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Article ; Online: Implementation of advanced vascular access, physiological monitoring and goal-directed resuscitation during OHCA in a helicopter emergency medical service.

Aziz, Shadman / Lachowycz, Kate / Major, Rob / Rees, Paul / Barratt, Jon

2024 , Page(s) 11297298241242157

Abstract: Outcomes after out-of-hospital cardiac arrest (OHCA) remain poor in the UK. In order to increase the chances of successful resuscitation, international society guidelines on cardiopulmonary resuscitation quality have recommended titration of chest ... ...

Abstract	Outcomes after out-of-hospital cardiac arrest (OHCA) remain poor in the UK. In order to increase the chances of successful resuscitation, international society guidelines on cardiopulmonary resuscitation quality have recommended titration of chest compression parameters and vasopressor administration to arterial diastolic blood pressure if invasive catheters are in situ at the time of cardiac arrest. However, prehospital initiation of arterial and central venous catheterisation is seldom undertaken due to the risks and significant technical challenges in the context of ongoing resuscitation in this environment. In 2019, a dedicated programme was started at East Anglian Air Ambulance (EAAA) to enable the safe introduction of contemporary emergency vascular access devices, in order to improve physiological monitoring intra-arrest and deliver nuanced, goal-directed resuscitation in OHCA patients. This programme was entitled Specialist Percutaneous Emergency Aortic Resuscitation (SPEAR). This article details the EAAA SPEAR technique; and the development, implementation and governance of this novel endovascular strategy in our UK physician-paramedic staffed helicopter emergency medical service.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/11297298241242157
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Article ; Online: Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM).

Price, James / Lachowycz, Kate / Steel, Alistair / Moncur, Lyle / Major, Rob / Barnard, Ed B G

Scandinavian journal of trauma, resuscitation and emergency medicine

2022 Volume 30, Issue 1, Page(s) 44

Abstract: Background: Pre hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre hospital advanced airway management. Previous data demonstrating ... ...

Abstract	Background: Pre hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre hospital advanced airway management. Previous data demonstrating significantly lower FPS by non-physicians does not distinguish between non-physicians operating in isolation or within physician teams. In several UK HEMS, the role of the intubating provider is interchangeable between the physician and critical care paramedic-termed the Inter-Changeable Operator Model (ICOM). The objectives of this study were to compare first-pass intubation success rate between physicians and critical care paramedics (CCP) in a large regional, multi-organisational dataset of trauma PHEA patients, and to report the application of the ICOM. Methods: A retrospective observational study of consecutive trauma patients ≥ 16 years old who underwent PHEA at two different ICOM Helicopter Emergency Medical Services in the East of England, 2015-2020. Data are presented as number (percentage) and median [inter-quartile range]. Fisher's exact test was used to compare proportions, reported as odds ratio (OR (95% confidence interval, 95% CI)), p value. The study design complied with the STROBE (Strengthening The Reporting of Observational studies in Epidemiology) reporting guidelines. Results: In the study period, 13,654 patients were attended. 674 (4.9%) trauma patients ≥ 16 years old who underwent PHEA were included in the final analysis: the median age was 44 [28-63] years old, and 502 (74.5%) were male. There was no significant difference in the FPS rate between physicians and CCPs-90.2% and 87.4% respectively, OR 1.3 (95% CI 0.7-2.5), p = 0.38. The cumulative first, second, third, and fourth-pass intubation success rates were 89.6%, 98.7%, 99.7%, and 100%. Patients who had a physician-operated initial intubation attempt weighed more and had a higher heart rate, compared to those who had a CCP-operated initial attempt. Conclusion: In an ICOM setting, we demonstrated 100% intubation success in adult trauma patients undergoing PHEA. There was no significant difference in first-pass intubation success between physicians and CCPs.
MeSH term(s)	Adolescent ; Adult ; Anesthesia ; Anesthesiology ; Emergency Medical Services/methods ; Female ; Humans ; Intubation, Intratracheal/methods ; Male ; Middle Aged ; Retrospective Studies
Language	English
Publishing date	2022-07-08
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-022-01032-2
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Article ; Online: Nine golden codes: improving the accuracy of Helicopter Emergency Medical Services (HEMS) dispatch-a retrospective, multi-organisational study in the East of England.

