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Alashek WA, Ali SA. Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review. Libyan J Med 2024; 19:2301829. [PMID: 38197179 PMCID: PMC10783830 DOI: 10.1080/19932820.2024.2301829] [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: 09/01/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024] Open
Abstract
Background: Telemedicine became a fundamental part of healthcare provision during COVID-19 pandemic. An evaluation of telemedicine-associated satisfaction helps the service develop more viable applications. This review evaluated the satisfaction of healthcare users and providers and their willingness to use this modality in future.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search on empirical articles published between March 2020 and December 2022 was performed on 'PubMed' and 'Scopus' databases. Findings that reported on satisfaction of patients, families and caregivers as well as clinicians were extracted and analysed. Quality of included studies was assessed. After applying inclusion and exclusion criteria, the review included 27 eligible studies.Results: Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare. Almost all studies were undertaken within the NHS. There were many tools that measured satisfaction. Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%. Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information. Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people. In general, willingness to use telemedicine in future was high in the recipients as well as the providers of healthcare.Conclusion: COVID-19 pandemic has transformed healthcare in the UK and promoted a revolution in telemedicine applications. Satisfaction was high among both recipient and provider of healthcare. Telemedicine managed to provide a continued care throughout the pandemic while maintaining social distance. The current review presented commendable evidence to encourage different specialities to engage in telemedicine application.
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Affiliation(s)
- WA. Alashek
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - SA. Ali
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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2
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Schneider P, Devlin N, van Hout B, Brazier J. Exploring health preference heterogeneity in the UK: Using the online elicitation of personal utility functions approach to construct EQ-5D-5L value functions on societal, group and individual level. Health Econ 2024; 33:894-910. [PMID: 38243895 DOI: 10.1002/hec.4805] [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: 08/25/2022] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024]
Abstract
A new method has recently been developed for valuing health states, called 'Online elicitation of Personal Utility Functions' (OPUF). In contrast to established methods, such as time trade-off or discrete choice experiments, OPUF does not require hundreds of respondents, but allows estimating utility functions for small groups and even at the individual level. In this study, we used OPUF to elicit EQ-5D-5L health state preferences from a (not representative) sample of the UK general population, and then compared utility functions on the societal-, group-, and individual level. A demo version of the survey is available at: https://eq5d5l.me. Data from 874 respondents were included in the analysis. For each respondent, we constructed a personal EQ-5D-5L value set. These personal value sets predicted respondents' choices in three hold-out discrete choice tasks with an accuracy of 78%. Overall, preferences varied greatly between individuals. However, PERMANOVA analysis showed that demographic characteristics explained only a small proportion of the variability between subgroups. While OPUF is still under development, it has important strengths: it can be used to construct value sets for patient reported outcome instruments such as EQ-5D-5L, while also allowing examination of underlying preferences in an unprecedented level of detail. In the future, OPUF could be used to complement existing methods, allowing valuation studies in smaller samples, and providing more detailed insights into the heterogeneity of preferences across subgroups.
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Affiliation(s)
- Paul Schneider
- ScHARR, The University of Sheffield, Sheffield, UK
- Valorem Health, Bochum, Germany
| | - Nancy Devlin
- University of Melbourne, Melbourne, Victoria, Australia
| | - Ben van Hout
- ScHARR, The University of Sheffield, Sheffield, UK
- Open Health, York, UK
| | - John Brazier
- ScHARR, The University of Sheffield, Sheffield, UK
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3
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Uskul AK, Cila J, Gul P, Kirchner-Häusler A, Hubená B. Honour, acculturation and well-being: Evidence from the UK and Canada. Br J Soc Psychol 2024. [PMID: 38623702 DOI: 10.1111/bjso.12751] [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: 10/04/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
Adopting a social psychological approach, across three studies (N = 927) in two western immigrant-receiving societies (UK and Canada), we examined the role of honour in acculturation variables (i.e., immigrants' heritage and mainstream cultural orientation and well-being), controlling for some of the commonly studied predictors of immigrant adaptation. We assessed honour as concern (Studies 1 and 2) and as a desired attribute for men and women (Study 3) and studied well-being in terms of acculturative stress (Study 1) and subjective evaluation of one's life (Studies 1 and 3). We examined our questions among groups of immigrants originating from honour (Studies 1 and 2) and dignity cultural groups (Study 1) and from first- and second-generation immigrants (Study 3). Overall, despite some significant associations at the bivariate level between honour and acculturation outcomes, findings provided mixed support for the claim that honour (measured as concerns and cultural codes) plays a significant role in immigrant acculturation above and beyond commonly studied predictors of immigrant adaptation.
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Affiliation(s)
- Ayse K Uskul
- School of Psychology, University of Sussex, Brighton, UK
| | - Jorida Cila
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Pelin Gul
- Campus Fryslân, University of Groningen, Groningen, The Netherlands
| | | | - Barbora Hubená
- Department of Psychology, Masaryk University, Brno, Czech Republic
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4
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Dema E, Peters H, Gilleece Y, Thorne C. Residential and healthcare mobility during pregnancy among women living with HIV in the UK, 2009-2019. HIV Med 2024. [PMID: 38599574 DOI: 10.1111/hiv.13648] [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: 01/04/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The extent to which individuals living with HIV experience residential and healthcare mobility during pregnancy in the UK is unknown. We aimed to determine a minimum estimate of residential and healthcare mobility during pregnancy in people living with HIV in the UK in 2009-2019 to explore patterns of and factors associated with mobility and to assess whether mobility was associated with specific HIV outcomes. METHODS We analyzed data from the Integrated Screening Outcomes Surveillance Service to assess pregnancies with HIV in the UK and included livebirths and stillbirths with estimated delivery in 2009-2019. Residential mobility was defined as changing residential postcode between notification and delivery, and healthcare mobility was defined as changing NHS Trust or Strategic Health Authority (SHA) in that same timeframe. We used logistic regression to determine factors associated with residential and healthcare mobility and with detectable delivery viral load. RESULTS Among 10 305 pregnancies, 19.6% experienced residential mobility, 8.1% changed NHS Trust, and 4.5% changed SHA during pregnancy. Mobility was more likely to be experienced by younger women, migrants, and those with new antenatal diagnosis; residential but not healthcare mobility declined over time. In a fully adjusted model, mobility was not associated with having a detectable viral load at delivery. Higher proportions of infants were lost to follow-up after mobile pregnancies than after non-mobile pregnancies. CONCLUSIONS This analysis provides new knowledge on mobility during pregnancy in the context of HIV, but further research is needed to understand its broader impacts and its utility as a marker to help identify families requiring additional follow-up and support.
