Shantini Paranjothy

• Cardiff University

Objectives: There is a growing concern in high-income countries over reports and observations that some parents may struggle to afford formula milk and food for their babies. The objective of this scoping review is to identify and summarise the current evidence on factors that lead to infant food insecurity in high-income countries. Design: We sear...

Background: Early life exposures can increase the risk of both obesity and hypertension in adulthood. In this paper we identify exposures across five pre-hypothesised childhood domains, explore them as predictors of obesity and hypertension comorbidity using the 1958 National Child Development Study (NCDS), and discuss these results in comparison t...

Background For outcomes such as obesity and hypertension, determinants are likely to be complex and multidimensional. Therefore, to design realistic interventions, epidemiological research should incorporate information from multiple risk exposure domains to assess the effect on health. In this paper we explore risk scores for five early life domai...

Background Research consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions o...

Background: Interactions with secondary care, including multiple outpatient appointments and hospital admissions, represents a common and often burdensome aspect of healthcare utilisation for people living with multiple long-term conditions. Lifecourse factors such as education and academic ability may play a role in shaping the risk of healthcare...

Many studies use a reductionist approach to isolate the influence of one factor in childhood on multimorbidity rather than consider the combined effect of wider determinants. We explored how potential multiple early life determinants of multimorbidity can be characterised across three UK cohort studies. We used the National Child Development Study...

Objectives Many studies use a reductionist approach to isolate the influence of one factor in childhood on multimorbidity rather than consider the combined effect of wider determinants. We aimed to explore how potential multiple early-life determinants of multimorbidity can be audited and characterised across three UK cohort studies. ApproachWe use...

Objective Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth. Design Cohort study with non‐...

Background Epidemiological research commonly investigates single exposure-outcome relationships, while children’s experiences across a variety of early lifecourse domains are intersecting. To design realistic interventions, epidemiological research should incorporate information from multiple risk exposure domains to assess effect on health outcome...

Objectives This systematic review intended to assess the effectiveness of financial support interventions for household fuel poverty in the UK in terms of reducing adverse impacts on the health and wellbeing of recipients. Methods Bibliographic databases and grey literature sources were searched from the UK for studies that evaluated the health an...

Many studies use a reductionist approach to isolate the influence of one factor in childhood on multimorbidity rather than consider the combined effect of wider determinants. We explored how multiple early-life determinants of multimorbidity can be characterised across three UK cohort studies. We used the National Child Development Study (NCDS), th...

Background Preterm birth affects between 7% and 8% of births in the UK and is a leading cause of infant mortality and childhood disability. Prevalence of preterm birth has been shown to have significant and consistent socioeconomic inequalities. Objective To estimate how much of the association between socioeconomic status (SES) and gestational ag...

Background Social, biological and environmental factors in early life, defined as the period from preconception until age 18, play a role in shaping the risk of Multiple Long-Term Condition Multimorbidity (MLTC-M). There is a need for conceptual framing of these factors to inform and shape future research on aetiology and for modelling prevention s...

Background Childhood urinary tract infection (UTI) can cause renal scarring, and possibly hypertension, chronic kidney disease (CKD), and end-stage renal failure (ESRF). Previous studies have focused on selected populations, with severe illness or underlying risk factors. The risk for most children with UTI is unclear. Aim To examine the associati...

Background Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as ‘early onset’). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a resea...

Objectives We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for future longitudinal research. Design Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthc...

Citation: Hurt, L.; Uzun, O.; Morris, S.; Bethel, J.; Evans, A.; Seaborne, M.; Daniel, R.; Brophy, S.; Paranjothy, S. Abstract: There is uncertainty about outcomes associated with cardiac echogenic foci (CEF) seen at the midtrimester ultrasound scan because of limited population-based follow-up data. This can lead to unnecessary invasive testing an...

Introduction This protocol outlines aims to test the wider impacts of the COVID-19 pandemic on pregnancy and birth outcomes and inequalities in Scotland. Method and analysis We will analyse Scottish linked administrative data for pregnancies and births before (March 2010 to March 2020) and during (April 2020 to October 2020) the pandemic. The Comm...