Edmunds, Christopher T / Lachowycz, Kate / McLachlan, Sarah / Downes, Andrew / Smith, Andrew / Major, Rob / Barnard, Edward B G

Scandinavian journal of trauma, resuscitation and emergency medicine

2023 Volume 31, Issue 1, Page(s) 27

Abstract: Background: Helicopter Emergency Medical Services (HEMS) are a limited and expensive resource, and should be intelligently tasked. HEMS dispatch was identified as a key research priority in 2011, with a call to identify a 'general set of criteria with ... ...

Abstract	Background: Helicopter Emergency Medical Services (HEMS) are a limited and expensive resource, and should be intelligently tasked. HEMS dispatch was identified as a key research priority in 2011, with a call to identify a 'general set of criteria with the highest discriminating potential'. However, there have been no published data analyses in the past decade that specifically address this priority, and this priority has been reaffirmed in 2023. The objective of this study was to define the dispatch criteria available at the time of the initial emergency call with the greatest HEMS utility using a large, regional, multi-organizational dataset in the UK. Methods: This retrospective observational study utilized dispatch data from a regional emergency medical service (EMS) and three HEMS organisations in the East of England, 2016-2019. In a logistic regression model, Advanced Medical Priority Dispatch System (AMPDS) codes with ≥ 50 HEMS dispatches in the study period were compared with the remainder to identify codes with high-levels of HEMS patient contact and HEMS-level intervention/drug/diagnostic (HLIDD). The primary outcome was to identify AMPDS codes with a > 10% HEMS dispatch rate of all EMS taskings that would result in 10-20 high-utility HEMS dispatches per 24-h period in the East of England. Data were analysed in R, and are reported as number (percentage); significance was p < 0.05. Results: There were n = 25,491 HEMS dispatches (6400 per year), of which n = 23,030 (90.3%) had an associated AMPDS code. n = 13,778 (59.8%) of HEMS dispatches resulted in patient contact, and n = 8437 (36.6%) had an HLIDD. 43 AMPDS codes had significantly greater rates of patient contact and/or HLIDD compared to the reference group. In an exploratory analysis, a cut-off of ≥ 70% patient contact rate and/or ≥ 70% HLIDD (with a > 10% HEMS dispatch of all EMS taskings) resulted in 17 taskings per 24-h period. This definition derived nine AMPDS codes with high HEMS utility. Conclusion: We have identified nine 'golden' AMPDS codes, available at the time of initial emergency call, that are associated with high-levels of whole-system and HEMS utility in the East of England. We propose that UK EMS should consider immediate HEMS dispatch to these codes.
MeSH term(s)	Humans ; Retrospective Studies ; Emergency Medical Dispatch ; Emergency Medical Services ; England ; Aircraft
Language	English
Publishing date	2023-06-12
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-023-01094-w
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Article ; Online: Prehospital invasive arterial blood pressure monitoring in critically ill patients attended by a UK helicopter emergency medical service- a retrospective observational review of practice.

Butterfield, Emma D / Price, James / Bonsano, Marco / Lachowycz, Kate / Starr, Zachary / Edmunds, Christopher / Barratt, Jon / Major, Rob / Rees, Paul / Barnard, Ed B G

Scandinavian journal of trauma, resuscitation and emergency medicine

2024 Volume 32, Issue 1, Page(s) 20

Abstract: Background: Accurate haemodynamic monitoring in the prehospital setting is essential. Non-invasive blood pressure measurement is susceptible to vibration and motion artefact, especially at extremes of hypotension and hypertension: invasive arterial ... ...