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Affiliation(s)
- Emily Dema
- Institute for Global Health, University College London, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Helen Peters
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Yvonne Gilleece
- Brighton & Sussex Medical School, Brighton, UK
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Claire Thorne
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Engler J, Filliter C, Montastruc F, Abenhaim H, Rej S, Renoux C. Risk of abnormal uterine bleeding associated with high-affinity compared with low-affinity serotonin and norepinephrine reuptake inhibitors. J Affect Disord 2024; 350:813-821. [PMID: 38246277 DOI: 10.1016/j.jad.2024.01.163] [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] [Received: 09/29/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Concerns have been raised about the potential association between selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) and the risk of abnormal uterine bleeding (AUB), which may be influenced by the affinity of SSRIs/SNRIs for serotonin transporter. Thus, we assessed whether SSRIs/SNRIs with high-affinity for serotonin transporter are associated with AUB compared to SSRIs/SNRIs with low-affinity in non-pregnant women. METHODS Using the UK Clinical Practice Research Datalink, we identified a cohort of women aged 15-24 years, newly prescribed a high- or low-affinity SSRI/SNRI between 1990 and 2019. Confounding was addressed using standardized morbidity ratio weighting. We used weighted Cox proportional hazards models to estimate the hazard ratio (HR) and 95 % confidence interval (CI) of AUB associated with high-affinity compared with low-affinity SSRIs/SNRIs. We assessed the risk of anemia as a secondary outcome. RESULTS The cohort included 156,307 users of high-affinity SSRIs/SNRIs and 102,631 users of low-affinity SSRIs/SNRIs. High-affinity SSRIs/SNRIs were not associated with an increased risk of AUB compared with low-affinity SSRIs/SNRIs (incidence rates: 46.3 versus 42.4 per 1000 person-years, respectively; HR 1.01, 95 % CI 0.93-1.09). Duration of use, age, and comorbidities did not modify the risk. However, high-affinity SSRIs/SNRIs were associated with an increased risk of anemia (HR 1.29, 95 % CI 1.04-1.61) compared with low-affinity SSRIs/SNRIs. LIMITATIONS Residual confounding may still be present. CONCLUSIONS The risk of AUB did not differ between high- and low-affinity SSRIs/SNRIs. However, the potential risk of anemia suggests the need for monitoring and further investigation of the risk of AUB with these medications.
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Affiliation(s)
- Julie Engler
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Christopher Filliter
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, Toulouse, France
| | - Haim Abenhaim
- Department of Obstetrics & Gynecology, McGill University, Montreal, Canada
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Christel Renoux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.
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Jidong DE, Ike TJ, Murshed M, Francis C, Mwankon SB, Jidong JE, Pwajok JY, Nyam PP, Husain N. Postnatal depression in British mothers of African and Caribbean origin: a randomised controlled trial of learning through play plus culturally adapted cognitive behaviour therapy compared with psychoeducation. Front Psychiatry 2024; 15:1383990. [PMID: 38606412 PMCID: PMC11007128 DOI: 10.3389/fpsyt.2024.1383990] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Background One in every three women worldwide experiences postnatal depression after childbirth, with long-term negative consequences on their children. The mainstream mental healthcare provision for British mothers of African/Caribbean origin is mostly unsuccessful due to a lack of culturally appropriate care. Methods The study adopts a mixed-methods randomised controlled trial (RCT) design. A 12-session (60 minutes each) of online Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) intervention was employed for treating postnatal depression in comparison with psychoeducation (PE). Participants aged 19-53 were screened for depression using the Patient Health Questionnaire (PHQ-9). N=130 participants who scored >5 on PHQ-9 were randomised into LTP+CaCBT (n=65) or PE (n=65) groups. N=12 focus groups (LTP+CaCBT, n=6; PE, n=6) and n=15 individual interviews (LTP+CaCBT, n=8; PE, n=7) were conducted, transcribed verbatim and analysed. Results Satisfaction with intervention (LTP+CaCBT, 72.9%; PE, 65.2%); retention rates (LTP+CaCBT, 91%; PE, 71%); reduction in postnatal depression was higher in LTP+CaCBT on PHQ-9 Md=1.00 with z= -4.046; compared to PE, Md=1.00 with z= -1.504. Both groups showed reduced levels of anxiety on GAD-7 with no significant difference. Emerging themes from the qualitative findings showed increased positive moods, reduced worries about parenting difficulties and the facilitative role of remote intervention. Conclusions LTP+CaCBT intervention is culturally appropriate and acceptable and reduces postnatal depression in British mothers of African/Caribbean origin. A fully powered RCT is recommended to evaluate the clinical and cost-effectiveness of LTP+CaCBT, including the child's outcomes compared with routine treatment as usual. Clinical trial registration www.ClinicalTrials.gov, identifier NCT04820920.
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Affiliation(s)
- Dung Ezekiel Jidong
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Tarela Juliet Ike
- School of Social Science, Humanity and Law (SSSHL), Department of Humanities and Social Sciences, Teesside University, Middlesbrough, United Kingdom
| | | | | | | | | | | | | | - Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
- Mersey Care National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
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Loveland J, Mackenzie A. Radiation doses received in the UK breast screening programmes 2019-2023. Br J Radiol 2024; 97:787-793. [PMID: 38291906 DOI: 10.1093/bjr/tqad039] [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: 09/06/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE To report the latest UK mammography dose survey results and to compare radiation doses from digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in UK breast screening. METHODS Anonymized exposure factors were collected for 111 152 screening cases and 5113 assessment cases from 405 x-ray sets across the United Kingdom using an online submission system linked to a national database of mammography quality control data. Output and beam quality measurements from each set were combined with exposure data to estimate mean glandular doses (MGD). RESULTS FFDM doses increased by ∼10% compared to the 2016-2019 national survey but compressed breast thicknesses (CBT) remained similar. DBT doses were 34%-40% higher than FFDM overall and 34% higher than FFDM for breasts 50-60 mm thick. We found a possible overestimation of PMMA breast equivalent thicknesses at low CBTs, but the evidence was not conclusive. CONCLUSION Recent changes to the mix of x-ray models in use in UK breast screening have resulted in higher FFDM breast doses. DBT doses in the NHSBSP are on average higher than FFDM by ∼34%-40%. ADVANCES IN KNOWLEDGE This is the first national study to report DBT and FFDM MGDs in UK breast screening.