Background: There are complex medical, psychological, social and economic aspects to becoming a parent with Cystic Fibrosis (CF). A shared decision-making (SDM) approach could help women with CF make informed decisions about their reproductive goals that are sensitive to their individual values and preferences. This study investigated capability,...

Background: Children receive care and support from social services due to risk of harm or impeded development, or because of disability. This study aimed to identify typologies of adversity experienced by children receiving care and support from social services, and to explore how typologies differ by sociodemographic characteristics. Methods: A...

Objectives: We investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of ADHD and/or ASD for future longitudinal research. Design: Individuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthcare datasets were compared with matched controls and a sample of dire...

Introduction Early alcohol use has significant association with poor health outcomes. Individual risk factors around early alcohol use have been identified, but a holistic, data-driven investigation into health and household environmental factors on early alcohol use is yet to be undertaken. Objectives This study aims to investigate the relationsh...

Background Rates of preterm birth are substantial with significant inequalities. Understanding the role of risk factors on the pathway from maternal socioeconomic status (SES) to preterm birth can help inform interventions and policy. This study therefore aimed to identify mediators of the relationship between maternal SES and preterm birth, assess...

Background Pregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the pandemic impact on pregnancy experience, rates of primary childhood immunisations and the differences in birth outcomes in during 2020 to those of previous years. Methods Self-reported pregnancy experience: 21...

Background Despite recent advances, mortality in children with Down syndrome remains five times higher than in the general population. This study aims to describe the burden, patterns and causes of hospital admissions in infants with Down syndrome, and compare this with infants without Down syndrome in a population-based cohort. Methods This study...

Objective: To compare pregnancy rates and outcomes for women with cystic fibrosis in the UK with the general population and assess the effect of introduction of disease modifying treatment. Design: A population-based longitudinal study, 2003-17 SETTING: United Kingdom POPULATION: Women aged 15-44 years in the UK CF Registry compared to women in...

Background Pregnancy can be a stressful time and the COVID-19 pandemic is thought to have heightened maternal stress. This study aimed to investigate the effect of the COVID-19 pandemic on population birth outcomes, uptake of primary immunisations, and expectant mothers' experiences of pregnancy in Wales. Methods In this mixed methods study we ana...

Background: The growth and maturation of infants reflect their overall health and nutritional status. The purpose of this study is to examine the associations of prenatal and early postnatal factors with infant growth (IG). Methods: A data-driven model was constructed by structural equation modelling to examine the relationships between pre- and...

Background Preterm birth is a major public health problem, affecting 8% of births in the UK overall with significant socioeconomic inequalities observed. Children who are born pre-term have an increased risk of negative health and education outcomes. These outcomes are socially patterned but it is not clear how the effects of preterm birth are modi...

Background Prevalence of preterm birth (PTB) is increasing in England. Given significant inequalities in prevalence by maternal socioeconomic status (SES) and subsequent negative consequences on health and educational attainment for children, this represents a significant risk of widening population health inequalities. The aim is to understand how...

Background Approximately 8% of births in the UK are preterm, and rates have been increasing for the past decade. There are significant inequalities in the prevalence of preterm birth, with some estimates showing 50% higher prevalence in mothers with low socioeconomic status (SES). Understanding and explaining how low SES increases the risk of prete...

Background Cystic fibrosis (CF) is an inherited, progressive condition affecting over 10 000 individuals in the UK. With advancement in care leading to improved prognosis and survival, women with CF are increasingly considering starting families, but there is currently a paucity of population-based evidence on the epidemiology of pregnancy in the C...

Background: Pregnancy can be a stressful time and the COVID 19 pandemic has affected all aspects of life. This study aims to investigate the impact of the pandemic on population birth outcomes in Wales, rates of primary immunisations and examine expectant mothers experiences of pregnancy including self reported levels of stress and anxiety. Methods...

