Rebound of Gonorrhea after Lifting of COVID-19 Preventive Measures, England

After lifting of all COVID-19 preventive measures in England in July 2021, marked, widespread increases in gonorrhea diagnoses, but not testing numbers, were observed, particularly in persons 15-24 years of age. Continued close surveillance and public health messaging to young persons are needed to control and prevent gonorrhea transmission.

Fatal West Nile Virus Infection in Horse Returning to United Kingdom from Spain, 2022

We report fatal West Nile virus (WNV) infection in a 7-year-old mare returning to the United Kingdom from Spain. Case timeline and clustering of virus sequence with recent WNV isolates suggest that transmission occurred in Andalusía, Spain. Our findings highlight the importance of vaccination for horses traveling to WNV-endemic regions.

Covid lockdowns and hospitalisations for oro-facial trauma among children in Australia and the United Kingdom

BACKGROUND/AIM

This retrospective study investigated the effect of lockdowns for Covid-19 on the rates of oro-facial trauma hospitalisations in children in Australia and the United Kingdom (UK).

MATERIALS AND METHODS

Hospitalisation data for children up to 19 years old for oro-facial trauma injuries (according to ICD-10-AM principal diagnosis codes) over 5 years were collected for Australian and UK children. The age-standard rate (ASR) for each age group was calculated per 100,000 population.

RESULTS

In the younger Australian children, there was no statistically significant change in the ASR of oro-facial trauma hospitalisations during the 'Covid year', compared to the average rate over the 3 years preceding. However, there was a significant decrease in the ASR of oro-facial trauma hospitalisations during the 'Covid year' in older Australian children (aged 10-19), and for all UK children, except for infants under one-year-old.

CONCLUSIONS

Reduction of the ASR of hospitalisations due to oro-facial trauma during the 'Covid year', and the implementation of lockdown measures in the two countries provides further evidence of the impact of physical activities and travel as contributing factors to oro-facial injuries in children. In addition to its role in reducing the spread of virus infections during the pandemic, the lockdown measures also resulted in a simultaneous decrease in trauma injuries.

Burnout in trauma and orthopaedics: a cross-sectional study of surgeons from across the United Kingdom

INTRODUCTION

Improving psychological wellbeing in healthcare professionals has demonstrable links with improvements in system-performance and patient outcomes. The aims of this study were to determine the prevalence of burnout among orthopaedic surgeons within the United Kingdom (UK) and to identify any influencing factors.

METHODS

This prospective, cross-sectional nationwide study used the Oldenburg Burnout Inventory to assess burnout among orthopaedic registrars, middle grades and consultants from across the UK. In total, 369 participants completed an anonymised online survey. Reasons for burnout were assessed using a list of 20 stressors followed by a white-space box for elaboration.

RESULTS

Respondents included 204 (55.3%) consultants, 100 (27.1%) registrars and 65 (17.6%) who were an associate specialist, trust grade or fellow. Some 252 (68.3%) participants experienced moderate-level burnout and 81 (22.0%) high-level burnout. There was no significant association between burnout and grade (p = 0.283), gender (p = 0.433), marital status (p = 0.932), years since graduation (p = 0.397), overseas training (p = 0.642), hours worked (p = 0.601), region (p = 0.699) or hospital type (p = 0.813). A high level of disengagement and exhaustion were identified, with the latter being a greater contributory factor. The most common reasons for burnout were insufficient staff numbers, an overload of administrative work and limited time to see patients.

CONCLUSION

There was a moderate to high level of burnout among orthopaedic surgeons within the UK. Clinical and management teams should focus on improving staff numbers, reducing administrative work and increasing clinic consultation times to limit any further disengagement and exhaustion from surgeons. Reducing burnout may help to improve mental wellbeing, work satisfaction and workforce productivity.

Efficacy and safety of onasemnogene abeparvovec in children with spinal muscular atrophy type 1: real-world evidence from 6 infusion centres in the United Kingdom

Background

Real-world data on the efficacy and safety of onasemnogene abeparvovec (OA) in spinal muscular atrophy (SMA) are needed, especially to overcome uncertainties around its use in older and heavier children. This study evaluated the efficacy and safety of OA in patients with SMA type 1 in the UK, including patients ≥2 years old and weighing ≥13.5 kg.

Methods

This observational cohort study used data from patients with genetically confirmed SMA type 1 treated with OA between May 2021 and January 2023, at 6 infusion centres in the United Kingdom. Functional outcomes were assessed using age-appropriate functional scales. Safety analyses included review of liver function, platelet count, cardiac assessments, and steroid requirements.

Findings

Ninety-nine patients (45 SMA therapy-naïve) were treated with OA (median age at infusion: 10 [range, 0.6-89] months; median weight: 7.86 [range, 3.2-20.2] kg; duration of follow-up: 3-22 months). After OA infusion, mean ± SD change in CHOP-INTEND score was 11.0 ± 10.3 with increased score in 66/78 patients (84.6%); patients aged <6 months had a 13.9 points higher gain in CHOP-INTEND score than patients ≥2 years (95% CI, 6.8-21.0; P < 0.001). Asymptomatic thrombocytopenia (71/99 patients; 71.7%), asymptomatic troponin-I elevation (30/89 patients; 33.7%) and transaminitis (87/99 patients; 87.9%) were reported. No thrombotic microangiopathy was observed. Median steroid treatment duration was 97 (range, 28-548) days with dose doubled in 35/99 patients (35.4%). There were 22.5-fold increased odds of having a transaminase peak >100 U/L (95% CI, 2.3-223.7; P = 0.008) and 21.2-fold increased odds of steroid doubling, as per treatment protocol (95% CI, 2.2-209.2; P = 0.009) in patients weighing ≥13.5 kg versus <8.5 kg. Weight at infusion was positively correlated with steroid treatment duration (r = 0.43; P < 0.001). Worsening transaminitis, despite doubling of oral prednisolone, led to treatment with intravenous methylprednisolone in 5 children. Steroid-sparing immunosuppressants were used in 5 children to enable steroid weaning. Two deaths apparently unrelated to OA were reported.

Interpretation

OA led to functional improvements and was well tolerated with no persistent clinical complications, including in older and heavier patients.

Funding

Novartis Innovative Therapies AG provided a grant for independent medical writing services.

Plastic Surgery Teaching to United Kingdom Undergraduate Medical Students: A Systematic Review

Background  There are varying reports about United Kingdom medical students' exposure and teaching methods regarding plastic and reconstructive surgery. To date, no systematic review has been done looking at this topic. Methods  Three databases (PubMed, Embase, and Medline) were searched from January 1, 2011 to July 20, 2023 for studies that assessed United Kingdom medical students' exposure to plastic surgery and suggested recommendations to improve teaching. Three authors performed data extraction and screening, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results  Fifteen studies were included. Medical students' average current exposure to plastic surgery was 29.44%, but this was highly variable across the studies. The most common method of currently teaching plastic surgery was through lectures (34% of studies), and the most common suggested method of teaching was through courses (40% of studies). Many of the studies (12/15) were deemed as being at high risk of bias. Conclusion  More recent studies need to be performed to assess current levels of teaching of plastic surgery in the United Kingdom medical school curriculum. Greater exposure to plastic surgery through lectures and integrated clinical placements is needed to ensure equitable access for all medical students to plastic surgery as a profession.

Triumphs and trials with the UK abortion law: The power of collaboration in abortion reform

The UK is usually viewed as having liberal abortion regulations, providing good access to abortion care within a publicly funded health service. However, the underlying laws are authoritarian, dating from an era when public executions drew large crowds and 67 years before women were able to vote. Abortion is only legal when two doctors certify it meets the permitted grounds, and the penalty for self-managed abortion is up to life imprisonment for both the woman and any accomplice. These laws had prevented the use of mifepristone and misoprostol at home. Changes to the regulations for misoprostol in 2018 and mifepristone in 2020 permitted home use, but the government announced they were rescinding the approval for mifepristone in 2022. This article discusses how, despite the opposition of government, significant progressive changes to the abortion laws were achieved. Early medical abortion at home is now protected in law, and safe access zones protect patients and staff from harassment and intimidation from protesters. Despite this progress, increasing numbers of women are facing criminal investigation and face long prison sentences if convicted. The need for decriminalization and for abortion care to be regulated like all other health care is the next pressing issue.