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Affiliation(s)
- John Loveland
- National Coordinating Centre for the Physics in Mammography (NCCPM), Royal Surrey NHS Foundation Trust, 18 Frederick Sanger Road Surrey Research Park, Guildford, GU2 7YD, United Kingdom
| | - Alistair Mackenzie
- National Coordinating Centre for the Physics in Mammography (NCCPM), Royal Surrey NHS Foundation Trust, 18 Frederick Sanger Road Surrey Research Park, Guildford, GU2 7YD, United Kingdom
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Bosse NI, Abbott S, Bracher J, van Leeuwen E, Cori A, Funk S. Human judgement forecasting of COVID-19 in the UK. Wellcome Open Res 2024; 8:416. [PMID: 38618198 PMCID: PMC11009611 DOI: 10.12688/wellcomeopenres.19380.2] [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] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background In the past, two studies found ensembles of human judgement forecasts of COVID-19 to show predictive performance comparable to ensembles of computational models, at least when predicting case incidences. We present a follow-up to a study conducted in Germany and Poland and investigate a novel joint approach to combine human judgement and epidemiological modelling. Methods From May 24th to August 16th 2021, we elicited weekly one to four week ahead forecasts of cases and deaths from COVID-19 in the UK from a crowd of human forecasters. A median ensemble of all forecasts was submitted to the European Forecast Hub. Participants could use two distinct interfaces: in one, forecasters submitted a predictive distribution directly, in the other forecasters instead submitted a forecast of the effective reproduction number R t. This was then used to forecast cases and deaths using simulation methods from the EpiNow2 R package. Forecasts were scored using the weighted interval score on the original forecasts, as well as after applying the natural logarithm to both forecasts and observations. Results The ensemble of human forecasters overall performed comparably to the official European Forecast Hub ensemble on both cases and deaths, although results were sensitive to changes in details of the evaluation. R t forecasts performed comparably to direct forecasts on cases, but worse on deaths. Self-identified "experts" tended to be better calibrated than "non-experts" for cases, but not for deaths. Conclusions Human judgement forecasts and computational models can produce forecasts of similar quality for infectious disease such as COVID-19. The results of forecast evaluations can change depending on what metrics are chosen and judgement on what does or doesn't constitute a "good" forecast is dependent on the forecast consumer. Combinations of human and computational forecasts hold potential but present real-world challenges that need to be solved.
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Affiliation(s)
- Nikos I. Bosse
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- NIHR Health Protection Research Unit in Modelling & Health Economics, London, UK
| | - Sam Abbott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Johannes Bracher
- Computational Statistics Group, Heidelberg Institute for Theoretical Studies, Heidelberg, Germany
- Chair of Statistical Methods and Econometrics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Edwin van Leeuwen
- NIHR Health Protection Research Unit in Modelling & Health Economics, London, UK
- Modelling Economics Unit, UK Health Security Agency, London, UK
| | - Anne Cori
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, England, UK
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- NIHR Health Protection Research Unit in Modelling & Health Economics, London, UK
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Abstract
Current World Health Organization (WHO) reports claim a decline in COVID-19 testing and reporting of new infections. To discuss the consequences of ignoring severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, the endemic characteristics of the disease in 2023 with the ones estimated before using 2022 data sets are compared. The accumulated numbers of cases and deaths reported to the WHO by the 10 most infected countries and global figures were used to calculate the average daily numbers of cases DCC and deaths DDC per capita and case fatality rates (CFRs = DDC/DCC) for two periods in 2023. In some countries, the DDC values can be higher than the upper 2022 limit and exceed the seasonal influenza mortality. The increase in CFR in 2023 shows that SARS-CoV-2 infection is still dangerous. The numbers of COVID-19 cases and deaths per capita in 2022 and 2023 do not demonstrate downward trends with the increase in the percentages of fully vaccinated people and boosters. The reasons may be both rapid mutations of the coronavirus, which reduced the effectiveness of vaccines and led to a large number of re-infections, and inappropriate management.
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Affiliation(s)
- Igor Nesteruk
- Institute of Hydromechanics, National Academy of Sciences of Ukraine, Kyiv, Ukraine
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10
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Mullen H, Turkson C, Acquaye A. An examination of motivation factors driving investor behaviours towards socially responsible community energy initiatives. Heliyon 2024; 10:e27490. [PMID: 38495143 PMCID: PMC10943446 DOI: 10.1016/j.heliyon.2024.e27490] [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: 04/05/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Community energy initiatives play a significant role at the grassroots level in the transition to Renewable Energy Communities and a low-carbon economy. However, these initiatives are hampered by multiple barriers at the market, institutional, organisational, and individual level. Funding cuts of state-supported feed-in tariff (FiT) policy in major markets such as Germany, Japan, China and the additional capping of the number of new installations that could be accredited under the FiT scheme in the UK. In light of these market changes and the need to accelerate the development and growth through the creation of new and/or complementary future community energy models consisting of private investors, a detailed understanding of the dynamics of community energy investor characteristics and socio-psychological motivations is increasingly important. First, a review is conducted including the theories that underpin and explain the factors that affect investor behaviour, after which a conceptual framework to examine investor behaviours towards socially responsible community energy initiatives is developed. The framework is used as the basis to construct and administer a survey involving sampling of 295 UK investors in community energy initiatives and the subsequent statistical analysis of the survey data and discussions of the findings. The results first capture the differences among investors with differing regional affect and investment behaviours. The study also provides the needed insight into better understanding the dynamics of investor characteristics and motivations of community energy initiatives. Results also indicate that investors are predominantly ethically-oriented, particularly toward environmental concerns. Additionally, community and social factors also appear to play significant roles in investor participation while financial orientation is least dominant.
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Affiliation(s)
- Helen Mullen
- Sustainability Monitor, Innovation Centre, University Road, Canterbury, UK
| | | | - Adolf Acquaye
- Department of Management Science and Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
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Di Tonno D, Martena L, Taurisano M, Perlin C, Loiacono AC, Lagravinese S, Marsigliante S, Maffia M, Esposito S, Villa G, Gori G, Bray L, Distante A, Miani A, Piscitelli P, Argentiero A. The Requirements of Managing Phase I Clinical Trials Risks: The British and Italian Case Studies. Epidemiologia (Basel) 2024; 5:137-145. [PMID: 38534806 DOI: 10.3390/epidemiologia5010009] [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: 12/19/2023] [Revised: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety of the new compound. To mitigate the possible risks associated with drug administration and treatment, the European Competent Authority issued various guidelines to provide provisions and harmonize risk management processes. In the UK and Italy, particular attention should be paid to the Medicines & Healthcare Products Regulatory Agency (MHRA) phase I accreditation scheme and the specific rules set by the Italian Drug Authority through the AIFA Determination no. 809/2015. Both reference documents are based on the concept of quality risk management while conducting phase I clinical studies. Moreover, the AIFA determination outlines specific requirements for those sites that want to conduct non-profit phase I clinical trials. Indeed, the document reports peculiar activities to the "Clinical Trial Quality Team", which is a team that should support the clinical site researchers in designing, starting, performing, and closing non-profit phase I studies. In this paper, we provide a general overview of the main European guidelines concerning the management of risks during phase I trials, focusing on the main peculiarities of the schemes and rules set by the MHRA and AIFA.