Background Adverse childhood experiences (ACEs) are negatively associated with a range of child health outcomes. In this study, we explored associations between five individual ACEs and child mental health diagnoses or symptoms. ACEs included living with someone who had an alcohol-related problem, common mental health disorder or serious mental ill...

Background: Nausea and vomiting are distressing symptoms which are experienced commonly during caesarean section under regional anaesthesia and in the postoperative period. OBJECTIVES: To assess the efficacy of pharmacological and non-pharmacological interventions versus placebo or no intervention given prophylactically to prevent nausea and vomit...

Introduction Approximately 60 000 (9/100) infants are born into water annually in the UK and this is likely to increase. Case reports identified infants with water inhalation or sepsis following birth in water and there is a concern that women giving birth in water may sustain more complex perineal trauma. There have not been studies large enough t...

Background There is conflicting research about the association between asthma and poor educational attainment that may be due to asthma definitions. Our study creates seven categories of current chronic and acute asthma to investigate if there is an association for poorer educational attainment at age 6–7 years, and the role of respiratory infectio...

Objectives: Adverse childhood experiences (ACEs) have a negative impact on childhood health, but their impact on education outcomes is less well known. We investigated whether or not ACEs were associated with reduced educational attainment at age 7 and 11 years. Study design: The study design used in the study is a population-based electronic cohor...

Childhood exposure to domestic violence (DV) can lead to mental health problems including internalizing symptoms. This systematic literature review aimed to identify individual-, familial-, and community-level factors that mediate or modify the effect of DV exposure on internalizing symptoms among children and adolescents. This systematic literatur...

IntroductionWorldwide large cohort studies have invested in community engagement to promote studies and aidrecruitment. HealthWise Wales, a national population study, aims to create a register of ‘researchready’ participants and provide long-term follow up data on health behaviours, outcomes andwider social and environmental determinants. Public in...

Background Little is known about alcohol‐related harm in children and young adults with type1 diabetes (T1D). Education on managing alcohol intake is provided to teenagers with T1D in paediatric clinics in Wales, but its effectiveness is unknown.We compared the patterns in risk of alcohol‐related hospital admissions (ARHA) between individuals with...

The Dementias Platform UK Data Portal is a data repository facilitating access to data for 3 370 929 individuals in 42 cohorts. The Data Portal is an end-to-end data management solution providing a secure, fully auditable, remote access environment for the analysis of cohort data. All projects utilising the data are by default collaborations with t...

Foetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disability. Prenatal alcohol use is the sole necessary cause of FASD, but it is not always sufficient. Multiple factors influence a child’s susceptibility to FASD following prenatal alcohol exposure. Much of the FASD risk factor literature has been limited to discussions...

Aims/hypothesis The aim of this study was to describe the characteristics and outcomes of pregnancies in a national cohort of teenage (<20 years) and young adult women (≥20 years) with and without childhood-onset (<15 years) type 1 diabetes. We hypothesised that, owing to poor glycaemic control during the teenage years, pregnancy outcomes would be...

Around half of pregnant women in the United Kingdom are overweight or obese. The antenatal period provides an opportunity for encouraging women to adopt positive lifestyle changes, and in recent years, this has included development of strategies to support women in avoiding excessive gestational weight gain. The objective of this interventional coh...

Introduction: Individual, social and economic circumstances faced by young mothers (19 years or under) can challenge a successful start in life for their children. Intervening early might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) is an intensive nurse-led home visiting programme developed in the US which ai...

Objectives To assess whether the direction of movement along the social gradient was associated with changes in mental health status. Design Longitudinal record-linkage study using a multistate model. Setting Caerphilly, Wales, UK between 2001 and 2015. Participants The analytical sample included 10 892 (60.8% female) individuals aged 18–74 year...

Poor mental health has been associated with socioeconomic deprivation. The aim was to describe possible mechanisms underpinning the narrowing of mental health inequalities demonstrated by Communities First, an area-wide regeneration programme in Wales, UK. Propensity score matched data from the Caerphilly Health and Social Needs Electronic Cohort S...

