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Objective: This study aimed to estimate the public hospital costs associated with primary liver cancer (PLC) in the first and second years following the cancer diagnosis. Methods: This study linked administrative datasets of patients diagnosed with PLC in Victoria, Australia, from January 2008 to December 2015. The health system perspective was adopted to estimate the direct healthcare costs associated with PLC, based on inpatient and emergency costs. Costs were estimated for the first 12 months and 12–24 months after the PLC diagnosis and expressed in 2017 Australian dollars (A$). The cost estimated was then extrapolated nationally. The linear mixed model with a Box–Cox transformation of the costs was used to explore the relationship between costs and patients' sociodemographic and clinical characteristics. Results: For the first 12 months, the total and annual per-patient cost was A$211.4 million and A$63 664, respectively. Costs for the subsequent year were A$49.7 million and A$46 751, respectively. Regarding the cost extrapolation to Australia, the total cost was A$137 million for the first 12 months after notification and A$42.6 million for the period from 12 to 24 months. Higher costs per episode of care were mostly associated with older age, hepatocellular carcinoma type of PLC, metropolitan hospitals, and Asian birth region. Conclusion: This study showed the public hospital admission and emergency costs associated with PLC and the substantial economic burden this cancer has placed on the Australian health system. What is known about the topic? There are limited data on the economic burden of primary liver cancer in Australia. What does this paper add? This study showed the cost in the second year after cancer diagnosis was substantially lower than that of the first year. Higher costs per episode of care were mostly associated with older age, metropolitan hospitals, and Asian birth region. What are the implications for practitioners? Results from this study can be used as a baseline for comparison with other initiatives to mitigate cancer risk factors or inputs for future economic evaluations of cancer surveillance. [ABSTRACT FROM AUTHOR]

Background: Electronic administrative data exist in several domains which, if linked, are potentially useful for research. However, benefits from data linkage should be considered alongside risks such as the threat to privacy. Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study. The Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. Qualitative research was incorporated in the PEARL study to examine participants' views about data linkage and inform approaches to information sharing. This paper focusses on issues of consent.Methods: Digitally recorded interviews were conducted with 55 participants aged 17-19 years. Terms and processes relating to consent, anonymization and data linkage were explained to interviewees. Scenarios were used to prompt consideration of linking different sources of data, and whether consent should be requested. Interview recordings were fully transcribed. Thematic analysis was undertaken using the Framework approach.Results: Participant views on data linkage appeared to be most influenced by: considerations around the social sensitivity of the research question, and; the possibility of tangible health benefits in the public interest. Some participants appeared unsure about the effectiveness of anonymization, or did not always view effective anonymization as making consent unnecessary. This was related to notions of ownership of personal information and etiquette around asking permission for secondary use. Despite different consent procedures being explained, participants tended to equate consent with 'opt-in' consent through which participants are 'asked' if their data can be used for a specific study. Participants raising similar concerns came to differing conclusions about whether consent was needed. Views changed when presented with different scenarios, and were sometimes inconsistent.Conclusions: Findings from this study question the validity of 'informed consent' as a cornerstone of good governance, and the extent to which potential research participants understand different types of consent and what they are consenting, or not consenting, to. Pragmatic, imaginative and flexible approaches are needed if research using data linkage is to successfully realise its potential for public good without undermining public trust in the research process. [ABSTRACT FROM AUTHOR]

Aim: The World Health Organization (WHO) 2006 growth standards were adopted in most countries, Israel included. We aimed to study the assumption that growth in early years is similar across populations by studying the validity of the WHO growth standards in a large population-based study of Israeli infants. Methods: Computerized data on infants born in 2011–2015 who were followed in the well-baby clinics for the first 2 years of their lives were retrieved from the Ministry of Health. Data included sociodemographics, delivery information, and visit-specific measurements of weight, recumbent length, and head circumference. Sex- and age-specific z-scores, percentiles, and outliers of anthropometric measurements were calculated and compared with the Standards. These analyses were repeated for "ideally grown" infants. Results: Israeli infants were consistently shorter, with z-scores ranging from −0.07 SD (standard deviation) to −0.5 SD. Also, Israeli infants weighed less than predicted by the standards in the first 9 months. The proportion over 2 SD in weight-for-length increased with age from 2.2–2.9% in the first 6 months of life to 3.4–5.1% in the second year of life, which is well above the expected value of 2.3%. Conclusion: Israeli infants were shorter and more likely to be obese than predicted by the Standards. Having differences in length even more prominent among "ideally grown" children suggest that the WHO standards might not be optimal for monitoring the growth of Israeli infants. [ABSTRACT FROM AUTHOR]

This study investigated students' use of the central library of the University of the Punjab in Lahore, Pakistan, including the effect of various demographic and academic characteristics on the utilization of library services. The study also examined library users' methods of finding information sources and their perceived importance of the academic library as a place. A validated, self-administered questionnaire was distributed to 400 library users in eight different library locations. Of 400 questionnaires, 317 responses were submitted, for a response rate of 79 percent. The findings indicated that students frequently visit the library for an academic reading environment and a quiet zone for individual study. Overall, many factors influence library use, including both demographic and academic characteristics. Respondents perceive the value of the library as a place for learning, deep thinking, and information-seeking, and they regard the library's collection as important. The university library could apply these insights to strengthen library services and provide more places for learning and study. This article's findings will also prove useful to other Pakistani regional academic libraries considering use patterns and future areas for service development. [ABSTRACT FROM AUTHOR]

