Why are Disability Rates for Older Working-Age Adults in Northern Ireland So High?

Northern Ireland has substantially higher rates of disability and disability benefit receipt than England, despite a common institutional context. This paper exploits newly available data from the NICOLA and ELSA surveys to examine potential health and labour market explanations for this gap, specifically among older working-age people. Observable differences in health and labour markets are sufficient to explain the gap in self-reported activity-limiting disability, but only half of the gap in worklimiting disability and income-replacement disability benefit receipt, and only one-third of the gap in additional costs disability benefit receipt. Possible reasons for these remaining unexplained gaps are discussed

Spectral fluctuation properties of spherical nuclei

The spectral fluctuation properties of spherical nuclei are considered by use of NNSD statistic. With employing a generalized Brody distribution included Poisson, GOE and GUE limits and also MLE technique, the chaoticity parameters are estimated for sequences prepared by all the available empirical data. The ML-based estimated values and also KLD measures propose a non regular dynamic. Also, spherical odd-mass nuclei in the mass region, exhibit a slight deviation to the GUE spectral statistics rather than the GOE.Comment: 10 pages, 2 figure

The Impact of debt and financial stress on health in Northern Irish households

We analyse data collected from a survey of Northern Irish low-income households experiencing varying degrees of financial hardship and examine how debt affects health and health-related behaviours. Our results indicate that the subjective experience of feeling financially stressed has a robust relationship with most aspects of health, including ability to self-care, problems performing usual activities, pain problems and psychological health. In contrast, the size of the debt, the type of debt or the number of different lenders does not add any extra explanatory power. Additionally, our results indicate that the pathway from financial difficulties to worse health runs through worse diets and increased consumption of cigarettes and drugs. This research is timely as household debt burdens will soon surpass the high levels seen at the time of the financial crisis and the introduction of welfare reform in Northern Ireland will put additional strain on low-income households. </jats:p

Identifying the relative importance of stock characteristics

There is no consensus in the literature as to which stock characteristic best explains returns. In this study, we employ a novel econometric approach better suited than the traditional characteristic sorting method to answer this question for the UK market. We evaluate the relative explanatory power of market, size, momentum, volatility, liquidity and book-to-market factors in a semiparametric characteristic-based factor model which does not require constructing characteristic portfolios. We find that momentum is the most important factor and liquidity is the least important based on their relative contribution to the fit of the model and the proportion of sample months for which factor returns are significant. Overall, this study provides strong evidence to support that the momentum characteristic can best explain stock returns in the UK market. The econometric approach employed in this study is a novel way to assess relevant investment risk in international financial markets outside U.S. Moreover, multinational institutions and investors can use this approach to identify regional factors in order to diversify their portfolios

The economic burden of colorectal cancer across Europe: a population-based cost-of-illness study.

BACKGROUND: Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach. METHODS: In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries. FINDINGS: The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259-36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1-84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015. INTERPRETATION: Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy. FUNDING: Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN

Abstracts from the 5th International Conference for Healthcare and Medical Students (ICHAMS)

