Atopic Dermatitis (AD, also known as atopic eczema and eczema) is a common disease affecting 20% of children in the UK and other high-income countries. The major genetic risk factor for AD is loss of function mutations in filaggrin, a critical skin barrier protein. There are many theories around the high prevalence of filaggrin mutations in European and Asian populations and of eczema including some proposals that having a leaky skin barrier and an overactive skin immune system might lead to skin immune cells being activated through the skin resulting in protection against pandemics. The COVID-19 pandemic is associated with substantial COVID-related health problems and deaths.

We will use data from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective birth cohort study questionnaires and clinical visits to identify people with evidence of eczema in childhood, and genetic data to identify people with filaggrin null mutations. We are very familiar with these data in ALSPAC and have very recently analysed these data. We will then determine if people in early adulthood (the age of the cohort at the time of pandemic emergence) with evidence of childhood eczema are at reduced risk of reporting symptoms suggestive of COVID-19. The subsequent analysis will involve assessing if those with filaggrin null mutations (with and without eczema) have reduced risk of reporting COVID-19 symptoms. We will stratify by the presence or absence of asthma to see if the risks vary in these subgroups.

Existing research on depression vulnerability shows that early experiences such as exposure to childhood abuse could leave “cognitive scars”, which could increase vulnerability in later stages of life. Childhood emotional maltreatment is found to be strongly associated with vulnerability to psychopathology in comparison to physical and sexual maltreatment.(1) Adolescents having experienced childhood maltreatment were shown to depict reduced positive spontaneous thought, a feature of ruminative thinking constituting a risk factor for depression.(2) However, the role of mediating factors like cognitive styles in the association between childhood trauma and depression could be further explored. Various trauma types excepting physical neglect, predict depressive rumination, which predicts depression.(3) The differential association between age of exposure to trauma or specific trauma types and depression could be further researched as exposure to trauma in adolescence may have a greater effect size than that during early childhood with regard to developing increased odds of psychotic experiences. Examining the influence of mediating factors could be beneficial for preventing mental health issues such as distress and impairment at the population level by targeting negative cognitive styles.(4) Age groups requiring further support and intervention could be identified for addressing specific types of childhood trauma

Adverse childhood experiences (ACEs) have been consistently linked to psychiatric difficulties in adolescents. Individuals with at least 4 ACEs are at four times the risk of experiencing mental distress and disorder in their lives. ACEs have been estimated to contribute to approximately 30% of cases of anxiety and 40% of depression in adults in a North American sample and more than a quarter for both conditions in Europe. The combined annual costs of depression and anxiety attributed to ACEs were approximately $51 billion in Europe and $82 billion in North America. Adolescence is a tumultuous time, with significant life events and high rates of mental disorder occurring during this life stage. It is essential to assess the effect of exposure to ACEs on the severity of mental disorders at this stage in the life course.

Cancers develop for many years before they are diagnosed. Using data from first-generation ALSPAC offspring, we aim in this study to estimate the effects of being more genetically susceptible to obesity-related cancers that commonly emerge in adulthood on metabolic traits measured in blood across early life; this should help to reveal what early stages of cancer development look like and when they occur. More specifically, we will examine associations of genetic risk scores for different cancers that are known to be influenced by obesity, e.g. colorectal cancer, with traits from targeted metabolomics measured in childhood (age 8y), adolescence (age 15y), and young adulthood (age 18y and 25y). This allows us to view subtle changes in metabolism over time which precede the onset of clinically detectable cancer by several decades. Recognizing the early signs of cancer development is vital for informing early detection, preventing its onset in older age, and improving survival.

The Covid-19 lockdown has shone a light on the importance of where we live for our health and wellbeing. Living in the countryside; having a garden; living in a cohesive neighbourhood; being within walking distance of a park: these factors create very different lockdown experiences, even between neighbours living a stone’s throw apart.

Research into neighbourhood factors and mental health is not new. However, lockdown has created a natural experiment in which people’s activities outside the home are largely being confined to their immediate neighbourhoods. Lockdown has thus amplified the potential detrimental – and protective – effects of neighbourhood conditions on our mental health. Investigating this relationship is not simple. It is important to take into consideration potential factors that might confound associations (e.g., prior mental health). It is also important to take into consideration how individual-level factors such as housing type might modify any associations of neighbourhood characteristics with mental health.

The current project will explore the relationship between neighbourhood characteristics during lockdown – including population density, greenspace, deprivation, and social fragmentation – and people’s symptoms of anxiety and depression during and after lockdown. Analyses will control for key confounders of the association. Moderation of associations according to household composition, housing type, garden access, and perceived access to nature will be explored.