Abstract	Background: Accurate haemodynamic monitoring in the prehospital setting is essential. Non-invasive blood pressure measurement is susceptible to vibration and motion artefact, especially at extremes of hypotension and hypertension: invasive arterial blood pressure (IABP) monitoring is a potential solution. This study describes the largest series to date of cases of IABP monitoring being initiated prehospital. Methods: This retrospective observational study was conducted at East Anglian Air Ambulance (EAAA), a UK helicopter emergency medical service (HEMS). It included all patients attended by EAAA who underwent arterial catheterisation and initiation of IABP monitoring between 1st February 2015 and 20th April 2023. The following data were retrieved for all patients: sex; age; aetiology (medical cardiac arrest, other medical emergency, trauma); site of arterial cannulation; operator role (doctor/paramedic); time of insertion and, where applicable, times of pre-hospital emergency anaesthesia, and return of spontaneous circulation following cardiac arrest. Descriptive analyses were performed to characterise the sample. Results: 13,556 patients were attended: IABP monitoring was initiated in 1083 (8.0%) cases, with a median age 59 years, of which 70.8% were male. 546 cases were of medical cardiac arrest: in 22.4% of these IABP monitoring was initiated during cardiopulmonary resuscitation. 322 were trauma cases, and the remaining 215 were medical emergencies. The patients were critically unwell: 981 required intubation, of which 789 underwent prehospital emergency anaesthesia; 609 received vasoactive medication. In 424 cases IABP monitoring was instituted en route to hospital. Conclusion: This study describes over 1000 cases of prehospital arterial catheterisation and IABP monitoring in a UK HEMS system and has demonstrated feasibility at scale. The high-fidelity of invasive arterial blood pressure monitoring with the additional benefit of arterial blood gas analysis presents an attractive translation of in-hospital critical care to the prehospital setting.
MeSH term(s)	Humans ; Male ; Middle Aged ; Female ; Blood Pressure ; Arterial Pressure ; Hemodynamic Monitoring ; Retrospective Studies ; Critical Illness ; Emergency Medical Services ; Aircraft ; Air Ambulances ; Heart Arrest ; United Kingdom
Language	English
Publishing date	2024-03-12
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-024-01193-2
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Article ; Online: Does walking explain associations between access to greenspace and lower mortality?

Lachowycz, Kate / Jones, Andy P

Social science & medicine (1982)

2014 Volume 107, Page(s) 9–17

Abstract: Despite emerging evidence that access to greenspace is associated with longer life expectancy, little is understood about what causal mechanisms may explain this relationship. Based on social-ecological theories of health, greenspace has multifaceted ... ...

Abstract	Despite emerging evidence that access to greenspace is associated with longer life expectancy, little is understood about what causal mechanisms may explain this relationship. Based on social-ecological theories of health, greenspace has multifaceted potential to influence mortality but the potential alternative mediating pathways have not been empirically tested. This study evaluates relationships between access to greenspace, walking and mortality. Firstly, we test for an association between access to greenspace and self-reported levels of walking using a survey of 165,424 adults across England collected during 2007 and 2008. Negative binomial regression multilevel models were used to examine associations between greenspace access and self reported number of days walked in the last month, in total and for recreational and health purposes, after controlling for relevant confounders. Secondly we use an area level analysis of 6781 middle super output areas across England to examine if recreational walking mediates relationships between greenspace access and reduced premature mortality from circulatory disease. Results show clear evidence of better greenspace access being associated with higher reported recreational walking. There were between 13% and 18% more days of recreational walking in the greenest quintile compared with the least green after adjustment for confounders. Tests for mediation found no evidence that recreational walking explain the associations between greenspace and mortality. Futhermore, whilst the relationship between greenspace access and walking was observed for all areas, the relationship between greenspace access and reduced mortality was only apparent in the most deprived areas. These findings indicate that the association between greenspace and mortality, if causal, may be explained by mediators other than walking, such as psychosocial factors. Future research should concentrate on understanding the causal mechanisms underlying observed associations.
MeSH term(s)	Adolescent ; Adult ; Aged ; England/epidemiology ; Environment Design/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Mortality/trends ; Poverty Areas ; Recreation ; Self Report ; Walking/statistics & numerical data ; Young Adult
Language	English
Publishing date	2014-02-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2014.02.023
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Article ; Online: Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study.