Trends in research grant applications and outcomes among medical students in the United Kingdom: a national self-reported cross-sectional survey

BACKGROUND

Research funding disparities contribute to clinical academic workforce inequalities. Hence, our study explores the association between student demographics and research grant application rates and outcomes among UK medical students.

METHODS

This is a national multicentre cross-sectional survey of UK medical students in the 2020-21 academic year. Multiple zero-inflated negative binomial regression and generalized linear model (binomial distribution; logit link) were utilized to investigate the association between student demographics, number of grant applications submitted, and successful grant applications (yes or no). P-values less than a Bonferroni-corrected significance level of 0.05/36 = 0.0014 were considered to be statistically significant.

RESULTS

A total of 1528 students participated from 36 medical schools. One hundred fifty-one respondents (9.9%) had applied for research grants. Black students submitted applications 2.90 times more often than white students [Incident rate ratio (IRR): 2.90, 95% confidence interval (CI): 1.37-6.16], with no ethnic disparity in the odds of successful applications. Gender did not influence application rates significantly (P = .248), but women were 4.61 times more likely to secure a grant than men [odds ratio: 4.61, 95% CI: 2.04-10.4]. Being a PubMed-indexed author was associated with increased grant application submission rates [IRR: 3.61, 95% CI: 2.20- 5.92] while conducting more research was associated with greater odds of securing a grant [odds ratio: 1.42, 95% CI: 1.17- 1.73].

CONCLUSION

Although black students submitted more applications, ethnicity did not influence success rates. Gender did not influence application rates, but women were more successful. These findings underscore the need for strategies supporting women and underrepresented students for continued academic achievement after graduation.

KEY MESSAGES

What is already known on this topic Research funding for post-PhD researchers is believed to be a major driver of gender and ethnic inequalities in the clinical academic workforce.Students who receive research grants are more likely to receive postgraduate research grants.What this study adds Black students applied for more research grants than white students, but there were no ethnic differences in the odds of securing a grant.There were no gender differences in the research grant application rates. However, female students had greater odds of securing research grants compared to male students.How this study might affect research, practice or policy Medical schools should incorporate grant writing skills into the undergraduate research curriculum. Also, to sustain women's academic success post medical school, the NIHR and affiliates should provide research award extensions and childcare support for women when required.

Do Socioeconomic Inequalities Exist Within Ophthalmology and Orthoptics in the UK?: A Scoping Review

Introduction

It is well documented that socioeconomic disadvantage adversely affects general health and ocular health worldwide. Within orthoptics, while clinicians recognise a relationship between socioeconomic situation and treatment outcome, no previous literature review was found to address this issue. Neither was a UK-specific literature review found to address the same issue for ophthalmology as a whole.

Aim

This literature review evaluates evidence for an association between socioeconomic situation and ophthalmic/orthoptic conditions and their treatment outcomes, specifically within the UK.

Methods

Keyword searches were conducted on Google Scholar and the University of Liverpool library catalogue. Results for the main analyses were limited to full papers, specific to the UK, written in English. Literature was only included from pre-2000 if more recent evidence was insufficient.

Results

There is evidence of socioeconomic disadvantage being associated with the following: reduced visual acuity; reduced attendance at diabetic retinopathy screening appointments; and delayed presentation of glaucoma, cataracts, and diabetic retinopathy. However, evidence linking socioeconomic disadvantage to AMD is mixed. There is limited evidence of the increased prevalence of amblyopia and subsequent barriers to its treatment for socioeconomically underserved children. There is also evidence of a reduction in quality of life for socioeconomically underserved adults with strabismus.

Conclusions

Health inequalities within ophthalmology and orthoptics are reported, but with confounding results for some conditions. Further research should explore the reasons behind the inequalities that are found and identify methods of reducing them.

'Reputation, reputation, reputation! Oh, I have lost my reputation!'; A literature review on alcohol addiction in the British Sikh and/or Punjabi community and the barriers to accessing support

AIMS

The literature review aimed to identify the barriers the Punjabi and/or Sikh community have in accessing support for alcohol addiction.

METHOD

A systematic review of the literature was undertaken of four scholarly databases, Google Scholar and grey literature on UK-based research conducted after 1980 into alcohol addiction in the Punjabi and/or Sikh community. Fourteen papers met the inclusion criteria outlined in the paper and were included in the review.

RESULTS

Ten main barriers to accessing support were found; stigma, religion, lack of understanding of addiction, over reliance on a medical model of treatment and disregard of therapy, cultural implications of being a member of the Punjabi and/or Sikh community and the addiction community, gender and generational differences and a lack of government commitment to alcohol support for BME communities with a lack of culturally specific services.

CONCLUSION

Despite the many barriers explored, the role of stigma remained a powerful theme throughout often underpinning other barriers. A key recommendation across many papers was the need for culturally sensitive support services. Several areas for future research were identified.

Corrigendum: Concurrent use of oral anticoagulants and sulfonylureas in individuals with type 2 diabetes and risk of hypoglycemia: a UK population-based cohort study

[This corrects the article DOI: 10.3389/fmed.2022.893080.].

Housing tenure and disability in the UK: trends and projections 2004-2030

Introduction

Housing is a major influence on health. Housing tenure is associated with housing conditions, affordability, and security and is an important dimension of housing. In the UK there have been profound changes in both housing conditions and the distribution of households by tenure over the past century, that is during the lifetimes of the current population.

Methods

We firstly reviewed and summarise changes in housing conditions, housing policy and tenure distribution as they provide a context to possible explanations for health variations by housing tenure, including health related selection into different tenure types. We then use 2015-2021 data from a large nationally representative UK survey to analyse associations between housing tenure and self-reported disability among those aged 40-69 controlling for other socio-demographic factors also associated with health. We additionally examine changes in the association between housing tenure and self-reported disability in the population aged 25 and over in the first two decades of the 21st century and project trends forward to 2030.

Results

Results show that associations between housing tenure and disability by tenure were stronger than for any other indicator of socio-economic position considered with owner-occupiers having the best, and social renters the worst, health. Differences were particularly marked in reported mental health conditions and in economic activity, with 28% of social renters being economically inactive due to health problems, compared with 4% of owner-occupiers. Rates of disability have increased over time, and become increasingly polarised by tenure. By 2020 the age standardised disability rate among tenants of social housing was over twice as high as that for owner occupiers, with projections indicating further increases in both levels, and differentials in, disability by 2030.

Discussion

These results have substantial implications for housing providers, local authorities and for public health.

Treatment patterns in essential tremor: Real-world evidence from a United Kingdom and France primary care database

BACKGROUND AND PURPOSE

Essential tremor (ET) is one of the most common neurological disorders, but information on treatment pattern is still scant. The aim of this study was to describe the demographic and clinical characteristics, treatment patterns, and determinants of drug use in patients with newly diagnosed ET in France and the United Kingdom.

METHODS

Incident cases of ET diagnosed between January 1, 2015 and December 31, 2018 with 2 years of follow-up were identified by using The Health Improvement Network (THIN®) general practice database. During the follow-up, we assessed the daily prevalence of use and potential switches from first-line to second-line treatment or other lines of treatment. Logistic regression models were conducted to assess the effect of demographic and clinical characteristics on the likelihood of receiving ET treatment.

RESULTS

A total of 2957 and 3249 patients were selected in the United Kingdom and France, respectively. Among ET patients, drug use increased from 12 months to 1 month prior the date of index diagnosis (ID). After ID, nearly 40% of patients received at least one ET treatment, but during follow-up drug use decreased and at the end of the follow-up approximately 20% of patients were still on treatment. Among treated patients, ≤10% maintained the same treatment throughout the entire follow-up, nearly 20% switched, and 40%-75% interrupted any treatment. Results from the multivariate analysis revealed that, both in France and the United Kingdom, patients receiving multiple concomitant therapies and affected by psychiatric conditions were more likely to receive an ET medication.

