A Longitudinal Study of Stargardt Disease: Quantitative Assessment of Fundus Autofluorescence, Progression and Genotype Correlations

PURPOSE To characterise subtypes of fundus autofluorescence (AF), the progression of retinal atrophy and correlate these findings with genotype in Stargardt Disease. METHODS Full clinical examination and AF imaging was undertaken in 68 patients with Stargardt Disease. The baseline data were compared with those at follow-up. Patients were classified into three AF subtypes: type 1 had a localised low signal at the fovea surrounded by a homogeneous background; type 2 had a localised low signal at the macula surrounded by a heterogeneous background with numerous foci of abnormal signal; type 3 had multiple low signal areas at the posterior pole with a heterogeneous background. At baseline, there were 19 patients with type 1, 41 with type 2, and 8 with type 3. The areas of reduced AF signal were measured and rate of atrophy enlargement (RAE) was calculated as the difference of the atrophy size over time (mm2) divided by the follow-up interval (yrs). Molecular screening of ABCA4 was undertaken. RESULTS The mean follow-up interval was 9.1 years. 42% of type 1 progressed to type 2, and 12% of type 2 progressed to type 3. RAE (mm2/yr) based upon baseline AF subtypes was significantly different; 0.06 in type 1, 0.67 in type 2, and 4.37 in type 3. ABCA4 variants were identified in 57 patients. There was a significant association between AF subtype and genotype. CONCLUSIONS The AF pattern at baseline influences the enlargement of atrophy over time and has genetic correlates. These data are likely to assist in the provision of counselling on prognosis in Stargardt Disease and be valuable for future clinical trials.

Abstinence from alcohol may indeed be the best policy: 32 month longitudinal outcomes among adolescents in the United Kingdom.

The present study investigated the longitudinal relationship between alcohol consumption at age 13, and at age 16. Alcohol-specific measures were frequency of drinking, amount consumed at last use and alcohol related harms. Self-report data were gathered from 1113 high school students at T1, and 981 students at T2. Socio-demographic data were gathered, as was information on context of use, alcohol-related knowledge and attitudes, four domains of aggression and delay reward discounting. Results indicated that any consumption of alcohol, even supervised consumption, at T1 was associated with significantly poorer outcomes at T2. In other words, compared to those still abstinent at age 13, those engaging in alcohol use in any context reported significantly more frequent drinking, more alcohol-related harms and more units consumed at last use at age 16. Results also support the relationship between higher levels of physical aggression at T1 and a greater likelihood of more problematic alcohol use behaviours at T2. The findings support other evidence suggesting that abstinence in early adolescence has better longitudinal outcomes that supervised consumption of alcohol. These results suggest support for current guidance on adolescent drinking in the United Kingdom (UK).

Prevalence of potentially inappropriate prescribing and prescribing omissions in Irish adults: findings from the Irish LongituDinal Study on Ageing (TILDA)

Purpose: We sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥65 years using data from The Irish LongituDinal Study on Ageing (TILDA).

Methods: A subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression.

Results: The overall prevalence of PIP in the study population (n = 3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % (n = 1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg (n = 341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05–3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23–1.75 for prescribing omissions).

Conclusion: Our findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost.

The role of personality and self-efficacy in the selection and retention of successful nursing students:a longitudinal study

Aim: This paper is a report of a study to examine the role of personality and self-efficacy in predicting academic performance and attrition in nursing students.

Background: Despite a considerable amount of research investigating attrition in nursing students and new nurses, concerns remain. This particular issue highlights the need for a more effective selection process whereby those selected are more likely to complete their preregistration programme successfully, and remain employed as Registered Nurses.

Method: A longitudinal design was adopted. A questionnaire, which included measures of personality and occupational and academic self-efficacy, was administered to 384 students early in the first year of the study. At the end of the programme, final marks and attrition rates were obtained from university records for a total of 350 students. The data were collected from 1999 to 2002.

Findings: Individuals who scored higher on a psychoticism scale were more likely to withdraw from the programme. Occupational self-efficacy was revealed to be a statistically significant predictor of final mark obtained, in that those with higher self-efficacy beliefs were more likely to achieve better final marks. Extraversion was also shown to negatively predict academic performance in that those with higher extraversion scores were more likely to achieve lower marks.

Conclusion: More research is needed to explore the attributes of successful nursing students and the potential contribution of psychological profiling to a more effective selection process.

Bereavement After Informal Caregiving: Assessing Mental Health Burden Using Linked Population Data

Methods. We linked prescription records for antidepressant and anxiolytic drugs to characteristics and life-event data of members of the Northern Ireland Longitudinal Study (n = 317 264). Using a case-control design, we fitted logistic regression models, stratified by age, to model relative likelihood of mental health problems, using the proxy measures of mental health–related prescription.