Background little is known about the relationship between multimorbidity and social care use (also known as long-term care). The aim of this study was to assess the relationship between receipt of formal social care services and multimorbidity. Methods this retrospective data linkage, observational study included all individuals over the age of 65 in the population of Scotland in financial years 2014–15 and 2015–16 (n  = 975,265). The main outcome was receipt of social care measured by presence in the Scottish Social Care Survey. Logistic regression models were used to assess the influence of multimorbidity, age, sex and socioeconomic position on the outcome reporting average marginal effects (AME). Findings 93.3% of those receiving social care had multimorbidity, 16.2% of those with multimorbidity received social care compared with 3.7% of those without. The strongest magnitudes of AME for receiving social care were seen for age and multimorbidity (respectively, 50 and 18% increased probability comparing oldest to youngest and most severe multimorbidity to none). A 5.5% increased probability of receiving social care was observed for the most-deprived compared with the least-deprived. Interpretation higher levels of social care receipt are observed in those with increasing age, severe multimorbidity and living in more deprived areas. Multimorbidity does not fully moderate the relationship between social care receipt and either age or deprivation. [ABSTRACT FROM AUTHOR]

Purpose Of the Study: To explore which factors increase the likelihood of being deemed appointable to core anaesthesia training in the UK and whether those factors subsequently predict performance in postgraduate training.Study Design: Observational study linking UK medical specialty recruitment data with postgraduate educational performance, as measured by Annual Review of Competence Progression (ARCP) outcomes. Data were available for 2782 trainee doctors recruited to anaesthesia core training from 2012 to 2016 with at least one subsequent ARCP outcome.Results: Both higher interview and shortlisting scores were independent and statistically significant (p≤0.001) predictors of more satisfactory ARCP outcomes, even after controlling for the influence of postgraduate exam failure. It was noted that a number of background variables (eg, age at application) were independently associated with the odds of being deemed appointable at recruitment. Of these, increasing age and experience were also negative predictors of subsequent ARCP rating. These influences became statistically non-significant once ARCP outcomes associated with exam failure were excluded.Conclusions: The predictors of 'appointability' largely also predict subsequent performance in postgraduate training, as indicated by ARCP ratings. This provides evidence for the validity of the selection process. Our results also suggest that greater weight could be applied to shortlisting scores within the overall process of ranking applicants for posts. [ABSTRACT FROM AUTHOR]

Objective: To trace the evolution of type 1 diabetes (T1D) in Navarre in children under 15, between 1977 and 2016, and their characteristics at onset regarding age and sex. Subjects and methods: We performed a descriptive analysis, using prospective‐retrospective information. The study included all cases of T1D diagnosed in Navarre in children aged 0 to 14 years old from 1 January 1977 until 31 December 2016. The capture‐recapture method was used, retrieving information from three independent sources: the five hospitals in Navarre as a primary source, and the Navarre Association of Diabetics (ANADI) and the primary healthcare system as the secondary source. Estimates and confidence intervals were calculated assuming a subjacent Poisson distribution. Chi square test was used to compare incidence between groups. The analysis of changes in incidence since 1977, adjusted for age group, sex and year of diagnosis, were evaluated with a multivariate Poisson regression model and joinpoint regression. Results: A total of 577 cases were registered resulting in a crude incidence rate of 14.99/100 000 inhabitants‐year (95% confidence interval [CI]: 13.79‐16.26). From 1977, the incidence has increased in cycles, reaching an incidence rate of 22.98 (95% CI: 18.52‐28.21) in 2016. The relative annual increase is 3% (95% CI: 2.3‐3.8). The highest incidence is in the 10 to 14 age group (P < 0.001). No differences in sex were found. The mean age at onset in children under 15 years has not changed significantly (P = 0.572). Conclusions: The incidence of T1D in Navarre has increased 4‐fold in the last four decades but is stable since 2001. [ABSTRACT FROM AUTHOR]

Background: Population factors, including social deprivation and morbidity, predict the use of emergency departments (EDs).Aim: To link patient-level primary and secondary care data to determine whether the association between deprivation and ED attendance is explained by multimorbidity and other clinical factors in the GP record.Design and Setting: Retrospective cohort study based in East London.Method: Primary care demographic, consultation, diagnostic, and clinical data were linked with ED attendance data. GP Patient Survey (GPPS) access questions were linked to practices.Results: Adjusted multilevel analysis for adults showed a progressive rise in ED attendance with increasing numbers of long-term conditions (LTCs). Comparing two LTCs with no conditions, the odds ratio (OR) is 1.28 (95% confidence interval [CI] = 1.25 to 1.31); comparing four or more conditions with no conditions, the OR is 2.55 (95% CI = 2.44 to 2.66). Increasing annual GP consultations predicted ED attendance: comparing zero with more than two consultations, the OR is 2.44 (95% CI = 2.40 to 2.48). Smoking (OR 1.30, 95% CI = 1.28 to 1.32), being housebound (OR 2.01, 95% CI = 1.86 to 2.18), and age also predicted attendance. Patient-reported access scores from the GPPS were not a significant predictor. For children, younger age, male sex, white ethnicity, and higher GP consultation rates predicted attendance.Conclusion: Using patient-level data rather than practice-level data, the authors demonstrate that the burden of multimorbidity is the strongest clinical predictor of ED attendance, which is independently associated with social deprivation. Low use of the GP surgery is associated with low attendance at ED. Unlike other studies, the authors found that adult patient experience of GP access, reported at practice level, did not predict use. [ABSTRACT FROM AUTHOR]