CONCLUSION

This study shows that ET is an undertreated disease with a lower-than-expected number of patients receiving and maintaining pharmacological treatment. Misclassification of ET diagnosis should be acknowledged; thus, results require cautious interpretation.

A qualitative study exploring the ritual-like activity and therapeutic relationship between Pilates teachers and clients with persistent low back pain

BACKGROUND AND PURPOSE

Pilates is a commonly recommended exercise modality for the management of persistent low back pain. Whilst guidelines recommend the use of exercise for low back pain, research suggests that no one exercise is superior, creating a question over the mechanism of effect. The patient-practitioner relationship may be important in managing low back pain; however, the relationship between Pilates teachers and clients is not well understood. The purpose of this study was to identify the components of the relationship between Pilates teachers and clients with persistent low back pain, explore key influences on the relationship, and ascertain the nature of the relationship.

METHOD

We conducted a qualitative, ethnographically-informed study at eight sites in the South of England, observing 24 Pilates sessions and interviewing 9 Pilates teachers and 10 clients with persistent low back pain. Fieldnotes and interview transcripts were analysed thematically.

RESULTS

The findings demonstrate a complex, multi-faceted interaction that occurs during Pilates sessions, grounded within certain health perceptions, and predicated on expectations of individuality, choice and expertise. A key finding reveals the perceived importance of mastery of prescribed movements with control and precision, in which clients particularly value the authority of the teacher in a directive learning environment.

CONCLUSION

We contend that the role of the Pilates teacher in this study facilitated the alleviation of clients' distress through the application of ritual-like Pilates activity. We conclude that the relationship between Pilates teachers and clients with persistent low back pain may be considered a therapeutic relationship.

Pseudomonas guariconensis Necrotizing Fasciitis, United Kingdom

We describe a case of necrotizing fasciitis in the United Kingdom in which Pseudomonas guariconensis was isolated from multiple blood culture and tissue samples. The organism carried a Verona integron-encoded metallo-β-lactamase gene and evidence of decreased susceptibility to β-lactam antimicrobial agents. Clinicians should use caution when treating infection caused by this rare pathogen.

Emergence of Novel Norovirus GII.4 Variant

We detected a novel GII.4 variant with an amino acid insertion at the start of epitope A in viral protein 1 of noroviruses from the United States, Gabon, South Africa, and the United Kingdom collected during 2017-2022. Early identification of GII.4 variants is crucial for assessing pandemic potential and informing vaccine development.

Genomic Diversity and Zoonotic Potential of Brucella neotomae

After reports in 2017 of Brucella neotomae infections among humans in Costa Rica, we sequenced 12 strains isolated from rodents during 1955-1964 from Utah, USA. We observed an exact strain match between the human isolates and 1 Utah isolate. Independent confirmation is required to clarify B. neotomae zoonotic potential.

The value of healthy ageing: Estimating the economic value of health using time use data

INTRODUCTION

Economic arguments in favour of investing in health and health care are important for policy making, yet demonstrating the potential economic gains associated with health at older ages can be empirically challenging due to older peoples' limited attachment to the labour market.

METHODS

We develop a novel method to quantify the economic value of health through time use data. Using data on people aged 65 years-old and older from the United Kingdom Time Use Survey (UKTUS) 2014-15, we apply survey-weighted generalized linear models to predict the time spent in non-market productive activities conditional on characteristics including age and self-perceived health. We weight these estimates of predicted minutes spent in each activity using household satellite accounts to quantify the monetary value of time spent engaging in non-market productive activities according to health status and simulate the monetary impact of health gains at older ages.

RESULTS

Both age and self-perceived health status were associated with minutes spent in many non-market productive activities. Summing the monetized predictions of minutes spent across all types of activities indicates that being in "very good" instead of "very bad" self-perceived health is associated with an additional production of 439£, 629£ and 598£ (in real 2015 GBP) per month for an average individual aged 65 to 74 years-old, 75 to 84 years-old and 85 years-old and older, respectively. Using our simulation model, if 10% of older people in "very bad" health in the United Kingdom were to transition to "very good" health it could lead to an increase of up to 278£ million through the production of non-market activities.

CONCLUSIONS

Health at older ages creates considerable economic value which is not observed using standard national accounting measures. Our method to quantify the monetary value of health can be adapted to other settings to make the economic case for investing in healthy ageing.

Control and guidance: a comparative study of building and planning standards for age-friendly built environment in the UK and China

The crux of building and planning standards for age-friendly built environment in all countries resides in the regulation of age-friendly built environment practices, yet there exist variations in the representation of content dimensions. The UK is distinguished by its discretionary approach to guidance, whereas China exhibits a highly controlled disposition. Control and guidance may appear to be antithetical, it is essential to recognize that the building and planning standards for age-friendly built environment in both countries never deviate from the legal constraints while providing guidance in achieving age-friendly environments, thus striking a delicate balance between control and guidance. The study examines the standard systems of national standards, local standards and organizational standards, as well as the three dimensions of foundation standards, generic standards and specialized standards. The analysis of building and planning standards for age-friendly built environment in the UK and China scrutinizes the disparities between control and guidance, identifying similarities and differences in the building and planning standard system and content dimensions of the two countries. This analysis serves as a valuable reference for the development of building and planning standards for age-friendly built environment in China.

Digital Therapeutic Intervention for Women in the UK Armed Forces Who Consume Alcohol at a Hazardous or Harmful Level: Protocol for a Randomized Controlled Trial

BACKGROUND

Alcohol misuse is common in the United Kingdom Armed Forces (UKAF), with prevalence significantly higher than in the general population. To date, digital health initiatives to support alcohol misuse have focused on male individuals, who represent approximately 89% of the UKAF. However, female veterans drink disproportionally more than female members of the public.

OBJECTIVE

This 2-arm participant-blinded (single-blinded) confirmatory randomized controlled trial (RCT) aims to assess the efficacy of a brief alcohol intervention (DrinksRation) in reducing weekly self-reported alcohol consumption between baseline and a 3-month follow-up (day 84) among women who have served in the UKAF.

METHODS

In this 2-arm single-blinded RCT, a smartphone app that includes interactive user-focused features tailored toward the needs of female veterans and designed to enhance participants' motivations to reduce the amount of alcohol they consume is compared with the UK Chief Medical Officer guidance on alcohol consumption. The trial will be conducted among women who have served at least 1 day of paid service in the UKAF. Recruitment, consent, and data collection will be carried out automatically through the DrinksRation app or the BeAlcoholSmart platform. The primary outcome is change in self-reported weekly alcohol consumption between baseline (day 0) and the 3-month follow-up (day 84) measured using the Timeline Follow Back for alcohol consumption. The secondary outcome is the change in the Alcohol Use Disorders Identification Test score measured at baseline and 3-month follow-up between the control and intervention groups. The process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire.

RESULTS

RCT recruitment will begin in January 2024 and last for 5 months. We aim to complete all data collection, including interviews, by May 2024.

CONCLUSIONS

This study will assess whether a smartphone app tailored to the needs of women who have served in the UKAF is efficacious in reducing self-reported alcohol consumption. If successful, the digital therapeutics platform could be used not only to support women who have served in the UKAF but also for other conditions and disorders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05970484; https://www.clinicaltrials.gov/study/NCT05970484.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/51531.

Greenspace use during the COVID-19 pandemic: A longitudinal population mobility study in the United Kingdom

BACKGROUND

The coronavirus pandemic greatly disrupted the lives of people. Restrictions introduced worldwide to limit the spread of infection included stay-at-home orders, closure of venues, restrictions to travel and limits to social contacts. During this time, parks and outdoor greenspaces gained prominent attention as alternative location for respite. Population mobility data offers a unique opportunity to understand the impact of the pandemic on outdoor behaviour. We examine the role of the restrictions on park use throughout the full span of the pandemic while controlling for weather and region.

