ObjectivesTo assess whether the direction of movement along the social gradient was associated wi... more ObjectivesTo assess whether the direction of movement along the social gradient was associated with changes in mental health status.DesignLongitudinal record-linkage study using a multistate model.SettingCaerphilly, Wales, UK between 2001 and 2015.ParticipantsThe analytical sample included 10 892 (60.8% female) individuals aged 18–74 years.Primary and secondary outcome measuresDeprivation change at lower super output area level using the 2008 Welsh Index of Multiple Deprivation. Mental health was assessed in 2001 and 2008 using the Mental Health Inventory subscale of the short-form 36 V.2.ResultsMental health selection was shown whereby individuals with common mental health disorders were less likely to move to areas of lower deprivation but more likely to move to areas of greater deprivation.ConclusionPoor mental health seems to drive health selection in a similar way to poor physical health. Therefore, funding targeted at areas of higher deprivation should consider the demand to b...
We identified four parental substance use classes using quantity-frequency measures. • Heavy use ... more We identified four parental substance use classes using quantity-frequency measures. • Heavy use of alcohol formed a class which also included a large proportion of drug users. • Mothers' and their partner's tended to have similar patterns of substance use behaviours.
Introduction Excessive alcohol consumption has adverse effects on health but there is a recognise... more Introduction Excessive alcohol consumption has adverse effects on health but there is a recognised need for longitudinal analysis of population data to improve our understanding of the patterns of alcohol use, harms to consumers and those in their immediate environment. This paper describes the protocol for the project “Electronic Longitudinal Alcohol Study in Communities” (ELAStiC) that aims to leverage the value of a broad set of cross-linked cohorts, e-cohorts, surveys and data linkage facilities to construct an alcohol-specific analytical platform in the United Kingdom. Aims and objectives ELAStiC aims to address four aims: (a) the effect on children’s’ health and educational achievement of living in household in which one or more adults experience alcohol-related harm; (b) the longitudinal relationship between alcohol consumption, physical and mental health in adults in a Welsh county (Caerphilly); (c) the patterns of Welsh alcohol-related hospital admissions across 16 years; (...
Fetal alcohol spectrum disorders (FASDs) are lifelong disabilities caused by prenatal alcohol exp... more Fetal alcohol spectrum disorders (FASDs) are lifelong disabilities caused by prenatal alcohol exposure. Prenatal alcohol use is common in the UK, but FASD prevalence was unknown. Prevalence estimates are essential for informing FASD prevention, identification and support. We applied novel screening algorithms to existing data to estimate the screening prevalence of FASD. Data were from a population-based cohort study (ALSPAC), which recruited pregnant women with expected delivery dates between 1991 and 1992 from the Bristol area of the UK. We evaluated different missing data strategies by comparing results from complete case, single imputation (which assumed that missing data indicated no exposure and no impairment), and multiple imputation methods. 6.0% of children screened positive for FASD in the analysis that used the single imputation method (total N = 13,495), 7.2% in complete case analysis (total N = 223) and 17.0% in the analysis with multiply imputed data (total N = 13,495). A positive FASD screen was more common among children of lower socioeconomic status and children from unplanned pregnancies. Our analyses showed that the complete case and single imputation methods that are commonly used in FASD prevalence studies are likely to underestimate FASD prevalence. Although not equivalent to a formal diagnosis, these screening prevalence estimates suggest that FASD is likely to be a significant public health concern in the UK. Given current patterns of alcohol consumption and recent changes in prenatal guidance, active case ascertainment studies are urgently needed to further clarify the current epidemiology of FASD in the general population of the UK.
IntroductionSelf reported data on health is often burdensome and expensive. Administrative data p... more IntroductionSelf reported data on health is often burdensome and expensive. Administrative data provides inexpensive global coverage of health and is less prone to social desirability for behaviors such as alcohol consumption. Recent studies have found varying correspondence between self-reported and administrative data for a number of chronic and acute conditions. Objectives and ApproachWe sought to test the agreement between self-rated heavy drinking (35+ units for women, 50+ for men) and primary care physician (GP) coded (Read mapped ICD-10 codes) heavy drinking, and their association with alcohol related hospital admissions. We assessed agreement between self-reported and GP coded heavy drinking data, from a prospective UK cohort and linked GP and hospital data using Cohen's kappa (95% CI). Then using Cox regression we the compared the time to alcohol related admission for both. Goodness-of-fit was assessed using AIC. ResultsOf the 10,892 participants a total of 6,609 were l...
Recent studies found evidence of health selective migration whereby healthy people move to less d... more Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivatio...
Journal of epidemiology and community health, Jan 30, 2018
To examine the combined influence of changes in physical activity, diet, smoking and alcohol cons... more To examine the combined influence of changes in physical activity, diet, smoking and alcohol consumption on all-cause mortality. Health behaviours were assessed in 1984/1985 and 1991/1992 in 8123 adults from the UK (4666 women, median age 41.0 years). An unhealthy lifestyle score was calculated, allocating one point for smoking, fruits and vegetables <3 times a day, physical activity <2 hours a week and >14 units (women) or >21 units of alcohol (men) per week. There were 2003 deaths over a median follow-up of 6.6 years (IQR 5.9-7.2) following the resurvey. The modal change in the unhealthy lifestyle score was zero, 41.8% had the same score, 35.5% decreased and 22.7% increased score between surveys. A one unit decrease in the unhealthy lifestyle score was not associated with a beneficial effect on mortality (HR 0.93; 95% CI 0.83 to 1.04). A one unit increase in the unhealthy lifestyle score increased the risk of mortality (adjusted HR 1.09; 95% CI 1.01 to 1.18). In this g...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2018
Overuse and inappropriate prescribing of antibiotics is driving antibiotic resistance. GPs often ... more Overuse and inappropriate prescribing of antibiotics is driving antibiotic resistance. GPs often prescribe antibiotics for upper respiratory tract infections (URTIs) in young children despite their marginal beneficial effects. To assess the quality of antibiotic prescribing for common infections in young children attending primary care and to investigate influencing factors. An observational, descriptive analysis, including children attending primary care sites in England and Wales. The Diagnosis of Urinary Tract infection in Young children study collected data on 7163 children aged <5 years, presenting to UK primary care with an acute illness (<28 days). Data were compared with the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) disease-specific quality indicators to assess prescribing for URTIs, tonsillitis, and otitis media, against ESAC-Net proposed standards. Non-parametric trend tests and χ2 tests assessed trends and differences in prescribing by le...
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Papers by Giles Greene