Price, James / Moncur, Lyle / Lachowycz, Kate / Major, Rob / Sagi, Liam / McLachlan, Sarah / Keeliher, Chris / Steel, Alistair / Sherren, Peter B / Barnard, Ed B G

Scandinavian journal of trauma, resuscitation and emergency medicine

2023 Volume 31, Issue 1, Page(s) 26

Abstract: Background: Post-intubation hypotension (PIH) after prehospital emergency anaesthesia (PHEA) is prevalent and associated with increased mortality in trauma patients. The objective of this study was to compare the differential determinants of PIH in ... ...

Abstract	Background: Post-intubation hypotension (PIH) after prehospital emergency anaesthesia (PHEA) is prevalent and associated with increased mortality in trauma patients. The objective of this study was to compare the differential determinants of PIH in adult trauma patients undergoing PHEA. Methods: This multi-centre retrospective observational study was performed across three Helicopter Emergency Medical Services (HEMS) in the UK. Consecutive sampling of trauma patients who underwent PHEA using a fentanyl, ketamine, rocuronium drug regime were included, 2015-2020. Hypotension was defined as a new systolic blood pressure (SBP) < 90 mmHg within 10 min of induction, or > 10% reduction if SBP was < 90 mmHg before induction. A purposeful selection logistic regression model was used to determine pre-PHEA variables associated with PIH. Results: During the study period 21,848 patients were attended, and 1,583 trauma patients underwent PHEA. The final analysis included 998 patients. 218 (21.8%) patients had one or more episode(s) of hypotension ≤ 10 min of induction. Patients > 55 years old; pre-PHEA tachycardia; multi-system injuries; and intravenous crystalloid administration before arrival of the HEMS team were the variables significantly associated with PIH. Induction drug regimes in which fentanyl was omitted (0:1:1 and 0:0:1 (rocuronium-only)) were the determinants with the largest effect sizes associated with hypotension. Conclusion: The variables significantly associated with PIH only account for a small proportion of the observed outcome. Clinician gestalt and provider intuition is likely to be the strongest predictor of PIH, suggested by the choice of a reduced dose induction and/or the omission of fentanyl during the anaesthetic for patients perceived to be at highest risk.
MeSH term(s)	Adult ; Humans ; Middle Aged ; Rocuronium ; Hypotension/etiology ; Anesthesia ; Emergency Medical Services ; Fentanyl ; Retrospective Studies ; Intubation, Intratracheal/adverse effects
Chemical Substances	Rocuronium (WRE554RFEZ) ; poly(2-hydroxyethyl acrylate) (26022-14-0) ; Fentanyl (UF599785JZ)
Language	English
Publishing date	2023-06-02
Publishing country	England
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-023-01091-z
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Article ; Online: Critical hypertension in trauma patients following prehospital emergency anaesthesia: a multi-centre retrospective observational study.

Sagi, Liam / Price, James / Lachowycz, Kate / Starr, Zachary / Major, Rob / Keeliher, Chris / Finbow, Benjamin / McLachlan, Sarah / Moncur, Lyle / Steel, Alistair / Sherren, Peter B / Barnard, Ed B G

Scandinavian journal of trauma, resuscitation and emergency medicine

2023 Volume 31, Issue 1, Page(s) 104

Abstract: Background: Critical hypertension in major trauma patients is associated with increased mortality. Prehospital emergency anaesthesia (PHEA) is performed for 10% of the most seriously injured patients. Optimising oxygenation, ventilation, and cerebral ... ...