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Affiliation(s)
- Davide Di Tonno
- ClinOpsHub srl., 72023 Mesagne, Italy
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | | | - Manuela Taurisano
- ClinOpsHub srl., 72023 Mesagne, Italy
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Caterina Perlin
- ClinOpsHub srl., 72023 Mesagne, Italy
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Anna Chiara Loiacono
- ClinOpsHub srl., 72023 Mesagne, Italy
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | | | - Santo Marsigliante
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Michele Maffia
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy
| | - Susanna Esposito
- Division of Pediatrics, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Gianluca Villa
- Section of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, 50100 Florence, Italy
- Clinical Trial Unit for Phase 1 Studies, Careggi University Hospital, 50100 Florence, Italy
| | - Giovanni Gori
- Clinical Pharmacology Center for Drug Experimentation, University Hospital of Pisa, 56126 Pisa, Italy
| | - Leonardo Bray
- School of Medicine, St. Camillus International University for Health Sciences, 00042 Rome, Italy
| | - Alessandro Distante
- Euro Mediterranean Scientific Biomedical Institute (ISBEM), 72023 Mesagne, Italy
| | | | - Prisco Piscitelli
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy
- Italian Society of Environmental Medicine, 20123 Milan, Italy
| | - Alberto Argentiero
- Division of Pediatrics, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
- Euro Mediterranean Scientific Biomedical Institute (ISBEM), 72023 Mesagne, Italy
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Langford R, Brockman R, Banks J, Jago R, Gillison F, Coulman K, Moore T, Nobles J. Co-designing adult weight management services: a qualitative study exploring barriers, facilitators, and considerations for future commissioning. BMC Public Health 2024; 24:778. [PMID: 38475750 DOI: 10.1186/s12889-024-18031-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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Weight management services have not always benefitted everyone equally. People who live in more deprived areas, racially minoritised communities, those with complex additional needs (e.g., a physical or mental disability), and men are less likely to take part in weight management services. This can subsequently widen health inequalities. One way to counter this is to co-design services with under-served groups to better meet their needs. Using a case study approach, we explored how co-designed adult weight management services were developed, the barriers and facilitators to co-design, and the implications for future commissioning. METHODS We selected four case studies of adult weight management services in Southwest England where co-design had been planned, representing a range of populations and settings. In each case, we recruited commissioners and providers of the services, and where possible, community members involved in co-design activities. Interviews were conducted online, audio-recorded, transcribed verbatim, and analysed using thematic analysis. RESULTS We interviewed 18 participants (8 female; 10 male): seven commissioners, eight providers, and three community members involved in co-designing the services. The case studies used a range of co-design activities (planned and actualised), from light-touch to more in-depth approaches. In two case studies, co-design activities were planned but were not fully implemented due to organisational time or funding constraints. Co-design was viewed positively by participants as a way of creating more appropriate services and better engagement, thus potentially leading to reduced inequalities. Building relationships- with communities, individual community members, and with partner organisations- was critical for successful co-design and took time and effort. Short-term and unpredictable funding often hindered co-design efforts and could damage relationships with communities. Some commissioners raised concerns over the limited evidence for co-design, while others described having to embrace "a different way of thinking" when commissioning for co-design. CONCLUSIONS Co-design is an increasingly popular approach to designing health in services but can be difficult to achieve within traditional funding and commissioning practices. Drawing on our case studies, we present key considerations for those wanting to co-design health services, noting the importance of building strong relationships, creating supportive organisational cultures, and developing the evidence base.
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Affiliation(s)
- Rebecca Langford
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK.
| | - Rowan Brockman
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
| | - Jonathan Banks
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
| | - Russell Jago
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Oakfield House, Oakfield Grove, BS8 2BN, Bristol, UK
| | - Fiona Gillison
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, BA2 7AY, Bath, UK
| | - Karen Coulman
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, BS8 1NU, Bristol, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, BS1 2NT, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK
| | - James Nobles
- Health, Nutrition & Environment, Leeds Beckett University, Calverley Building, City Campus, LS1 3HE, Leeds, UK
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Warren J, Nigbur D. Lived experiences of Sri Lankan Tamil refugees in the UK: Migration and identity. Br J Soc Psychol 2024. [PMID: 38456575 DOI: 10.1111/bjso.12736] [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: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Sri Lankan Tamil refugees (SLTRs) have lived in the United Kingdom in substantial numbers for about three decades. However, they remain under-represented in academic and public discourse, and little is known about their migration experiences. This study examined first-hand accounts of such experiences, with special attention paid to identity and acculturation. Data were collected through four semi-structured interviews and analysed using interpretative phenomenological analysis (IPA). The results suggest that SLTRs' experience of conflict as an imposed life disruption continues to shape their adaptation, identity, and meaning-making ("Afflicted life"). Changing social identities mediate protection from, as well as risk of, trauma. SLTRs try to remedy the socio-economic and emotional losses suffered in the conflict, but achieve only a partial compensation. Consequently their repair efforts are a source not only of positive emotions but also of dissatisfaction ("Living past"). Finally, participants' sense of belonging and quest for home represent a challenging socio-emotional process in which they continue to engage even decades after migration ("Continuing quest for home"). This nuanced analysis of how the past continues to shape lived experience, contributes to the under-developed literature on qualitative psychological investigations of acculturation, research on forced migration, and the establishment of IPA in social psychology.