Whilst it is established that children of lower socioeconomic position (SEP) generally have worse mental health outcomes, most existing research is cross-sectional. Longitudinal studies are important for understanding when inequalities first emerge and the course they take (e.g. stable, widening or decreasing). Whilst longitudinal approaches are now commonly used to model inequalities in height and weight they have rarely been used for mental health outcomes. The aim of this project is use data from multiple EU studies to describe how inequalities in key mental health and cognitive outcomes emerge across childhood.

The aim of this project is to investigate the effect of socioeconomic position on trajectories of key mental health and cognitive outcomes across childhood. It will also serve as a ‘proof of concept’ for using DataSHIELD to conduct multilevel analyses. Our specific aims are to (1) to identify the age at which inequalities emerge for different mental health outcomes, and (2) to describe whether inequalities decrease, remain stable, or widen over time.

There is currently a pandemic of a new disease, COVID19, which is caused by a virus called SARS-CoV-2.

Asthma, eczema and hay fever and are common diseases in childhood and responsible for a significant burden on families and health services. Atopic eczema, hay fever (allergic rhinitis) and atopic asthma often co-exist. Early diagnosis and appropriate management can reduce progression and severity of these diseases.
The Born in Bradford (BiB) birth cohort includes over 13,500 children born between 2007 and 2011, with around half born to women of Pakistani ethnicity. Linked primary care and hospital admission data are available for 97% of BiB children. Two sub-studies within BiB, the Allergy and Infection Study (ALL IN, n=2559) and Mechanisms of the Development of ALLergy (MeDALL, n=1814), have collected detailed parental questionnaire data at age 1 and 2 years (ALL IN) and at 4 years (MeDALL). The current data collection phase for the whole BiB cohort, Growing Up, at ages 7-11 years is ongoing and also includes questions on these outcomes.
The BiB data provide an opportunity to investigate trajectories of allergic disease and asthma through childhood, by ethnic group. The linked primary care and hospital electronic health records (EHR) will contribute a wealth of data which can be analysed with machine learning methods. There is uncertainty over the validity of routine data but the extensive BiB questionnaire data at different ages provide a rare opportunity to test this.
The aims of this proposed study are:
1) to link research and routine data to explore early life and childhood longitudinal trajectories and describe clinical phenotypes of asthma, eczema and hay fever;
2) to investigate ethnic inequalities in access to care and presentation of these diseases
3) to investigate early life risk factors for these diseases
Questionnaire data are available from the BiB ALL IN sub-study at age 1 year, including questions on pets, family history of asthma/eczema/hay fever, housing conditions (damp, heating, flooring, bedding etc.), and at 2 years (as for age 1 plus eczema, hay fever, food allergy). Detailed data relevant to asthma, eczema and hay fever are available for the MeDALL sub-study participants at 4 years, including skin prick testing for 2269.
BiB receive regular extracts of primary care EHR data on diagnoses and prescriptions for BiB children, which will be linked to the BiB maternal baseline questionnaire data, including socio-demographic and household characteristics. Linked hospital admissions data are available from the Bradford Royal Infirmary. We will also compare EHR data and questionnaire data from the Avon Longitudinal Study of Parents and Children (ALSPAC).
Latent class analysis or other cluster methods, such as k-means clustering, will be used to identify clinical phenotypes of asthma, eczema and hay fever. Longitudinal extensions of these cluster methods will be used to describe trajectories over age.
This study will provide important data on the validity of routine primary care EHR for asthma and allergic diseases, which is relevant as EHR are increasingly used for research studies. The comparison of questionnaire and EHR data will indicate whether there are ethnic differences in access to primary care for these diseases. Identification of clinical phenotypes of asthma, eczema and hay fever will inform appropriate treatment and management and the identification of factors associated with disease progression or severity could indicate potential prevention strategies.

Better Care South-West Partnership is a collaboration of NHS commissioners, primary, secondary, community and mental health care providers, local authorities, and academia. They look to address real-world health problems using the Bristol, North Somerset and South Gloucestershire (BNSSG) Systemwide health and social care dataset and have an ambition to use individual-level, linked routine care and administrative data to deliver a learning, Integrated Care System for the local population.
The Partnership represents a step change in using advanced analytics to deliver Better Care Loops across a care system and benefit patients and partner organisations. Its results will be scalable across the region and nationally.
Research Projects
· P-NEWS: personalised early warning scores for preventing unplanned critical care admission
· Precision antimicrobial prescribing: safeguarding patient outcomes and preserving future efficacy
· Using operation research methods to improve flow between acute and social care: modelling the responsiveness of system-level expenditure to changes in social care capacity
· Improving hospital efficiency by forecasting demand for hospital beds
· Underpinning infrastructure to the BNSSG Systemwide dataset