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Martín-Ambrosio Francés M, Seth M, Sharman M, Pollard D, Ortiz AL, Miller R, Natsiopoulos T, Walker D, Jones B, Hardwick J, Glanemann B, Garcia AS, Bacon J, Selgas AG. Causes of thrombocytopenia in dogs in the United Kingdom: A retrospective study of 762 cases. Vet Med Sci 2023. [PMID: 37218364 DOI: 10.1002/vms3.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Thrombocytopenia is a common laboratory abnormality in dogs, and numerous diseases have been associated with its development. Estimates for the sensitivity and specificity of the degree of reduction of platelet concentration for the diagnosis of primary immune-mediated thrombocytopenia (pITP) have not been reported. OBJECTIVES To report the prevalence of different causes of thrombocytopenia in dogs in the United Kingdom and to investigate the utility of platelet concentration to differentiate causes of thrombocytopenia. METHODS Medical records of 762 dogs with thrombocytopenia presented to seven referral hospitals from January 2017 to December 2018 were retrospectively reviewed. Cases were assigned into the following categories: pITP, infectious diseases, neoplasia, inflammatory/other immune-mediated disorders and miscellaneous causes. The prevalence of the different categories was estimated, and platelet concentrations were compared. Receiver-operating characteristic (ROC) curves were used to investigate the utility of platelet concentration to differentiate between causes of thrombocytopenia. RESULTS The most common disease category associated with thrombocytopenia was neoplasia (27.3%), followed by miscellaneous causes (26.9%), pITP (18.8%), inflammatory/immune-mediated disorders (14.4%) and infectious diseases (12.6%). Dogs with pITP had significantly lower platelet concentrations (median 8 × 109 /L, range: 0-70 × 109 /L) than dogs in the other four categories. Platelet concentration was useful for distinguishing pITP from other causes of thrombocytopenia (area under ROC curve = 0.89, 95% confidence interval 0.87, 0.92), with a platelet concentration ≤12 × 109 /L being 60% sensitive and 90% specific. CONCLUSIONS Severe thrombocytopenia was highly specific for a diagnosis of pITP, which was more prevalent in this UK population of thrombocytopenic dogs compared with previous epidemiological studies. Conversely, the proportion of dogs with infectious diseases was lower than in previous reports from other locations.
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Affiliation(s)
| | | | - Mellora Sharman
- Animal Health Trust, Newmarket, Suffolk, UK
- The VetCT Teleconsulting Hospital, Cambridge, UK
| | | | - Ana Liza Ortiz
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - Rachel Miller
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
- VetOracle Telemedicine CVS Referrals, Diss, Norfolk, UK
| | | | - David Walker
- Anderson Moores Veterinary Specialists, Winchester, Hampshire, UK
| | - Bryn Jones
- Anderson Moores Veterinary Specialists, Winchester, Hampshire, UK
| | - Joshua Hardwick
- Langford Vets, University of Bristol, Langford, UK
- Cave Veterinary Specialists, West Buckland, Wellington, UK
| | - Barbara Glanemann
- Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Andrés Salas Garcia
- Pride Veterinary Centre, Derby, UK
- Davies Veterinary Specialists, Higham Gobion, Hitchin, UK
| | - Jessica Bacon
- Wear Referrals Veterinary Hospital, Stockton-on-Tees, UK
| | - Aida Gómez Selgas
- Animal Health Trust, Newmarket, Suffolk, UK
- The VetCT Teleconsulting Hospital, Cambridge, UK
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152
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Shi L, Wang Y, Han X, Wang Y, Xu J, Yang H. Comorbid asthma decreased the risk for COVID-19 mortality in the United Kingdom: Evidence based on a meta-analysis. Int Immunopharmacol 2023; 120:110365. [PMID: 37224652 DOI: 10.1016/j.intimp.2023.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
The study aimed to investigate the influence of comorbid asthma on the risk for mortality among patients with coronavirus disease 2019 (COVID-19) in the United Kingdom (UK) by utilizing a quantitative meta-analysis. The pooled odds ratio (OR) with 95% confidence interval (CI) was estimated by conducting a random-effects model. Sensitivity analysis, I2 statistic, meta-regression, subgroup analysis, Begg's analysis and Egger's analysis were all implemented. Our results presented that comorbid asthma was significantly related to a decreased risk for COVID-19 mortality in the UK based on 24 eligible studies with 1,209,675 COVID-19 patients (pooled OR = 0.81, 95% CI: 0.71-0.93; I2 = 89.2%, P < 0.01). Coming through further meta-regression to seek the possible cause of heterogeneity, none of elements might be responsible for heterogeneity. A sensitivity analysis proved the stability and reliability of the overall results. Both Begg's analysis (P = 1.000) and Egger's analysis (P = 0.271) manifested that publication bias did not exist. In conclusion, our data demonstrated that COVID-19 patients with comorbid asthma might bear a lower risk for mortality in the UK. Furthermore, routine intervention and treatment of asthma patients with severe acute respiratory syndrome coronavirus 2 infection should be continued in the UK.
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Affiliation(s)
- Liqin Shi
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, 450016, Henan Province, China
| | - Xueya Han
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Ying Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan Province, China.
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Lee KS, Gillespie CS, Chari A, Momin S, Turner C, Jenkinson MD, Brownstone R. Current landscape of academic neurosurgical training in the United Kingdom: analysis by the Society of British Neurological Surgeons. Br J Neurosurg 2023:1-7. [PMID: 37199545 DOI: 10.1080/02688697.2023.2213329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Little is known about the impact of academic training on Neurosurgery in the United Kingdom (UK). The aim was to understand the early career clinical and research training journeys of potential future clinical academics, with a view to informing future policy and strategy to improve career development for academic neurosurgical trainees and consultants in the UK. METHODS An online survey from the Society of British Neurological Surgeons (SBNS) academic committee was distributed to both the SBNS and British Neurosurgical Trainee Association (BNTA) mailing lists in early 2022. Neurosurgical trainees for any period between 2007 and 2022 or who had done any dedicated academic or clinical academic placement were encouraged to complete the survey. RESULTS Sixty responses were received. Six (10%) were females and fifty-four (90%) were males. At the time of response, nine (15.0%) were clinical trainees, four (6.7%) were Academic Clinical Fellows (ACF), six (10.0%) were Academic Clinical Lecturers (ACL), four (6.7%) were post-CCT fellows, eight (13.3%) were NHS consultants, eight (13.3%) were academic consultants, eighteen (30.0%) were out of the programme (OOP) pursuing a PhD potentially returning to training, whilst three (5.0%) had left neurosurgery training entirely and no longer performing clinical neurosurgery. The mentorship was sought in most programmes, which tended to be informal. Self-reported success on a scale of 0 to 10 with 10 being the most successful, was greatest in the MD and the "Other research degree/fellowship group" which does not include a PhD. There was a significant positive association between completing a PhD and having an academic consultant appointment (Pearson Chi-Square = 5.33, p = 0.021). CONCLUSIONS This study provides a snapshot to better understand the opinions of academic training in neurosurgery within the UK. Establishing clear, modifiable, and achievable goals, as well as providing tools for research success, may contribute to the success of this nationwide academic training.
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Affiliation(s)
- Keng Siang Lee
- Department of Neurosurgery, King's College Hospital, London, UK
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Conor S Gillespie
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sheikh Momin
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Carole Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Robert Brownstone
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, University College London, London, UK
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154
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Abed Al Ahad M, Demšar U, Sullivan F, Kulu H. The spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnic groups in the United Kingdom: a multilevel longitudinal analysis. BMC Public Health 2023; 23:897. [PMID: 37189130 DOI: 10.1186/s12889-023-15853-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Air pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the rest of the population. This study uses longitudinal data to investigate the spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnicity in the United-Kingdom (UK). METHODS Longitudinal individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals with 404,264 repeated responses over 11 years (2009-2019) were utilized and were linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution once at the local authority and once at the census Lower Super Output Area (LSOA) of residence for each individual. This allows for analysis at two geographical scales over time. The association between air pollution and individuals' health (Likert scale: 1-5, Excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on health. RESULTS Higher concentrations of NO2, SO2, PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across local authorities or LSOAs) and within (temporal: across years within each local authority or LSOA) effects showed a significant between effect for NO2 and SO2 pollutants at both geographical scales, while a significant between effect for PM10 and PM2.5 was shown only at the LSOAs level. No significant within effects were detected at an either geographical level. Indian, Pakistani/Bangladeshi, Black/African/Caribbean and other ethnic groups and non-UK-born individuals reported poorer health with increasing concentrations of NO2, SO2, PM10, and PM2.5 pollutants in comparison to the British-white and UK-born individuals. CONCLUSION Using longitudinal data on individuals' health linked with air pollution data at two geographical scales (local authorities and LSOAs), this study supports the presence of a spatial-temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK, partly explained by location-specific differences. Air pollution mitigation is necessary to improve individuals' health, especially for ethnic minorities who are affected the most.
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Affiliation(s)
- Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK.
| | - Urška Demšar
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Hill Kulu
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK
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155
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Holland A, McManus J, Wiseman A, Powell M, Eastwood N, Harris M. Public health ethics and punitive drug policy: Are new proposed sanctions for drug possession in the UK ethically justifiable? Int J Drug Policy 2023; 117:104057. [PMID: 37182350 DOI: 10.1016/j.drugpo.2023.104057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Adam Holland
- Faculty of Public Health Drugs Special Interest Group, 4 St Andrews Place, London, NW1 4LB, UK.
| | - Jim McManus
- Association of Directors of Public Health, Hamilton House, 1 Temple Avenue, London, EC4Y 0HA, UK
| | - Alice Wiseman
- Association of Directors of Public Health, Hamilton House, 1 Temple Avenue, London, EC4Y 0HA, UK
| | - Martin Powell
- Transform Drug Policy Foundation, The Station, Silver Street, Bristol, BS1 2AG, UK
| | | | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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156
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Klöckl C, Wehrle S, Schmidt J. Low cost, uncertain value: Why cheap PV may still not become UK's main power source. Patterns (N Y) 2023; 4:100754. [PMID: 37223270 PMCID: PMC10201291 DOI: 10.1016/j.patter.2023.100754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We contrast a recent assessment by Mandys et al. that dropping PV LCOE in the UK will lead to photovoltaics becoming the most competitive renewable energy technology by 2030, by arguing that (1) strong seasonal variation, (2) too little demand correlation, and (3) highly concentrated production periods still lead to overall more competitiveness and less system cost of wind power production.
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Affiliation(s)
- Claude Klöckl
- Institute of Sustainable Economic Development, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Sebastian Wehrle
- Institute of Sustainable Economic Development, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Johannes Schmidt
- Institute of Sustainable Economic Development, University of Natural Resources and Life Sciences, Vienna, Austria
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157
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Brown ME, Collin V, Parekh R, Kumar S. A contextual definition of longitudinal integrated clerkships within the UK and Ireland: A bi-national modified Delphi study. Educ Prim Care 2023:1-14. [PMID: 37161989 DOI: 10.1080/14739879.2023.2204463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team's experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants' qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation.