Abstract	Background: Critical hypertension in major trauma patients is associated with increased mortality. Prehospital emergency anaesthesia (PHEA) is performed for 10% of the most seriously injured patients. Optimising oxygenation, ventilation, and cerebral perfusion, whilst avoiding extreme haemodynamic fluctuations are the cornerstones of reducing secondary brain injury. The aim of this study was to report the differential determinants of post-PHEA critical hypertension in a large regional dataset of trauma patients across three Helicopter Emergency Medical Service (HEMS) organisations. Methods: A multi-centre retrospective observational study of consecutive adult trauma patients undergoing PHEA across three HEMS in the United Kingdom; 2015-2022. Critical hypertension was defined as a new systolic blood pressure (SBP) > 180mmHg within 10 min of induction of anaesthesia, or > 10% increase if the baseline SBP was > 180mmHg prior to induction. Purposeful logistical regression was used to explore variables associated with post-PHEA critical hypertension in a multivariable model. Data are reported as number (percentage), and odds ratio (OR) with 95% confidence interval (95%CI). Results: 30,744 patients were attended by HEMS during the study period; 2161 received PHEA and 1355 patients were included in the final analysis. 161 (11.9%) patients had one or more new episode(s) of critical hypertension ≤ 10 min post-PHEA. Increasing age (compared with 16-34 years): 35-54 years (OR 1.76, 95%CI 1.03-3.06); 55-74 years (OR 2.00, 95%CI 1.19-3.44); ≥75 years (OR 2.38, 95%CI 1.31-4.35), pre-PHEA Glasgow Coma Scale (GCS) motor score four (OR 2.17, 95%CI 1.19-4.01) and five (OR 2.82, 95%CI 1.60-7.09), patients with a pre-PHEA SBP > 140mmHg (OR 6.72, 95%CI 4.38-10.54), and more than one intubation attempt (OR 1.75, 95%CI 1.01-2.96) were associated with post-PHEA critical hypertension. Conclusion: Delivery of PHEA to seriously injured trauma patients risks haemodynamic fluctuation. In adult trauma patients undergoing PHEA, 11.9% of patients experienced post-PHEA critical hypertension. Increasing age, pre-PHEA GCS motor score four and five, patients with a pre-PHEA SBP > 140mmHg, and more than intubation attempt were independently associated with post-PHEA critical hypertension.
MeSH term(s)	Adult ; Humans ; Air Ambulances ; Anesthesia ; Emergency Medical Services ; Hypertension/epidemiology ; Retrospective Studies
Chemical Substances	poly(2-hydroxyethyl acrylate) (26022-14-0)
Language	English
Publishing date	2023-12-20
Publishing country	England
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-023-01167-w
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Article: Towards a better understanding of the relationship between greenspace and health: Development of a theoretical framework

Lachowycz, Kate / Andy P. Jones

Landscape and urban planning. 2013 Oct., v. 118

2013

Abstract: A growing body of evidence investigates whether access to greenspace, such as parks and woodland, is beneficial to well-being. Potential health benefits of greenspace exposure include opportunity for activities within the space and psychological benefits ...

Abstract	A growing body of evidence investigates whether access to greenspace, such as parks and woodland, is beneficial to well-being. Potential health benefits of greenspace exposure include opportunity for activities within the space and psychological benefits of viewing and interacting with nature. However, empirical research evidence on the effects of greenspace exposure shows mixed findings. Hence we suggest that the key questions of “if, why and how?” greenspace influences health remain largely unanswered. We argue that researchers have inadequately considered the causal pathways which drive the relationship. In particular, an improved understanding is needed of potential mediators and moderators. In this paper we draw on social–ecological theories and a review of the literature to develop a novel theoretical framework which summarises current knowledge about hypothetical causal pathways between access to greenspace and health outcomes. The framework highlights how mediators – such as use of greenspace and perceptions of the living environment – drive associations between access and both physical and psychological health outcomes. We propose key moderators based on evidence that associations between greenspace and health differ by demographic factors such as gender, ethnicity and socio-economic status, living context, greenspace type and climate. We discuss the evidence for how and why these factors act as moderators and consider the implications which arise from this improved understanding of the relationship between greenspace and health. In conclusion, we discuss how the framework can be used to inform planning of research studies, and how it may be developed in the future as more evidence emerges.
Keywords	climate ; gender ; nationalities and ethnic groups ; parks ; research planning ; researchers ; socioeconomic status ; woodlands
Language	English
Dates of publication	2013-10
Size	p. 62-69.
Publishing place	Elsevier B.V.
Document type	Article
ZDB-ID	742504-1
ISSN	1872-6062 ; 0169-2046
ISSN (online)	1872-6062
ISSN	0169-2046
DOI	10.1016/j.landurbplan.2012.10.012
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: What can global positioning systems tell us about the contribution of different types of urban greenspace to children's physical activity?