Background: Alcohol-related harm has been found to be higher in disadvantaged groups, despite similar alcohol consumption to advantaged groups. This is known as the alcohol harm paradox. Beverage type is reportedly socioeconomically patterned but has not been included in longitudinal studies investigating record-linked alcohol consumption and harm...

Purpose Recruitment and follow-up in epidemiological studies are time-consuming and expensive. Combining online data collection with a register of individuals who agree to be contacted about research opportunities provides an efficient, cost-effective platform for population-based research. HealthWise Wales (HWW) aims to facilitate research by recr...

Background Informal caregiving has become an integral part of many societies, however there is increasing concern about the well-being of carers and how they manage their care-related responsibilities in conjunction with their health and mental health. Previous studies have reported mixed results with some proposing that carers are intrinsically h...

Background Guidelines recommend the prompt diagnosis and treatment of UTI in young children to reduce the risk of renal scarring and possible long-term complications. However, the evidence for this association is weak and has been questioned. There is an urgent need to clarify this as the correct approach to urine sampling and diagnosis of UTI in...

Background Heavy alcohol consumption by mothers during pregnancy is associated with developmental problems in their children. However, the impact of light to moderate consumption on the long-term health and educational attainment up to adolescence has not been established. Main Aim To investigate the association between mother’s alcohol use duri...

Background Informal care is increasingly common in ageing populations. However, the impact of caring responsibilities on carers’ mental health remains unclear. We used data from the HealthWise Wales (HWW) cohort to examine the impact of caregiving on the mental health of carers. Methods HWW collects demographic, lifestyle, and opinion data, which...

Background Children and young people with type-1 diabetes (T1D) have excess all-cause hospital admissions, particularly younger children with lower socioeconomic status. Education on managing alcohol consumption is given to teenagers with T1D in paediatric diabetes services, but little is known about alcohol-related harm. We compare the risk of alc...

Background and objective Health status in childhood is correlated with educational outcomes. Emergency hospital admissions during childhood are common but it is not known how these unplanned breaks from schooling impact on education outcomes. We hypothesised that children who had emergency hospital admissions had an increased risk of lower educatio...

Background Chronic kidney disease (CKD) is a growing contributor to the global burden of noncommunicable diseases. Early diagnosis and treatment can reduce the severity of kidney damage and the need for dialysis or transplantation. It is not known whether mild-to-moderate renal pelvis dilatation (RPD) identified at 18–20 weeks gestation is an early...

Objective Harmful levels of alcohol consumption in young people are prevalent and of increasing public concern in the western world. Rates of alcohol-related emergency hospital admissions in children and young people between 10 to 17 years were described, and the reasons for these admissions and their association with socio-demographic factors were...

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 Alc...

Purpose Clinical guidelines recommend at least 7 days of antibiotic treatment for older men with urinary tract infection (UTI). There may be potential benefits for patients, health services, and antimicrobial stewardship if shorter antibiotic treatment resulted in similar outcomes. We aimed to determine if treatment duration could be reduced by est...

Purpose: Recruitment and follow-up in epidemiological studies is challenging, time-consuming and expensive. Combining online data collection with a register of individuals who agree to be contacted with information on research opportunities provides an efficient, cost-effective platform for population-based research. HealthWise Wales (HWW) aims to...

Introduction Current guidelines advise the prompt diagnosis and treatment of urinary tract infection (UTI) in children to improve both short and longer term outcomes. However, the risk of long-term complications following childhood UTI is unclear. UTI is relatively common but difficult to diagnose in children as symptoms are non-specific. Diagnosis...

Background Nitrofurantoin is widely recommended for empirical treatment of urinary tract infection (UTI) but primary care clinicians may prescribe alternative antibiotics to improve prognosis in older, sicker patients. We assessed if prescribing alternative antibiotics was associated with reduced risk of adverse outcomes in older patients. Methods...