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Affiliation(s)
- Megan El Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Victoria Collin
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Sonia Kumar
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
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158
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Ogaz D, Allen H, Reid D, Brown JRG, Howarth AR, Pulford CV, Mercer CH, Saunders J, Hughes G, Mohammed H. COVID-19 infection and vaccination uptake in men and gender-diverse people who have sex with men in the UK: analyses of a large, online community cross-sectional survey (RiiSH-COVID) undertaken November-December 2021. BMC Public Health 2023; 23:829. [PMID: 37147609 PMCID: PMC10161154 DOI: 10.1186/s12889-023-15779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Men and gender-diverse people who have sex with men are disproportionately affected by health conditions associated with increased risk of severe illness due to COVID-19 infection. METHODS An online cross-sectional survey of men and gender-diverse people who have sex with men in the UK recruited via social networking and dating applications from 22 November-12 December 2021. Eligible participants included self-identifying men, transgender women, or gender-diverse individuals assigned male at birth (AMAB), aged ≥ 16, who were UK residents, and self-reported having had sex with an individual AMAB in the last year. We calculated self-reported COVID-19 test-positivity, proportion reporting long COVID, and COVID-19 vaccination uptake anytime from pandemic start to survey completion (November/December 2021). Logistic regression was used to assess sociodemographic, clinical, and behavioural characteristics associated with SARS-CoV-2 (COVID-19) test positivity and complete vaccination (≥ 2 vaccine doses). RESULTS Among 1,039 participants (88.1% white, median age 41 years [interquartile range: 31-51]), 18.6% (95% CI: 16.3%-21.1%) reported COVID-19 test positivity, 8.3% (95% CI: 6.7%-10.1%) long COVID, and 94.5% (95% CI: 93.3%-96.1%) complete COVID-19 vaccination through late 2021. In multivariable models, COVID-19 test positivity was associated with UK country of residence (aOR: 2.22 [95% CI: 1.26-3.92], England vs outside England) and employment (aOR: 1.55 [95% CI: 1.01-2.38], current employment vs not employed). Complete COVID-19 vaccination was associated with age (aOR: 1.04 [95% CI: 1.01-1.06], per increasing year), gender (aOR: 0.26 [95% CI: 0.09-0.72], gender minority vs cisgender), education (aOR: 2.11 [95% CI: 1.12-3.98], degree-level or higher vs below degree-level), employment (aOR: 2.07 [95% CI: 1.08-3.94], current employment vs not employed), relationship status (aOR: 0.50 [95% CI: 0.25-1.00], single vs in a relationship), COVID-19 infection history (aOR: 0.47 [95% CI: 0.25-0.88], test positivity or self-perceived infection vs no history), known HPV vaccination (aOR: 3.32 [95% CI: 1.43-7.75]), and low self-worth (aOR: 0.29 [95% CI: 0.15-0.54]). CONCLUSIONS In this community sample, COVID-19 vaccine uptake was high overall, though lower among younger age-groups, gender minorities, and those with poorer well-being. Efforts are needed to limit COVID-19 related exacerbation of health inequalities in groups who already experience a greater burden of poor health relative to other men who have sex with men.
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Affiliation(s)
- Dana Ogaz
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK.
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK.
| | - Hester Allen
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - David Reid
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
- Institute for Global Health, University College London, London, UK
- Sigma Research, Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Jack R G Brown
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
- Institute for Global Health, University College London, London, UK
| | - Alison R Howarth
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
- Institute for Global Health, University College London, London, UK
| | - Caisey V Pulford
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
| | - Catherine H Mercer
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
- Institute for Global Health, University College London, London, UK
| | - John Saunders
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
- Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
- The National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the, UK Health Security Agency, London, UK
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159
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Schley K, Kowalik JC, Sullivan SM, Vyse A, Czudek C, Tichy E, Findlow J. Assessing the Role of Infant and Toddler MenACWY Immunisation in the UK: Does the Adolescent MenACWY Programme Provide Sufficient Protection? Vaccines (Basel) 2023; 11:vaccines11050940. [PMID: 37243043 DOI: 10.3390/vaccines11050940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
A combined Haemophilus influenzae type b (Hib)/meningococcal serogroup C (MenC) vaccine will soon be unavailable in the UK immunisation schedule due to discontinuation by the manufacturer. An interim statement by the Joint Committee on Vaccination and Immunisation (JCVI) advises stopping MenC immunisation at 12 months of age when this occurs. We undertook an analysis of the public health impact of various potential meningococcal vaccination strategies in the UK in the absence of the Hib/MenC vaccine. A static population-cohort model was developed evaluating the burden of IMD (using 2005-2015 epidemiological data) and related health outcomes (e.g., cases, cases with long-term sequelae, deaths), which allows for the comparison of any two meningococcal immunisation strategies. We compared potential strategies that included different combinations of infant and/or toddler MenACWY immunisations with the anticipated future situation in which a 12-month MenC vaccine is not used, but the MenACWY vaccine is routinely given in adolescents. The most effective strategy is combining MenACWY immunisation at 2, 4, and 12 months of age with the incumbent adolescent MenACWY immunisation programme, resulting in the prevention of an additional 269 IMD cases and 13 fatalities over the modelling period; of these cases, 87 would be associated with long-term sequelae. Among the different vaccination strategies, it was observed that those with multiple doses and earlier doses provided the greatest protection. Our study provides evidence suggesting that the removal of the MenC toddler immunisation from the UK schedule would potentially increase the risk of unnecessary IMD cases and have a detrimental public health impact if not replaced by an alternate infant and/or toddler programme. This analysis supports that infant and toddler MenACWY immunisation can provide maximal protection while complementing both infant/toddler MenB and adolescent MenACWY immunisation programmes in the UK.
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Affiliation(s)
| | - Jack C Kowalik
- Pfizer Ltd., Walton Oaks, Dorking Rd., Tadworth KT20 7NS, UK
| | | | - Andrew Vyse
- Pfizer Ltd., Walton Oaks, Dorking Rd., Tadworth KT20 7NS, UK
| | - Carole Czudek
- Pfizer Ltd., Walton Oaks, Dorking Rd., Tadworth KT20 7NS, UK
| | - Eszter Tichy
- Evidera/PPD, Bocskai ut 134-144, Dorottya Udvar, Building E, Floor 2, H-1113 Budapest, Hungary
| | - Jamie Findlow
- Pfizer Ltd., Walton Oaks, Dorking Rd., Tadworth KT20 7NS, UK
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160
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Ojo AS, Nnyanzi LA, Giles EL, Ells L, Okeke SR, Ajayi KV, Bolarinwa OA. "I am not really into the government telling me what I need to eat": exploring dietary beliefs, knowledge, and practices among ethnically diverse communities in England. BMC Public Health 2023; 23:800. [PMID: 37131140 PMCID: PMC10152749 DOI: 10.1186/s12889-023-15689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/16/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Communities with diverse ethnicity in high-income countries are disproportionately affected by poor diet-related health outcomes. In England, the United Kingdom's government's healthy eating dietary resources are not well accepted and are underutilised among this population. Thus, this study explored perceptions, beliefs, knowledge, and practices around dietary intake among communities with African and South Asian ethnicity residing in Medway, England. METHODS This qualitative study generated data from 18 adults aged 18 and above using a semi-structured interview guide. These participants were sampled using purposive and convenience sampling strategies. All the interviews were conducted in English over the telephone, and responses were thematically analysed. RESULTS Six overarching themes were generated from the interview transcripts: eating patterns, social and cultural factors, food preferences and routines, accessibility and availability, health and healthy eating, and perceptions about the United Kingdom government's healthy eating resources. CONCLUSION The results of this study indicate that strategies to improve access to healthy foods are required to improve healthy dietary practices among the study population. Such strategies could help address this group's structural and individual barriers to healthy dietary practices. In addition, developing a culturally responsive eating guide could also enhance the acceptability and utilisation of such resources among communities with ethnic diversity in England.
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Affiliation(s)
- Abimbola S Ojo
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Lawrence A Nnyanzi
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Emma L Giles
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Louisa Ells
- School of Health, Leeds Beckett University, Leeds, UK
| | - Sylvester R Okeke
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, United States
| | - Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-being, Faculty of Health & Social Care, University of Chester, Castle Drive, Chester, CH1 1SL, UK.
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
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Rooney L, Rapley T, Whitehead PJ. Normative puzzles for local government: Managing the introduction of single-handed care in England. Sociol Health Illn 2023; 45:718-733. [PMID: 36708356 DOI: 10.1111/1467-9566.13618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/10/2023] [Indexed: 05/04/2023]
Abstract
A crisis in social care is apparent across the developed world as ageing populations put unprecedented demand on understaffed social care workforces. A recent popular response to this 'care crisis' within the UK involves the 'innovation' of single-handed care (SHC). SHC involves a care package with two or more homecare workers being reduced to one worker using advanced equipment and new moving and handling techniques. In this article, we explore how SHC is rendered in 245 documents from 52 local authorities in England. Using Actor Network Theory as an interpretative lens, we suggest documents attempt to satisfy three 'duties of care': to the individual wellbeing of citizens, morally and fiscally to the collective and to innovation. Each appeal to different stakeholder groups necessary for SHC to work, but the combination of duties can pose problems in enabling coherent stories of SHC. Duties can be kept apart in different documents, but at times they must be brought together in certain textual spaces to enact SHC as a coherent enterprise. Here, the potential tensions that emerge are routinely orientated to as (merely) problems of process that can and should be managed in and through a more refined approach to change management.
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Affiliation(s)
| | - Tim Rapley
- Northumbria University, Newcastle upon Tyne, UK
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162
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Wood GT, Onali E, Grosman A, Haider ZA. A very British state capitalism: Variegation, political connections and bailouts during the COVID-19 crisis. Environ Plan A 2023; 55:673-696. [PMID: 37192929 PMCID: PMC10172842 DOI: 10.1177/0308518x211072545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The COVID-19 pandemic has resulted in governments playing increasingly prominent roles as active economic agents. However, state capitalism does not necessarily serve broad developmental purposes, and rather can be directed to supporting sectional and private interests. As the literature on variegated capitalism alerts us, governments and other actors regularly devise fixes in response to a systemic crisis, but the focus, scale, and scope of the interventions vary considerably, according to the constellation of interests. Rapid progress with vaccines notwithstanding, the UK government's response to COVID-19 has been associated with much controversy, not only because of an extraordinarily high death rate, but also because of allegations of cronyism around the granting of government contracts and bailouts. We focus on the latter, investigating more closely who got bailed out. We find that badly affected sectors (e.g. hospitality, transportation) and larger employers were more likely to get bailouts. However, the latter also favored the politically influential and those who had run up debt profligately. Although, as with state capitalism, crony capitalism is most often associated with emerging markets, we conclude that the two have coalesced into a peculiarly British variety, but one that has some common features with other major liberal markets. This might suggest that the eco-systemic dominance of the latter is coming to an end, or, at the least, that this model is drifting towards one that assumes many of the features commonly associated with developing nations.
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163
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Yiu HHE, Buckell J, Petrou S, Stewart-Brown S, Madan J. Derivation of a UK preference-based value set for the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) to allow estimation of Mental Well-being Adjusted Life Years (MWALYs). Soc Sci Med 2023; 327:115928. [PMID: 37201343 DOI: 10.1016/j.socscimed.2023.115928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The Mental Well-being Adjusted Life Year (MWALY) is an alternative outcome measure to the quality-adjusted life year (QALY) in economic evaluations of interventions aimed at improving mental well-being. However, there is a lack of preference-based mental well-being instruments for capturing population mental well-being preferences. OBJECTIVES To derive a UK preference-based value set for the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). METHODS 225 participants that were interviewed between December 2020 and August 2021 completed 10 composite time trade-off (C-TTO) and 10 discrete choice experiment (DCE) interviewer-administered exercises. Heteroskedastic Tobit and conditional logit models were used to model C-TTO and DCE responses respectively. The DCE utility values were rescaled to a C-TTO comparable scale through anchoring and mapping. An inverse variance weighting hybrid model (IVWHM) was used to derive weighted-average coefficients from the modelled C-TTO and DCE coefficients. Model performance was assessed using statistical diagnostics. RESULTS The valuation responses confirmed the feasibility and face validity of the C-TTO and DCE techniques. Apart from the main effects models, statistically significant associations were estimated between the predicted C-TTO value and participants' SWEMWBS scores, gender, ethnicities, education levels, and the interaction terms between age and useful feeling. The IVWHM was the most optimal model with the fewest logically inconsistent coefficients and the lowest pooled standard errors. The utility values generated by the rescaled DCE models and the IVWHM were generally higher than those of the C-TTO model. The predictive ability of the two DCE rescaling methods was similar according to the mean absolute deviation and root mean square deviation statistics. CONCLUSIONS This study has produced the first preference-based value set for a measure of mental well-being. The IVWHM provided a desirable blend of both C-TTO and DCE models. The value set derived by this hybrid approach can be used for cost-utility analyses of mental well-being interventions.
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Affiliation(s)
- Hei Hang Edmund Yiu
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - John Buckell
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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164
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King R, Laker S, Alden S, Ryan T, Wood E, Tod A, Senek M, Taylor B, Robertson S. Training and development experiences of nursing associate trainees based in primary care across England: a qualitative study. Prim Health Care Res Dev 2023; 24:e32. [PMID: 37114453 PMCID: PMC10156463 DOI: 10.1017/s1463423623000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care. AIM To explore the experiences and career development opportunities for trainee nursing associates based in primary care. METHODS This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically. FINDINGS Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a 'valuable opportunity for career progression'. Trainees were frustrated by the 'emphasis on secondary care' in both academic content and placement portfolio requirements. They also experienced 'inconsistency in support' from their managers and assessors and noted a number of 'constraints to their learning opportunities', including the opportunity to progress to become registered nurses. CONCLUSION This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.
