed descriptively, with weekly differences from winter averages calculated.ResultsFollowing initial media reports and UKHSA messaging, internet search interest rose sharply (4%–63%). In the subsequent week, there were increases in NHS 111 contacts (fevers +256%, sore throats +953%), acute respiratory infection ED visits (+155%), GP pharyngitis consultations (+356%), and community penicillin prescriptions (+134%) compared to winter averages. Compared to the previous week, consultations for scarlet fever declined.ConclusionsThis is the first study to link outbreak communications with system-wide NHS activity in real time. Messaging likely prompted appropriate care-seeking, but the rapid return to baseline and the low predictive value of consultations for iGAS suggest that many were for self-limiting illness. Findings highlight the need for tailored messaging, interdisciplinary collaboration, and scalable healthcare capacity during outbreaks
Ophthalmic abnormalities in children with developmental coordination disorder.
No full textAIM: To explore associations between developmental coordination disorder (DCD) and ophthalmic abnormalities in children aged 7 to 8 years. METHOD: Cross-sectional analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, was performed. DCD was defined according to DSM-IV criteria. Children with neurological difficulties or IQ less than 70 were excluded. Ophthalmic abnormalities including visual acuity, refraction, and binocular function were assessed using standard tests. Children who achieved less than the 5th centile in the ALSPAC coordination test and either failed the National Curriculum handwriting test, or achieved less than the 10th centile in the Activities of Daily Living scale (ADL) were defined as having severe DCD, while those who scored between the 5th and 15th centiles in the coordination test and either failed the handwriting test, or achieved less than the 15th centile in the ADL were defined as having moderate DCD. RESULTS: Complete data were available for 7154 children. One hundred and twenty children (1.8%) met the criteria for severe DCD. A further 215 children had moderate DCD. Children with severe DCD were more likely to have the following: abnormal sensory fusion at near (odds ratio [95% confidence interval]) (1.98 [1.13-3.48]) and distance (2.59 [1.16-5.79]) and motor fusion (1.74 [1.07-2.84]); reduced stereoacuity (2.75 [1.78-4.23]); hypermetropia (2.29 [1.1-4.57]) and anisometropia (2.27 [1.13-4.60]). The majority of children found to have both DCD and a refractive error, had been previously prescribed glasses and wore them for the assessments (71%). INTERPRETATION: Children with severe DCD had abnormalities in binocular vision, refractive error, and ocular alignment. We recommend that children with DCD be assessed for ocular abnormalities as early intervention may improve long-term visual outcome. The impact of untreated ocular abnormalities such as refractive error on the accuracy of the diagnosis of DCD is difficult to ascertain and further work would be of benefit
Ophthalmic abnormalities and reading impairment
No full textOBJECTIVES: To explore associations between specific learning disorder with impairment in reading (dyslexia) and ophthalmic abnormalities in children aged 7 to 9 years.METHODS: Cross-sectional analysis was performed on cohort study data from the Avon Longitudinal Study of Parents and Children. Reading impairment was defined according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Children who achieved >2 SD below the mean in the Neale Analysis of Reading Ability Scale II and level <4 in nonmathematical national key stage 2 tests were defined as having severe reading impairment (SRI). Children with blindness or IQ <70 were excluded.RESULTS: Data were available for 5822 children, of whom 172 (3%) met the criteria for SRI. No association was found between SRI and strabismus, motor fusion, sensory fusion at a distance, refractive error, amblyopia, convergence, accommodation, or contrast sensitivity. Abnormalities in sensory fusion at near were mildly higher in children with SRI compared with their peers (1 in 6 vs 1 in 10, P = .08), as were children with stereoacuity worse than 60 seconds/arc (1 in 6 vs 1 in 10, P = .001).CONCLUSIONS: Four of every 5 children with SRI had normal ophthalmic function in each test used. A small minority of children displayed minor anomalies in stereoacuity or fusion of near targets. The slight excess of these children among those with SRI may be a result of their reading impairment or may be unrelated. We found no evidence that vision-based treatments would be useful to help children with SRI.</p