METHODS

This study provides a longitudinal population analysis of park visitation using Google COVID-19 Community Mobility Reports data in the UK. Daily park visitation was plotted and ANOVA analyses tested season and year effects in visitation. Then, regressions examined park visitation beyond weather (temperature and rain), according to COVID-19 restrictions, while controlling for region specificities through unit fixed effect models.

RESULTS

Time series and ANOVA analyses documented the significant decrease in park visitation in the spring of 2020, the seasonal pattern in visitation, and an overall sustained and elevated use over nearly three years. Regressions confirmed park visitation increased significantly when temperature was greater and when it rained less. More visitation was also seen when there were fewer COVID-19 cases and when the stringency level of restrictions was lower. Of special interest, a significant interaction effect was found between temperature and stringency, with stringency significantly supressing the effect of higher temperature on visitation.

CONCLUSIONS

COVID-19 restrictions negatively impacted park visitation on warm days. Given the general health, social, and wellbeing benefits of greenspace use, one should consider the collateral negative impact of restrictions on park visitation. When social distancing of contacts is required, the few remaining locations where it can safely occur should instead be promoted.

Time-varying disaggregation of the income-emissions nexus: New evidence from the United Kingdom

This paper's objective is to investigate the validity of the Environmental Kuznets Curve (EKC) hypothesis utilizing three unique approaches in this era of accelerating climate change and economic volatility. The first step is to introduce and employ a new cointegration test which allows smooth and sharp structural changes through a dummy variable and a Fourier function. Using a time-varying causality approach, the second stage is to assess the EKC hypothesis's validity for each year of a given period, as opposed to the entire period. The third stage is to conduct time-varying analyses not only of the effect of Gross Domestic Product or aggregate income on environmental degradation but also of the effects of the four major economic units' incomes, namely those of the government, non-financial corporations, households, and the rest of the world. This research derives three conclusions using the United Kingdom as a case study from 1830 to 2016. The impacts of aggregate income and the incomes of the three economic units on carbon emissions are consistent with the EKC hypothesis. Second, each of these effects occurs at different times. Thirdly, the EKC hypothesis regarding the association between the nation's trade income and carbon emissions cannot be validated. To provide policymakers with a dynamic, unit-specific, and effective strategy for mitigating environmental degradation, the paper proposes testing the EKC hypothesis for each year over a specific time period, as well as for the effects of both aggregate income and the disaggregate income of four major economic units.

Exploring multimorbidity profiles in middle-aged inpatients: a network-based comparative study of China and the United Kingdom

BACKGROUND

Multimorbidity is better prevented in younger ages than in older ages. This study aims to identify the differences in comorbidity patterns in middle-aged inpatients from China and the United Kingdom (UK).

METHODS

We utilized 184,133 and 180,497 baseline hospitalization records in middle-aged populations (40-59 years) from Shaanxi, China, and UK Biobank. Logistic regression was used to calculate odds ratios and P values for 43,110 unique comorbidity patterns in Chinese inpatients and 21,026 unique comorbidity patterns in UK inpatients. We included the statistically significant (P values adjusted by Bonferroni correction) and common comorbidity patterns (the pattern with prevalence > 1/10,000 in each dataset) and employed network analysis to construct multimorbidity networks and compare feature differences in multimorbidity networks for Chinese and UK inpatients, respectively. We defined hub diseases as diseases having the top 10 highest number of unique comorbidity patterns in the multimorbidity network.

RESULTS

We reported that 57.12% of Chinese inpatients had multimorbidity, substantially higher than 30.39% of UK inpatients. The complete multimorbidity network for Chinese inpatients consisted of 1367 comorbidities of 341 diseases and was 2.93 × more complex than that of 467 comorbidities of 215 diseases in the UK. In males, the complexity of the multimorbidity network in China was 2.69 × more than their UK counterparts, while the ratio was 2.63 × in females. Comorbidities associated with hub diseases represented 68.26% of comorbidity frequencies in the complete multimorbidity network in Chinese inpatients and 55.61% in UK inpatients. Essential hypertension, dyslipidemia, type 2 diabetes mellitus, and gastritis and duodenitis were the hub diseases in both populations. The Chinese inpatients consistently demonstrated a higher frequency of comorbidities related to circulatory and endocrine/nutritional/metabolic diseases. In the UK, aside from these comorbidities, comorbidities related to digestive and genitourinary diseases were also prevalent, particularly the latter among female inpatients.

CONCLUSIONS

Chinese inpatients exhibit higher multimorbidity prevalence and more complex networks compared to their UK counterparts. Multimorbidity with circulatory and endocrine/nutritional/metabolic diseases among both Chinese and UK inpatients necessitates tailored surveillance, prevention, and intervention approaches. Targeted interventions for digestive and genitourinary diseases are warranted for the UK.

Understanding for whom, under what conditions and how smoking cessation services for pregnant women in the United Kingdom work-a rapid realist review

BACKGROUND

Maternal smoking in pregnancy is associated with several adverse maternal and infant health outcomes including increased risk of miscarriage, stillbirth, low birth weight, preterm birth, and asthma. Progress to reduce rates of smoking at time of delivery in England have been slow and over the last decade, less than half of pregnant women who accessed services went onto report having quit. This realist review was undertaken to improve the understanding of how smoking cessation services in pregnancy work and to understand the heterogeneity of outcomes observed.

METHODS

The initial programme theory was developed using the National Centre for Smoking Cession and Training Standard Treatment Programme for Pregnant Women and the National Institute for Health and Care Excellence guidance on treating tobacco dependency. A search strategy and inclusion criteria were developed. Four databases were searched to identify published papers and four websites were hand searched to identify any unpublished literature that could contribute to theory building. Realist logic was applied to the analysis of papers to identify the contexts in which the intended behaviour change mechanism(s) were triggered, or not, and towards what outcomes to develop context mechanism outcome configurations.

RESULTS

The review included 33 papers. The analysis produced 19 context mechanism outcome configurations structured under five closely interconnected domains (i) articulating harm, (ii) promoting support, (iii) managing cravings, (iv) maintaining commitment and (v) building self-efficacy. This review identifies two key processes involved in how services achieve their effects: how material resources are implemented and relationships. Of the two key processes identified, more existing literature was available evidencing how material resources are implemented. However, the review provides some evidence that non-judgemental and supportive relationships with healthcare workers where regular contact is provided can play an important role in interrupting the social cues and social practice of smoking, even where those around women continue to smoke.

CONCLUSIONS

This review clarifies the range of interconnected and bi-directional relationships between services and the personal and social factors in women's lives. It underscores the importance of aligning efforts across the models five domains to strengthen services' ability to achieve smoking cessation.

A scoping review of the reasons for and approaches to non-uptake of pertussis and influenza vaccinations in pregnant women in the United Kingdom and Ireland

BACKGROUND

Pertussis and influenza cause significant morbidity and mortality in pregnancy and the neonatal period. Maternal vaccination in pregnancy would reduce harm, but low vaccine uptake is a concern. This scoping review aimed to understand the reasons for, and approaches, to non-uptake of pertussis and influenza vaccinations in pregnant women in the UK and Ireland.

METHODS

The inclusion criteria of this scoping review consist of pregnant women who avail of pertussis and influenza vaccines in the UK and Ireland. MEDLINE, EMBASE, Web of Science and CINAHL databases were searched in June 2021 and updated in October 2022. Searches were limited to English language reports published after 2011. We followed the Joanna Briggs Institute guidance on scoping reviews. Data were extracted and charted.

RESULTS

Five themes emerged from the literature. Acceptability, as well as organisational and awareness issues, were overarching themes regarding reasons for and approaches to non-uptake of the vaccines respectively. Other themes included healthcare professional factors, information interpretation and pregnancy-related factors.

CONCLUSIONS

Women need clear, comprehensible information, ideally provided by their healthcare professionals, in a way that is meaningful and addresses their circumstances and risk perceptions. This research will serve as a base for future work that aims behaviour science interventions at the wider pregnant population as well as the target groups that have been identified in this review.