Results. Both caregivers and bereaved individuals were estimated to be at between 20% and 50% greater risk for mental health problems than noncaregivers in similar circumstances (for bereaved working-age caregivers, odds ratio = 1.41; 95% confidence interval = 1.27, 1.56). For older people, there was no evidence of additional risk to bereaved caregivers, though there was for working-age people. Older people appeared to recover more quickly from caregiver bereavement.

Higher effort-reward imbalance and lower job control predict exit from the labour market at the age of 61 years or younger: Evidence from the English Longitudinal Study of Ageing

Background: We examined whether higher effort-reward imbalance (ERI) and lower job control are associated with exit from the labour market. 

Methods: There were 1263 participants aged 50-74 years from the English Longitudinal Study on Ageing with data on working status and work-related psychosocial factors at baseline (wave 2; 2004-2005), and working status at follow-up (wave 5; 2010-2011). Psychosocial factors at work were assessed using a short validated version of ERI and job control. An allostatic load index was formed using 13 biological parameters. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Exit from the labour market was defined as not working in the labour market when 61 years old or younger in 2010-2011. 

Results: Higher ERI OR=1.62 (95% CI 1.01 to 2.61, p=0.048) predicted exit from the labour market independent of age, sex, education, occupational class, allostatic load and depression. Job control OR=0.60 (95% CI 0.42 to 0.85, p=0.004) was associated with exit from the labour market independent of age, sex, education, occupation and depression. The association of higher effort OR=1.32 (95% CI 1.01 to 1.73, p=0.045) with exit from the labour market was independent of age, sex and depression but attenuated to non-significance when additionally controlling for socioeconomic measures. Reward was not related to exit from the labour market. 

Conclusions: Stressful work conditions can be a risk for exiting the labour market before the age of 61 years. Neither socioeconomic position nor allostatic load and depressive symptoms seem to explain this association.

Education, gender, and state-level disparities in the health of older Indians: Evidence from biomarker data

Using new biomarker data from the 2010 pilot round of the Longitudinal Aging Study in India (LASI), we investigate education, gender, and state-level disparities in health. We find that hemoglobin level, a marker for anemia, is lower for respondents with no schooling (0.7 g/dL less in the adjusted model) compared to those with some formal education and is also lower for females than for males (2.0 g/dL less in the adjusted model). In addition, we find that about one third of respondents in our sample aged 45 or older have high C-reaction protein (CRP) levels (>3 mg/L), an indicator of inflammation and a risk factor for cardiovascular disease. We find no evidence of educational or gender differences in CRP, but there are significant state-level disparities, with Kerala residents exhibiting the lowest CRP levels (a mean of 1.96 mg/L compared to 3.28 mg/L in Rajasthan, the state with the highest CRP). We use the Blinder–Oaxaca decomposition approach to explain group-level differences, and find that state-level disparities in CRP are mainly due to heterogeneity in the association of the observed characteristics of respondents with CRP, rather than differences in the distribution of endowments across the sampled state populations.

Data on carotid intima-media thickness and lipoprotein subclasses in type 1 diabetes from the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC)

Type 1 diabetes (T1DM) is associated with increased risk of macrovascular complications. We examined longitudinal associations of serum conventional lipids and nuclear magnetic resonance (NMR)-determined lipoprotein subclasses with carotid intima-media thickness (IMT) in adults with T1DM (n=455) enrolled in the Diabetes Control and Complications Trial (DCCT). Data on serum lipids and lipoproteins were collected at DCCT baseline (1983-89) and were correlated with common and internal carotid IMT determined by ultrasonography during the observational follow-up of the DCCT, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, at EDIC 'Year 1' (199-1996) and EDIC 'Year 6' (1998-2000). This article contains data on the associations of DCCT baseline lipoprotein profiles (NMR-based VLDL & chylomicrons, IDL/LDL and HDL subclasses and 'conventional' total, LDL-, HDL-, non-HDL-cholesterol and triglycerides) with carotid IMT at EDIC Years 1 and 6, stratified by gender. The data are supplemental to our original research article describing detailed associations of DCCT baseline lipids and lipoprotein profiles with EDIC Year 12 carotid IMT (Basu et al. in press) [1].

Impaired orthostatic blood pressure recovery and cognitive performance at two-year follow up in older adults: The Irish Longitudinal Study on Ageing

Background: Prospective investigations of the association between impaired orthostatic blood pressure (BP) regulation and cognitive decline in older adults are limited, and findings to-date have been mixed. The aim of this study was to determine whether impaired recovery of orthostatic BP was associated with change in cognitive function over a 2-year period, in a population based sample of community dwelling older adults. 

Methods: Data from the first two waves of the Irish Longitudinal Study on Ageing were analysed. Orthostatic BP was measured during a lying to standing orthostatic stress protocol at wave 1 using beat-to-beat digital plethysmography, and impaired recovery of BP at 40 s post stand was investigated. Cognitive function was assessed at wave 1 and wave 2 (2 years later) using the Mini-Mental State Exam (MMSE), verbal fluency and word recall tasks. 