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Affiliation(s)
- Jana Warren
- Department of Psychology, Faculty of Arts, Charles University Prague, Brno, Czech Republic
| | - Dennis Nigbur
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
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Hirani R, Hoad VC, Gosbell IB, Irving DO. Has the frequency of ABO RhD blood groups in Australian blood donors changed as a result of the removal of the variant Creutzfeldt-Jakob disease-based deferral? Vox Sang 2024. [PMID: 38451394 DOI: 10.1111/vox.13614] [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: 01/18/2024] [Revised: 02/13/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Until 25 July 2022, Australians who had spent more than 6 months in the United Kingdom or territories between 1980 and 1996 were deferred from blood donation due to the risk of variant Creutzfeldt-Jakob disease. Removal of this geography-based donor deferral on RhD-negative blood availability has not been reported. MATERIALS AND METHODS All donors who donated at least once from 25 July 2022 to 25 July 2023 were included. UK donor status, first-time donor and ABO RhD data were extracted from the National Blood Management System. RESULTS Data from 566,447 blood donors with a valid ABO RhD result were analysed. Of these, 34,560 were new or returning lapsed donors following removal of the UK donor deferral. The median age [range] in years for all donors was 43 [75] with UK donors being older 53 [70]. There was a higher prevalence of RhD-negative status in UK donors (20.2%) compared with first-time blood donors (15.7%). CONCLUSION UK donors were generally older, female and more likely to be RhD-negative. Although UK donors provided a boost to RhD-negative blood collections, the overall prevalence of ABO RhD blood groups in the total Australian blood donor panel remained similar to previous estimates.
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Affiliation(s)
- Rena Hirani
- Australian Red Cross Lifeblood, Sydney, Australia
- School of Natural Sciences, Macquarie University, Sydney, Australia
| | | | - Iain B Gosbell
- Australian Red Cross Lifeblood, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - David O Irving
- Australian Red Cross Lifeblood, Sydney, Australia
- Faculty of Health, University of Technology, Sydney, Australia
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Xu T, Liu X, Zhang Z, Li Y. Review of casualties and losses of UK fishing vessels from 2013 to 2020. Int J Occup Saf Ergon 2024; 30:129-135. [PMID: 37779365 DOI: 10.1080/10803548.2023.2266279] [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] [Indexed: 10/03/2023]
Abstract
This study analyses the relationship between vessel groups (small, medium and large) and casualty or loss type of UK fishing vehicles based on a summary of information concerning casualties and losses that occurred on fishing vessels in the UK from 2013 to 2020. The study establishes loss of control as the main cause of casualty occurrences for all fishing vessels. Further, flooding/foundering is the main contributor to the loss of fishing vessels smaller than 24 m in length, and grounding/stranding is the main contributor to the loss of fishing vessels 24 m or longer. Fishing vessels below 15 m in length comprise the majority of casualties and losses, while medium-size vessels (15 m or longer, but less than 24 m) make the highest average contribution per vessel to casualties.
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Affiliation(s)
- Tianyu Xu
- Technical Advice and Support, Maritime New Zealand, New Zealand
- Policy Advisory Division, New Zealand Migration Agency, New Zealand
| | - Xiaojing Liu
- School of Innovation, Design and Technology, Wellington Institute of Technology, New Zealand
- Local Government Branch, Department of Internal Affairs, New Zealand
| | - Zeling Zhang
- Ocean Travel School, Zhejiang International Maritime College, People's Republic of China
| | - Yuhan Li
- Organisational Strategy and Systems, Maritime New Zealand, New Zealand
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Pattanaik A, Bhandarkar B S, V S, Mukhopadhyay C. Recent cluster of neonatal enteroviral myocarditis cases in the United Kingdom of Great Britain and Northern Ireland - current scenario and counteracting prospects. IJID Reg 2024; 10:197-199. [PMID: 38356998 PMCID: PMC10864858 DOI: 10.1016/j.ijregi.2024.01.009] [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] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/16/2024]
Abstract
Objectives Neonatal myocarditis is a rare but life-threatening complication of enterovirus infection that presents like bacterial sepsis. Outbreak A sudden upsurge in cases of neonatal enteroviral myocarditis, reported from South West England and South Wales between June 2022 and April 2023 has alerted health agencies to bring in counteracting measures. Impact In view of this outbreak situation, the World Health Organisation advisory has urged clinicians seeing neonates and infants with shock may consider myocarditis as a differential diagnosis and test for enteroviruses.
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Affiliation(s)
- Amrita Pattanaik
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, India
| | - Sushma Bhandarkar B
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, India
| | - Sreelakshmi V
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, India
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Whitcroft KL, Alobid I, Altundag A, Andrews P, Carrie S, Fahmy M, Fjaeldstad AW, Gane S, Hopkins C, Hsieh JW, Huart C, Hummel T, Konstantinidis I, Landis BN, Mori E, Mullol J, Philpott C, Poulios A, Vodička J, Ward VM. International clinical assessment of smell: An international, cross-sectional survey of current practice in the assessment of olfaction. Clin Otolaryngol 2024; 49:220-234. [PMID: 38153760 DOI: 10.1111/coa.14123] [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: 01/27/2023] [Revised: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. DESIGN Anonymous online questionnaire with cross-sectional non-probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non-rhinologists') was performed, with geographical comparisons only made according to subgroup. PARTICIPANTS ENT surgeons who assess olfaction. RESULTS Responses were received from 465 clinicians (217 from UK and 17 countries total). Country-specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios-though rhinologists did so more often than non-rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. CONCLUSIONS To our knowledge, this is the most comprehensive UK-based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems.