Lachowycz, Kate / Jones, Andy P / Page, Angie S / Wheeler, Benedict W / Cooper, Ashley R

Health & place

2012 Volume 18, Issue 3, Page(s) 586–594

Abstract: Urban greenspace is hypothesised to be an important location for physical activity in children, but their actual use of the resource to be active is not well known. In this study, global positioning systems (GPS) and accelerometers were used to measure ... ...

Abstract	Urban greenspace is hypothesised to be an important location for physical activity in children, but their actual use of the resource to be active is not well known. In this study, global positioning systems (GPS) and accelerometers were used to measure activity within green environments for 902 English children aged 11-12. We summarised activity intensities in different types of greenspace on weekday evenings, weekend days and by season. Around half of outdoor moderate-vigorous activity took place in greenspace at the weekend and use was consistent across seasons. The findings suggest the importance of certain types of greenspace to children's physical activity.
MeSH term(s)	Actigraphy/instrumentation ; Child ; England ; Environment Design ; Female ; Geographic Information Systems ; Humans ; Male ; Motivation ; Motor Activity
Language	English
Publishing date	2012-01-25
Publishing country	England
Document type	Journal Article
ZDB-ID	1262540-1
ISSN	1873-2054 ; 1353-8292
ISSN (online)	1873-2054
ISSN	1353-8292
DOI	10.1016/j.healthplace.2012.01.006
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Article ; Online: Teenage conceptions, abortions, and births in England, 1994-2003, and the national teenage pregnancy strategy.

Wilkinson, Paul / French, Rebecca / Kane, Ros / Lachowycz, Kate / Stephenson, Judith / Grundy, Chris / Jacklin, Paul / Kingori, Patricia / Stevens, Maryjane / Wellings, Kaye

Lancet (London, England)

2006 Volume 368, Issue 9550, Page(s) 1879–1886

Abstract: Background: The aim of this study was to quantify the change in the number of conceptions and abortions among women younger than 18 years in England in relation to the government's national teenage pregnancy strategy.: Methods: We undertook ... ...

Abstract	Background: The aim of this study was to quantify the change in the number of conceptions and abortions among women younger than 18 years in England in relation to the government's national teenage pregnancy strategy. Methods: We undertook geographic analysis of data for 148 top-tier local authority areas. The main outcomes were changes in under-18 conceptions, abortions, and births between the 5-year period before implementation of the strategy (1994-98) and the period immediately after implementation (1999-2003). Findings: The number of teenage conceptions peaked in 1998, then declined after the implementation in 1999 of the teenage pregnancy strategy. Under-18 conception rates fell by an average of 2.0% (95% CI 1.8 to 2.2) per year between 1998 and 2003, below the rate needed to achieve the target of 50% reduction by 2010. The net change between 1994-98 and 1999-2003 was a fall in conceptions of 3.2% (2.6 to 3.9) or 1.4 per 1000 women aged 15-17 years, a rise in abortions of 7.5% (6.5 to 8.6) or 1.4 per 1000, and a fall in births of 10.6% (9.9 to 11.3) or 2.8 per 1000. The change in the number of conceptions was greater in deprived and more rural areas, and in those with lower educational attainment. The change was greater in areas where services and access to them were poorer, but greater where more strategy-related resources had been targeted. Interpretation: The decline in under-18 conception and birth rates since 1998 and evidence that the declines have been greatest in areas receiving higher amounts of strategy-related funding provides limited evidence of the effect of England's national teenage pregnancy strategy. The full effect of local prevention will be clear only with longer observation, and substantial further progress is needed to remedy England's historically poor international position in teenage conceptions.
MeSH term(s)	Abortion, Induced/statistics & numerical data ; Abortion, Induced/trends ; Adolescent ; Birth Rate/trends ; England/epidemiology ; Female ; Fertilization ; Health Priorities ; Humans ; Mass Media ; Pregnancy ; Pregnancy in Adolescence/prevention & control ; Pregnancy in Adolescence/statistics & numerical data ; Sex Education/methods ; Socioeconomic Factors
Language	English
Publishing date	2006-11-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(06)69777-8
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