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 screen...

Background Chronic kidney disease is a growing contributor to the global burden of non-communicable diseases. Early diagnosis and treatment in childhood can reduce the severity of kidney damage. It is not known whether renal pelvis dilatation (RPD) identified at the 18–20 weeks' fetal anomaly scan is a useful screening tool. We aimed to assess whet...

Background Few studies have investigated the risk of adverse outcomes in older people with renal impairment presenting to primary care with a urinary tract infection (UTI). The aim of this study was to determine the risk of adverse outcomes in patients aged ≥65 years presenting to primary care with a UTI, by estimated glomerular filtration rate (eG...

Introduction The Family Nurse Partnership(FNP) is an intensive home-visiting service for teenage first-time mothers (and children), developed/trialled in the US and adapted/trialled across Europe.The Scottish Government(SG) aims to build on and supplement the existing national/international evidence base for FNP, to assess effectiveness and opportu...

RECORD statement. RECORD, reporting of studies conducted using observational routinely-collected health data. (DOCX)

Identifying clinically diagnosed UTI using read and ICD-10 codes. UTI, urinary tract infection. (DOCX)

Adjusted odds ratios and 95% confidence intervals for each outcome by eGFR category restricted to the 37,379 patients with a creatinine measurement in the 90 days prior to the UTI event. eGFR, estimated glomerular filtration rate. (DOCX)

Adjusted odds ratios and 95% confidence intervals for a combined ‘hospitalisation or death’ outcome in matched trimethoprim versus nitrofurantoin groups, across three eGFR categories. eGFR, estimated glomerular filtration rate. (DOCX)

Background Greater area deprivation is associated with a higher risk of alcohol-related harm. Few studies have investigated longitudinal patterns of harm using record-linked alcohol consumption, and none considered drink type which is associated with deprivation. This study aims to investigate whether the type of drink is associated with the observ...

IntroductionThe most recent Welsh Antimicrobial Resistance Programme (WARP) report on antibiotic use in primary care found significant variations between Health Boards and hospitals in gross antibiotic use in 2014. The aim of this study was to evaluate the association between socioeconomic deprivation and antibiotic prescribing volumes. Objectives...

Background Antibiotic prescription rates have decreased steadily since 2011 in Wales. The most recent Welsh Antimicrobial Resistance Programme (WARP) report on antibiotic use in primary care found significant variations between Health Boards in gross antibiotic use in 2014. It is however not clear whether there is widening gap in prescribing volume...

An uncontrolled study with process evaluation was conducted in three UK community maternity sites to establish the feasibility and acceptability of delivering a novel breastfeeding peer‐support intervention informed by Motivational Interviewing (Mam‐Kind). Peer‐supporters were trained to deliver the Mam‐Kind intervention that provided intensive one...

Introduction Self 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...

Introduction Evaluations of healthcare utilisation for children and young people (CYP) with chronic conditions, are increasingly relying upon routinely collected healthcare data to estimate healthcare burden and inform national policy and practice. However, chronic conditions are not consistently or accurately recorded making it difficult to conduc...

Introduction Children with special educational needs (SEN) are more likely to have disadvantaged backgrounds than their peers, attend school less and do not achieve as well academically. Many children with a cerebral palsy (CP) have SEN but little is known about their educational outcomes. Objectives and Approach To investigate the background of c...

Background: clinical guidelines recommend antibiotic prophylaxis for preventing recurrent urinary tract infections (UTIs), but there is little evidence for their effectiveness in older adults. Methods: this was a retrospective cohort study of health records from 19,696 adults aged ≥65 with recurrent UTIs. We used prescription records to ascertai...

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 gov...

Background Poor growth during infancy and childhood is a characteristic feature of cystic fibrosis (CF). However, the impact of CF on intrauterine growth is unclear. We studied the effect of CF on birth weight in Denmark and Wales, and assessed whether any associations are due to differences in gestational age at birth. Methods We conducted nation...