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Affiliation(s)
- Katherine L Whitcroft
- UCL Ear Institute, University College London, London, UK
- Smell and Taste Clinic, Department of Otolaryngology, TU Dresden, Dresden, Germany
- Centre for Olfactory Research Applications (CORA), IP, School of Advanced Study, London, UK
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Isam Alobid
- Skull Base Unit, ENT Department, Hospital Clinic Barcelona University, Barcelona, Spain
- CIBER of Respiratory diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Aytug Altundag
- Department of Otolaryngology, Head and Neck Surgery, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Sean Carrie
- Department of Otolaryngology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Miriam Fahmy
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Alexander W Fjaeldstad
- Department of Otorhinolaryngology, Flavour Clinic, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
| | - Simon Gane
- Centre for Olfactory Research Applications (CORA), IP, School of Advanced Study, London, UK
- Royal National and ENT Hospital (RNENT), London, UK
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' NHS Trust, London, UK
| | - Julien Wen Hsieh
- Rhinology-Olfactory Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - Caroline Huart
- ENT Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otolaryngology, TU Dresden, Dresden, Germany
| | - Iordanis Konstantinidis
- 2nd Academic Department, Smell and Taste Clinic, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Baslie N Landis
- Rhinology-Olfactory Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Joaquim Mullol
- CIBER of Respiratory diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Rhinology Unit and Smell Clinic, ENT Department Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carl Philpott
- Norwich Medical School, Norwich, UK
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, James Paget and Norfolk and Norwich University Hospitals, Norfolk, UK
- Fifth Sense, London, UK
| | - Aristotelis Poulios
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Jan Vodička
- Department of Otorhinolaryngology and Head and Neck Surgery, Regional Hospital Pardubice, Pardubice, Czech Republic
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Victoria M Ward
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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Hernandez-Colina A, Seechurn N, Costa T, Lopez J, Baylis M, Hesson JC. Surveillance of Culex spp. vectors and zoonotic arboviruses at a zoo in the United Kingdom. Heliyon 2024; 10:e26477. [PMID: 38404807 PMCID: PMC10884501 DOI: 10.1016/j.heliyon.2024.e26477] [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: 10/10/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 02/27/2024] Open
Abstract
The emergence of several zoonotic mosquito-borne pathogens in Europe, including West Nile virus, Sindbis virus and Usutu virus, has emphasised the importance of consistent surveillance. Considerable fieldwork effort is usually needed to detect low-prevalence pathogens in mosquitoes and screening vertebrate hosts and reservoirs is rarely done simultaneously with mosquito sampling. Zoological gardens offer an opportunity for the surveillance of pathogens, mosquitoes, hosts, and reservoirs concurrently; thus, the aim of this study was undertaking integrated surveillance for mosquito-borne pathogens of wild birds and mosquitoes in Chester Zoo (Cheshire) in the United Kingdom. Mosquitoes were collected in September 2020 and tested for zoonotic bird-hosted arboviruses (i.e., West Nile virus, Usutu virus and Sindbis virus) using RT-qPCRs. Of the 3316 mosquitoes trapped, 98% were identified as Culex spp. The average minimum prevalence of the viruses found in the literature was used to calculate the sample size needed for detecting these viruses with 99% confidence. The testing of 2878 Culex females found no evidence of presence of the three viruses. Significant differences were found in mosquito abundance per sampling site and collection date; furthermore, important sources of immature and resting mosquitoes were found near aviaries. Eighteen wild birds belonging to 11 species were found dead in the zoo from May to December 2020 and were RT-qPCR tested for West Nile virus and Usutu virus; all samples resulted negative for viral infection. It is unlikely that these viruses were present in the zoo during the sampling period; however, since they circulate in Europe and Usutu virus has been isolated in the United Kingdom and may overwinter here, continued monitoring of mosquitoes and wild birds is recommended as virus introduction and dissemination are possible. This study highlights the importance of regular and integrated arboviral surveillance of zoonotic pathogens in zoos providing baseline information to that end.
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Affiliation(s)
- Arturo Hernandez-Colina
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire, CH64 7TE, UK
- North of England Zoological Society (Chester Zoo), Caughall Road, Chester, CH2 1LH, UK
- Department of Medical Biochemistry and Microbiology/Zoonosis Science Centre, Uppsala University, Box 582, SE-751 23, Uppsala, Sweden
| | - Nicola Seechurn
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire, CH64 7TE, UK
- North of England Zoological Society (Chester Zoo), Caughall Road, Chester, CH2 1LH, UK
| | - Taiana Costa
- Department of Veterinary Anatomy, Physiology and Pathology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire, CH64 7TE, UK
- The Veterinary Pathology Group, Horner Court, 637 Gloucester Road, Horfield, Bristol, BS7 0BJ, UK
| | - Javier Lopez
- North of England Zoological Society (Chester Zoo), Caughall Road, Chester, CH2 1LH, UK
| | - Matthew Baylis
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire, CH64 7TE, UK
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK
| | - Jenny C. Hesson
- Department of Medical Biochemistry and Microbiology/Zoonosis Science Centre, Uppsala University, Box 582, SE-751 23, Uppsala, Sweden
- Biologisk Myggkontroll, Nedre Dalälvens Utvecklings AB, Gysinge, Sweden
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Palmer AL, Nash D. Radiochromic film dosimetry in radiotherapy: a survey of current practice in the United Kingdom. Br J Radiol 2024; 97:646-651. [PMID: 38273671 DOI: 10.1093/bjr/tqae008] [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: 10/05/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To establish the variation in film dosimetry usage in radiotherapy centres across the United Kingdom. To identify consensus and highlight areas of potential improvement to enhance radiotherapy dosimetry verification with film. METHODS A survey questionnaire was designed by members of the Institute of Physics and Engineering in Medicine Interdepartmental Dosimetry Audit Group via Microsoft Forms and distributed to all Heads of Radiotherapy Physics in the United Kingdom. The survey was open from June 19, 2023, to July 31, 2023. RESULTS Forty responses were received from the 62 radiotherapy centres in the United Kingdom, of which 58% were currently using film dosimetry and a further 7 were keen to commence use. Many reported film use had decreased in recent years but was still valuable particularly for commissioning and implementing new techniques. The variation and consensus of methods for film dosimetry calibration, measurement, and application was established. A review of barriers to implementation and methods to reduce uncertainty were included in the assessment. CONCLUSIONS A comprehensive assessment of film dosimetry usage in radiotherapy in the United Kingdom has been collated, which demonstrates a wide variation in methods, across typical clinical users, but maintains film as a valuable dosimetry option. ADVANCES IN KNOWLEDGE This research provides a snapshot of current film dosimetry use across the United Kingdom. It examines the variation and consensus of practice to which individual users can compare their systems, and identifies opportunities to improvement in the accuracy of film dosimetry.