'Turbulence even in a bubble': a reflexive thematic analysis with family caregivers of people with dementia in the United Kingdom during and beyond the COVID-19 pandemic

OBJECTIVE

This study aimed to understand how family caregivers of people with dementia managed changes caused by COVID-19 restrictions and how they adjusted to the lifting of restrictions. A particular focus of the study was on understanding the impact of social isolation, a reduction of social interactions, and reduced access to healthcare services.

METHODS AND MEASURES

Fourteen voluntary caregivers (nine women) were interviewed using a semi-structured interview schedule.

RESULTS

Five themes were identified based on reflexive thematic analysis: (i) Outlets to cope with lockdown; (ii) 'Not all doom and gloom': A silver lining amid COVID-19; (iii) Optimism helps provide resilience; (iv) The challenges and joys of reopening; and (v) Caregiving toward a new normality.

CONCLUSION

The research highlighted difficulties reported by family caregivers and people with dementia during COVID-19, while also showing how such carers coped. Interviews also identified ways that family caregivers often used optimism to help navigate through lockdown and to tackle the reopening stage. Family caregivers in this study reported coping well overall, but welcomed the lifting of restrictions.

Dementia: A call for a paradigm shift in pre-registration nurse education

Dementia is a progressive brain disorder that affects memory, thinking and behaviour. It is a major global public health concern, with an estimated 55 million people worldwide living with the condition. In the UK, there is an estimated 944,000 people with dementia. This number is expected to double by 2050. Dementia is a major cause of disability and dependency, and it places a significant burden on families and carers. The current level of dementia education in pre-registration nursing programmes in the UK is inadequate. There are no pre-registration nursing educational programmes that offer dementia as a speciality. This is a major concern, as nurses are the primary providers of care to people with dementia. This article argues that dementia should be established as a branch of pre-registration nursing education that leads to a Registered Nurse (RN) - Dementia. This could help to address the shortage of specialist dementia nurses in the country. This article provides an important suggestion for countries with a shortage of specialist dementia nurses to consider establishing a stand-alone pre-registration branch of dementia nurse education. This would result in a more specialised workforce with the skills and knowledge to provide high-quality care to people with dementia.

Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation

INTRODUCTION

While screening uptake is variable, many individuals feel they 'ought' to participate in screening programmes to aid the detection of conditions amenable to early treatment. Those not taking part in screening are often presented as either hindered by practical or social barriers or personally at fault. Why some people choose not to participate receives less consideration.

METHODS

We explored screening nonparticipation by examining the accounts of participants who chose not to participate in screening offered by a national research trial of atrial fibrillation (AF) screening in England (SAFER: Screening for Atrial Fibrillation with ECG to Reduce stroke). AF is a heart arrhythmia that increases in prevalence with age and increases the risk of stroke. Systematic screening for AF is not a nationally adopted programme within the United Kingdom; it provides a unique opportunity to explore screening nonparticipation outside of the norms and values attached to existing population-based screening programmes. We interviewed people aged over 65 (n = 50) who declined an invitation from SAFER and analysed their accounts thematically.

RESULTS

Beyond practical reasons for nonparticipation, interviewees challenged the utility of identifying and managing AF earlier. Many questioned the benefits of screening at their age. The trial's presentation of the screening as research made it feel voluntary-something they could legitimately decline.

CONCLUSION

Nonparticipants were not resistant to engaging in health-promoting behaviours, uninformed about screening or unsupportive of its potential benefits. Instead, their consideration of the perceived necessity, legitimacy and utility of this screening shaped their decision not to take part.

PATIENT OR PUBLIC CONTRIBUTION

The SAFER programme is guided by four patient and carer representatives. The representatives are embedded within the team (e.g., one is a co-applicant, another sits on the programme steering committee) and by participating in regular meetings advise on all aspects of the design, management and delivery of the programme, including engaging with interpreting and disseminating the findings. For the qualitative workstream, we established a supplementary patient and public involvement group with whom we regularly consult about research design questions.

Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland

Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics.

Young people's perspectives on addressing UK health inequalities: utopian visions and preferences for action

INTRODUCTION

It is increasingly recognised by UK researchers and population health advocates that an important impetus to effective policy action to address health inequalities is activation of public dialogue about the social determinants of health and how inequalities might be addressed. The limited body of existing scholarship reaches varying conclusions on public preferences for responding to health inequalities but with consensus around the importance of tackling poverty. Young people's perspectives remain underexplored despite their increasingly visible role in activism across a range of policy issues and the potential impact of widening inequalities on their generation's health and wellbeing.

METHODS

Six groups of young people (39 in total) from two UK cities (Glasgow and Leeds) were engaged in online workshops to explore views on health inequalities and potential solutions. Inspired by calls to employ notions of utopia, artist-facilitators and researchers supported participants to explore the evidence, debating solutions and imagining a more desirable society, using visual and performance art. Drawing together data from discussions and creative outputs, we analysed participants' perspectives on addressing health inequalities across four domains: governance, environment, society/culture and economy.

FINDINGS

Proposals ranged from radical, whole-systems change to support for policies currently being considered by governments across the United Kingdom. The consensus was built around embracing more participatory, collaborative governance; prioritising sustainability and access to greenspace; promoting inclusivity and eliminating discrimination and improving the circumstances of those on the lowest incomes. Levels of acceptable income inequality, and how best to address income inequality were more contested. Individual-level interventions were rarely presented as viable options for addressing the social inequalities from which health differences emanate.

CONCLUSION

Young people contributed wide-ranging and visionary solutions to debates around addressing the enduring existence of health inequalities in the United Kingdom. Their reflections signal support for 'upstream' systemic change to achieve reductions in social inequalities and the health differences that flow from these.

PUBLIC CONTRIBUTION

An advisory group of young people informed the development of project plans. Participants shaped the direction of the project in terms of substantive focus and were responsible for the generation of creative project outputs aimed at influencing policymakers.

The intergenerational transmission of mental and physical health in the United Kingdom

As health is increasingly recognized as a key component of human welfare, a new line of research on intergenerational mobility has emerged that focuses on broad measures of health. We extend this research to consider two key components of health: physical health and mental health. We use rich survey data from the United Kingdom linking the health of adult children at around age 30 to their parents. We estimate that the rank-rank slope in health is 0.17 and the intergenerational health association is 0.19 suggesting relatively rapid mobility compared to other outcomes such as income. We find that while both mental and physical health have a similar degree of intergenerational persistence, parents' mental health is much more strongly associated with broad measures of adult children's health than parents' physical health. We also show that the primacy of parent mental health over physical health on children's health appears to emerge during early adolescence. Finally, we construct a comprehensive measure of welfare by combining income and health and estimate a rank-rank association of 0.27. This is considerably lower than the comparable estimate of 0.43 from the US suggesting that there is greater mobility in welfare in the UK than in the US.

The associations of physical incapacity and wealth with remaining in paid employment after age 60 in five middle-income and high-income countries

Previous studies on health and socioeconomic determinants of later-life labour force participation have mainly come from high-income European countries and the United States of America (USA). Findings vary between studies due to different measures of socioeconomic status and labour force outcomes. This study investigated longitudinal associations of physical incapacity and wealth with remaining in paid employment after age 60 in middle- and high-income countries. Using harmonised cohort data in the USA, England, Japan, Mexico and China (N=32,132), multilevel logistic regression was applied for main associations. The age-related probabilities of remaining in paid employment by physical incapacity and wealth were estimated using marginal effects. This study found that physical incapacity predicted lower odds of remaining in paid employment in each country. Wealth was associated with higher odds of remaining in paid employment in the USA, England, and Japan, but not in Mexico. Probabilities of remaining in paid employment were high in Mexico but low in China. The absolute difference in the probability of remaining in paid employment between the richest and the poorest groups was greater in the USA than that in any other country. In the USA, England and Japan, the inverse association between physical incapacity and remaining in paid employment could be partially compensated by wealth only when physical incapacity was not severe. National policies, including considering older adults' changing capacities for job placement and prioritising the provision of supportive services for socioeconomically disadvantaged older adults, developing pathways for informal workers to access social security and pension coverage, and encouraging employers to hire socioeconomically disadvantaged older workers and enhancing their employability, could be facilitated. Future studies, such as exploring health and socioeconomic determinants of remaining in part-time and full-time paid employment separately in more countries, and the moderating effects of relevant policies on these associations, are needed.

Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey

OBJECTIVES

This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections.

STUDY DESIGN

The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland.

METHODS

Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression.

RESULTS

Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043).

CONCLUSIONS

Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.

Climate change and pavement burns in the United Kingdom: a case report of two patients

Pavement burns are more common in locations familiarised with high temperatures and a dry climate zone, but have not previously been reported in temperate climates. We present two cases of patients who suffered pavement burns in the United Kingdom during an unprecedentedly hot day in July 2022. The first case involved a 66-year-old male who suffered partial and full thickness burns requiring excision and skin grafting. The second case involved a 58-year-old female with partial thickness burns also requiring excision and skin grafting. Both patients had pre-existing co-morbidities and their pavement burns were precipitated by heat stroke. Pavement burns represent a mechanism of injury that necessitates increased operative management, length of hospital stay and cost per surface area burned when compared to flame or scald burns (Silver et al., 2015). As a result of global warming, we anticipate extreme heat events, and subsequently pavement burns, to increase in incidence in the United Kingdom. There is opportunity for education of the public and health professionals for prevention.

"We're potentially worsening health inequalities": Evaluating how delivery of the 2022 London polio booster campaign was tailored to Orthodox Jewish families to reduce transmission vulnerability

A polio booster campaign targeting all children aged 1-9 was implemented across London between August-December 2022 as part of a national enhanced poliovirus incident response. Orthodox Jewish (OJ) children were particularly vulnerable to transmission due to disparities in childhood vaccination coverage and the transnational spread of poliovirus affecting linked populations in New York and Israel. This study aimed to evaluate how the polio booster campaign was tailored to increase uptake and enable access for OJ families in northeast and north central London boroughs, and the impact of the campaign on local-level vaccine inequities. Semi-structured in-depth interviews (n = 36) were conducted with participants involved in the implementation and delivery of the polio booster campaign, and OJ mothers. Site visits (n = 5) were conducted at vaccine clinics, and rapid interviews (n = 26) were held to explore parental perceptions of the poliovirus incident and childhood immunisations. Enablers to vaccination during the campaign included the production of targeted printed communications and offering flexible clinic times in primary care settings or complementary delivery pathways embedded in family-friendly spaces. Barriers included digital booking systems. Mothers reported being aware of the poliovirus incident, but the majority of those interviewed did not feel their children were at risk of contracting polio. Healthcare provider participants raised concerns that the vaccine response had limited impact on reducing disparities in vaccine uptake. While OJ families were recognised as a priority for public health engagement during the poliovirus incident response, this evaluation identified limitations in reducing transmission vulnerability during the booster campaign. Lessons for future campaign delivery include effectively conveying transmission risk and the urgency to vaccinate. Priorities for mitigating vaccine inequities include public engagement to develop messaging strategies and strengthening the capacity of primary care and complementary delivery pathways to serve families with higher-than-average numbers of children.

Doubly disadvantaged: Unemployment, young age, and electoral participation in the United Kingdom

Previous studies examine how unemployment affects socio-political behaviour, but this literature has scarcely focused on the role of the life-course. Integrating the frameworks of unemployment scarring and political socialisation, we posit that unemployment experiences, or scars, undermine electoral participation, and that this is exacerbated at younger ages. We test these hypotheses relying on the British Household Panel Survey and Understanding Society datasets (1991-2020), employing panel data analysis approaches as Propensity Score Matching, Individual Fixed Effects, and Individual Fixed Effects with Individual Slopes. Results suggest that unemployment experiences depress electoral participation in the UK, with effect sizes around -5% of a Standard Deviation in turnout. However, this effect varies powerfully by age: the impact of unemployment on electoral participation is stronger at younger ages (-21% SD at age 20), and weaker to not significant after age 35. This is robust across the three main approaches and several robustness checks. Further analyses show that the first unemployment spell matters the most for electoral participation, and that for individuals under 35, there is a scar effect lasting up to 5 years after the first unemployment spell. The life-course emerges as central to better understand the relationship between labour market hardships and socio-political behaviour.

The determinants of ecological footprint in the UK: The role of transportation activities, renewable energy, trade openness, and globalization

The objective of this study is to explore the interaction between transportation energy consumption, GDP, renewable energy, trade, globalization and ecological footprint in the United Kingdom over the period 1990-2020. To achieve this aim, the study uses the autoregressive distributed lag (ARDL) approach and Fourier Toda-Yamamoto causality test. The research findings demonstrate that an increase in transportation energy consumption, renewable energy, and globalization is associated with a reduction in environmental pollution. On the contrary, GDP and trade contribute to worsening the environment. Moreover, there exists a unidirectional causal relationship from transportation energy consumption, GDP, renewable energy, trade, and globalization towards the ecological footprint. The findings of the study recommend that the policymakers should implement strategies and provide incentives to increase the deployment of renewables in the transportation sector, specifically focusing on electric vehicles (EVs) and the necessary charging infrastructure. Overall, the UK government should prioritize sustainable environmental development when planning its economic development strategies.

Partnership status and positive DNA methylation age acceleration across the adult lifespan in the UK

Although a significant body of research has shown that married people are healthier and live longer, empirical research on sex differences in the link between marital status and health suggests results are mixed. Moreover, the sex disparities in marital status and health relationships vary across adulthood. The literature on partnership status and measures of ageing is largely focused on older age groups and is limited in its view of early adulthood. Data from waves 2 and 3 (2010-2012) of Understanding Society: UKHLS were used to examine the association of current partnership status with epigenetic age acceleration (AA) assessed with DNA methylation (DNAm) algorithms 'Phenoage' and ' DunedinPACE ' in 3492 participants (aged 16-97). Regression models were estimated separately for men and women, and further stratified by age groups. Divorced/separated and widowed people showed positive age acceleration compared to the married/cohabiting people (reference group). Some sex differences were apparent, especially, among the single and divorced/separated groups. Age differences were also apparent, for example in men, being single was negatively associated with DNAmAA in the youngest group, but positively in the oldest group compared to partnered counterparts. These findings illustrate the importance of partnerships on the ageing process, in particular marital change through divorce and widowhood for positive age acceleration in adults. For single groups, observations were heterogenous by age and sex.

Association between ethnicity and migration status with the prevalence of single and multiple long-term conditions in UK healthcare workers

BACKGROUND

Healthcare workers' (HCW) well-being has a direct effect on patient care. However, little is known about the prevalence and patterns of long-term medical conditions in HCWs, especially those from ethnic minorities. This study evaluated the burden of multiple long-term conditions (MLTCs), i.e. the presence of two or more single long-term conditions (LTCs), among HCWs in the United Kingdom (UK) and variation by ethnicity and migration status.

METHODS

We used baseline data from the UK-REACH cohort study collected December 2020-March 2021. We used multivariable logistic regression, adjusting for demographic, occupational and lifestyle factors to examine the relationship between self-reported LTCs/MLTCs and ethnicity, migration status and time since migration to the UK.

RESULTS

Of 12,100 included HCWs, with a median age of 45 years (IQR: 34-54), 27% were overseas-born, and 30% were from non-White ethnic groups (19% Asian, 4% Black, 4% Mixed, 2% Other). The most common self-reported LTCs were anxiety (14.9%), asthma (12.2%), depression (10.7%), hypertension (8.7%) and diabetes (4.0%). Mental health conditions were more prevalent among UK-born than overseas-born HCWs for all ethnic groups (adjusted odds ratio (aOR) using White UK-born as the reference group each time: White overseas-born 0.77, 95%CI 0.66-0.95 for anxiety). Diabetes and hypertension were more common among Asian (e.g. Asian overseas, diabetes aOR 2.97, 95%CI 2.30-3.83) and Black (e.g. Black UK-born, hypertension aOR 1.77, 95%CI 1.05-2.99) groups than White UK-born. After adjustment for age, sex and deprivation, the odds of reporting MLTCs were lower in most ethnic minority groups and lowest for those born overseas, compared to White UK-born (e.g. White overseas-born, aOR 0.68, 95%CI 0.55-0.83; Asian overseas-born aOR 0.75, 95%CI 0.62-0.90; Black overseas-born aOR 0.52, 95%CI 0.36-0.74). The odds of MLTCs in overseas-born HCWs were equivalent to the UK-born population in those who had settled in the UK for ≥ 20 years (aOR 1.14, 95%CI 0.94-1.37).