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Affiliation(s)
- Rachel King
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
| | - Sara Laker
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
- Department of Nursing, Winona State University, Stark Hall, Room 303, Winona, MN55987, USA
| | - Sarah Alden
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
| | - Tony Ryan
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
| | - Emily Wood
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
| | - Angela Tod
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
| | - Michaela Senek
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
| | - Bethany Taylor
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
| | - Steven Robertson
- RCN Strategic Research Alliance, Division of Nursing & Midwifery, Health Sciences School, Barber House Annexe, 3a Clarkehouse Road, SheffieldS10 2LA, UK
- Leeds Beckett University, Leeds, UK
- Waterford Institute of Technology, Waterford, Ireland
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165
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Phillips J. Determining sustainability using the Environmental Performance Index and Human Development Index - An alternative approach to the Environmental Human Index through a holistic quantitative dynamic framework. Sci Total Environ 2023; 884:163752. [PMID: 37120018 DOI: 10.1016/j.scitotenv.2023.163752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/22/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
The Environmental Human Index (EHI) was recently proposed and demonstrated as a new sustainability assessment tool which uses data from the Environmental Performance Index (EPI) and the Human Development Index (HDI). However, the EHI has potential conceptual and operational issues in respect to its consistency with established concepts and principles of the coupled environment-human system and sustainability. Specifically, the thresholds of sustainability the EHI uses, the bias towards the anthroposphere, and the absence of unsustainability. These issues raise potential questions concerning the EHI's value and approach adopted to utilise the EPI and HDI data to determine potential or actual sustainability outcomes. Therefore, to demonstrate how the EPI and HDI can be used to determine sustainability outcomes, the Sustainability Dynamics Framework (SDF) is applied in respect to the case study of the United Kingdom 1995-2020. The results indicated strong sustainability occurring throughout the specified period, within a S-value range of [+0.503 ≤ S(t) ≤ +0.682]. The Pearson correlation analysis showed a significant negative relationship between E and HNI-values and between HNI and S-values, and a significant positive relationship between E and S-values. The Fourier analysis indicated a three-phase change in the nature of the environment-human system dynamics over the 1995-2020 period. The SDF application to the EPI and HDI data has shown the importance of using a consistent holistic conceptual and operational framework to determine and evaluate sustainability outcomes.
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Affiliation(s)
- Jason Phillips
- College of Life and Environmental Sciences, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4RJ, United Kingdom.
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166
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Bolarinwa OA, Holt N. Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review. BMC Health Serv Res 2023; 23:390. [PMID: 37087506 PMCID: PMC10122823 DOI: 10.1186/s12913-023-09410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020. Specifically, breast and cervical cancer incidence and mortality prevalence among women of the minority group or marginalised populations in Europe have continued to be a public health concern due to the low uptake of cancer screening. Thus, this study utilised a mixed-method systematic review to identify barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom. METHODS Databases including PubMed, CINAHL, British Nursing Index, Web of Science, EMBASE, and Scopus databases, were systematically searched for studies on barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom published in English between January 2010 to July 2022. This mixed-method systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in reporting the included studies' results. The cluster mapping approach was used to identify and classify the barriers into themes. RESULTS Thirteen eligible studies were included in this current review. Seven of the thirteen studies used quantitative cross-sectional research design, while six used qualitative cross-sectional research design. These studies were conducted across the United Kingdom. Five themes were developed from the cluster mapping, and thirty-four sub-theme barriers to the uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom were identified. The developed themes in relation to the barriers include; socio-demographic characteristics, health service delivery, cultural, religious & language, the gap in knowledge & awareness, and emotional, sexual & family support. CONCLUSION The study concluded that barriers in socio-demographic characteristics, health service delivery, cultural, religious and language, the gap in knowledge & awareness, and emotional, sexual & family support were identified as non-uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom. Reducing or eliminating these barriers would improve the benefits of timely breast and cervical cancer screening in the United Kingdom.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-Being, Faculty of Health & Social Care, University of Chester, Chester, UK.
- Institute for Advanced Studies in the Humanities, University of Edinburgh, Edinburgh, UK.
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK.
| | - Nicole Holt
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
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167
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Aujla N, Frost H, Guthrie B, Hanratty B, Kaner E, O'Donnell A, Ogden ME, Pain HG, Shenkin SD, Mercer SW. A comparative overview of health and social care policy for older people in England and Scotland, United Kingdom (UK). Health Policy 2023; 132:104814. [PMID: 37075590 DOI: 10.1016/j.healthpol.2023.104814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Responsibility for health and social care was devolved to Scotland in 1999 with evidence of diverging policy and organisation of care compared to England. This paper provides a comparative overview of major health and social care policies in England and Scotland published between 2011 and 2023 relating to the care of older people. METHODS We searched United Kingdom (UK) and Scotland government websites for macro-level policy documents between 2011 and 2023 relating to the health and social care of older people (aged 65+). Data were extracted and emergent themes were summarised according to Donabedian's structure-process-outcome model. RESULTS We reviewed 27 policies in England and 28 in Scotland. Four main policy themes emerged that were common to both countries. Two related to the structure of care: integration of care and adult social care reform. Two related to service delivery/processes of care: prevention and supported self-management and improving mental health care. Cross-cutting themes included person-centred care, addressing health inequalities, promoting use of technology, and improving outcomes. CONCLUSION Despite differences in the structure of care, including more competition, financial incentivization, and consumer-based care in England compared to Scotland, there are similarities in policy vision around delivery/processes of care (e.g. person-centred care) and performance and patient outcomes. Lack of UK-wide health and social care datasets hinders evaluation of policies and comparison of outcomes between both countries.
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Affiliation(s)
- Navneet Aujla
- Population Health Sciences Institute, Newcastle University, United Kingdom; NIHR Applied Research Collaboration North-East and North-Cumbria, Newcastle University, United Kingdom
| | - Helen Frost
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, United Kingdom; NIHR Applied Research Collaboration North-East and North-Cumbria, Newcastle University, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, United Kingdom; NIHR Applied Research Collaboration North-East and North-Cumbria, Newcastle University, United Kingdom
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | | | - Susan D Shenkin
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
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168
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Smalley H, Edwards K. Understanding the burden of chronic back pain: a spatial microsimulation of chronic back pain at small area level across England. Eur Spine J 2023:10.1007/s00586-023-07584-w. [PMID: 37005929 DOI: 10.1007/s00586-023-07584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/29/2023] [Accepted: 02/04/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Chronic back pain (CBP) carries a significant burden. Understanding how and why CBP prevalence varies spatially, as well as the potential impact of policies to decrease CBP would prove valuable for public health planning. This study aims to simulate and map the prevalence of CBP at ward-level across England, identify associations which may explain spatial variation, and explore 'what-if' scenarios for the impact of policies to increase physical activity (PA) on CBP. METHODS A two-stage static spatial microsimulation approach was used to simulate CBP prevalence in England, combining national-level CBP and PA data from the Health Survey for England with spatially disaggregated demographic data from the 2011 Census. The output was validated, mapped, and spatially analysed using geographically weighted regression. 'What-if' analysis assumed changes to individuals' moderate-to-vigorous physical activity (MVPA) levels. RESULTS Large significant clusters of high CBP prevalence were found predominantly in coastal areas and low prevalence in cities. Univariate analysis found a strong positive correlation between physical inactivity and CBP prevalence at ward-level (R2 = 0.735; Coefficient = 0.857). The local model showed the relationship to be stronger in/around cities (R2 = 0.815; Coefficient: Mean = 0.833, SD = 0.234, Range = 0.073-2.623). Multivariate modelling showed this relationship was largely explained by confounders (R2 = 0.924; Coefficient: Mean = 0.070, SD = 0.001, Range = 0.069-0.072). 'What-if' analysis showed a detectable reduction in CBP prevalence for increases in MVPA of 30 and 60 min (- 2.71%; 1, 164, 056 cases). CONCLUSION CBP prevalence varies at ward-level across England. At ward-level, physical inactivity is strongly positively correlated with CBP. This relationship is largely explained by geographic variation in confounders (the proportion of residents that are: over 60, in low-skilled jobs, female, pregnant, obese, smokers, white or black, disabled). Policies to increase PA by 30 min weekly MVPA will likely result in a significant reduction in CBP prevalence. To maximise their impact, policies could be tailored to areas of high prevalence, which are identified by this study.
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Affiliation(s)
- Harrison Smalley
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Kimberley Edwards
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
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169
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Heather A, Goodwin E, Green C, Morrish N, Ukoumunne OC, Middleton RM, Hawton A. Multiple sclerosis health-related quality of life utility values from the UK MS register. Mult Scler J Exp Transl Clin 2023; 9:20552173231178441. [PMID: 37324245 PMCID: PMC10265354 DOI: 10.1177/20552173231178441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Background New interventions for multiple sclerosis (MS) commonly require a demonstration of cost-effectiveness using health-related quality of life (HRQoL) utility values. The EQ-5D is the utility measure approved for use in the UK NHS funding decision-making. There are also MS-specific utility measures - e.g., MS Impact Scale Eight Dimensions (MSIS-8D) and MSIS-8D-Patient (MSIS-8D-P). Objectives Provide EQ-5D, MSIS-8D and MSIS-8D-P utility values from a large UK MS cohort and investigate their association with demographic/clinical characteristics. Methods UK MS Register data from 14,385 respondents (2011 to 2019) were analysed descriptively and using multivariable linear regression, with self-report Expanded Disability Status Scale (EDSS) scores. Results The EQ-5D and MSIS-8D were both sensitive to differences in demographic/clinical characteristics. An inconsistency found in previous studies whereby mean EQ-5D values were higher for an EDSS score of 4 rather than 3 was not observed. Similar utility values were observed between MS types at each EDSS score. Regression showed EDSS score and age were associated with utility values from all three measures. Conclusions This study provides generic and MS-specific utility values for a large UK MS sample, with the potential for use in cost-effectiveness analyses of treatments for MS.
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Affiliation(s)
- A Heather
- PenCHORD (The Peninsula Collaboration for Health Operational Research and Data Science), Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - E Goodwin
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
| | - C Green
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
- Department for Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
- Biogen UK & Ireland, Berkshire, UK
| | - N Morrish
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
| | - OC Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | - A Hawton
- Health Economics Group, Department of Health and Community Sciences, University of Exeter,
Exeter, UK
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, University of Exeter, Exeter, UK
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170
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Abstract
RATIONALE AND OBJECTIVE Perceptions of frailty can influence how families cope, quality of life and access to support services. Yet little is known of how lay members of the UK general public perceive frailty. This scoping review aimed to explore how frailty is perceived among the lay public in the United Kingdom. METHODS The established scoping review methodology by Arksey and O'Malley was followed and searches were conducted across eight electronic databases and grey literature websites for articles published between 1990 and August 2022. In total, 6,705 articles were identified, of which six were included in the review. Data were analysed using Braun and Clarke's thematic analysis framework. RESULTS Three key themes were identified; frailty as a normal part of ageing, perceived consequences of frailty and coping with frailty. Overall, frailty has negative connotations and is perceived as linked to a natural part of the ageing process, increased dependency, loss of identity and social exclusion and stigma. However, it is unclear whether these perceptions have a direct bearing on access to support services for communities. CONCLUSION AND IMPLICATIONS This review identifies that it is imperative for health and social care service providers to consider the individual meaning of frailty for older people and families, to understand and integrate their particular needs and preferences when planning and delivering person centred frailty care and support. There is also a need for development of interventions that focus on increasing education and reducing stigma around frailty in order to change frailty perceptions in the UK.
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Affiliation(s)
| | - Melanie Haith-Cooper
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
| | - Rebecca Hawkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LH, UK
| | - Sahdia Parveen
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
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171
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Cash-Gibson L, Martinez-Herrera E, Benach J. Why and how has the United Kingdom become a high producer of health inequalities research over the past 50 years? A realist explanatory case study. Health Res Policy Syst 2023; 21:23. [PMID: 36959666 PMCID: PMC10037802 DOI: 10.1186/s12961-023-00968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Evidence on health inequalities has been growing over the past few decades, yet the capacity to produce research on health inequalities varies between countries worldwide and needs to be strengthened. More in-depth understanding of the sociohistorical, political and institutional processes that enable this type of research and related research capacity to be generated in different contexts is needed. A recent bibliometric analysis of the health inequalities research field found inequalities in the global production of this type of research. It also found the United Kingdom to be the second-highest global contributor to this research field after the United States. This study aims to understand why and how the United Kingdom, as an example of a "high producer" of health inequalities research, has been able to generate so much health inequalities research over the past five decades, and which main mechanisms might have been involved in generating this specific research capacity over time. METHODS We conducted a realist explanatory case study, which included 12 semi-structured interviews, to test six theoretical mechanisms that we proposed might have been involved in this process. Data from the interviews and grey and scientific literature were triangulated to inform our findings. RESULTS We found evidence to suggest that at least four of our proposed mechanisms have been activated by certain conditions and have contributed to the health inequalities research production process in the United Kingdom over the past 50 years. Limited evidence suggests that two new mechanisms might have potentially also been at play. CONCLUSIONS Valuable learning can be established from this case study, which explores the United Kingdom's experience in developing a strong national health inequalities research tradition, and the potential mechanisms involved in this process. More research is needed to explore additional facilitating and inhibiting mechanisms and other factors involved in this process in this context, as well as in other settings where less health inequalities research has been produced. This type of in-depth knowledge could be used to guide the development of new health inequalities research capacity-strengthening strategies and support the development of novel approaches and solutions aiming to tackle health inequalities.
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Affiliation(s)
- Lucinda Cash-Gibson
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain.
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain.
- UPF Barcelona School of Management (UPF-BSM), Barcelona, Spain.
| | - Eliana Martinez-Herrera
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain
- Research Group of Epidemiology, National School of Public Health "Héctor Abad Gómez", University of Antioquia, Calle 62 No. 52-59 Bloque 33 Segundo Piso, Medellín, Colombia
| | - Joan Benach
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma, Madrid, Spain
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172
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Drewniok M, Gao Y, Cullen JM, Cabrera Serrenho A. What to Do about Plastics? Lessons from a Study of United Kingdom Plastics Flows. Environ Sci Technol 2023; 57:4513-4521. [PMID: 36877788 PMCID: PMC10035030 DOI: 10.1021/acs.est.3c00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Plastics are one of the most widely used materials on the planet, owing to their usefulness, durability, and relatively low cost. Yet, making, using, and disposing of plastics create important environmental impacts, most notably greenhouse gas emissions and waste pollution. Reducing these impacts while still enjoying the benefits of plastic use requires an integrated assessment of all of the life cycles of plastics. This has rarely been attempted due to the wide variety of polymers and the lack of knowledge on the final uses and applications of plastics. Using trade statistics for 464 product codes, we have mapped the flows of the 11 most widely used polymers from production into six end-use applications for the United Kingdom (UK) in 2017. With a dynamic material flow analysis, we have anticipated demand and waste generation until 2050. We found that the demand for plastics seems to have saturated in the UK, with an annual demand of 6 Mt, responsible for approximately 26 Mt CO2e/a. Owing to a limited recycling capacity in the UK, only 12% of UK plastic waste is recycled domestically, leading to 21% of the waste being exported, labeled as recycling, but mostly to countries with poor practices of waste management. Increasing recycling capacity in the UK could both reduce GHG emissions and prevent waste pollution. This intervention should be complemented with improved practices in the production of primary plastics, which currently accounts for 80% of UK plastic emissions.
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Affiliation(s)
- Michał
P. Drewniok
- School
of Civil Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Woodhouse Ln., Woodhouse, LS2 9DY Leeds, United Kingdom
- Department
of Engineering, University of Cambridge, CB2 1PZ Cambridge, United Kingdom
| | - Yunhu Gao
- Department
of Engineering, University of Cambridge, CB2 1PZ Cambridge, United Kingdom
| | - Jonathan M. Cullen
- Department
of Engineering, University of Cambridge, CB2 1PZ Cambridge, United Kingdom
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173
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Jones JD, Trippett C, Suleman M, Clokie MRJ, Clark JR. The Future of Clinical Phage Therapy in the United Kingdom. Viruses 2023; 15:721. [PMID: 36992430 PMCID: PMC10053292 DOI: 10.3390/v15030721] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Bacteriophage (phage) therapy is a promising alternative antimicrobial strategy with the potential to transform the way bacterial infections are treated. In the United Kingdom, phages are classed as a biological medicine. Although no phages are licensed for UK use, they may be used as unlicensed medicinal products where licensed alternatives cannot meet a patient's clinical needs. In the last 2 years, 12 patients in the UK have received phage therapy, and there is burgeoning clinical interest. Currently, clinical phage provision in the UK is ad hoc and relies upon networking with international sources of phages. The provision of phage therapy in the UK will not progress beyond an increasing number of ad hoc cases until an onshore sustainable and scalable source of well-characterised phages manufactured in accordance with Good Manufacturing Practice (GMP) is established. Here, we present an exciting new collaboration between UK Phage Therapy, the Centre for Phage Research at University of Leicester, CPI, and Fixed Phage. These partners, and others as we develop, will establish sustainable, scalable, and equitable phage therapy provision in the UK. We set out a vision for how phage therapy will be integrated into the NHS and healthcare more broadly, including the complementarity between licensed (cocktail) and unlicensed (personalised) phage preparations. Key elements of phage therapy infrastructure in the UK will be GMP phage manufacturing, a national phage library, and a national clinical phage centre. Together, this infrastructure will support NHS microbiology departments to develop and oversee phage therapy provision across the UK. As it will take time to deliver this, we also describe considerations for clinicians seeking to use unlicensed phage therapy in the interim. In summary, this review sets out a roadmap for the delivery of clinical phage therapy to the UK, the benefits of which we hope will reverberate for patients for decades to come.
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Affiliation(s)
| | - Clare Trippett
- CPI, 1 Union Square, Central Park, Darlington DL1 1GL, UK
| | - Mehrunisha Suleman
- The Ethox Centre, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford OX3 7LF, UK
| | - Martha R. J. Clokie
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Jason R. Clark
- Fixed Phage, West of Scotland Science Park, Block 2, Kelvin Campus, 2317 Maryhill Road, Glasgow G20 0SP, UK
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174
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Jones JD, Stacey HJ, Brailey A, Suleman M, Langley RJ. Managing Patient and Clinician Expectations of Phage Therapy in the United Kingdom. Antibiotics (Basel) 2023; 12:502. [PMID: 36978369 PMCID: PMC10044641 DOI: 10.3390/antibiotics12030502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Bacteriophage (phage) therapy is a promising alternative antimicrobial approach which has the potential to transform the way we treat bacterial infections. Phage therapy is currently being used on a compassionate basis in multiple countries. Therefore, if a patient has an antibiotic refractory infection, they may expect their clinician to consider and access phage therapy with the hope of improvement. The expectations of clinicians may be similar and may also include expectations around data collection. However, there are multiple biological and practical barriers to fulfilling patient and clinician expectations. While it is possible to access phage therapy, the path to acquisition is not straightforward and expectations therefore need to be managed appropriately to avoid raising false hope and undermining confidence in phage therapy. Phage scientists have an important contribution to make in educating clinicians and the broader public about phage therapy. However, it is clinicians that are responsible for managing the expectations of their patients and this relies on clear communication about the barriers and limitations.
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Affiliation(s)
- Joshua D. Jones
- Clinical Microbiology, Ninewells Hospital, NHS Tayside, Dundee DD2 1SG, UK
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Helen J. Stacey
- Public Health, Kings Cross Hospital, Clepington Road, Dundee DD3 8EA, UK
| | - Arlene Brailey
- Antibiotic Research UK, Genesis 5, York Science Park, Church Lane, Heslington, York YO10 5DQ, UK
| | - Mehrunisha Suleman
- The Ethox Centre, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford OX3 7LF, UK
| | - Ross J. Langley
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, UK
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow G12 8QQ, UK
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175
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Yuill C, Keraudren S, Murphy R, Uddin N, Rocca-Ihenacho L. Developing the midwifery Unit Self-Assessment (MUSA) Framework: A mixed methods study in six European midwifery units. Sex Reprod Healthc 2023; 35:100819. [PMID: 36822025 DOI: 10.1016/j.srhc.2023.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Evidence indicates that midwifery units are associated with improved health outcomes and experiences; however, there are barriers to their development and scale-up. Guidelines are crucial to their implementation, ensuring that they are developed and integrated sustainably and safely. This study aimed to evaluate and explore the use of a self-assessment tool and improvement process for midwifery units in Europe. METHODS A mixed methods study was conducted with six midwifery units located in Europe. Quantitative and qualitative data were collected and analysed concurrently, and each informed the other, making the approach both interactive and iterative. The six midwifery units were invited to complete the self-assessment tool, the responses of which were analysed descriptively, and implement an improvement process into practice. Interviews were conducted with midwives using the tool and analysed thematically. RESULTS Findings indicate benefits and potential feasibility of an improvement process for midwifery units, and suggest that the self-assessment tool is a generative and reflexive practice for midwives. However, issues were identified around limitations of the tool, structural barriers and professional autonomy. Midwifery units require a framework to guide and support their implementation, improvement and scale-up. CONCLUSION Results highlight the need for more consideration of how macro-level barriers, encompassing social, legal and political dimensions of maternity care, factor locally in the implementation and scale-up of midwifery units. More research is needed to evaluate the feasibility and outcomes of implementing a self-assessment and improvement framework in midwifery units across Europe.
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176
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Sandhu H, Xu W, Olivieri AV, Lübker C, Smith I, Antavalis V. Once-Weekly Subcutaneous Semaglutide 2.4 mg Injection is Cost-Effective for Weight Management in the United Kingdom. Adv Ther 2023; 40:1282-1291. [PMID: 36630047 PMCID: PMC9988790 DOI: 10.1007/s12325-022-02423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The objective of the current preliminary study was to present the cost-effectiveness analyses submitted to the National Institute for Health and Care Excellence (NICE) (TA10765) that deemed semaglutide 2.4 mg subcutaneous (s.c.) injection a cost-effective option for weight management in the United Kingdom (UK) alongside diet and exercise (D&E). METHODS The study was conducted from the National Health Service (NHS) and Personal Social Services perspective and based on the NICE reference case. The clinical safety and efficacy of semaglutide 2.4 mg s.c. injection were obtained from the Semaglutide Treatment Effect in People with Obesity (STEP) 1 trial. The previously published and validated Core Obesity Model was used to project lifetime occurrence of obesity complications, their costs and quality of life consequences over 40 years. The base case cohort had a mean starting age of 48 years and BMI of 38.7 kg/m2. The confidential NHS price for semaglutide 2.4 mg s.c. injection was provided by Novo Nordisk. The incremental cost-effectiveness ratios (ICERs) were expressed as cost/quality-adjusted life-year (QALY). Uncertainty was assessed through sensitivity analyses, including a scenario analysis using clinical data from the STEP 2 trial and a previously published and validated Core Diabetes Model to investigate a cohort with type 2 diabetes at baseline. RESULTS Semaglutide 2.4 mg s.c. injection showed higher total costs and health benefits compared with D&E, with an ICER of £14,827/QALY gained. The probabilistic sensitivity analysis showed that semaglutide 2.4 mg s.c. injection was cost-effective in 90% of cases at a willingness-to-pay threshold of £20,000/QALY. The ICER from the scenario analysis for the diabetic population was £16,613/QALY gained, using the Core Diabetes Model. CONCLUSION Semaglutide 2.4 mg s.c. injection is a cost-effective therapy compared to D&E alone for patients with obesity and weight-related comorbidities in the UK. Sensitivity and scenario analyses confirm the robustness of the analyses.
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Affiliation(s)
| | | | | | | | - Inger Smith
- White Box Health Economics Ltd, Worthing, UK
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177
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Nelson D, Inghels M, Kenny A, Skinner S, McCranor T, Wyatt S, Phull J, Nanyonjo A, Yusuff O, Gussy M. Mental health professionals and telehealth in a rural setting: a cross sectional survey. BMC Health Serv Res 2023; 23:200. [PMID: 36849933 PMCID: PMC9970689 DOI: 10.1186/s12913-023-09083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/18/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Telehealth usage has been promoted in all settings but has been identified as a panacea to issues of access and equity in the rural context. However, uptake and widespread integration of telehealth across all parts of the health system has been slow, with a myriad of barriers documented, including in rural settings. The crisis of the COVID-19 pandemic, saw barriers rapidly overturned with the unprecedented and exponential rise in telehealth usage. The uniqueness of the crisis forced telehealth adoption, but as the urgency stabilises, pandemic learnings must be captured, utilised, and built upon in a post-pandemic world. The aim of this study was to document staff experiences and perceptions of delivering rural psychological therapies via telehealth during the pandemic and to capture learnings for future rural telehealth delivery. METHODS An online cross-sectional survey that explored mental health professional's experiences, use, and perceptions of telehealth before and after pandemic-enforced changes to service delivery. RESULTS Sixty-two respondents completed the questionnaire (response rate 68%). Both the delivery of telehealth via telephone and online video conferencing significantly increased during the pandemic (66% vs 98%, p < .001 for telephone and 10% vs 89%, p < 0.001 for online video). Respondents indicated that client's access to services and attendance had improved with telehealth use but their attention and focus during sessions and non-verbal communication had been negatively affected. The challenges for older adults, people with learning and sensory disabilities, and residents in remote areas with poorer mobile/internet connectivity were identified. Despite these challenges, none of the respondents indicated a preference to return to fully face-to-face service delivery with most (86%) preferring to deliver psychological therapies fully or mostly via telehealth. CONCLUSIONS This study addresses three major gaps in knowledge: the experience of delivering local telehealth solutions to address rural mental health needs, the provision of strong rural-specific telehealth recommendations, and the dearth of rural research emanating from the United Kingdom. As the world settles into a living with COVID-19 era, the uniqueness of the rural telehealth context may be forgotten as urban myopia continues to dominate telehealth policy and uptake. It is critical that rural resourcing and digital connectivity are addressed.
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Affiliation(s)
- David Nelson
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK
| | - Maxime Inghels
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK ,grid.4399.70000000122879528Centre Population et Développement (UMR 196 Paris Descartes – IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France
| | - Amanda Kenny
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK ,grid.1018.80000 0001 2342 0938La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Steve Skinner
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Tracy McCranor
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Stephen Wyatt
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Jaspreet Phull
- grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Agnes Nanyonjo
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK
| | - Ojali Yusuff
- grid.36511.300000 0004 0420 4262Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK ,grid.500529.b0000 0004 0489 4451Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK ,grid.464673.40000 0004 0469 8549Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK
| | - Mark Gussy
- Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK. .,La Trobe Rural Health School, La Trobe University, Bendigo, Australia.
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178
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Osunronbi T, Adeboye W, Faluyi D, Sofela J, Shoker S, O'Riordan M, Mitoko CA, Mberu VK, Mandangu C, Madume R, Kolawole AI, Jones RI, Inyang D, Ibrahim U, Ibeanusi IM, Fofanah IJ, Corriero AC, Chimba C, Akhionbare I, Ahmad Z, Adamu-Biu F, Abraha S, Abankwa E, Sofela A. Predictors of self-reported research self-efficacy and perception of research amongst medical students in the United Kingdom: a national cross-sectional survey. Postgrad Med J 2023; 99:69-76. [PMID: 36841225 DOI: 10.1093/postmj/qgad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/24/2022] [Accepted: 01/06/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE There has been a decline in the number of academic clinicians in the UK, and there are ethnic/gender disparities in the academic workforce. Higher research self-efficacy (RSE) and a positive perception of research (PoR) amongst students are associated with a higher motivation to engage in academic medicine. Hence, this study aimed to determine the factors that influence RSE and PoR amongst UK medical students. METHODS This is a multicentre cross-sectional survey of medical students in 36 UK medical schools in the 2020/21 academic year. Multiple linear regression was used to investigate the association between students' demographics and RSE/PoR. P-values less than a Bonferroni-corrected significance level of .05/28 = .0018 were considered statistically significant. RESULTS In total, 1573 individuals participated from 36 medical schools. There were no ethnic differences in PoR or RSE scores. Although there were no gender differences in PoR, female students had lower RSE scores than male students (adjusted β = -1.75; 95% CI: -2.62, -0.89). Research experience before medical school (adjusted β = 3.02; 95% CI: 2.11, 3.93), being in the clinical training phase (adjusted β = 1.99; 95% CI: 1.09, 2.90), and completing a degree before medical school (adjusted β = 3.66; 95% CI: 2.23, 5.09) were associated with higher RSE. CONCLUSION There were no associations between the predictor variables and PoR. Female students had lower self-reported RSE scores. Future studies should investigate the role of targeted research mentorship in improving RSE amongst female medical students.
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Affiliation(s)
- Temidayo Osunronbi
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom.,Department of Health Sciences, University of York, York YO10 5DD, United Kingdom
| | - William Adeboye
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - David Faluyi
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Jasmine Sofela
- Faculty of Health, University of Plymouth, Plymouth PL6 8BT, United Kingdom
| | - Serena Shoker
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | | | | | - Chenai Mandangu
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Rachael Madume
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | - Robert I Jones
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Deborah Inyang
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | | | - Isata J Fofanah
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Anna C Corriero
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Chimba Chimba
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | - Zain Ahmad
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | | | - Semhar Abraha
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Efua Abankwa
- Melanin Medics Research Network, Luton LU4 8DY, United Kingdom
| | - Agbolahan Sofela
- Faculty of Health, University of Plymouth, Plymouth PL6 8BT, United Kingdom
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179
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Bolckmans R, Askari A, Currie A, Ahmed AR, Batterham RL, Byrne J, Hopkins J, Khan OA, Mahawar K, Miras AD, Pring CM, Small PK, Welbourn R. Clinical characteristics of patients undergoing primary bariatric surgery in the United Kingdom based on the National Bariatric Surgery Registry. Clin Obes 2023; 13:e12585. [PMID: 36807508 DOI: 10.1111/cob.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/23/2023]
Abstract
Baseline demographic characteristics and operations undertaken for patients having bariatric surgery in the United Kingdom are largely unknown. This study aimed to describe the profile of patients having primary bariatric surgery in the National Health Service (NHS) or by self-pay, and associated operations performed for both pathways. The National Bariatric Surgery Registry dataset for 5 years between January 2015 and December 2019 was used. 34 580 patients underwent primary bariatric surgery, of which 75.9% were NHS patients. Mean patient age and initial body mass index were significantly higher for NHS compared to self-pay patients (mean age 45.8 ± 11.3 [SD] vs. 43.0 ± 12.0 years and initial body mass index 48.0 ± 7.9 vs. 42.9 ± 7.3 kg/m2 , p < .001). NHS patients were more likely to have obesity-related complications compared to self-pay patients: prevalence of Type 2 diabetes mellitus 27.7% versus 8.3%, hypertension 37.1% versus 20.1%, obstructive sleep apnoea 27.4% versus 8.9%, severely impaired functional status 19.3% versus 13.9%, musculoskeletal pain 32.5% versus 20.1% and being on medication for depression 31.0% versus 25.9%, respectively (all p < .001). Gastric bypass was the most commonly performed primary NHS bariatric operation 57.2%, but sleeve gastrectomy predominated in self-pay patients 48.7% (both p < .001). In contrast to self-pay patients, NHS patients are receiving bariatric surgery only once they are older and at a much more advanced stage of obesity-related disease complications.
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Affiliation(s)
- Roel Bolckmans
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | | | - Andrew Currie
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - James Byrne
- University Hospital Southampton, Southampton, UK
| | - James Hopkins
- Department of Bariatric and Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Omar A Khan
- Population Health Research Institute, St George's Hospital, University of London, London, UK
- Department Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, UK
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Alexander Dimitri Miras
- School of Medicine, Ulster University, Belfast, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Chris M Pring
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Sussex (St Richard's Hospital), Chichester, UK
| | - Peter K Small
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
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von Philipsborn P, Huizinga O, Leibinger A, Rubin D, Burns J, Emmert-Fees K, Pedron S, Laxy M, Rehfuess E. Interim Evaluation of Germany's Sugar Reduction Strategy for Soft Drinks: Commitments versus Actual Trends in Sugar Content and Sugar Sales from Soft Drinks. Ann Nutr Metab 2023; 79:282-290. [PMID: 36809753 PMCID: PMC10568594 DOI: 10.1159/000529592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION A high intake of sugar, in particular from sugar-sweetened soft drinks, increases the risk for obesity, type 2 diabetes mellitus, and dental caries. Germany has pursued a national strategy for sugar reduction in soft drinks based on voluntary commitments by industry since 2015, but its effects are unclear. METHODS We use aggregated annual sales data from Euromonitor International to assess trends in mean sales-weighted sugar content of soft drinks and per capita sugar sales from soft drinks in Germany from 2015 to 2021. We compare these trends to the reduction path set by Germany's national sugar reduction strategy and to data for the United Kingdom, which adopted a soft drinks tax in 2017 and which we selected as best practice comparison country based on pre-defined criteria. RESULTS Between 2015 and 2021, the mean sales-weighted sugar content of soft drinks sold in Germany decreased by 2% from 5.3 to 5.2 g/100 mL, falling short of an interim 9% reduction target and a 29% reduction observed in the United Kingdom over the same period. Sugar sales from soft drinks in Germany decreased from 22.4 to 21.6 g/capita/day (-4%) between 2015 and 2021 but remain high from a public health perspective. CONCLUSIONS Reductions observed under Germany's sugar reduction strategy fall short of stated targets and trends observed internationally under best practice conditions. Additional policy measures may be needed to support sugar reduction in soft drinks in Germany.
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Affiliation(s)
- Peter von Philipsborn
- Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Oliver Huizinga
- German Non-Communicable Disease Alliance (DANK), Berlin, Germany
| | - Anna Leibinger
- Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Diana Rubin
- Centre for Nutritional Medicine, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Jacob Burns
- Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany
| | - Karl Emmert-Fees
- Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Sara Pedron
- Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany
| | - Michael Laxy
- Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany
| | - Eva Rehfuess
- Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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181
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Turner J, Tancred T. Maternity care provision for women living with female genital mutilation/cutting: A qualitative study from a high asylum-seeking dispersal context in the UK. Int J Health Plann Manage 2023; 38:790-804. [PMID: 36808645 DOI: 10.1002/hpm.3625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To explore the perspectives of midwives and obstetrician/gynaecologists providing maternity care to women living with female genital mutilation/cutting (FGM/C) in a high asylum-seeker dispersal area in the North West of England. METHODS We carried out a qualitative study in four hospitals providing maternal health services within the North West of England, with the highest population of asylum-seeking individuals (many from high-prevalence FGM/C countries) in the UK. Participants included 13 practicing midwives and an obstetrician/gynaecologist. In-depth interviews were conducted with study participants. Data collection and analysis were carried out concurrently until theoretical saturation was reached. Data were analysed thematically to generate three key overarching themes. RESULTS There is a disconnect between Home Office dispersal policy and healthcare policy. Participants indicated that there was inconsistent identification or disclosure of FGM/C, constraining appropriate follow-up and care prior to labour and childbirth. All participants noted existing safeguarding policies and protocols, which were seen by most as being important to protect female dependants, but potentially detrimental to the patient-provider relationship and to the woman's care. Unique challenges around accessing and maintaining continuity of care for asylum-seeking women due to dispersal schemes were indicated. All participants highlighted a lack of specialised training for FGM/C to support provision of clinically appropriate and culturally sensitive care. CONCLUSIONS There is a clear need for harmony between health and social policy as well as specialised training that centres holistic wellbeing for the woman living with FGM/C, particularly where there are increased numbers of asylum-seeking women from high-prevalence FGM/C countries.
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Affiliation(s)
- Jessica Turner
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tara Tancred
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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182
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Patel G, Phung VH, Trueman I, Pattinson J, Botan V, Parvin Hosseini SM, Ørner R, Asghar Z, Smith MD, Rowan E, Spaight R, Evans J, Brewster A, Mountain P, Siriwardena AN. "It's like a swan, all nice and serene on top, and paddling like hell underneath": community first responders' practices in attending patients and contributions to rapid emergency response in rural England, United Kingdom-a qualitative interview study. Scand J Trauma Resusc Emerg Med 2023; 31:7. [PMID: 36782273 DOI: 10.1186/s13049-023-01071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Community First Responder (CFR) schemes are a long-established service supplementing ambulance trusts in their local community in the United Kingdom. CFRs are community members who volunteer to respond to people with life-threatening conditions. Previous studies highlighted the motivations for becoming CFRs, their training, community (un)awareness and implications of their work on themselves and others. The practices of CFRs in prehospital care remain underexplored. Therefore, we aimed to explore real-world practice of Community First Responders and their contribution to prehospital emergency care. METHODS We conducted 47 interviews with CFRs (21), CFR leads (15), ambulance clinicians (4), commissioners (2) and patients and relatives (5) from six ambulance services and regions of England, United Kingdom. Thematic analysis enabled identification of themes and subthemes, with subsequent interpretation built on the theory of practice wisdom. RESULTS Our analysis revealed the embeddedness of the concept of doing the right thing at the right time in CFR practice. CFRs' work consisted of a series of sequential and interconnected activities which included: identifying patients' signs, symptoms and problems; information sharing with the ambulance control room on the patient's condition; providing a rapid emergency response including assessment and care; and engaging with ambulance clinicians for patient transfer. The patient care sequence began with recognising patients' signs and symptoms, and validation of patient information provided by the ambulance control room. The CFRs shared patient information with ambulance control who in turn notified the ambulance crew en-route. The practices of CFRs also included delivery of emergency care before ambulance clinicians arrived. Following the delivery of a rapid emergency response, CFRs engaged with the ambulance crew to facilitate patient transfer to the nearest medical facility. CONCLUSION The sequential CFR practices supported ambulance services in delivering prehospital and emergency care in rural areas. CFR practices were founded on the principle of practice wisdom where CFRs constructed their practice decisions based on the patient's condition, their training, availability of equipment and medications and their scope of practice.
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183
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Sinnathamby MA, Warburton F, Reynolds AJ, Cottrell S, O'Doherty M, Domegan L, O'Donnell J, Johnston J, Yonova I, Elgohari S, Boddington NL, Andrews N, Ellis J, de Lusignan S, McMenamin J, Pebody RG. An intercountry comparison of the impact of the paediatric live attenuated influenza vaccine (LAIV) programme across the UK and the Republic of Ireland (ROI), 2010 to 2017. Influenza Other Respir Viruses 2023; 17:e13099. [PMID: 36824392 PMCID: PMC9942272 DOI: 10.1111/irv.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/16/2023] Open
Abstract
Background The universal paediatric live attenuated influenza vaccine (LAIV) programme commenced in the United Kingdom (UK) in 2013/2014. Since 2014/2015, all pre-school and primary school children in Scotland and Northern Ireland have been offered the vaccine. England and Wales incrementally introduced the programme with additional school age cohorts being vaccinated each season. The Republic of Ireland (ROI) had no universal paediatric programme before 2017. We evaluated the potential population impact of vaccinating primary school-aged children across the five countries up to the 2016/2017 influenza season. Methods We compared rates of primary care influenza-like illness (ILI) consultations, confirmed influenza intensive care unit (ICU) admissions, and all-cause excess mortality using standardised methods. To further quantify the impact, a scoring system was developed where each weekly rate/z-score was scored and summed across each influenza season according to the weekly respective threshold experienced in each country. Results Results highlight ILI consultation rates in the four seasons' post-programme, breached baseline thresholds once or not at all in Scotland and Northern Ireland; in three out of the four seasons in England and Wales; and in all four seasons in ROI. No differences were observed in the seasons' post-programme introduction between countries in rates of ICU and excess mortality, although reductions in influenza-related mortality were seen. The scoring system also reflected similar results overall. Conclusions Findings of this study suggest that LAIV vaccination of primary school age children is associated with population-level benefits, particularly in reducing infection incidence in primary care.
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Affiliation(s)
| | | | | | | | | | - Lisa Domegan
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | - Joan O'Donnell
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | | | - Ivelina Yonova
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)LondonUK,University of SurreyGuilfordUK
| | | | | | | | | | - Simon de Lusignan
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)LondonUK,University of SurreyGuilfordUK,University of OxfordUK
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184
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Viney W. Parklife and the public: 40 years of personalization in the United Kingdom. Distinktion 2023; 24:195-216. [PMID: 38013838 PMCID: PMC10503126 DOI: 10.1080/1600910x.2023.2173267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
This article historicises practices called 'personalization' in the UK. It presents data from interviews with practitioners to show how business leaders, public sector managers, policy analysts, activists and others have crafted their personalizing practices through commercial and governmental work over a 40-year period. These public histories are illuminated by professional biographies, which reveal common interests in the transfer and application of technology, data and data analytics. Yet they also illuminate attempts to reform bureaucracies in public and private sectors alike during the late 20th and early twenty-first century. The article asks how mobility - of professionals and their personalizing practices - has affected the pre-existing contrast between, and separation of, public and private organizations. This article contributes to commentaries on personalization that view it as an essentially private and privatizing process. What remains of such domains once they have been crossed, and from whose perspective? This UK history raises questions for comparative histories of personalization and its synonyms elsewhere.
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Affiliation(s)
- William Viney
- Department of Anthropology, Goldsmiths, University of London, London, UK
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185
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Jackson DB, Jones MS, Semenza DC, Testa A. Adverse Childhood Experiences and Adolescent Delinquency: A Theoretically Informed Investigation of Mediators during Middle Childhood. Int J Environ Res Public Health 2023; 20:3202. [PMID: 36833897 PMCID: PMC9959059 DOI: 10.3390/ijerph20043202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The purposes of this study are twofold. First, we explore the associations between cumulative ACEs at ages 5 and 7 and delinquency at age 14 in a national sample of youth in the United Kingdom (UK). Second, we explore the role of five theoretically relevant mediators in explaining this relationship. METHODS Analyses were based on data from the UK Millennium Cohort Study-a prospective, longitudinal birth-cohort study of more than 18,000 individuals in the United Kingdom. RESULTS The results indicate that early ACEs are significantly associated with adolescent delinquency, with effects becoming significantly larger as ACEs accumulate. Findings also reveal that child property delinquency, substance use, low self-control, unstructured socializing, and parent-child attachment at age 11 all significantly mediate the relationship between early ACEs and delinquency in adolescence, with early delinquency and low self-control emerging as the most robust mediators. CONCLUSIONS Findings point to a need for early ACEs screening and a Trauma-Informed Health Care (TIC) approach in early delinquency prevention efforts. Early intervention efforts that bolster child self-control and curtail early-onset problem behaviors may also disrupt pathways from ACEs to adolescent delinquency.
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Affiliation(s)
- Dylan B. Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Melissa S. Jones
- Sociology Department, College of Family, Home, and Social Sciences, Brigham Young University, Provo, UT 84602, USA
| | - Daniel C. Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers, Camden, The State University of New Jersey, 405-7 Cooper Street, Camden, NJ 08102, USA
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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186
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Taylor B, Tod A, Gardiner C, Ejegi-Memeh S, Harrison M, Sherborne V, Couchman E, Senek M, Bachas Brook H, Ross J, Zhang X. Mesothelioma patient and carer experience research: A research prioritisation exercise. Eur J Oncol Nurs 2023; 63:102281. [PMID: 36905742 DOI: 10.1016/j.ejon.2023.102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES Incidence of mesothelioma worldwide is growing and the UK reports the highest global incidence. Mesothelioma is an incurable cancer with a high symptom burden. However, it is under researched when compared to other cancers. The aim of this exercise was to identify unanswered questions about the mesothelioma patient and carer experience in the UK and to prioritise research areas of most importance through consultation with patients, carers and professionals. MATERIALS AND METHODS A virtual Research Prioritisation Exercise was conducted. This involved a review of mesothelioma patient and carer experience literature to identify research gaps and a national online survey to identify and rank research gaps. Following this, a modified consensus method with mesothelioma experts (patients, carers and professionals from healthcare, legal, academic and volunteer organisations) was undertaken to reach a consensus regarding mesothelioma patient and carer experience research priorities. RESULTS Survey responses were received from 150 patients, carers and professionals and 29 research priorities were identified. During consensus meetings, 16 experts refined these into a list of 11 key priorities. The five most urgent priorities were symptom management, receiving a mesothelioma diagnosis, palliative and end of life care, treatment experiences, barriers and facilitators to joined up service provision. CONCLUSION This novel priority setting exercise will shape the national research agenda, contribute knowledge to inform nursing and wider clinical practice and ultimately improve the experiences of mesothelioma patients and carers.
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Affiliation(s)
- Bethany Taylor
- Mesothelioma UK Research Centre, University of Sheffield, UK.
| | - Angela Tod
- Mesothelioma UK Research Centre, University of Sheffield, UK
| | - Clare Gardiner
- Mesothelioma UK Research Centre, University of Sheffield, UK
| | | | | | | | - Emilie Couchman
- Mesothelioma UK Research Centre, University of Sheffield, UK
| | - Michaela Senek
- Mesothelioma UK Research Centre, University of Sheffield, UK
| | | | - Jennifer Ross
- Mesothelioma UK Research Centre, University of Sheffield, UK
| | - Xueming Zhang
- Mesothelioma UK Research Centre, University of Sheffield, UK
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187
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Leightley D, Palmer L, Williamson C, Leal R, Chandran D, Murphy D, Fear NT, Stevelink SAM. Identifying Military Service Status in Electronic Healthcare Records from Psychiatric Secondary Healthcare Services: A Validation Exercise Using the Military Service Identification Tool. Healthcare (Basel) 2023; 11:healthcare11040524. [PMID: 36833058 PMCID: PMC9957026 DOI: 10.3390/healthcare11040524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Electronic healthcare records (EHRs) are a rich source of information with a range of uses in secondary research. In the United Kingdom, there is no pan-national or nationally accepted marker indicating veteran status across all healthcare services. This presents significant obstacles to determining the healthcare needs of veterans using EHRs. To address this issue, we developed the Military Service Identification Tool (MSIT), using an iterative two-staged approach. In the first stage, a Structured Query Language approach was developed to identify veterans using a keyword rule-based approach. This informed the second stage, which was the development of the MSIT using machine learning, which, when tested, obtained an accuracy of 0.97, a positive predictive value of 0.90, a sensitivity of 0.91, and a negative predictive value of 0.98. To further validate the performance of the MSIT, the present study sought to verify the accuracy of the EHRs that trained the MSIT models. To achieve this, we surveyed 902 patients of a local specialist mental healthcare service, with 146 (16.2%) being asked if they had or had not served in the Armed Forces. In total 112 (76.7%) reported that they had not served, and 34 (23.3%) reported that they had served in the Armed Forces (accuracy: 0.84, sensitivity: 0.82, specificity: 0.91). The MSIT has the potential to be used for identifying veterans in the UK from free-text clinical documents and future use should be explored.
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Affiliation(s)
- Daniel Leightley
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Correspondence:
| | - Laura Palmer
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Charlotte Williamson
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Ray Leal
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Dave Chandran
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE58AB, UK
| | - Dominic Murphy
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Combat Stress, Tyrwhitt House, Oaklawn Road, Leatherhead, London KT22 0BX, UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Academic Department of Military Mental Health, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE58AB, UK
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188
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Ansari AS, Tung ASW, Wright DM, Watts P, Williams GS. Stress and cataract surgery: A nationwide study evaluating surgeon burnout. Eur J Ophthalmol 2023:11206721231154611. [PMID: 36734150 DOI: 10.1177/11206721231154611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to evaluate the nationwide prevalence of stress induced burnout among cataract surgeons. We believe that knowledge of these factors can help formulate a solution to this underreported problem. METHODS A three-part nationwide cross-sectional survey was disseminated with via the Royal College of Ophthalmologists (RCOphth) in the United Kingdom(UK). All consultants, trainees and specialty doctors and associate specialists(SAS) were invited to participate. We evaluated burnout using the Maslach Burnout Inventory (MBI). Logistic regression modelling was completed to look at factors linked to high level burnout in certain domains. RESULTS A total of 406 respondents completed our survey. Prevalence of cataract surgery-related high burnout was estimated at 3.45% (Section A and/or B) and 40% within Personal Accomplishment (PA)(Section C of the MBI). Multiple factors were associated with increased burnout within PA: Increasing age: 61+ OR: 2.99 (1.02-8.78, p = 0.05), Number of cataract operations completed: >3000 OR 2.98 (1.03-8.64, p = 0.04), Lists per week: 2: OR 2.99 (1.38-6.47, p < 0.01), 2.5: OR 8.95 (2.58-31.02, p < 0.01), 3 or more: OR 2.64 (1.07-6.54, p = 0.04). Sleeping 8 h or more was found to be protective OR 0.52 (0.28-0.96, p = 0.04). 17% of respondents indicated they would be willing to give up cataract surgery if given the opportunity. CONCLUSION The prevalence of stress induced burnout by cataract surgery appears to be present in a minority of surgeons. There appears to be a significant reduction in the feeling of personal achievement within the profession. A large proportion of this cohort appears to be willing to give up surgical responsibilities.
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Affiliation(s)
- Abdus Samad Ansari
- Singleton Eye Unit, Sketty Lane, Swansea, UK.,Section of Academic Ophthalmology, School of Life Course Sciences, FoLSM, King's College London, London, UK
| | - Annie See Wah Tung
- Singleton Eye Unit, Sketty Lane, Swansea, UK.,University Hospital Wales, Cardiff, UK
| | - David M Wright
- The Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, 1596Queen's University Belfast, Belfast, UK
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van den Berg LMM, Balaam MC, Nowland R, Moncrieff G, Topalidou A, Thompson S, Thomson G, de Jonge A, Downe S, Ellison G, Fenton A, Heazell A, de Jonge A, Kingdon C, Matthews Z, Severns A, Thomson G, Topalidou A, Wright A, Akooji N, Balaam MC, Cull J, van den Berg L, Crossland N, Feeley C, Franso B, Heys S, Moncrief G, Nowland R, Sarian A, Booker M, Sandall J, Thornton J, Lynskey-Wilkie T, Wilson V, Abe R, Awe T, Adeyinka T, Bender-Atik R, Brigante L, Brione R, Cadée F, Duff E, Draycott T, Fisher D, Francis A, Franx A, Erasmus M, Frith L, Griew L, Harmer C, Homer C, Knight M, Mansfield A, Marlow N, Mcaree T, Monteith D, Reed K, Richens Y, Rocca-Ihenacho L, Ross-Davie M, Talbot S, Taylor M, Treadwell M. The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study. Women Birth 2023; 36:127-135. [PMID: 35422406 PMCID: PMC8979792 DOI: 10.1016/j.wombi.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. AIM To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. METHOD A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. FINDINGS Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers' fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. CONCLUSION We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women's and families' values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.
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Affiliation(s)
- Lauri M M van den Berg
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands.
| | - Marie-Clare Balaam
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Rebecca Nowland
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Gill Moncrieff
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Anastasia Topalidou
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Suzanne Thompson
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands; Research Centre of Midwifery Science Maastricht, Zuyd University, The Netherlands
| | - Gill Thomson
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Ank de Jonge
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development, The Netherlands
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
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Peñuela-O Brien E, Wan MW, Berry K, Edge D. Central and Eastern European migrants' experiences of mental health services in the UK: A qualitative study post-Brexit. Patient Educ Couns 2023; 107:107562. [PMID: 36424290 DOI: 10.1016/j.pec.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/19/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Central and Eastern European (CEE) migrants are a large minority group in the UK who are vulnerable to experiencing mental health problems. However, due to their shared 'whiteness' with the majority population, health service disparities may be overlooked. This is the first study exploring CEE-born people's experiences of mental health services post-Brexit. METHOD Thirteen CEE migrants who had received mental health services in the UK were interviewed and data was thematically analysed. RESULTS Barriers and facilitators to engagement reflected: 1) attitudes towards help-seeking; 2) cultural in/visibility; and 3) professional-service user communication. Some barriers were unique to the CEE community and not shared by other minority groups, such as the 'invisibility' of ethnic identity and this framed the way participants navigated interactions with services. CONCLUSIONS Cultural differences and mental health stigma were reported to influence understanding of mental health, attitudes to help-seeking, and experiences of services. Flexible ethnic identity and majority group "passing" could conceal inequalities in healthcare. PRACTICE IMPLICATIONS The need for culturally informed approaches, professional upskilling, strengthened inter-agency working, and collaboration with CEE communities. The need to build on pre-existing strengths, for self-directed and self-care activities, for appropriate pacing and confidentiality discussions, and the use of web-based resources.
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Affiliation(s)
- Estefanía Peñuela-O Brien
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, England, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, England, UK.
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, England, UK.
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, England, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, England, UK.
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, England, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, England, UK.
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191
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Wigglesworth S, Neligan A, Dickson JM, Pullen A, Yelland E, Anjuman T, Reuber M. The incidence and prevalence of epilepsy in the United Kingdom 2013-2018: A retrospective cohort study of UK primary care data. Seizure 2023; 105:37-42. [PMID: 36702018 DOI: 10.1016/j.seizure.2023.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The aim of this study was to update overall incidence and prevalence calculations for epilepsy of the United Kingdom (UK) and its constituent nations (England, Northern Ireland, Scotland, and Wales). METHODS We used data from primary care practices contributing to the Clinical Practice Research Datalink (CRPD), based on the electronic health records of 14 million patients, representing approximately 20% of the population. CPRD contains data from two different health record systems: the Vision clinical system (CPRD GOLD database) and the EMIS Web® clinical system (CPRD Aurum database). We calculated incidence and prevalence rates with 95% confidence intervals (CIs). Data were stratified by age, gender, deprivation, country (England, Scotland, Wales and Northern Ireland) and region (England only). RESULTS In the UK, the estimated overall point prevalence for epilepsy was 9.37 per 1000 persons / year (95% CI 9.34-9.40) and the overall estimated incidence rate was 42.68 per 100,000 person-years (95% 42.18-43.18) using the CPRD GOLD database. In England, the estimated incidence (37.41 (95% CI 36.96-37.83)) and prevalence (8.85 (95% CI 8.83-8.87)) was lower (combined databases) compared to figures for Scotland (incidence 47.76 (95% CI 46.15-49.42)); prevalence 10.13 (95% CI 10.06-10.20)) (CPRD GOLD only), Wales (incidence 54.84 (95% CI 52.79-56.95); prevalence 11.40 (95% CI 11.31-11.49)) (CPRD GOLD only) and Northern Ireland (incidence 46.18 (95% CI 43.13-49.90); prevalence 12.08 (95% CI 11.93-12.23))(combined databases). Prevalence and incidence were higher in more deprived regions. CONCLUSION The prevalence and incidence of epilepsy in the UK is broadly in line with other high income countries, showing the usual pattern of high incidence in the young and the old, with a nadir in middle age. The prevalence of epilepsy has fallen slightly since 2011. There is significant geographical variation (between countries and between regions), and a suggestion of a relationship between deprivation and epilepsy which needs further investigation.
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Affiliation(s)
- S Wigglesworth
- Former employee of Epilepsy Action, Yeadon, Leeds, United Kingdom.
| | - A Neligan
- Homerton University Hospital Foundation Trust, Homerton Row, London E9 6SR, United Kingdom; DCEE, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - J M Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, United Kingdom
| | - A Pullen
- Epilepsy Research UK, London, United Kingdom
| | - E Yelland
- Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - T Anjuman
- Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - M Reuber
- Academic Neurology Unit, University of Sheffield, Sheffield, United Kingdom
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192
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Mladovsky P. Mental health coverage for forced migrants: Managing failure as everyday governance in the public and NGO sectors in England. Soc Sci Med 2023; 319:115385. [PMID: 36175262 DOI: 10.1016/j.socscimed.2022.115385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
High-income countries (HICs) which are said to have "reached" universal health coverage (UHC) typically still have coverage gaps, due to both formal policies and informal barriers which result in "hypothetical access". In England, a user fee exemption has in principle made access to treatment for post-traumatic stress disorder (PTSD) and other mental health conditions thought to be caused by certain forms of violence universal, regardless of immigration status. This study explores the everyday governance of this mental health coverage for forced migrants in the English National Health Service (NHS) and NGO sector. Fieldwork was conducted in two waves, in 2015-2016 and 2019-2021, including six months of participant observation in an NGO and 21 semi-structured interviews with psy professionals across 16 NHS and NGO service providers. Further interviews were conducted with mental health commissioners and policymakers, as well as analysis of grey literature. Despite being formally covered for certain types of mental health care, in practice asylum seekers and undocumented migrants were often excluded by NHS providers. Undocumented migrants were also often excluded by NGO providers. Several rationalities linked discursive fields to practices developed by psy professionals and other street-level bureaucrats to govern coverage, in a process of "managing failure". These rationalities are presented under three paired themes which draw attention to tensions and resistance in the governance of coverage: medicalisation and biolegitimacy; austerity and ethico-politics; and differential racialisation and decolonisation. Rationalities were associated with strategies and tactics such as social triage, clinical advocacy, obfuscation, evidence-based advocacy and silencing critique. The concept of "health coverage assemblage" is introduced to explain the complex, unstable, contingent and fragmented nature of UHC policies and programmes. Misrecognition and underestimation of the everyday work of health professionals in promoting, resisting and reproducing diverse rationalities within the assemblage may lead to missed opportunities for reform.
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Affiliation(s)
- Philipa Mladovsky
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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193
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Chung GK, Robinson M, Marmot M, Woo J. Monitoring socioeconomic inequalities in health in Hong Kong: insights and lessons from the UK and Australia. Lancet Reg Health West Pac 2023; 31:100636. [PMID: 36879790 DOI: 10.1016/j.lanwpc.2022.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
In many developed countries such as the UK and Australia, addressing socioeconomic inequalities in health is a priority in their policy agenda, with well-established practices and authorities to collect and link selected health and social indicators for long-term monitoring. Nonetheless, the monitoring of socioeconomic inequalities in health in Hong Kong remains in a piecemeal manner. Also, the common international practice to monitor inequalities at area level appears to be unsuitable in Hong Kong due to its small, compact, and highly interconnected built environment that limits the variation of neighbourhood deprivation level. To enhance inequality monitoring in Hong Kong, we aim to draw reference and lesson from the UK and Australia to explore the feasible steps forward regarding collection of health indicators and contextually appropriate equity stratifiers with strong implication on policy actions, and discuss potential strategies to promote the public awareness and motivations for a more comprehensive inequality monitoring system.
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194
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Khachatryan A, Doobaree IU, Spentzouris G, Gusto G, Zawaneh Y, Mughal F, Anastassopoulou A, Manu M, Fay M. Direct Oral Anticoagulant (DOAC) Dosing in Patients with Non-valvular Atrial Fibrillation (NVAF) in the United Kingdom: A Retrospective Cohort Study Using CPRD Gold Database. Adv Ther 2023; 40:504-520. [PMID: 36399317 DOI: 10.1007/s12325-022-02368-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Per-label dosing of direct oral anticoagulants (DOACs) is important for the prevention of stroke and systemic embolism among patients with non-valvular atrial fibrillation (NVAF), especially those with poor renal function, advanced age, low body weight or concomitant P-glycoprotein inhibitors. The study described DOAC use and dosing patterns in patients with NVAF in the UK. METHODS Using Clinical Practice Research Datalink (CPRD Gold), patients' profiles were described at DOAC initiation (1 January 2016-31 March 2021) and followed for a mean [standard deviation (SD)] 2 (1) years. Patients were categorised as under-dosing: received a lower dose with no indication for a reduced dose; over-dosing: received a standard dose with an indication for a reduced dose; per-label dosing, according to Summary Product Characteristics (SmPC). RESULTS Forty thousand seven hundred forty-four adult patients with NVAF were identified (mean age: 75.3 (11.2) years; males: 55.4%); 22,827 (56.0%) initiated treatment with apixaban, 930 (2.3%) dabigatran, 5633 (13.8%) edoxaban and 11,354 (27.9%) rivaroxaban. Baseline Charlson comorbidity index ≥ 4 was 65.1%; CHA2DS2-VASc score ≥ 4 was 22.5%; HAS-BLED score ≥ 3 was 18.3%; ~ 2% had prior major bleed and 4.4% a stroke ≤ 2 years before DOAC initiation. Overall, 18.0% of patients received incorrect dosing (~ one in five). Under-dosing was highest for dabigatran (156, 16.8%) and over-dosing was highest for rivaroxaban (1084, 9.6%). Per-label dosing was highest for edoxaban (4773, 84.7%), followed by apixaban (18,756, 82.2%), rivaroxaban (9161, 80.7%) and dabigatran (732, 78.7%). Treatment persistence (no switching or discontinuation) was 79% among edoxaban users, followed by 75% for apixaban, 69% for rivaroxaban and 62% for dabigatran. About 15% of dabigatran users, 10% of rivaroxaban users, 5% of apixaban users and 4% of edoxaban users switched treatment to another DOAC during follow-up. CONCLUSION Although most patients received per-label dosing, ~ one in five patients was incorrectly dosed with DOAC, which may lead to serious clinical consequences and increased healthcare burden.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Matthew Fay
- Warwick Medical School, Warwick University, Warwick, UK.,The Willows Medical Practice, Bradford, UK
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195
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Chang K, Gunter MJ, Rauber F, Levy RB, Huybrechts I, Kliemann N, Millett C, Vamos EP. Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. EClinicalMedicine 2023; 56:101840. [PMID: 36880051 PMCID: PMC9985039 DOI: 10.1016/j.eclinm.2023.101840] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
Background Global dietary patterns are increasingly dominated by relatively cheap, highly palatable, and ready-to-eat ultra-processed foods (UPFs). However, prospective evidence is limited on cancer development and mortality in relation to UPF consumption. This study examines associations between UPF consumption and risk of cancer and associated mortality for 34 site-specific cancers in a large cohort of British adults. Methods This study included a prospective cohort of UK Biobank participants (aged 40-69 years) who completed 24-h dietary recalls between 2009 and 2012 (N = 197426, 54.6% women) and were followed up until Jan 31, 2021. Food items consumed were categorised according to their degree of food processing using the NOVA food classification system. Individuals' UPF consumption was expressed as a percentage of total food intake (g/day). Prospective associations were assessed using multivariable Cox proportional hazards models adjusted for baseline socio-demographic characteristics, smoking status, physical activity, body mass index, alcohol and total energy intake. Findings The mean UPF consumption was 22.9% (SD 13.3%) in the total diet. During a median follow-up time of 9.8 years, 15,921 individuals developed cancer and 4009 cancer-related deaths occurred. Every 10 percentage points increment in UPF consumption was associated with an increased incidence of overall (hazard ratio, 1.02; 95% CI, 1.01-1.04) and specifically ovarian (1.19; 1.08-1.30) cancer. Furthermore, every 10 percentage points increment in UPF consumption was associated with an increased risk of overall (1.06; 1.03-1.09), ovarian (1.30; 1.13-1.50), and breast (1.16; 1.02-1.32) cancer-related mortality. Interpretation Our UK-based cohort study suggests that higher UPF consumption may be linked to an increased burden and mortality for overall and certain site-specific cancers especially ovarian cancer in women. Funding The Cancer Research UK and World Cancer Research Fund.
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Affiliation(s)
- Kiara Chang
- Public Health Policy Evaluation Unit, Imperial College London, London, W6 8RP, United Kingdom
| | - Marc J. Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, 69372, Lyon, France
| | - Fernanda Rauber
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, 01246-904, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, 01246-904, Brazil
| | - Renata B. Levy
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, 01246-904, Brazil
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, 01246-904, Brazil
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, 69372, Lyon, France
| | - Nathalie Kliemann
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, 69372, Lyon, France
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, W6 8RP, United Kingdom
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Eszter P. Vamos
- Public Health Policy Evaluation Unit, Imperial College London, London, W6 8RP, United Kingdom
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196
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Sirkeci F, Moss J, Belli AM, McPherson K, Daniels J, Manyonda I, Middleton L, Cheed V, Wu O, Lumsden MA. Effects on heavy menstrual bleeding and pregnancy of uterine artery embolization (UAE) or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: The FEMME randomized controlled trial. Int J Gynaecol Obstet 2023; 160:492-501. [PMID: 36511801 PMCID: PMC10107788 DOI: 10.1002/ijgo.14626] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/13/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine treatment options (myomectomy vs. uterine artery embolization (UAE)) for women wishing to avoid hysterectomy. METHODS A multicenter randomized controlled trial was conducted on 254 women and data were collected on fibroid-specific quality of life (UFS-QOL), loss of menstrual blood, and pregnancy. RESULTS At 4 years, the mean difference in the UFS-QOL was 5.0 points (95% confidence interval (CI) -1.4 to 11.5; P = 0.13) in favor of myomectomy. This was not statistically significant as it was at 2 years. There were no differences in bleeding scores, rates of amenorrhea, or heavy bleeding. Of those who were still menstruating, the majority reported regular or fairly regular periods: 36 of 48 (75%) in the UAE group and 30 of 39 (77%) in the myomectomy group. Twelve women after UAE and six women after myomectomy became pregnant (4 years) with seven and five live births, respectively (hazard ratio 0.48, 95% CI 0.18-1.28). There was no difference between the levels of hormones associated with the uterine reserve in each group. CONCLUSION Leiomyoma are common in reproductive-aged women, causing heavy menses and subfertility. Among women with uterine fibroids, myomectomy resulted in better fibroid-related quality of life at 4 years, compared with UAE but the treatments decreased menstrual bleeding equally. There was also no significant difference in the impact of treatment on ovarian reserve.
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Affiliation(s)
- Fusun Sirkeci
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester NHS Foundation Trust, Manchester, UK
| | - John Moss
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Anna M Belli
- Department of Radiology, St George's Hospital and Medical School, London, UK
| | - Klim McPherson
- Department of Primary Care, University of Oxford, Oxford, UK
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Isaac Manyonda
- Department of Gynaecology, St George's Hospital and Medical School, London, UK
| | - Lee Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Versha Cheed
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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197
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Singh I. An insight into the efficacy and sustainability of cardiac auscultation training in first year medical students - A United Kingdom medical student's perspective. J Cardiol 2023; 81:250. [PMID: 36057485 DOI: 10.1016/j.jjcc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 01/10/2023]
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198
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Shen V, Haffner L, Walker N, Ni Mhurchu C, Lang B. 'It's somewhere here, isn't it'? The provision of information and health warnings for alcoholic beverages sold online in New Zealand and the United Kingdom. Drug Alcohol Rev 2023; 42:476-486. [PMID: 36394975 PMCID: PMC10099350 DOI: 10.1111/dar.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Alcohol beverages in many countries are required to display health information and warnings on all product packaging, given the individual and societal harm caused by alcohol. It is unclear whether consumers purchasing alcohol online are able to easily view such information. This study examines the presence, type and location of mandatory and voluntary health information and warnings consumers are exposed to when entering online alcohol retail shopping environments in the United Kingdom (UK) and New Zealand (NZ). METHODS Using an observational study design, 1407 randomly sampled alcoholic beverages from 14 online alcohol retailers (7 per country) were reviewed to ascertain the visual presence or absence of mandatory and voluntary health information and warnings. RESULTS UK online alcohol retailers were more compliant than NZ retailers in showing mandatory health information (e.g., alcohol by volume percentage was visible on 92% of alcoholic beverages sold online in the UK, compared to 31% in NZ, p < 0.001). A similar pattern was noted for voluntary health warnings. Online retailers in both countries had a low proportion of alcohol products with the viewable mandatory information, and voluntary health warnings were rarely present and/or viewable. DISCUSSION AND CONCLUSIONS Mandatory health information and warnings for alcoholic beverages are not fully adhered to within the UK and NZ online retail environments, impacting the ability of consumers to make informed purchase decisions. In both countries, alcohol policy needs to stipulate that mandatory health information and warnings should be clearly viewable on the product page and product imagery of online alcohol retailers.
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Affiliation(s)
- Vicky Shen
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lily Haffner
- Department of Marketing, Business School, University of Auckland, Auckland, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Addiction Research, University of Auckland, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- The George Institute for Global Health, Sydney, Australia
| | - Bodo Lang
- Department of Marketing, Business School, University of Auckland, Auckland, New Zealand
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199
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Mohanty S, Podmore B, Cuñado Moral A, Weiss T, Matthews I, Sarpong E, Méndez I, Qizilbash N. Incidence of acute otitis media from 2003 to 2019 in children ≤ 17 years in England. BMC Public Health 2023; 23:201. [PMID: 36717794 PMCID: PMC9885604 DOI: 10.1186/s12889-023-14982-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2006 and the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 in the UK. PCVs are active immunization for the prevention of invasive disease, pneumonia and acute otitis media (AOM) caused by Streptococcus pneumoniae in children. The aim of this observational study was to estimate incidence rates (IRs) of AOM in children ≤17 years from 2003 to 2019 in England, before and after the introduction of pneumococcal conjugate vaccines (PCVs). METHODS AOM episodes were identified using Read diagnosis codes in children aged ≤17 years in the Clinical Practice Research Datalink (CPRD) Gold database from 2003 to 2019. Annual IRs with 95% confidence intervals (CI) by age group were calculated as the number of episodes/person-years (PY) at risk. Interrupted time series analyses were conducted to estimate incidence rate ratios (IRR) across post-PCV7 (2007-2009), early post-PCV13 (2011-2014) and late post-PCV13 (2015-2019) periods compared to the pre-PCV7 period (2003-2005) using generalized linear models. RESULTS From 2003 to 2019, 274,008 all-cause AOM episodes were identified in 1,500,686 children. The overall AOM IR was 3690.9 (95% CI 3677.1-3704.8) per 100,000 PY. AOM IRs were highest in children aged < 5 years and decreased by age; < 2 years: 8286.7 (95% CI 8216.8-8357.1); 2-4 years: 7951.8 (95% CI 7902.5-8001.4); 5-17 years: 2184.4 (95% CI 2172.1-2196.8) (per 100,000 PY). Overall AOM IRs declined by 40.3% between the pre-PCV7 period and the late-PCV13 period from 4451.9 (95% CI 4418.1-4485.9) to 2658.5 (95% CI 2628.6-2688.7) per 100,000 PY, and across all age groups. IRRs indicated a significant decrease in AOM IRs in all the post-vaccination periods, compared to the pre-PCV7 period: post-PCV7 0.87 (95% CI 0.85-0.89), early post-PCV13 0.88 (95% CI 0.86-0.91), and late post-PCV13 0.75 (95% CI 0.73-0.78). CONCLUSIONS The AOM IRs declined during the 2003-2019 period; however, the clinical burden of AOM remains substantial among children ≤17 years in England.
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Affiliation(s)
- Salini Mohanty
- Merck & Co., Inc, Center for Observational and Real-World Evidence (CORE), Rahway, NJ, USA.
| | - Bélène Podmore
- OXON Epidemiology Ltd, Epidemiology & Statistics, Madrid, Spain
| | | | - Thomas Weiss
- grid.417993.10000 0001 2260 0793Merck & Co., Inc, Center for Observational and Real-World Evidence (CORE), Rahway, NJ USA
| | - Ian Matthews
- grid.419737.f0000 0004 6047 9949MSD (UK) Ltd, Value, Access and Devolved nations (VAD), London, UK
| | - Eric Sarpong
- grid.417993.10000 0001 2260 0793Merck & Co., Inc., Real-world Data Analytics and Innovation (RDAI), Rahway, NJ USA
| | - Ignacio Méndez
- OXON Epidemiology Ltd, Epidemiology & Statistics, Madrid, Spain
| | - Nawab Qizilbash
- OXON Epidemiology Ltd, Epidemiology & Statistics, Madrid, Spain
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200
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Eysenbach G, Quintana Y. Social Media is Addictive and Influences Behavior: Should it Be Regulated as a Digital Therapeutic? J Med Internet Res 2023; 25:e43174. [PMID: 36701180 PMCID: PMC9912146 DOI: 10.2196/43174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 01/27/2023] Open
Abstract
Recently, we were deeply saddened by the findings of the coroner investigating the death of 14-year-old Molly Russell. Deeply saddened and angry but not surprised. This case should be seen as a sentinel event, given that this is the first time social media was directly implicated as a cause of death. We should use this opportunity to advance proposals for the regulations of the health effects of social media.
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Affiliation(s)
| | - Yuri Quintana
- Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States.,Homewood Research Institute, Guelph, ON, Canada
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