O1: Assessing the protective effect of dexrazoxane against doxorubicin-induced toxicity in HL-1 cardiomyocytes Yvonne Sweeney, Hugh O’Neill, Garry Duffy O2: Role of KCNQ1 in epithelial barrier repair Daniel Creegan, Viviana Bustos, Brian J. Harvey O3: The suitability of non-small cell lung cancer cytology preparations for the analysis of anaplastic lymphoma kinase gene rearrangements Alexander Dalphy, Anthony O’Grady, Elaine Kay O4: Penetrating keratoplasty and descemet’s stripping automated endothelial keratoplasty may lead to deterioration in glaucoma management Katarzyna Samelska, Justyna Izdebska, Anna Kurowska O5: The effect of Resolvin D1 on normal and cystic fibrosis human bronchial epithelium Rena Al-Zubaidy, Magdalena Mroz, Brian Harvey O6: Validity of clinical assessment compared with plantar fascia thickness on ultrasound for plantar fasciitis: a cross-sectional study Ryan Fagan, Helen French, Vanessa Cuddy, Jennifer Ashton, Michelle Clarke P1: Undergraduate medical research in Gulf Cooperation Council (GCC) countries: A descriptive study of students’ views Zaid Sayedalamin, Mukhtiar Baig, Osama Almutairi, Hassan Allam, Taher F. Halawa, Hazem M. Atta P2: Positive fluid balance as a prognostic factor in children with sepsis during first 3 hours of resuscitation in intensive care unit Linda Sirone, Renars Erts, Jana Pavare P3: Patients on aspirin: Too little or too much? Louis Richter, Joseph Morris, Irene Oglesby, Eimear Dunne, Dermot Kenny P4: Beta catenin/TCF4 activation reduces KCNQ1 current in colonic monolayers Ibrahim Mohammed Mahdi Khayyat, Viviana Bustos Salgado, Brian J. Harvey P5: Size Matters. Abdominal aortic aneurysm: adherence to surveillance imaging guidelines Jonavan Tan, Daragh Moneley, Austin Leahy, Patricia Fitzgerald P6: Endoscopic retrograde cholangiopancreatography in the west of Ireland: Procedural outcomes and peri-procedural complications Evelyn Fennelly, Grace Harkin, John Lee P7: The effect of the extracellular redox environment on polyamine-platelet interactions Erica O’Sullivan, Brian Kirby, Sarah O’Neill P8: Functionalized gold nanoparticles: preliminary data on in vitro toxicity and comparative photothermal effect Diana Gonciar, Teodora Mocan, Cristian Matea, Lucian Mocan, Cornel Iancu P9: Imaging proteasomal inhibition after seizures in the brain: A study into cellular activity in the hippocampus of epileptic transgenic mice Chloe Doran, Sarah Hoolahan, Tobias Engel P10: Investigating the ability of the Olfactory epithelial stem cells to differentiate into glial cells by assessing cell morphology and marker expression Maha Alkhattab, Tijna Alekseeva, William Lackington, Fergal O’Brien P11: Beaumont Hospital cystic fibrosis service audit and annual report Nabeehah Moollan, Chloe Doran, Noel Gerry McElvaney, Cedric Gunaratnam P12: Quick cognitive screening: the 6-item cognitive impairment test and the temporal orientation score Lorraine Scanlon, Noeleen Brady, Suzanne Timmons P13: Granular analysis of causes of peritoneal dialysis technique failure in the first six months of therapy Richard Bresler, Zita Abreu, Stefan Trohonel, Joanne Bargman P14: Job satisfaction of surgeons working in hajj pilgrimage: a multicenter study Ahmad A. Mirza, Ahmed Badrek-Amoudi, Rakan H. Aun, Hussam A. Senan, Abdulrahim A. Mirza, Mohammed S. Binsaad, Mian U. Farooq P15: Investigation of the role of Bok using wild-type, bax-, bok-, and bax/bok-double-deficient mice Saheli Nandi, Beatrice D’Orsi, Jochen Prehn P16: Is it possible to predict resistance of an organism to stress based on the level of corticosterone? Mariia Zharova, Pavel Umrukhin P17: Investigating the strength model of self-regulation (ego depletion) and medical decision making and error in medical students Wendy Evans-Uhegbu, Frank Doyle, Hope Kudryashova, Derek Dorris, Anthony Cummins P18: Does bladder drainage with intermittent catheterisation preserve kidney function in boys with posterior urethral valves? Jemma Doheny-Shanley, Mark Woodward, Wesley Hayes P19: Investigating the role of Stonin 2, a Clathrin Mediated Endocytosis adaptor protein, in altered hippocampal synaptic transmission characterized in schizophrenia Marina Yostos, David Cotter, Melanie Focking P20: Predicting