CONCLUSIONS

Among UK HCWs, the prevalence of common LTCs and odds of reporting MLTCs varied by ethnicity and migrant status. The lower odds of MLTCs in migrant HCWs reverted to the odds of MLTCs in UK-born HCWs over time. Further research on this population should include longitudinal studies with linkage to healthcare records. Interventions should be co-developed with HCWs from different ethnic and migrant groups focussed upon patterns of conditions prevalent in specific HCW subgroups to reduce the overall burden of LTCs/MLTCs.

Impact of compliance to oral cysteamine treatment on the costs of Kidney failure in patients with nephropathic cystinosis in the United Kingdom

BACKGROUND

Nephropathic Cystinosis (NC), a rare disease characterised by intra-lysosomal accumulation of cystine, results in progressive kidney failure (KF). Compliance to lifelong oral cysteamine, the only therapy, is often compromised. The relationship between compliance and costs of NC has not been previously formally assessed. The present study evaluates the impact of compliance on lifetime (direct) costs of treating KF in NC patients in the United Kingdom.

METHODS

A three-state (KF-free, post-KF, death) partitioned survival model was developed for hypothetical 'Good Compliance' (GC) and 'Poor Compliance' (PC) cohorts. Survival in the KF-free state was determined by a published regression function of composite compliance score (CCS). The CCS is a summation of annual compliance scores (ACS) over treatment duration prior to KF. ACSs are indexed on annual (average) leukocyte cystine levels (LCL). The Poor Compliance cohort was defined to reflect NC patients in a previous study with a mean LCL of 2.35 nmols nmol half-cystine/mg protein over the study period - and an estimated mean ACS of 1.64 over a 13.4 year treatment duration. The Good Compliance cohort was assumed to have an ACS of 2.25 for 21 years. Major KF costs were evaluated - i.e., dialysis, kidney transplants, and subsequent monitoring.

RESULTS

The mean CCS was 47 for the GC and 22 for the PC cohort respectively, corresponding to estimated lifetime KF costs of £92,370 and £117,830 respectively - i.e., a cost saving of £25,460/patient, or £1,005/patient for every 1-unit improvement in CCS.

CONCLUSION

This analysis indicates that lifetime costs of KF in NC can be reduced through improved treatment compliance with oral cysteamine.

A Principle-Based Approach to Visual Identification Systems for Hospitalized People with Dementia

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier.

UK Chickpea Consumption Doubled from 2008/09-2018/19

Background: Only 9% of individuals in the United Kingdom (UK) meet the recommendation for dietary fibre intake. Little is known about chickpea consumption in the UK. Methods: Chickpea intake trends and sociodemographic patterns were analysed using the National Diet and Nutrition Survey Rolling Programme data collected from 2008/09 to 2018/19 among 15,655 individuals ≥1.5 years completing a four-day food diary. Chickpea consumers were identified based on a list of chickpea-containing foods, with the most consumed foods being hummus, boiled chickpeas, chickpea flour, and low/reduced-fat hummus. Micronutrient and food group intakes were compared between chickpea consumers and non-consumers; the Modified Healthy Dietary Score was also assessed, which measures adherence to UK dietary recommendations. Results: Chickpea consumption increased from 6.1% (2008-2012) to 12.3% (2016-2019). Among 1.5-3 years, consumption increased from 5.7% to 13.4%, and among 19-64 years, consumption increased from 7.1% to 14.4%. The percentage of individuals eating chickpeas was higher among individuals with higher incomes and more education. Healthy-weight adults were more likely to consume chickpeas compared to those who were overweight or obese. Compared to both bean and non-bean consumers, chickpea consumers ate significantly more dietary fibre, fruits and vegetables, pulses, nuts, and less red meat and processed meat products. Chickpea consumers also had a higher Modified Healthy Dietary Score. Conclusions: In the UK, chickpea consumption more than doubled from 2008/09 to 2018/19. Chickpea consumers had a higher diet quality than non-consumers.

Living with polypharmacy: a narrative interview study with older Pakistanis in East London

BACKGROUND

Polypharmacy is a growing and major public health issue. It can be burdensome and risky for patients and costly to healthcare systems. Older adults and those from ethnic minority backgrounds are disproportionately affected by polypharmacy. This study focuses on medication practices among Urdu-speaking Pakistani patients, a significant ethnic group in the UK. Most existing research on medication practices within South-Asian communities centres on adherence, leaving the social and moral dimensions of polypharmacy unpacked. Understanding how British Pakistani patients understand and manage polypharmacy in the context of their daily lives is crucial to avoiding harmful polypharmacy.

METHODS

In-depth narrative interviews were conducted with 15 first-generation Pakistani patients using the Biographical Narrative Interview Method. Participants were recruited from GP practices in East London. All participants were prescribed ten or more regular medications (a pragmatic marker of 'higher risk' polypharmacy) and were aged over 50. Interviews were conducted with a bilingual researcher at home and were designed to elicit narratives of patients' experiences of polypharmacy in the context of their biographies and daily lives.

RESULTS

Polypharmacy is enacted through networks of interpersonal and socio-material relationships. The doctor-patient relationship and the family network held particular significance to study participants. In addition, participants described emotional bonds between themselves and their medicines, identifying them as 'forces for good'-substances which allowed them to maintain their health through the intercession of God. Meanings attributed to medicines and enacted through these social, emotional, and spiritual relationships contributed to emerging and sustaining polypharmacy.

CONCLUSIONS

Patients make sense of and manage treatments in culturally specific ways. Developing an understanding of how medication practices in different communities are enacted is important for informing meaningful and effective conversations with patients about their medicines. Our findings contribute to enabling the integration of culturally sensitive approaches to prescribing.

Cost of illness due to pertussis in adults ≥50 years of age in the United Kingdom

BACKGROUND

Pertussis is an endemic respiratory tract infection caused by Bordetella pertussis that may affect all individuals from infants to older adults. Pertussis incidence in adults is often underreported and in various countries, including the United Kingdom (UK), there are evidence gaps on pertussis-associated economic burden in the older adult population. We aimed to quantify the economic burden of pertussis in adults aged ≥50 years in the UK.

METHODS

A cost-of-illness study was conducted to estimate the cost of pertussis from a societal perspective. We utilized a sum diagnosis cost approach in which costs related to infection with pertussis were included. Medical, patient, and indirect costs were calculated individually and combined to calculate total costs. A framework was developed to assess costs for consecutive age groups from 50-54 years of age to ≥85 years of age. Sensitivity and scenario analyses were used to assess analysis uncertainty.

RESULTS

The base-case analysis estimated the total annual economic burden of pertussis to be approximately £238 million (M). This comprised approximately £159 M in indirect costs, £66 M in medical costs, and £13 M in patient costs. Costs for the age group 55-59 years had the highest impact on the economic burden, with approximately £79 M in total annual costs. Visits to general practitioners and nurses were the largest contributors to medical costs (∼£37 M) followed by inpatient visits (∼£21 M). Transportation costs (∼£10 M) were the major patient costs. Productivity loss (∼£71 M) and leisure time loss (∼£72 M) had comparable contributions to annual indirect costs. Sensitivity and scenario analyses suggested that incidence rates, indirect costs, and underreporting estimates had the highest impact on outcomes.

CONCLUSION

Total cost of pertussis in the UK among adults ≥50 years of age is substantial and highest for adults 55-59 years of age. Indirect costs were the main contributors to the economic burden.

