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Project Title Project Lead Lay Summary Date Issued to IGRP Outcome Date of IGRP approval Health Care Utilisation, Care Pathways and Ann John, Associate Professor Public 19/10/2015 Approved 23/12/2015 Educational Status in Children and Young People with Mental Health, Swansea University Mental health issues are of growing concern and a source of controversy in children and young people (CYP) in the United Kingdom (U.K). They have been found to contribute to adverse life outcomes (such as poor Adolescent Mental Health (AMH) problems with a educational achievement) and serious disruptions to CYP's lives and those of their families . It is estimated from Office of National Statistics population survey data that, at any one time, four in 100 of CYP, have a focus on Self harm, Eating Disorders and Anxiety and clinically diagnosable or relevant emotional disorder (anxiety or depression). Some disorders such as anxiety may start when children are as young as 11 years. Earlier age of onset appears to be associated with Depression) greater severity and poorer long term outcomes . Concerns are heightened by the persistence of childhood or adolescent mental health issues into adulthood where up to a fifth of the adult population may be affected by a common mental disorder at any one time. Many of these conditions are managed in primary care and there are issues about the transition of care between primary and hospital care and appropriate settings to deliver care to children. There are also issues relating to those that do make contact but are lost to services from childhood to adulthood and between primary care and hospital care. We will explore differences in outcomes for these children.This project develops work already done in Wales to across the UK looking at levels of these disorders and with a particular focus on self harm, eating disorders and anxiety and depression, patterns of healthcare contacts and educational attainment. We will explore the outcomes for those children who attend services and how they are manged with a view to informing interventions. This project has been funded by the Healthcare Quality Improvement partnership (HQIP) so has a unique opportunity to inform and impact on services. Follow—up study of patients with latent autoimmune Dr Mark D Atkinson, Research Officer, 13/10/2015 Approved 23/12/2015 diabetes in adults (LADA) and type 2 diabetes. School of Medicine, Swansea The majority of cases of diabetes after the age of 35 are type 2 diabetes, but there is a significant proportion of these (approx. 4%) who have a type of diabetes more like type 1 called Latent Autoimmune Diabetes in University Adults (LADA), who require insulin treatment more quickly. These can be distinguished with an antibody test (GADA). We have a group of people from South Wales already in SAIL who have had the antibody test don so we know who has type 2 diabetes and who has LADA. This was a pilot study carried out between 2004 and 2007 and GADA tests continued for a few years. GADA testing is not routine in Wales or any other part of the UK. We will be able to see, from GP and hospital data, how these 2 groups have been treated and what their glucose levels are. We can also see the various complications they may have developed. From this we can determine whether LADA patients received best treatment and compare their outcomes with type 2 patients. Although test results are often present in the GP data, some may only be found in the Morriston laboratory dataset (PAMOV) Another aim of the research is to attempt to distinguish LADA patients from type 2 patients in the absence of GADA tests. By looking at a wide range of factors in our cohort of known LADA and type 2 patients, we will try to find methods of distinguishing between the two. Factors would be, for example; BMI, presence of other autoimmune conditions including thyroid conditions, time from diagnosis to first prescription of insulin. Once a way of distinguishing between the two types of diabetes has been established, this method can be used to identify cases of LADA in the absence of GADA tests. We hope to test the idea that these patients may have worse outcomes than type 2 patients as their true condition is not known when treatment starts. If this is the case, we would hope to use the results to recommend the wider use of GADA testing. Tagged Electronic Cohort Cymru (TECC) Professor Sinead Brophy, Swansea In line with the aims of the National Centre for Population Health and Wellbeing Research, the Tagged Electronic Cohort Cymru (TECC) can help us to better understand illness and the effects of medications used to 18/09/2015 Approved 23/12/2015 University treat disease. The cohort will be developed from the linkage of routine data collected in Wales. Linking data from general practitioner records, hospital records and disease specific datasets (for example, for cancer and arthritis) will create a vast dataset of adults, comprising healthy individuals and those who may present with different conditions. This dataset allows researchers