Results: After adjustment for measured, potential confounders, and multiple imputation for missing data, the change in the number of errors between waves on the MMSE was 10 % higher [IRR (95 % CI) = 1.10 (0.96, 1.26)] in those with impaired recovery at 40 s. However, this was not statistically significant (p = 0.17). Impaired BP recovery was not associated with change in performance on any of the other cognitive measures. 

Conclusions: There was no clear evidence for an association between impaired recovery of orthostatic BP and change in cognition over a 2-year period in this nationally representative cohort of older adults. Longer follow-up and more detailed cognitive testing would be advantageous to further investigate the relationship between orthostatic BP and cognitive decline.

Mismatches and matches in address information from the Census and the BSO: A longitudinal perspective 2001-2011

Accurate address information from health service providers is fundamental for the effective delivery of health care and population monitoring and screening. While it is currently used in the production of key statistics such as internal migration estimates, it will become even more important over time with the 2021 Census of UK constituent countries integrating administrative data to enhance the quality of statistical outputs. Therefore, it is beneficial to improve understanding of the accuracy of address information held by health service providers and factors that influence this. This paper builds upon previous research on the social geography of address mismatch between census and health service records in Northern Ireland. It is based on the Northern Ireland Longitudinal Study; this is a large data linkage study including about 28 per cent of the Northern Ireland population, which is matched between the census (2001, 2011) and Health Card Registration System maintained by the Health and Social Care Business Service Organisation (BSO). This research compares address information from the Spring 2011 BSO download (Unique Property Reference Number, Super Output Area) with comparable geographic information from the 2011 Census. Multivariate and multilevel analyses are used to assess the individual and ecological determinants of match/mismatch between geographical information in both data sources to determine if the characteristics of the associated people and places are the same as the position observed in 2001. It is important to understand if the same people are being inaccurately geographically referenced in both Census years or if the situation is more variable.

People and places: Understanding geographical accuracy in administrative data from the census and healthcare systems

Administrative systems such as health care registration are of increasing importance in providing information for statistical, research, and policy purposes. There is thus a pressing need to understand better the detailed relationship between population characteristics as recorded in such systems and conventional censuses. This paper explores these issues using the unique Northern Ireland Longitudinal Study (NILS). It takes the 2001 Census enumeration as a benchmark and analyses the social, demographic and spatial patterns of mismatch with the health register at individual level. Descriptive comparison is followed by multivariate and multilevel analyses which show that approximately 25% of individuals are reported to be in different addresses and that age, rurality, education, and housing type are all important factors. This level of mismatch appears to be maintained over time, as earlier migrants who update their address details are replaced by others who have not yet done so. In some cases, apparent mismatches seem likely to reflect complex multi-address living arrangements rather than data error.

Tecnologias ubíquas nas aulas de ciências naturais : da surpresa à valorização e utilização plena : um estudo longitudinal

Tese de doutoramento, Educação (Didática das Ciências), Universidade de Lisboa, Instituto de Educação, 2014

Exploring Variations in Teachers' Work, Lives and Their Effects on Pupils: Key Findings and Implications from a Longitudinal Mixed Methods Study

This article outlines the research design of a large‐scale, longitudinal research study in England intended to describe and explore variations in teachers' work, lives and their effects on pupils' educational outcomes. The study, funded by the Department for Education and Skills (DfES) and incorporated into the Teaching and Learning Research Programme (TLRP) as an ‘Associate Project’, used an innovative mixed‐methods research design to create case studies of 300 teachers in Years 2, 6 and 9. The research was conducted over three consecutive academic years and collected a wide range of data through interviews, questionnaire surveys of teachers' and pupils' views and assessment data on pupils' attainments in English and mathematics. The text summarises the main findings from the research in relation to four interconnected themes of the study: Professional Life Phases; Professional Identity; Relative Effectiveness; and Resilience and Commitment. The influence of school context, in terms of level of social disadvantage of pupil intake, is also investigated. Key findings and their implications for policy and practice are highlighted.

Places and preferences: a longitudinal analysis of self-selection and contextual effects

Contextual theories of political behaviour assert that the contexts in which people live influence their political beliefs and vote choices. Most studies of political assimilation, however, rely on cross-sectional data and fail to distinguish contextual influence from self-selection of individuals into areas. This paper advances understanding of this longstanding controversy by tracking thousands of individuals over an 18-year period in England. We observe individual-level left-right position and party identification before and after residential moves across areas with different political orientations. We find evidence of both non-random selection into areas and assimilation of new entrants to the majority political orientation. However, these effects are contingent on the type of area an individual moves to and, moreover, contextual effects are weak and dominated by the larger effect of self-selection into areas.

Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.