Health care of the disadvantaged: chronic obstructive pulmonary disease in later life

Introduction

Chronic diseases have emerged as the foremost causes of death and disability worldwide. This article employs an ethnographic approach to conduct a gerontological investigation of chronic obstructive pulmonary disease (COPD), the third leading cause of global mortality, trailing only cardiovascular diseases and cancers.

Methods

This study is rooted in an extensive amalgamation of biomedical literature and official epidemiological data. Additionally, it offers enriched insights through an extensive ethnographic research methodology, encompassing ethnographic fieldwork, participant observation, interviews, and focus groups.

Results

The findings expound that individuals grappling with chronic obstructive pulmonary disease often undergo intricate cognitive and emotional experiences, necessitating holistic solutions that consider psychological processes, contextual factors, and subjective age. These challenges extend beyond the purview of a purely medical perspective.

Conclusion

This article concludes that the lens of gerontology is invaluable in comprehending chronic obstructive pulmonary disease, particularly due to its association with old age and increased longevity. Among older individuals, diagnosing the condition presents a formidable challenge. Breathlessness, a cardinal symptom, often overlaps with normal age-related declines in pulmonary function, rendering COPD's insidious onset misconstrued as a consequence of aging-related changes.

The epidemiology of psoriatic arthritis in the UK: a health intelligence analysis of UK Primary Care Electronic Health Records 1991-2020

OBJECTIVES

Epidemiological estimates of psoriatic arthritis (PsA) underpin the provision of healthcare, research, and the work of government, charities and patient organizations. Methodological problems impacting prior estimates include small sample sizes, incomplete case ascertainment, and representativeness. We developed a statistical modelling strategy to provide contemporary prevalence and incidence estimates of PsA from 1991 to 2020 in the UK.

METHODS

Data from Clinical Practice Research Datalink (CPRD) were used to identify cases of PsA between 1st January 1991 and 31st December 2020. To optimize ascertainment, we identified cases of Definite PsA (≥1 Read code for PsA) and Probable PsA (satisfied a bespoke algorithm). Standardized annual rates were calculated using Bayesian multilevel regression with post-stratification to account for systematic differences between CPRD data and the UK population, based on age, sex, socioeconomic status and region of residence.

RESULTS

A total of 26293 recorded PsA cases (all definitions) were identified within the study window (77.9% Definite PsA). Between 1991 and 2020 the standardized prevalence of PsA increased twelve-fold from 0.03 to 0.37. The standardized incidence of PsA per 100,000 person years increased from 8.97 in 1991 to 15.08 in 2020, an almost 2-fold increase. Over time, rates were similar between the sexes, and across socioeconomic status. Rates were strongly associated with age, and consistently highest in Northern Ireland.

CONCLUSION

The prevalence and incidence of PsA recorded in primary care has increased over the last three decades. The modelling strategy presented can be used to provide contemporary prevalence estimates for musculoskeletal disease using routinely collected primary care data.

The impact of COVID-19 lockdowns on the body mass index of people living with obesity: A UK retrospective cohort study using the UK Clinical Practice Research Datalink

BACKGROUND

Restrictions implemented by governments during the coronavirus disease 2019 (COVID-19) pandemic affected people's eating habits and physical activity. We investigated the effect of COVID-19 lockdowns and restrictions on body mass index (BMI) and weight in a UK population, according to BMI class, sex, age and ethnicity.

METHODS

This retrospective observational cohort study used the Clinical Practice Research Datalink AURUM database. Baseline spanned from 22 March 2017-22 March 2020, and the follow-up lockdown period was from 23 March 2020 (start of the lockdown in the UK) to 13 March 2021. The descriptive analysis included individuals with ≥ 1 valid BMI/weight measurements during both the baseline and follow-up periods, while the model-based analysis comprised individuals with ≥ 1 valid measurement(s) during baseline. Results were stratified by baseline BMI category, sex, age and ethnicity.

RESULTS

In the descriptive analysis (n = 273,529), most individuals did not change BMI category post-lockdown (66.4-83.3%). A greater proportion of women (12.6%) than men (9.5%) moved up BMI categories post-lockdown. Compared with older groups, a higher proportion of individuals < 45 years old increased post-lockdown BMI category. The model-based analysis (n = 938,150) revealed consistent trends, where changes in body weight and BMI trajectories pre- and post-lockdown were observed for women and for individuals < 45 years.

CONCLUSION

During COVID-19 restrictions, women and young individuals were more likely than other groups to increase BMI category and weight post-lockdown.

How has Covid-19 impacted the training of Urology trainees in South Wales?

OBJECTIVES

To determine whether Covid19 had a tangible effect on urology training in Wales. There has been no Welsh data available concerning how training has changed during the covid pandemic. This survey evaluated the overall impact on training, with the primary aims to identify changes in clinical and academic activities and evaluate a trainees' wellbeing during the crisis.

MATERIALS AND METHODS

Online questionnaires were sent to all Urology Trainees; n = 20 (83% response) working in the Welsh deanery in the United Kingdom, asking about changes in training particularly within operating list, out-patient clinics, diagnostic activities, educational courses, teaching sessions and examinations.

RESULTS

Across Wales trainees experienced a reduction in operating procedures, clinics and teaching courses. Due to a redesign of services, there was only a minimal impact on training for cancer diagnostics and Multi-Disciplinary Team (MDT) meetings. The majority of trainees felt their index procedures and ability to complete training will be affected.

CONCLUSION

Cancer work, including cancer related theatre lists, diagnostics and MDT were maintained. Trainees lacked confidence that they would reach their operative competencies and struggle to successfully complete training. Following BAPIO discussion, we suggest that training programmes readjust to focus on areas where exposure has been lacking.

Partnership and fertility trajectories of immigrants and descendants in the United Kingdom: A multilevel multistate event history approach

We study the interrelationships between partnership and fertility trajectories of immigrant women and female descendants of immigrants using the UK Household Longitudinal Study. We propose a novel multistate event history approach to analyse the outcomes of unpartnered, cohabiting, and married women. We find that the partnership and fertility behaviours of immigrants and descendants from European and Western countries are similar to those of native women: many cohabit first and then have children and/or marry. Those from countries with conservative family behaviours (e.g. South Asian countries) marry first and then have children. Women from the Caribbean show the weakest link between partnership changes and fertility: some have births outside unions; some form a union and have children thereafter. Family patterns have remained relatively stable across migrant generations and birth cohorts, although marriage is being postponed in all groups. Our findings on immigrants support the socialization hypothesis, whereas those on descendants are in line with the minority subculture hypothesis.

Gut microbiology of UK care home residents: a cross-sectional analysis from a randomised controlled trial

OBJECTIVE

To describe the prevalence of potentially clinically relevant gut pathogens and associations with the carriage of resistant organisms in UK care home residents.

METHODS

Stool samples were collected pre-randomisation from care home residents participating in a randomised placebo-controlled trial. Cultivable clinically relevant bacteria were analysed. Antimicrobial susceptibility testing was performed by agar dilution (amoxicillin, co-amoxiclav, gentamicin, trimethoprim, nitrofurantoin, and ciprofloxacin). We also aimed to detect resistance to third-generation cephalosporins, carbapenems, and vancomycin.

RESULTS

Stool samples were available for 159/310 residents participating in the trial (51%) from 23 care homes between 2016 and 2018. In total, 402 bacterial isolates were cultured from 158 stool samples and 29 different species were cultured. The five most common species were Escherichia coli (155/158, 98%), Pseudomonas aeruginosa (40/158, 25%), Enterococcus faecalis (35/158, 22%), Enterococcus faecium (30/158, 19%), and Proteus mirabilis (25/158, 16%). Enterobacterales isolates were cultured from 157 samples (99%), and resistance to at least one of the tested antimicrobials was found in 119 of these (76%). There were high levels of variation in outcomes by care home.

DISCUSSION

We demonstrated that care home residents harbour significant levels of antimicrobial-resistant organisms in their stool. This work emphasises the importance of both enhanced infection control practices and antimicrobial stewardship programmes to support the appropriate use of antimicrobials in this setting.