complications after colon resection Samantha Stancu, Florin Iordache, Bogdan A. Popescu P21: Knowledge, attitude and practice of the methods of primary and secondary prevention of cervical cancer among NYSC members in Lagos state, Nigeria Muhammad-Mujtaba A. Akanmu, Alero A. Robert, Ezekiel O. Oridota P22: Incidental glucose and lipid metabolisms disorders among office workers: a cross sectional study Ahmad A. Mirza, Ali K. Alzahrani, Omar Alfarhan, Essam Nour Eldin P23: Differentiating clinically significant spinal injuries; a review of emergency department presentations Bronagh MacManus, Owen Keane, Patrick Hillery, James Lee, Hugh O’Reilly, Niamh Collins P24: Pattern of renal colic occurrence due to urinary stones during Ramadan and other months of the year at King Abdulaziz Medical City, Riyadh, KSA Ibrahim Abu saq, Abdullah Al Mufarrih, Muath Jaafari, Abdullah Al Mahayni, Amen Bawazir, Sultan Alkhateeb P25: Proteomic analysis reveals novel AIB1 co-factors that may contribute to acquired endocrine resistance in breast cancer Amenah Dhannoon, Damir Vareslija, Arnold Hill, Leonie Young P26: Improving sedation practice in general ICU in Beaumont Hospital Declan Donoghue, Criona Walsh, Aileen McCabe, John Pope, Saturnino Pasco, Caroline Fallon, Don Solanki, Fiona Kiernan, Sinead Galvin, Jquan Mucvimicc, Johanna Mulvihill P27: Diagnosis and control of hypertension as indicators of the level of awareness among relatives of medical students Ahmad A. Mirza, Soha A. Elmosry P28: Evaluation of the antitumor potential from extracts of endemic plants of Brazilian caatinga against melanoma and hepatocarcinoma Lorenza Andres Ameida De Souza, Yuri de Oliveira, Diego Menezes, Alene Vanessa Santos P29: The role of Chromogranin A as a biomarker in drug resistant neuroblastoma Ahmad Zaki Asraf, Raymond Stallings, Olga Piskareva, Ross Conlon P30: Membrane sweep at term gestation in CUMH; a case-control study Siún Sweeney-Landers, Cathy Burke P31: Study of the variability of glucose levels in patients with diabetes undergoing continuous glucose monitoring Paraic Behan, Seamus Sreenan P32: Inflammatory cytokine response to decreased plasma alpha-1 antitrypsin levels in individuals with the MZ genotype Ahmed Organjee, Tatsiana Crosbie-Staunton, Emer Reeves, Noel McElvaney P33: Analysing the role of SRC-1 in breast cancer stem cell formation and activity Crystal Mieres, Leonie Young, Sara Charmsaz P34: Screening Streptococcus pneumoniae isolates for virulence genes Aya Al-Jalamdeh, Mary Corcoran, Martha McElligott, Niall Stevens, Hilary Humphreys P35: Assessment of the relevance of admission clerking criteria taught to medical students at King Abdulaziz University to real hospital practice Rashid Barnawi, Abdulaziz Ghurab, Sultan Alfaer, Hassan Balubaid, Kamal Hanbazazah, Mohammed Bukhari P36: Pattern of emergency department visits during Hajj period Mohammed Alsakkaf, Ahmad Mirza, Amrallah Mohammed P37: Anti-Dengue activity of Aspergillus terreus (sulochrin); An in vitro study Anastasia Pratanata, Maria Nathania, Tsabita Annisa, Beti Dewi P38: The comorbidome in alpha-1 antitrypsin deficiency Kuok Zhen Lee, Tomas P. Carroll, Laura Fee, Noel G. McElvaney P39: MLO-Y4 cells behave more like osteocytes in response to mechanical stimulation when cultured in 3D Rachel C. White, Robert T Brady, Fergal O’Brie

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Residential segregation, dividing walls and mental health: A population-based record linkage study

BACKGROUND: Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. While most previous research has relied on conceptualised measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or ‘peacelines’) which can be used to accurately identify residential segregation. METHODS: We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health. RESULTS: Using multilevel logistic regression models, we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a ‘peaceline’ increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI 1.14 to 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI 1.32 to 1.48), even after adjustment for gender, age, conurbation, deprivation and crime. CONCLUSIONS: Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation