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Crawshaw AF, Goldsmith LP, Deal A, Carter J, Knights F, Seedat F, Lau K, Hayward SE, Yong J, Fyle D, Aspray N, Iwami M, Ciftci Y, Wurie F, Majeed A, Forster AS, Hargreaves S. Driving delivery and uptake of catch-up vaccination among adolescent and adult migrants in UK general practice: a mixed methods pilot study. BMC Med 2024; 22:186. [PMID: 38702767 PMCID: PMC11068568 DOI: 10.1186/s12916-024-03378-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Migrants in the UK and Europe face vulnerability to vaccine-preventable diseases (VPDs) due to missed childhood vaccines and doses and marginalisation from health systems. Ensuring migrants receive catch-up vaccinations, including MMR, Td/IPV, MenACWY, and HPV, is essential to align them with UK and European vaccination schedules and ultimately reduce morbidity and mortality. However, recent evidence highlights poor awareness and implementation of catch-up vaccination guidelines by UK primary care staff, requiring novel approaches to strengthen the primary care pathway. METHODS The 'Vacc on Track' study (May 2021-September 2022) aimed to measure under-vaccination rates among migrants in UK primary care and establish new referral pathways for catch-up vaccination. Participants included migrants aged 16 or older, born outside of Western Europe, North America, Australia, or New Zealand, in two London boroughs. Quantitative data on vaccination history, referral, uptake, and sociodemographic factors were collected, with practice nurses prompted to deliver catch-up vaccinations following UK guidelines. Focus group discussions and in-depth interviews with staff and migrants explored views on delivering catch-up vaccination, including barriers, facilitators, and opportunities. Data were analysed using STATA12 and NVivo 12. RESULTS Results from 57 migrants presenting to study sites from 18 countries (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) over a minimum of 6 months of follow-up revealed significant catch-up vaccination needs, particularly for MMR (49 [86%] required catch-up vaccination) and Td/IPV (50 [88%]). Fifty-three (93%) participants were referred for any catch-up vaccination, but completion of courses was low (6 [12%] for Td/IPV and 33 [64%] for MMR), suggesting individual and systemic barriers. Qualitative in-depth interviews (n = 39) with adult migrants highlighted the lack of systems currently in place in the UK to offer catch-up vaccination to migrants on arrival and the need for health-care provider skills and knowledge of catch-up vaccination to be improved. Focus group discussions and interviews with practice staff (n = 32) identified limited appointment/follow-up time, staff knowledge gaps, inadequate engagement routes, and low incentivisation as challenges that will need to be addressed. However, they underscored the potential of staff champions, trust-building mechanisms, and community-based approaches to strengthen catch-up vaccination uptake among migrants. CONCLUSIONS Given the significant catch-up vaccination needs of migrants in our sample, and the current barriers to driving uptake identified, our findings suggest it will be important to explore this public health issue further, potentially through a larger study or trial. Strengthening existing pathways, staff capacity and knowledge in primary care, alongside implementing new strategies centred on cultural competence and building trust with migrant communities will be important focus areas.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Farah Seedat
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Karen Lau
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sally E Hayward
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Joanna Yong
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Desiree Fyle
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Nathaniel Aspray
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Michiyo Iwami
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Yusuf Ciftci
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Fatima Wurie
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
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Perkin MR, Ussher M, Goldsmith LP, Flohr C, Roberts A, Cornelius V, Wahlich C, Willis K, Boyle RJ. BabyBathe study protocol: A randomised controlled feasibility trial to change baby bathing practice during the first months of life. Clin Exp Allergy 2024; 54:353-355. [PMID: 38462778 DOI: 10.1111/cea.14464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Michael R Perkin
- Population Health Research Institute, St. George's University of London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St. George's University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lucy P Goldsmith
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College, London, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St. George's University of London, London, UK
| | - Kathryn Willis
- Population Health Research Institute, St. George's University of London, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
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Smith JG, Anderson K, Clarke G, Crowe C, Goldsmith LP, Jarman H, Johnson S, Lomani J, McDaid D, Park A, Turner K, Gillard S. The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England - CORRIGENDUM. Epidemiol Psychiatr Sci 2024; 33:e24. [PMID: 38605576 PMCID: PMC11022248 DOI: 10.1017/s2045796024000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
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Smith JG, Anderson K, Clarke G, Crowe C, Goldsmith LP, Jarman H, Johnson S, Lomani J, McDaid D, Park AL, Turner K, Gillard S. The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England. Epidemiol Psychiatr Sci 2024; 33:e15. [PMID: 38512000 DOI: 10.1017/s2045796024000209] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
AIMS High-quality evidence is lacking for the impact on healthcare utilisation of short-stay alternatives to psychiatric inpatient services for people experiencing acute and/or complex mental health crises (known in England as psychiatric decision units [PDUs]). We assessed the extent to which changes in psychiatric hospital and emergency department (ED) activity were explained by implementation of PDUs in England using a quasi-experimental approach. METHODS We conducted an interrupted time series (ITS) analysis of weekly aggregated data pre- and post-PDU implementation in one rural and two urban sites using segmented regression, adjusting for temporal and seasonal trends. Primary outcomes were changes in the number of voluntary inpatient admissions to (acute) adult psychiatric wards and number of ED adult mental health-related attendances in the 24 months post-PDU implementation compared to that in the 24 months pre-PDU implementation. RESULTS The two PDUs (one urban and one rural) with longer (average) stays and high staff-to-patient ratios observed post-PDU decreases in the pattern of weekly voluntary psychiatric admissions relative to pre-PDU trend (Rural: -0.45%/week, 95% confidence interval [CI] = -0.78%, -0.12%; Urban: -0.49%/week, 95% CI = -0.73%, -0.25%); PDU implementation in each was associated with an estimated 35-38% reduction in total voluntary admissions in the post-PDU period. The (urban) PDU with the highest throughput, lowest staff-to-patient ratio and shortest average stay observed a 20% (-20.4%, CI = -29.7%, -10.0%) level reduction in mental health-related ED attendances post-PDU, although there was little impact on long-term trend. Pooled analyses across sites indicated a significant reduction in the number of voluntary admissions following PDU implementation (-16.6%, 95% CI = -23.9%, -8.5%) but no significant (long-term) trend change (-0.20%/week, 95% CI = -0.74%, 0.34%) and no short- (-2.8%, 95% CI = -19.3%, 17.0%) or long-term (0.08%/week, 95% CI = -0.13, 0.28%) effects on mental health-related ED attendances. Findings were largely unchanged in secondary (ITS) analyses that considered the introduction of other service initiatives in the study period. CONCLUSIONS The introduction of PDUs was associated with an immediate reduction of voluntary psychiatric inpatient admissions. The extent to which PDUs change long-term trends of voluntary psychiatric admissions or impact on psychiatric presentations at ED may be linked to their configuration. PDUs with a large capacity, short length of stay and low staff-to-patient ratio can positively impact ED mental health presentations, while PDUs with longer length of stay and higher staff-to-patient ratios have potential to reduce voluntary psychiatric admissions over an extended period. Taken as a whole, our analyses suggest that when establishing a PDU, consideration of the primary crisis-care need that underlies the creation of the unit is key.
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Affiliation(s)
- J G Smith
- Population Health Research Institute, St George's, University of London, London, UK
- Clinical Research Unit, South West London & St George's Mental Health Trust, Springfield University Hospital, London, UK
| | - K Anderson
- Department of Psychology, Middlesex University, London, UK
| | - G Clarke
- Improvement Analytics Unit, The Health Foundation, London, UK
| | - C Crowe
- Sunflowers Court Inpatient Unit, North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, UK
| | - L P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - H Jarman
- Population Health Research Institute, St George's, University of London, London, UK
- Emergency Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Early Intervention Service, Camden and Islington NHS Foundation Trust, London, UK
| | - J Lomani
- NHS England and NHS Improvement, London, UK
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A L Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - K Turner
- Population Health Research Institute, St George's, University of London, London, UK
| | - S Gillard
- School of Health and Psychological Sciences, City, University of London, London, UK
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Goldsmith LP, Perkin MR, Wahlich C, Chandrasekaran L, Cornelius V, Boyle RJ, Flohr C, Roberts A, Willis K, Ussher M. Development of an intervention for reducing infant bathing frequency. PLoS One 2024; 19:e0298335. [PMID: 38421960 PMCID: PMC10903808 DOI: 10.1371/journal.pone.0298335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Bathing babies less frequently and intensively in the first six months of life may prevent eczema, but this has not yet been definitively tested in a randomised controlled trial. Such a trial would require evidence-based support to help parents engage with a minimal bathing routine. The present study reports the development of this support. METHODS We adopted a four-stage design process: (i) Pregnant women and their families (n = 31) were interviewed to ascertain key barriers and facilitators towards following the minimal bathing intervention. (ii) These barriers and facilitators were mapped to behaviour change techniques, focussing on the intervention types of education, persuasion and environmental restructuring, alongside appropriate modes of delivery, and prototype intervention materials were developed. (iii) We iteratively refined these materials in a workshop with multidisciplinary experts and Patient and Public Involvement and Engagement (PPIE) representatives (n = 13) and an (iv) intervention walkthrough with families (n = 5). The design process was informed by the Behaviour Change Wheel, Theoretical framework of acceptability and the Template for intervention description and replication. RESULTS Social influences and motivational factors are likely to influence both uptake and adherence to the intervention. Anticipated emotional reward from participating in research for the benefit of others was indicated to be a strong facilitator for intervention uptake. Alternatives to bathing, having fun with the baby and the night-time routine, alongside family support, were notable facilitators suggested to aid adherence to the intervention. Barriers included hygiene concerns and anticipated negative social appraisal. Barriers and facilitators were mapped to thirty-six behaviour change techniques, focussing on the intervention types of education, persuasion and environmental restructuring, all of which were embedded into the package of support. The prototype intervention materials received positive feedback from the expert workshop and study walkthrough with families. The final package of support comprises printed and digital prompts and cues, a study booklet, video, and digital tool for self-monitoring. CONCLUSIONS The intervention design process incorporated the 'real world' views and experiences of families, experts and PPIE representatives, alongside criteria for designing behavioural interventions. The effectiveness of the package of support will be tested in a feasibility trial and embedded process evaluation.
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Affiliation(s)
- Lucy P. Goldsmith
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Michael R. Perkin
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
| | - Charlotte Wahlich
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
| | - Lakshmi Chandrasekaran
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College, London, United Kingdom
| | - Robert J. Boyle
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St John’s Institute of Dermatology, Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, United Kingdom
| | - Kathryn Willis
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
- Institute of Social Marketing and Health, University of Stirling, Stirling, United Kingdom
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Donin AS, Goldsmith LP, Sharp C, Wahlich C, Whincup PH, Ussher MH. Identifying barriers and facilitators to increase fibre intakes in UK primary school children and exploring the acceptability of intervention components: a UK qualitative study. Public Health Nutr 2024; 27:e59. [PMID: 38299336 PMCID: PMC10897578 DOI: 10.1017/s1368980024000089] [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: 07/20/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Within the UK, dietary fibre intakes are well below recommended intakes and associated with increased risk of obesity. This study aimed to explore the views of parents and children on barriers and facilitators to increasing fibre intakes and improving diets, alongside investigating the appropriateness of intervention components to overcome modifiable barriers. DESIGN Qualitative study including semi-structured interviews and focus groups informed by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model. PARTICIPANTS Year 5 children (aged 9-10-years) and parents, recruited through London primary schools. RESULTS A total of twenty-four participants (eleven parents and thirteen children) took part. Five key themes were identified as barriers and facilitators, namely lack of (and improving) knowledge, social factors (including parent-child conflicts, limited time for food preparation, influence of peer and family members), current eating habits, influence of the school, community and home environment in shaping eating behaviours, and the importance of choice and variety in finding foods that are healthy and tasty. Parents strongly supported school-based dietary interventions to enable consistent messaging at home and school and help support dietary behaviour change. Practical sessions (such as workshops to strengthen knowledge, taste tests and food swap ideas) were supported by parents and children. CONCLUSIONS By using a theory-driven approach to explore the barriers and facilitators to increasing fibre intake, this research identified important themes and modifiable barriers to behaviour change and identifies acceptable intervention components to overcome barriers and bring about sustained dietary behaviour change in primary school children.
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Affiliation(s)
- Angela S Donin
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Clare Sharp
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Peter H Whincup
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
| | - Michael H Ussher
- Population Health Research Institute, St George’s, University of London, LondonSW17 0RE, England, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland, UK
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Goldsmith LP, Roberts A, Flohr C, Boyle RJ, Ussher M, Perkin MR. Routine infant skincare advice in the UK: A cross-sectional survey. Clin Exp Allergy 2024; 54:56-60. [PMID: 37818752 DOI: 10.1111/cea.14407] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/05/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Lucy P Goldsmith
- Population Health Research Institute, St. George's University of London, London, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St. George's University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Michael R Perkin
- Population Health Research Institute, St. George's University of London, London, UK
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Demetriou CA, Achilleos S, Quattrocchi A, Gabel J, Critselis E, Constantinou C, Nicolaou N, Ambrosio G, Bennett CM, Le Meur N, Critchley JA, Mortensen LH, Rodriguez-Llanes JM, Chong M, Denissov G, Klepac P, Goldsmith LP, Costa AJL, Hagen TP, Chan Sun M, Huang Q, Pidmurniak N, Zucker I, Cuthbertson J, Burström B, Barron M, Eržen I, Stracci F, Calmon W, Martial C, Verstiuk O, Kaufman Z, Tao W, Kereselidze M, Chikhladze N, Polemitis A, Charalambous A. Impact of the COVID-19 pandemic on total, sex- and age-specific all-cause mortality in 20 countries worldwide during 2020: results from the C-MOR project. Int J Epidemiol 2023; 52:664-676. [PMID: 36029524 PMCID: PMC9452146 DOI: 10.1093/ije/dyac170] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. METHODS Total, sex- and age-specific weekly all-cause mortality for 2015-2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015-2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. RESULTS Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the <45 age group. CONCLUSIONS This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.
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Affiliation(s)
- Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - John Gabel
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Elena Critselis
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicoletta Nicolaou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Giuseppe Ambrosio
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | | | - Nolwenn Le Meur
- University of Rennes, EHESP, CNRS, Inserm, Arènes—UMR 6051, RSMS—U 1309, Rennes, France
| | - Julia A Critchley
- Population Health Research Institute, St George’s, University of London, London, UK
| | | | | | - Mario Chong
- Departamento de Ingeniería, Universidad del Pacífico, Lima, Peru
| | - Gleb Denissov
- Estonian Causes of Death Registry, National institute for Health Development, Tallinn, Estonia
| | - Petra Klepac
- Department of Communicable Diseases, National Institute of Public Health, Ljubljana, Slovenia
| | - Lucy P Goldsmith
- Institute for Infection and Immunity, and Population Health Research Institute, St George's, University of London, London, UK
| | - Antonio José Leal Costa
- Institute of Studies in Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Terje P Hagen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marie Chan Sun
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Mauritius, Réduit, Mauritius
| | - Qian Huang
- Department of Geography, Center for Rural and Primary Healthcare, University of South Carolina, Columbia, SC, USA
| | - Nataliia Pidmurniak
- Department of Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Inbar Zucker
- School of Public Health, Ministry of Health, Ramat Gan, Israel
| | - Joseph Cuthbertson
- Disaster Resilience Initiative, Monash University, Clayton,VIC, Australia
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manuel Barron
- Department of Economics, Universidad del Pacifico Av Sanchez Cerro, Lima, Peru
| | - Ivan Eržen
- School of Public Health, National Institute of Public Health, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Fabrizio Stracci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi, Perugia, Italy
| | - Wilson Calmon
- Institute of Mathematics and Statistics, Fluminense Federal University, Niteroi, Brazil
| | - Cyndy Martial
- Department of Demography, Statistics Mauritius, LIC Centre, Port Louis, Mauritius
| | | | - Zalman Kaufman
- Israeli Center of Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Wenjing Tao
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and SURGERY, Karolinska Institutet, Stockholm, Sweden
| | - Maia Kereselidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nino Chikhladze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
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Magee L, Goldsmith LP, Chaudhry UAR, Donin AS, Wahlich C, Stovold E, Nightingale CM, Rudnicka AR, Owen CG. Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:1084-1097. [PMID: 36094530 PMCID: PMC9468945 DOI: 10.1001/jamapediatrics.2022.3172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022]
Abstract
Importance Adequate sleep duration is necessary for many aspects of child health, development, and well-being, yet sleep durations for children are declining, and effective strategies to increase sleep in healthy children remain to be elucidated. Objective To determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions. Data Sources CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021. Study Selection Randomized clinical trials of interventions to improve sleep duration in healthy children were independently screened by 2 researchers. A total of 28 478 studies were identified. Data Extraction and Synthesis Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Random-effects meta-analytic models were used to estimate pooled effect sizes. Main Outcomes and Measures Difference in sleep duration, measured in minutes. Results A total of 13 539 child participants from 45 randomized clinical trials were included. Of these, 6897 (50.9%) were in the intervention group and 6642 (49.1%) in the control group, and the mean age ranged from 18 months to 19 years. Pooled results indicate that sleep interventions were associated with 10.5 minutes (95% CI, 5.6-15.4) longer nocturnal sleep duration. There was substantial variation between trials. Sources of variation that were not associated with the study effect size included age group, whether the population was identified as having a sleep problem or being at a socioeconomic disadvantage (eg, coming from a low-income family or area), method of assessment of sleep duration (objective vs subjective), location of intervention delivery (home vs school), whether interventions were delivered in person or used parental involvement, whether behavioral theory was used, environmental change, or had greater or lower intensity. Interventions that included earlier bedtimes were associated with a 47-minute sleep extension (95% CI, 18.9-75.0; 3 trials) compared with remaining studies (7.4 minutes; 95% CI, 2.9-11.8; 42 trials) (P = .006 for group difference). Trials of shorter duration (6 months or less) had larger effects. Conclusions and Relevance Interventions focused on earlier bedtimes may offer a simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.
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Affiliation(s)
- Lucia Magee
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Lucy P. Goldsmith
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Umar A. R. Chaudhry
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Angela S. Donin
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Charlotte Wahlich
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Elizabeth Stovold
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Claire M. Nightingale
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Alicja R. Rudnicka
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Christopher G. Owen
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
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10
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Hargreaves S, Goldsmith LP, Rowland-Pomp M, Hanson K, Deal A, Crawshaw AF, Ahmad A, Razai M, Vandrevala T. The use of social media platforms by migrant populations during the COVID-19 pandemic. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The rapid expansion of internet and social media use has meant that both useful and potentially harmful health information can spread rapidly. Groups experiencing barriers to health systems may be more reliant on social media as a source of health information. We did a systematic review to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake.
Methods
We reviewed published and grey literature following PRISMA guidelines (PROSPERO registered CRD42021259190). Global research was included that reported on the use of social media by migrants and/or ethnic minority groups in relation to COVID-19.
Results
1849 unique records were screened, and 21 data sources included in our analysis involving studies from the UK, US, China, Jordan, Qatar, and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. There were positive and negative associations with social media use reported, with some evidence suggesting circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings of which are likely relevant to multiple population groups.
Conclusions
Urgent actions and further research are now needed to better understand the use of social media platforms for accessing health information by groups who may be marginalised from health systems, effective approaches to tackling circulating misinformation, and to seize on opportunities to make better use of social media platforms to support public health communication.
Key messages
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - M Rowland-Pomp
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - K Hanson
- Faculty of Health, Social Care and Education, Kingston University & St George’s , London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - AF Crawshaw
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Ahmad
- Population Health Research Institute, St George's University of London , London, UK
| | - M Razai
- Population Health Research Institute, St George's University of London , London, UK
| | - T Vandrevala
- Faculty of Health, Social Care and Education, Kingston University & St George’s , London, UK
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11
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Deal A, Crawshaw AC, Salloum M, Hayward SE, Knights F, Goldsmith LP, Carter J, Rustage K, Mounier-Jack S, Hargreaves S. Strategies to increase catch-up vaccination among migrants: a qualitative study and rapid review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
WHO’s Immunization Agenda 2030 has placed renewed focus on catch-up vaccination across the life course to meet global targets for reduction in vaccine-preventable diseases through increased vaccine coverage, including among migrant groups who may require catch-up vaccination to align them with host country vaccination schedules.
Methods
We did a global rapid review (01/2010 to 04/2022) to explore drivers of vaccine hesitancy among migrants followed by an in-depth qualitative study (semi-structured, telephone interviews) among recently arrived adult migrants (foreign-born, >18 years old, residing in the UK < 10 years). Interviews explored views on routine vaccination including accessibility, confidence and awareness. Data were analysed iteratively using thematic analysis.
Results
63 papers were included in the rapid review, including data from 22 countries/regions. Multiple factors driving under-immunisation and hesitancy in migrants were reported, including language barriers, low health literacy, social exclusion, low cultural competency and accessibility in healthcare systems. Our qualitative study recruited 40 migrants (mean age: 36.7 years; 62.5% female) resident in the UK (6 refugees, 19 asylum-seekers, 8 undocumented, 7 labour migrants). Major barriers to catch-up vaccination included a lack of provider recommendation and low awareness, with vaccination viewed as only relevant to children. Hesitancy around specific vaccines, such as MMR, was often influenced by misinformation. Participants suggested that novel strategies such as walk-in or mobile access points, consistent provider recommendations, and translation of information into relevant languages, may enhance accessibility and uptake of routine vaccinations.
Conclusions
Targeted and tailored information campaigns, versatile and proactive access pathways and education for healthcare staff on cultural competency will be needed to ensure uptake of catch-up vaccination among marginalised migrant groups.
Key messages
• Newly arrived adult migrants face barriers to catch-up vaccination in host countries, which may hinder immunisation coverage and increase the risk of vaccine-preventable disease outbreaks.
• Health systems must develop novel mechanisms to proactively offer culturally competent and accessible catch-up vaccination services to adult migrants on and after arrival.
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Affiliation(s)
- A Deal
- Institute for Infection and Immunity, St George’s, University of London , London, UK
- Faculty of Public Health and Policy, LSHTM , London, UK
| | - AC Crawshaw
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - M Salloum
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - SE Hayward
- Institute for Infection and Immunity, St George’s, University of London , London, UK
- Faculty of Public Health and Policy, LSHTM , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - J Carter
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | | | - S Hargreaves
- Institute for Infection and Immunity, St George’s, University of London , London, UK
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12
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Crawshaw AF, Farah Y, Deal A, Rustage K, Hayward SE, Carter J, Knights F, Goldsmith LP, Campos-Matos I, Wurie F, Majeed A, Bedford H, Forster AS, Hargreaves S. Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review. Lancet Infect Dis 2022; 22:e254-e266. [PMID: 35429463 DOI: 10.1101/2021.11.08.21266058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 05/18/2023]
Abstract
Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers-including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals-for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.
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Affiliation(s)
- Alison F Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Yasmin Farah
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kieran Rustage
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK; UK Health Security Agency, London, UK
| | - Fatima Wurie
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK; UK Health Security Agency, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Helen Bedford
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
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13
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Husain F, Powys VR, White E, Jones R, Goldsmith LP, Heath PT, Oakeshott P, Razai MS. COVID-19 vaccination uptake in 441 socially and ethnically diverse pregnant women. PLoS One 2022; 17:e0271834. [PMID: 35976810 PMCID: PMC9385003 DOI: 10.1371/journal.pone.0271834] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To explore COVID-19 vaccination uptake, facilitators and barriers in ethnically-diverse pregnant women. Design and setting An anonymous quality improvement questionnaire survey exploring COVID-19 vaccination uptake, causes of vaccine hesitancy and trusted sources of information among pregnant women in two acute district general hospitals in England (Berkshire and Surrey) between 1.9.21 and 28.2.22. Population 441 pregnant women attending routine antenatal clinic appointments. Methods Consented pregnant women completed the survey either electronically using a QR code or on paper. Descriptive data were summarised and free text responses were thematically analysed. Results 441 pregnant women, mean age 32 years (range 17–44), completed the survey. Twenty-six percent were from ethnic minority groups, and 31% had a co-morbid health condition. Most respondents (66.2%) had been vaccinated against COVID-19 with at least one dose (White British 71.9%, Asian 67.9%, White-other 63.6%, Black 33%). The most common reasons for not being vaccinated were concerns about effects on the unborn baby and future pregnancies, anxiety about possible adverse impact on the mother, not enough known about the vaccine, and lack of trust in vaccines. Comments included: “I’d rather not risk injecting the unknown into my body”, and “I don’t trust it.” Although 23% used social media for information on COVID-19 vaccination, the most trusted sources were the patient’s GP and midwife (43%) and official health-related websites such as NHS (39%). Conclusions A third of these pregnant women had not been vaccinated against COVID-19. Trusted health professionals like midwives and GPs could have a crucial role in increasing vaccination uptake.
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Affiliation(s)
- Fatima Husain
- Department of Obstetrics and Gynaecology, Wexham Park Hospital, Frimley Health Foundation Trust, Frimley, United Kingdom
| | - Veronica R. Powys
- Department of Obstetrics and Gynaecology, Wexham Park Hospital, Frimley Health Foundation Trust, Frimley, United Kingdom
| | - Eleanor White
- Department of Obstetrics and Gynaecology, Wexham Park Hospital, Frimley Health Foundation Trust, Frimley, United Kingdom
| | - Roxanne Jones
- Department of Obstetrics and Gynaecology, Wexham Park Hospital, Frimley Health Foundation Trust, Frimley, United Kingdom
| | - Lucy P. Goldsmith
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Paul T. Heath
- Vaccine Institute, St. George’s, University of London, London, United Kingdom
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Mohammad Sharif Razai
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- * E-mail:
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14
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Anderson K, Goldsmith LP, Lomani J, Ali Z, Clarke G, Crowe C, Jarman H, Johnson S, McDaid D, Pariza P, Park AL, Smith JA, Stovold E, Turner K, Gillard S. Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis. BJPsych Open 2022; 8:e144. [PMID: 35876075 PMCID: PMC9344431 DOI: 10.1192/bjo.2022.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units. AIMS This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units. METHOD We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies - of Interventions and Risk of Bias in Randomized Trials. RESULTS Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI -261.24 to -67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43-0.68; P < 0.001). CONCLUSIONS Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.
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Affiliation(s)
- Katie Anderson
- Division of Nursing, School of Health Sciences, City, University of London, UK
| | - Lucy P Goldsmith
- Division of Nursing, School of Health Sciences, City, University of London, UK
| | - Jo Lomani
- Division of Nursing, School of Health Sciences, City, University of London, UK
| | - Zena Ali
- Library Services, St George's, University of London, UK
| | | | - Chloe Crowe
- Sunflowers Court, North East London NHS Foundation Trust, UK
| | - Heather Jarman
- Emergency Care, St George's University Hospitals NHS Foundation Trust, London; and Population Health Research Institute, St George's, University of London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Paris Pariza
- Collabor8research, London, UK; and Division of Nursing, School of Health Sciences, City, University of London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Jared A Smith
- Population Health Research Institute, St George's, University of London, UK
| | - Elizabeth Stovold
- Population Health Research Institute, St George's, University of London, UK
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, UK
| | - Steve Gillard
- Division of Nursing, School of Health Sciences, City, University of London, UK
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15
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Gillard S, Foster R, White S, Barlow S, Bhattacharya R, Binfield P, Eborall R, Faulkner A, Gibson S, Goldsmith LP, Simpson A, Lucock M, Marks J, Morshead R, Patel S, Priebe S, Repper J, Rinaldi M, Ussher M, Worner J. The impact of working as a peer worker in mental health services: a longitudinal mixed methods study. BMC Psychiatry 2022; 22:373. [PMID: 35650562 PMCID: PMC9158348 DOI: 10.1186/s12888-022-03999-9] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peer workers are increasingly employed in mental health services to use their own experiences of mental distress in supporting others with similar experiences. While evidence is emerging of the benefits of peer support for people using services, the impact on peer workers is less clear. There is a lack of research that takes a longitudinal approach to exploring impact on both employment outcomes for peer workers, and their experiences of working in the peer worker role. METHODS In a longitudinal mixed methods study, 32 peer workers providing peer support for discharge from inpatient to community mental health care - as part of a randomised controlled trial - undertook in-depth qualitative interviews conducted by service user researchers, and completed measures of wellbeing, burnout, job satisfaction and multi-disciplinary team working after completing training, and four and 12 months into the role. Questionnaire data were summarised and compared to outcomes for relevant population norms, and changes in outcomes were analysed using paired t-tests. Thematic analysis and interpretive workshops involving service user researchers were used to analysis interview transcripts. A critical interpretive synthesis approach was used to synthesise analyses of both datasets. RESULTS For the duration of the study, all questionnaire outcomes were comparable with population norms for health professionals or for the general population. There were small-to-medium decreases in wellbeing and aspects of job satisfaction, and increase in burnout after 4 months, but these changes were largely not maintained at 12 months. Peer workers felt valued, empowered and connected in the role, but could find it challenging to adjust to the demands of the job after initial optimism. Supervision and being part of a standalone peer worker team was supportive, although communication with clinical teams could be improved. CONCLUSIONS Peer workers seem no more likely to experience negative impacts of working than other healthcare professionals but should be well supported as they settle into post, provided with in-work training and support around job insecurity. Research is needed to optimise working arrangements for peer workers alongside clinical teams.
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Affiliation(s)
| | - Rhiannon Foster
- grid.28577.3f0000 0004 1936 8497City, University of London, London, UK
| | - Sarah White
- grid.264200.20000 0000 8546 682XSt George’s, University of London, London, UK
| | - Sally Barlow
- grid.28577.3f0000 0004 1936 8497City, University of London, London, UK
| | - Rahul Bhattacharya
- grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, London, UK
| | - Paul Binfield
- grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, London, UK
| | - Rachel Eborall
- grid.37640.360000 0000 9439 0839South London & Maudsley NHS Foundation Trust, London, UK
| | | | - Sarah Gibson
- grid.264200.20000 0000 8546 682XSt George’s, University of London, London, UK
| | - Lucy P. Goldsmith
- grid.264200.20000 0000 8546 682XSt George’s, University of London, London, UK
| | - Alan Simpson
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Mike Lucock
- grid.15751.370000 0001 0719 6059University of Huddersfield, Huddersfield, UK
| | - Jacqui Marks
- grid.264200.20000 0000 8546 682XSt George’s, University of London, London, UK
| | - Rosaleen Morshead
- grid.264200.20000 0000 8546 682XSt George’s, University of London, London, UK
| | - Shalini Patel
- grid.439450.f0000 0001 0507 6811South West London & St George’s Mental Health NHS Trust, London, UK
| | - Stefan Priebe
- grid.4868.20000 0001 2171 1133Queen Mary, University of London, London, UK
| | - Julie Repper
- Implementing Recovery through Organisational Change, Nottingham, UK
| | - Miles Rinaldi
- grid.439450.f0000 0001 0507 6811South West London & St George’s Mental Health NHS Trust, London, UK
| | - Michael Ussher
- grid.264200.20000 0000 8546 682XSt George’s, University of London, London, UK ,grid.11918.300000 0001 2248 4331University of Stirling, Stirling, UK
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16
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Deal A, Hayward SE, Crawshaw AF, Goldsmith LP, Hui C, Dalal W, Wurie F, Bautista MA, Lebanan MA, Agan S, Hassan FA, Wickramage K, Campos-Matos I, Hargreaves S. Immunisation status of UK-bound refugees between January, 2018, and October, 2019: a retrospective, population-based cross-sectional study. The Lancet Public Health 2022; 7:e606-e615. [PMID: 35636439 PMCID: PMC9581781 DOI: 10.1016/s2468-2667(22)00089-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background WHO's new Immunization Agenda 2030 places a focus on ensuring migrants and other marginalised groups are offered catch-up vaccinations across the life-course. Yet, it is not known to what extent specific groups, such as refugees, are immunised according to host country schedules, and the implications for policy and practice. We aimed to assess the immunisation coverage of UK-bound refugees undergoing International Organization for Migration (IOM) health assessments through UK resettlement schemes, and calculate risk factors for under-immunisation. Methods We undertook a retrospective cross-sectional study of all refugees (children <10 years, adolescents aged 10–19 years, and adults >19 years) in the UK resettlement programme who had at least one migration health assessment conducted by IOM between Jan 1, 2018 and Oct 31, 2019, across 18 countries. Individuals' recorded vaccine coverage was calculated and compared with the UK immunisation schedule and the UK Refugee Technical Instructions. We carried out multivariate logistic regression analyses to assess factors associated with varying immunisation coverage. Findings Our study included 12 526 refugees of 36 nationalities (median age 17 years [IQR 7–33]; 6147 [49·1%] female; 7955 [63·5%] Syrian nationals). 26 118 vaccine doses were administered by the IOM (most commonly measles, mumps, and rubella [8741 doses]). During the study, 6870 refugees departed for the UK, of whom 5556 (80·9%) had at least one recorded dose of measles-containing vaccine and 5798 (84·4%) had at least one dose of polio vaccine, as per the UK Refugee Technical Instructions, and 1315 (19·1%) had at least one recorded dose of diphtheria-containing vaccine or tetanus-containing vaccine. 764 (11·1%) of refugees were fully aligned with the UK schedule for polio, compared with 2338 (34·0%) for measles and 380 (5·5%) for diphtheria and tetanus. Adults were significantly less likely than children to be in line with the UK immunisation schedule for polio (odds ratio 0·0013, 95% CI 0·0001–0·0052) and measles (0·29, 0·25–0·32). Interpretation On arrival to the UK, refugees' recorded vaccination coverage is suboptimal and varies by age, nationality, country of health assessment, and by disease, with particularly low coverage reported for diphtheria and tetanus, and among adult refugees. These findings have important implications for the delivery of refugee pre-entry health assessments and catch-up vaccination policy and delivery targeting child, adolescent, and adults migrants in the UK, and other refugee-receiving countries. This research highlights the need for improved data sharing and clearer definition of where responsibilities lie between host countries and health assessment providers. Funding UK National Institute for Health Research (NIHR300072) and Medical Research Council (MR/N013638/1).
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Crawshaw AF, Farah Y, Deal A, Rustage K, Hayward SE, Carter J, Knights F, Goldsmith LP, Campos-Matos I, Wurie F, Majeed A, Bedford H, Forster AS, Hargreaves S. Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review. The Lancet Infectious Diseases 2022; 22:e254-e266. [PMID: 35429463 PMCID: PMC9007555 DOI: 10.1016/s1473-3099(22)00066-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
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Crawshaw AF, Farah Y, Deal A, Goldsmith LP, Carter J, Rustage K, Campos-Matos I, Vandrevala T, Forster AS, Hargreaves S. Analysing drivers of routine and COVID-19 vaccination in migrants to develop tailored interventions. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrant-sensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic.
Methods
We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out.
Results
We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns about side-effects, and cultural beliefs/stigma around specific vaccinations. Migrants who had recently arrived, were older, female or of African and Eastern Mediterranean origin were at risk for under-immunisation for key vaccine-preventable diseases. Migrant community leaders reported considerable hesitancy towards COVID-19 vaccination in their communities and misinformation circulating via social media. Leaders requested support in producing simple COVID-19 guidance that could be translated and adapted locally, alongside more meaningful engagement and partnership-working.
Conclusions
Access barriers and vaccine hesitancy may affect vaccine uptake in some migrant populations in Europe, which needs to be urgently addressed for COVID-19 vaccine roll-out but also beyond the pandemic to strengthen uptake of routine vaccinations. Actively involving migrant communities in the planning, co-production and implementation of tailored and targeted approaches will be essential.
On behalf of ESGITM.
Key messages
Access barriers and vaccine hesitancy (from information gaps, cultural factors) contribute to low vaccine uptake in some migrant populations in the EU/EEA, with implications for COVID-19 vaccination. Meaningful engagement and co-production of tailored approaches with under-immunised migrants are urgently needed to ensure their inclusion in COVID-19 and routine vaccination programmes.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Y Farah
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - I Campos-Matos
- Health Improvement Division, Public Health England, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - T Vandrevala
- Department of Psychology, Kingston University London, London, UK
| | - AS Forster
- Department of Behavioural Science and Health, University College London, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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Goldsmith LP, Anderson K, Clarke G, Crowe C, Jarman H, Johnson S, Lloyd-Evans B, Lomani J, McDaid D, Park AL, Smith JA, Turner K, Gillard S. The psychiatric decision unit as an emerging model in mental health crisis care: a national survey in England. Int J Ment Health Nurs 2021; 30:955-962. [PMID: 33630402 DOI: 10.1111/inm.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/11/2020] [Revised: 01/14/2021] [Accepted: 01/31/2021] [Indexed: 12/25/2022]
Abstract
Psychiatric decision units have been developed in many countries internationally to address the pressure on inpatient services and dissatisfactory, long waits people in mental health crisis can experience in emergency departments. Research into these units lags behind their development, as they are implemented by healthcare providers to address these problems. This is the first-ever national survey to identify their prevalence, structure, activities, and contextual setting within health services, in order to provide a robust basis for future research. The response rate was high (94%), and six PDUs in England were identified. The results indicated that PDUs open 24/7, accept only voluntary patients, provide recliner chairs for sleeping rather than beds, and limit stays to 12-72 hours. PDUs are predominantly staffed by senior, qualified mental health nurses and healthcare assistants, with psychiatry input. Staff:patient ratios are high (1:2.1 during the day shift). Differences in PDU structure and activities (including referral pathway, length of stay, and staff:patient ratios) were identified, suggesting the optimal configuration for PDUs has not yet been established. Further research into the efficacy of this innovation is needed; PDUs potentially have a role in an integrated crisis care pathway which provides a variety of care options to service users.
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Affiliation(s)
- Lucy P Goldsmith
- Division of Nursing, School of Health Sciences, City, University of London, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
| | - Katie Anderson
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
| | | | - Chloe Crowe
- North East London NHS Foundation Trust, CEME Centre- West Wing, Rainham, Essex, UK
| | - Heather Jarman
- Division of Nursing, School of Health Sciences, City, University of London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jo Lomani
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jared A Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, London, UK
| | - Steve Gillard
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
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Achilleos S, Quattrocchi A, Gabel J, Heraclides A, Kolokotroni O, Constantinou C, Pagola Ugarte M, Nicolaou N, Rodriguez-Llanes JM, Bennett CM, Bogatyreva E, Schernhammer E, Zimmermann C, Costa AJL, Lobato JCP, Fernandes NM, Semedo-Aguiar AP, Jaramillo Ramirez GI, Martin Garzon OD, Mortensen LH, Critchley JA, Goldsmith LP, Denissov G, Rüütel K, Le Meur N, Kandelaki L, Tsiklauri S, O'Donnell J, Oza A, Kaufman Z, Zucker I, Ambrosio G, Stracci F, Hagen TP, Erzen I, Klepac P, Arcos González P, Fernández Camporro Á, Burström B, Pidmurniak N, Verstiuk O, Huang Q, Mehta NK, Polemitis A, Charalambous A, Demetriou CA. Excess all-cause mortality and COVID-19-related mortality: a temporal analysis in 22 countries, from January until August 2020. Int J Epidemiol 2021; 51:35-53. [PMID: 34282450 PMCID: PMC8344815 DOI: 10.1093/ije/dyab123] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 01/22/2023] Open
Abstract
Background This study aimed to investigate overall and sex-specific excess all-cause mortality since the inception of the COVID-19 pandemic until August 2020 among 22 countries. Methods Countries reported weekly or monthly all-cause mortality from January 2015 until the end of June or August 2020. Weekly or monthly COVID-19 deaths were reported for 2020. Excess mortality for 2020 was calculated by comparing weekly or monthly 2020 mortality (observed deaths) against a baseline mortality obtained from 2015–2019 data for the same week or month using two methods: (i) difference in observed mortality rates between 2020 and the 2015–2019 average and (ii) difference between observed and expected 2020 deaths. Results Brazil, France, Italy, Spain, Sweden, the UK (England, Wales, Northern Ireland and Scotland) and the USA demonstrated excess all-cause mortality, whereas Australia, Denmark and Georgia experienced a decrease in all-cause mortality. Israel, Ukraine and Ireland demonstrated sex-specific changes in all-cause mortality. Conclusions All-cause mortality up to August 2020 was higher than in previous years in some, but not all, participating countries. Geographical location and seasonality of each country, as well as the prompt application of high-stringency control measures, may explain the observed variability in mortality changes.
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Affiliation(s)
- Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - John Gabel
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Alexandros Heraclides
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Ourania Kolokotroni
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Nicoletta Nicolaou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | | | | | - Ekaterina Bogatyreva
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Eva Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Zimmermann
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Antonio Jose Leal Costa
- Institute of Studies in Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Ana Paula Semedo-Aguiar
- Nature, Life and Environment Sciences Department, University Jean Piaget of Cape Verde, Praia, Cape Verde
| | | | | | - Laust Hvas Mortensen
- Department of Public Health, University of Copenhagen, Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Gleb Denissov
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Kristi Rüütel
- Department of Drug and Infectious Diseases Epidemiology, National Institute for Health Development, Tallinn, Estonia
| | - Nolwenn Le Meur
- University of Rennes, EHESP, REPERES-EA 7449, Rennes, France
| | - Levan Kandelaki
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Joan O'Donnell
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - Ajay Oza
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - Zalman Kaufman
- Israel Center of Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- Israel Center of Disease Control, Ministry of Health, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giuseppe Ambrosio
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy.,CERICLET- Interdepartmental Center for Clinical and Translational Research, University of Perugia School of Medicine, Perugia, Italy
| | - Fabrizio Stracci
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Ivan Erzen
- Public Health School, National Institute of Public Health, Ljubljana, Slovenia
| | - Petra Klepac
- Communicable Diseases, National Institute of Public Health, Ljubljana, Slovenia
| | | | | | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Olesia Verstiuk
- Faculty of Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Qian Huang
- SC Center for Rural and Primary Health Care and Department of Geography, University of South Carolina, Columbia, SC, USA
| | - Neil Kishor Mehta
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
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Etti M, Fofie H, Razai M, Crawshaw AF, Hargreaves S, Goldsmith LP. Ethnic minority and migrant underrepresentation in Covid-19 research: Causes and solutions. EClinicalMedicine 2021; 36:100903. [PMID: 34095791 PMCID: PMC8164390 DOI: 10.1016/j.eclinm.2021.100903] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Hazel Fofie
- St George's University of London, London, UK
| | | | - Alison F. Crawshaw
- Migrant Health and Participatory Research, St George's University of London, London, UK
| | | | - Lucy P. Goldsmith
- Global Health, St George's University of London, London, UK
- Corresponding author.