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Affiliation(s)
- Antony L Palmer
- Medical Physics, Portsmouth Hospitals University NHS Trust, Portsmouth, PO6 3LY, United Kingdom
| | - David Nash
- Medical Physics, Portsmouth Hospitals University NHS Trust, Portsmouth, PO6 3LY, United Kingdom
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Dowd JB, Doniec K, Zhang L, Tilstra A. US exceptionalism? International trends in midlife mortality. Int J Epidemiol 2024; 53:dyae024. [PMID: 38508869 PMCID: PMC10954513 DOI: 10.1093/ije/dyae024] [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: 09/02/2023] [Accepted: 01/29/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. METHODS We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64 years) age-standardized death rates across 15 major cause-of-death categories. RESULTS US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54 year and in Canada, Poland and Sweden among for those aged 25-44 years. CONCLUSIONS The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Katarzyna Doniec
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Luyin Zhang
- Office of Population Research, Princeton University, Princeton, USA
| | - Andrea Tilstra
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
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Ibrahim ST, Edwards CJ, Ehrenstein MR, Griffiths B, Gordon C, Hewins P, Jayne D, Lightstone L, McLaren Z, Rhodes B, Vital EM, Reynolds JA. Differences in management approaches for lupus nephritis within the UK. Rheumatol Adv Pract 2024; 8:rkae017. [PMID: 38469156 PMCID: PMC10926897 DOI: 10.1093/rap/rkae017] [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: 10/21/2023] [Accepted: 01/21/2024] [Indexed: 03/13/2024] Open
Abstract
Objectives Outcomes of therapy for LN are often suboptimal. Guidelines offer varied options for treatment of LN and treatment strategies may differ between clinicians and regions. We aimed to assess variations in the usual practice of UK physicians who treat LN. Methods We conducted an online survey of simulated LN cases for UK rheumatologists and nephrologists to identify treatment preferences for class IV and class V LN. Results Of 77 respondents, 48 (62.3%) were rheumatologists and 29 (37.7%) were nephrologists. A total of 37 (48.0%) reported having a joint clinic between nephrologists and rheumatologists, 54 (70.0%) reported having a multidisciplinary team meeting for LN and 26 (33.7%) reported having a specialized lupus nurse. Of the respondents, 58 (75%) reported arranging a renal biopsy before starting the treatment. A total of 20 (69%) of the nephrologists, but only 13 (27%) rheumatologists, reported having a formal departmental protocol for treating patients with LN (P < 0.001). The first-choice treatment of class IV LN in pre-menopausal patients was MMF [41 (53.2%)], followed by CYC [15 (19.6%)], rituximab [RTX; 12 (12.5%)] or a combination of immunosuppressive drugs [9 (11.7%)] with differences between nephrologists' and rheumatologists' choices (P = 0.026). For class V LN, MMF was the preferred initial treatment, irrespective of whether proteinuria was in the nephrotic range or not. RTX was the preferred second-line therapy for non-responders. Conclusion There was variation in the use of protocols, specialist clinic service provision, biopsies and primary and secondary treatment choices for LN reported by nephrologists and rheumatologists in the UK.
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Affiliation(s)
- Sara T Ibrahim
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Internal Medicine and Nephrology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Christopher J Edwards
- NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | | | - Bridget Griffiths
- Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Peter Hewins
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Zoe McLaren
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Benjamin Rhodes
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
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22
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Willis R. Use of evidence and expertise in UK climate governance: the case of the Cumbrian Coal Mine. UCL Open Environ 2024; 6:e068. [PMID: 38332983 PMCID: PMC10851706 DOI: 10.14324/111.444/ucloe.000068] [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: 05/03/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024]
Abstract
There is an overall scientific consensus that no new coal mines can be developed, if the Paris Agreement to limit global temperature rises is to be met. Yet in December 2022, following a lengthy Public Inquiry, the UK Government approved the development of Woodhouse Colliery in Cumbria. In doing so, it accepted the claim that the coal mine would be 'zero carbon' and could even result in lower global emissions overall. As this paper demonstrates, there is no independent evidence to support these claims, whilst a large body of independent evidence comes to the opposite conclusion. This paper uses the example of Woodhouse Colliery to examine the use of evidence and expertise in climate governance processes. It finds that the nature of expertise and evidence is not properly considered, and that there is ambiguity and confusion surrounding the implementation of the UK's climate legislation, particularly the Climate Change Act. It also finds that the ways in which the decision-making process solicited and assessed evidence was flawed, promoting a 'false balance'. This ambiguity and false balance provide scope for developers to argue the case for destructive developments, even while claiming adherence to climate ambitions. The paper concludes by suggesting reforms to governance processes, to provide a more transparent and credible implementation of policies to achieve the UK's net zero target. Suggested reforms include clearer rules governing fossil fuel phase-out; greater transparency and better handling of conflicts of interest in decision-making; and devolution of climate responsibilities to local areas.
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Affiliation(s)
- Rebecca Willis
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
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23
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Kulu H, Mikolai J, Franke S. Partnership Status, Health, and Mortality: Selection or Protection? Demography 2024; 61:189-207. [PMID: 38226410 DOI: 10.1215/00703370-11147861] [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] [Indexed: 01/17/2024]
Abstract
Married individuals have better health and lower mortality than nonmarried people. Studies show that when cohabitants are distinguished from other nonmarried groups, health differences between partnered and nonpartnered individuals become even more pronounced. Some researchers have argued that partnered individuals have better health and lower mortality because a partnership offers protective effects (protection); others have posited that partnered people have better health and lower mortality because healthy persons are more likely to form a union and less likely to dissolve it (selection). This study contributes to this debate by investigating health and mortality by partnership status in England and Wales and analyzing the causes of mortality differences. We use combined data from the British Household Panel Survey and the UK Household Longitudinal Study and apply a simultaneous-equations hazard model to control for observed and unobserved selection into partnerships. We develop a novel approach to identify frailty based on self-rated health. Our analysis shows that partnered individuals have significantly lower mortality than nonpartnered people. We observe some selection into and out of unions on unobserved health characteristics, but the mortality differences by partnership status persist. The study offers strong support for the marital protection hypothesis and extends it to nonmarital partnerships.
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Affiliation(s)
- Hill Kulu
- Centre for Population Change, and School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Júlia Mikolai
- Centre for Population Change, and School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Sebastian Franke
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
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24
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Merz S, Hunter B, Bisht R, Murray SF. 'Not in it for huge profits but because it's right': The contested moral economies of UK-India exports in health worker education and training. Sociol Health Illn 2024; 46:219-235. [PMID: 37578685 DOI: 10.1111/1467-9566.13700] [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: 03/06/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
While the growth of global markets in health-related services may have significant consequences for healthcare provisioning and training, it has received relatively little attention from the social sciences. This article examines UK-India, and specifically England-India, exports in health worker education and training as one such global market, drawing on sociological scholarship on moral economies to understand how trading in this field is constructed and legitimated by the individuals and organisations involved, what tensions evolve, and what is at stake in them. We employ a qualitative mixed methods approach using publicly available materials on existing UK-India collaborations and primary data from interviews with key stakeholders in India and the UK, including government departments, arms-length bodies, NHS Trusts, trade associations and private providers. Our analysis illustrates the key discursive strategies used to legitimate engagement in these markets, and the complex and contested moral economies unfolding between and across these stakeholders and contexts. Not least, we demonstrate the conflicting moral sentiments and the boundary work required to realise commodification. Situating cross-border trade in health worker education and training in a moral economy framework thus illuminates the social context and moral worlds in which this evolving trade is embedded.