to report the number of people who have certain illnesses, who the illnesses are most likely to affect and when, as well as identifying illnesses that often exist together. The medications given to treat conditions will be examined, including associated adverse effects and interactions of medications. The dataset can answer basic questions about conditions in the Welsh population. TECC allows rapid analysis and can quickly support existing research ideas and generate new ones regarding illnesses, medical procedures and medications administered. Treatment of depression in patients with epilepsy Owen Pickrell, Clinical Lecturer It is known that people with epilepsy are more likely to suffer from psychiatric illnesses, especially depression, than the general population. There is some evidence that depression in people with epilepsy may be 24/08/2015 Approved 28/09/2015 (Neurology), College of inadequately treated despite treatment recommendations, although there have not been any large‐scale studies to our knowledge. MedicineSwansea University Building on previous depression (led by Ann John) and epilepsy (led by Mike Kerr) research using the SAIL databank, we aim to study the treatment of depression in people with epilepsy. We will compare anti‐ depressant prescribing rates and secondary care referral rates in people with and without epilepsy. Identification of an inequality in such treatment in people with epilepsy could partly explain the high rate of significant depression‐related problems, such as suicide attempts, in this population. The identification of any inequalities in treatment could also help to prioritise and guide service provision for people with epilepsy. Understanding the determinants of educational Chris Taylor, WISERD Professor, Understanding the determinants of educational achievement has been the focus of extensive research in recent years. However, much of this analysis is significantly constrained by a lack of information relating to 24/08/2015 Approved 28/09/2015 achievement and the association with health and well‐ WISERD, Cardiff University the background and educational experiences of children. Indeed, in Wales there is currently no ‘on‐entry’ assessment of a child’s educational development as they start school. Understanding the factors that being by age 14 in Wales. potentially influence children’s educational achievement is therefore important as this could contribute to the Welsh Government’s recommendations and policies to tackle inequalities in educational achievement as well as raise educational standards. In 2012/13 the Welsh Government introduced annual national reading and numeracy tests for all children in years 2 to 9 (aged 7‐14). This project will be the first to use this education data, and will combine it with information from the Millennium Cohort Study (MCS). The education and MCS data will be linked to administrative health records to explore what determines educational achievement and the association with children’s health. In addition, this project provides a unique opportunity to explore the benefits and usefulness of analysing linked administrative health records and survey data (such as the MCS), therefore contributing toward a better understanding on the factors influencing educational achievement with particular interest on the relationship with health. Previous research in Wales using the education and MCS data has been able to demonstrate, for example, the limitations of the free school meal indicator to properly identify factors that are associated with low levels of educational achievement. Unfortunately, this previous analysis has only studied educational achievement up to the age of 7 years (and the end of Key Stage 1). This project aims to extend this analysis to study children’s educational progress and levels of achievement by the age of 14 years (at the end of Key Stage 3). In addition, linkage with health‐related data (based on administrative health records) will allow to further explore the determinants of educational attainment and the association with children’s health. Variation in secondary care costs for patients Kendal Smith, Head of Financial Cwm Taf Local Health Boards has worked with the Public Health Observatory and NHS Wales Information Service beginning to ascertain which factors affect the variation in costs of patients undergoing similar 24/08/2015 Approved 28/09/2015 undergoing similar procedures Flows, Cwm Taf University Health procedures. Previous work has already indicated that it is possible to measure differences between organisations in the ‘additional’ cost of treating patients who have diabetes when compared to patients without Board diabetes. The cost of treatment and the length the patient stays in hospital are also affected by the age of the patients, the number of co‐morbidities they have but also whether they are treated on specialist wards. This shows that the PEDW dataset which is routinely collected by the organisation contains differences in performance depending on the patient pathway.

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