RESUMEN
BACKGROUND: Under the Children Act 1989, local authorities in Wales, UK, can issue care proceedings if they are concerned about the welfare of a child, which can lead to removal of a child from parents. For mothers at risk of child removal, timely intervention during pregnancy may avert the need for this and improve maternal/fetal health; however, little is known about this specific population during the antenatal period. The study examined maternity characteristics of mothers whose infants were subject to care proceedings, with the aim of informing preventative interventions targeted at high risk mothers. METHODS: Anonymised administrative data from Cafcass Cymru, who provide child-focused advice and support for family court proceedings in Wales, were linked to population-based maternity and health records held within the Secure Anonymised Information Linkage Databank. Linked data were available for 1111 birth mothers of infants involved in care proceedings between 2015 and 2018. Findings were benchmarked with reference to an age-deprivation-matched comparison group (n = 23,414), not subject to care proceedings but accessing maternity services during this period. Demographic characteristics, maternal health, reproductive history, interaction with midwifery services, and pregnancy and birth outcomes were examined. Descriptive and statistical tests of independence were used. RESULTS: Half of the women in the cohort (49.4%) resided in the most deprived areas. They were more likely to be younger at entry to motherhood (63.5% < 21 years-of-age compared to 42.7% in the comparison group), to have mental health (28.6% compared to 8.2%) and substance use issues (10.4% compared to 0.6%) and to smoke (62.7% compared to 24.8%) during pregnancy. The majority first engaged with maternity services within their first trimester of pregnancy (63.5% compared to 84.4%). Babies were more likely to be born preterm (14.2% compared to 6.7%) and, for full-term babies, to have low birthweights (8.0% compared to 2.8%). CONCLUSION: This novel linkage study highlights multiple vulnerabilities experienced by pregnant mothers who have experienced care proceedings concerning an infant. Policy and practice colleagues require a clearer picture of women's needs if child protection and health services are to offer effective services which prevent the need for family court proceedings and infant removal.
Asunto(s)
Servicios de Salud Materna , Resultado del Embarazo , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Salud Mental , Evaluación de Necesidades , Embarazo , Complicaciones del Embarazo/epidemiología , Web Semántica/estadística & datos numéricos , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Salud de la Mujer , Adulto JovenRESUMEN
INTRODUCTION: Although there has been considerable progress in the use of administrative data for applied health research, the family justice field lags behind. Better use of administrative data are essential to enhance understanding of how the family justice system is working, as well as the characteristics of, and outcomes for, children and families. The Family Justice Data Partnership (FJDP) supports this aim through analyses of core family justice and linked datasets in the SAIL Databank (Secure Anonymised Information Linkage). Cafcass Cymru provide expert advice for children involved in family court proceedings in Wales, ensuring decisions are made in the best interests of the child. We provide an overview of Cafcass Cymru data. We also describe and illustrate linkage to administrative datasets within SAIL. METHODS: Cafcass Cymru data was transferred to SAIL using a standardised approach to provide de-identified data with Anonymised Linking Fields (ALF) for successfully matched records. Three cohorts were created: all individuals involved in family court applications; all individuals with an ALF allowing subsequent health data linkage; and all individuals with a Residential Anonymised Linking Field (RALF) enabling area-level deprivation analysis. RESULTS: Cafcass Cymru application data are available for child protection matters (public law, range 2011-2019, n=12,745), and child arrangement disputes (private law, range 2005-2019, n=52,023). An 80% data linkage match rate was achieved. 40% had hospital admissions within two years pre or post application; 54% had emergency department attendances and 61% had outpatient appointments. Individuals were more likely to reside in deprived areas regardless of law type. CONCLUSION: Cafcass Cymru data can be accessed through the SAIL Databank. The FJDP will continue to enhance research opportunities for all to better understand the family justice system, and outcomes for those involved, such as health and wellbeing for children and family members.
RESUMEN
The extent of unnecessary insulin administration was assessed by reviewing the records of 350 patients with non-insulin-dependent diabetes (NIDDM). Subjects were included only if previously told that insulin therapy was to be permanent, and not if the need for insulin was known to be temporary (e.g. post-operatively). Fifty-one such patients were identified, 26 men and 25 women, mean age 59.5 (range 24-79) yr, with mean duration of diabetes 10.7 (1-34) yr. Insulin had been administered for a mean of 4.8 (0.3-34) yr in a mean daily dosage of 52.5 (12-280) units. Twenty-nine subjects (57%) were more than 110% of ideal body mass. Insulin therapy was ceased on an outpatient basis, using self blood glucose monitoring in nearly all cases. Mean duration of follow-up since ceasing insulin is 16 (3-48) months. Body mass in overmass subjects fell from (mean +/- S.D.) 92.3 +/- 20.5 to 82.1 +/- 17.8 kg (p less than 0.001). Mean HbA1 level fell from 12.0 +/- 2.2 to 11.0 +/- 2.0% (p less than 0.05). Sixteen patients are currently treated with diet, and 35 require diet and oral hypoglycemic agents. It appears that insulin therapy in NIDDM is often commenced for "dietary failure" rather than true secondary failure of oral hypoglycemic agents. Despite progressive increase in dosage, insulin may not improve diabetic control, and may cause weight gain. A management program of diet and exercise, based on self blood glucose monitoring allows reduction in dosage and withdrawal of insulin without hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)