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Goldsmith LP, Smith JG, Clarke G, Anderson K, Lomani J, Turner K, Gillard S. What is the impact of psychiatric decision units on mental health crisis care pathways? Protocol for an interrupted time series analysis with a synthetic control study. BMC Psychiatry 2020; 20:185. [PMID: 32326915 PMCID: PMC7178744 DOI: 10.1186/s12888-020-02581-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK mental health system is stretched to breaking point. Individuals presenting with mental health problems wait longer at the ED than those presenting with physical concerns and finding a bed when needed is difficult - 91% of psychiatric wards are operating at above the recommended occupancy rate. To address the pressure, a new type of facility - psychiatric decision units (also known as mental health decision units) - have been introduced in some areas. These are short-stay facilities, available upon referral, targeted to help individuals who may be able to avoid an inpatient admission or lengthy ED visit. To advance knowledge about the effectiveness of this service for this purpose, we will examine the effect of the service on the mental health crisis care pathway over a 4-year time period; the 2 years proceeding and following the introduction of the service. We use aggregate service level data of key indicators of the performance of this pathway. METHODS Data from four mental health Trusts in England will be analysed using an interrupted time series (ITS) design with the primary outcomes of the rate of (i) ED psychiatric presentations and (ii) voluntary admissions to mental health wards. This will be supplemented with a synthetic control study with the same primary outcomes, in which a comparable control group is generated for each outcome using a donor pool of suitable National Health Service Trusts in England. The methods are well suited to an evaluation of an intervention at a service delivery level targeting population-level health outcome and the randomisation or 'trialability' of the intervention is limited. The synthetic control study controls for national trends over time, increasing our confidence in the results. The study has been designed and will be carried out with the involvement of service users and carers. DISCUSSION This will be the first formal evaluation of psychiatric decision units in England. The analysis will provide estimates of the effect of the decision units on a number of important service use indicators, providing much-needed information for those designing service pathways. TRIAL REGISTRATION primary registry: isrctn.com Identifying number: ISRCTN77588384 Link: Date of registration in primary registry: 27/02/2020. PRIMARY SPONSOR St George's, University of London, Cramner Road, Tooting, SW17 ORE. Primary contact: Joe Montebello.
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Affiliation(s)
- L P Goldsmith
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK.
| | - J G Smith
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - G Clarke
- The Health Foundation, 8 Salisbury Square, London, UK
| | - K Anderson
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - J Lomani
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - K Turner
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - S Gillard
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
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Goldsmith LP, Dunn G, Bentall RP, Lewis SW, Wearden AJ. Correction: Therapist Effects and the Impact of Early Therapeutic Alliance on Symptomatic Outcome in Chronic Fatigue Syndrome. PLoS One 2016; 11:e0157199. [PMID: 27249413 PMCID: PMC4889075 DOI: 10.1371/journal.pone.0157199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0144623.].
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Goldsmith LP, Dunn G, Bentall RP, Lewis SW, Wearden AJ. Correction: Therapist Effects and the Impact of Early Therapeutic Alliance on Symptomatic Outcome in Chronic Fatigue Syndrome. PLoS One 2016; 11:e0156120. [PMID: 27191956 PMCID: PMC4871525 DOI: 10.1371/journal.pone.0156120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0144623.].
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Goldsmith LP, Dunn G, Bentall RP, Lewis SW, Wearden AJ. Therapist Effects and the Impact of Early Therapeutic Alliance on Symptomatic Outcome in Chronic Fatigue Syndrome. PLoS One 2015; 10:e0144623. [PMID: 26657793 PMCID: PMC4685991 DOI: 10.1371/journal.pone.0144623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 11/19/2015] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Few studies have examined therapist effects and therapeutic alliance (TA) in treatments for chronic fatigue syndrome (CFS). Therapist effects are the differences in outcomes achieved by different therapists. TA is the quality of the bond and level of agreement regarding the goals and tasks of therapy. Prior research suffers the methodological problem that the allocation of therapist was not randomized, meaning therapist effects may be confounded with selection effects. We used data from a randomized controlled treatment trial of 296 people with CFS. The trial compared pragmatic rehabilitation (PR), a nurse led, home based self-help treatment, a counselling-based treatment called supportive listening (SL), with general practitioner treatment as usual. Therapist allocation was randomized. Primary outcome measures, fatigue and physical functioning were assessed blind to treatment allocation. TA was measured in the PR and SL arms. Regression models allowing for interactions were used to examine relationships between (i) therapist and therapeutic alliance, and (ii) therapist and average treatment effect (the difference in mean outcomes between different treatment conditions). We found no therapist effects. We found no relationship between TA and the average treatment effect of a therapist. One therapist formed stronger alliances when delivering PR compared to when delivering SL (effect size 0.76, SE 0.33, 95% CI 0.11 to 1.41). In these therapies for CFS, TA does not influence symptomatic outcome. The lack of significant therapist effects on outcome may result from the trial's rigorous quality control, or random therapist allocation, eliminating selection effects. Further research is needed. TRIAL REGISTRATION ISRCTN74156610.
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Affiliation(s)
- Lucy P. Goldsmith
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- School of Health and Human Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Richard P. Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Shôn W. Lewis
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Alison J. Wearden
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
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Goldsmith LP. The scope of surgery in endodontics for the retention of anterior and posterior teeth. 2. Dent Dig 1970; 76:512-7. [PMID: 5275197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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27
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Goldsmith LP. The scope of surgery in endodontics for the retention of anterior and posterior teeth. I. Dent Dig 1970; 76:467-9. [PMID: 5273648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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