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Affiliation(s)
- Sibille Merz
- Department of International Development, King's College London, London, UK
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Benjamin Hunter
- School of Global Studies, University of Sussex, Brighton, UK
| | - Ramila Bisht
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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25
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Narayan P, Dong T, Dimagli A, Fudulu DP, Chan J, Sinha S, Angelini GD. Impact of explanted valve type on aortic valve reoperations: nationwide UK experience. Eur J Cardiothorac Surg 2024; 65:ezae031. [PMID: 38305431 PMCID: PMC10902681 DOI: 10.1093/ejcts/ezae031] [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: 09/29/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period. METHODS Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities. RESULTS Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37-1.05; P = 0.1]. Age (OR 1.03, 95% CI 1.01-1.05; P < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08-2.42; P < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17-4.04; P < 0.05) and endocarditis (OR 2.66, 95% CI 1.71-4.14; P < 0.05) emerged as risk factors for mortality. CONCLUSIONS The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Daniel P Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
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26
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Li Y, Ding L. Multiple disadvantages: class, social capital, and well-being of ethnic minority groups in the UK during the COVID-19 pandemic. Front Sociol 2024; 9:1215676. [PMID: 38375151 PMCID: PMC10875735 DOI: 10.3389/fsoc.2024.1215676] [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: 05/02/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
Introduction The COVID-19 pandemic has caused untold damage to the socio-economic lives of people all over the world. Research has also demonstrated great inequality in the pandemic experience. In the UK as in many other countries, people from ethnic minority backgrounds and in working-class positions have suffered disproportionately more than the majority group and those in salariat positions in terms of income loss, financial difficulty, and vulnerability to infection. Yet little is known about how people coped in the daily lives and tried to maintain their well-being during the most difficult days of the pandemic through social capital. Methods In this paper, we draw data from the COVID-19 Survey in Five National Longitudinal Studies to address these questions. The survey covered the period from May 2020 to February 2021, the height of the pandemic in the UK. It contains numerous questions on contact, help and support among family, friends, community members, socio-political trust, and physical and mental health. We conceptualise three types of social capital and one type of overall well-being and we construct latent variables from categorical indicator variables. We analyse the ethnic and socio-economic determinants of the three types of social capital and their impacts on well-being. Results Our analysis shows that social capital plays very important roles on well-being, and that ethnic minority groups, particularly those of Pakistani/Bangladeshi and Black heritages, faced multiple disadvantages: their poorer socio-economic positions prevented them from gaining similar levels of social capital to those of the white group. However, for people with the same levels of social capital, the effects on well-being are generally similar. Discussion Socio-economic (class) inequality is the root cause for ethnic differences in social capital which in turn affects people's well-being.
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Affiliation(s)
- Yaojun Li
- Department of Sociology, School of Social Sciences, Manchester University, Manchester, United Kingdom
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27
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Jewitt S, McClaughlin E, Elliott S, Smallman-Raynor M, Clark M, Dunham S, Tarlinton R. Veterinarians' knowledge and experience of avian influenza and perspectives on control measures in the UK. Vet Rec 2024:e3713. [PMID: 38234070 DOI: 10.1002/vetr.3713] [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: 06/25/2023] [Revised: 09/04/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND The scale of the outbreak of highly pathogenic avian influenza (HPAI) in 2021-23 due to the influenza A/H5N1 virus is unprecedented. METHODS An online survey was designed to explore veterinarians' experiences of and confidence in treating avian species, experiences of dealing with suspected HPAI and perspectives on control measures in the UK. The survey ran between December 2021 and March 2022. RESULTS Survey responses were received from 26 veterinarians. Although veterinarians are well placed to communicate HPAI-related information and guidance, a lack of confidence around treating birds and dealing with suspected cases of HPAI represent key barriers for non-specialist practices, and this limits opportunities to educate clients. LIMITATIONS This study presents the views of a small group of self-selected respondents and may over-represent veterinarians with existing interests in avian species and/or avian influenza and who engage with online fora. CONCLUSIONS Improved training and resources designed to increase confidence with avian species, along with guidance on diagnosing and reporting notifiable diseases, are needed for first opinion practices. Governing bodies should clarify regulations on treating birds in veterinary practices when HPAI outbreak numbers are high.
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Affiliation(s)
- Sarah Jewitt
- School of Geography, University of Nottingham, Nottingham, UK
| | | | - Sol Elliott
- One Virology, The Wolfson Centre for Global Virus Research, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | | | - Michael Clark
- One Virology, The Wolfson Centre for Global Virus Research, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Stephen Dunham
- One Virology, The Wolfson Centre for Global Virus Research, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Rachael Tarlinton
- One Virology, The Wolfson Centre for Global Virus Research, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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28
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Xue B, King M, Deindl C, Lacey R, Di Gessa G, McMunn A. Do Health and Well-Being Change Around the Transition to Informal Caring in Early Adulthood? A Longitudinal Comparison Between the United Kingdom and Germany. J Adolesc Health 2024:S1054-139X(23)00979-5. [PMID: 38206223 DOI: 10.1016/j.jadohealth.2023.11.398] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17-29 years old) influenced health and life satisfaction in the United Kingdom and Germany. METHODS Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009-2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care. RESULTS In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany. DISCUSSION The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.
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Affiliation(s)
- Baowen Xue
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.
| | - Markus King
- Department of Social Sciences, TU Dortmund University, Dortmund, Germany; Department of Education, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Christian Deindl
- Department of Social Sciences, TU Dortmund University, Dortmund, Germany
| | - Rebecca Lacey
- Department of Epidemiology and Public Health, University College London, London, United Kingdom; Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Giorgio Di Gessa
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Anne McMunn
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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29
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Oshima F, Takahashi T, Tamura M, Guan S, Seto M, Hull L, Mandy W, Tsuchiya K, Shimizu E. The association between social camouflage and mental health among autistic people in Japan and the UK: a cross-cultural study. Mol Autism 2024; 15:1. [PMID: 38178255 PMCID: PMC10768303 DOI: 10.1186/s13229-023-00579-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: 08/08/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND To examine the relationship between social camouflage and mental health in Japanese autistic adults and make an international comparison with a sample from the UK. METHODS This study analysed secondary data of participants with a self-reported diagnosis of autism from Japan (N = 210; 123 men and 87 women) and the UK (N = 305; 181 women, 104, men, and 18 nonbinary). The relationships between the quadratic term of the Camouflaging Autistic Traits Questionnaire and mental health scales, including depression and anxiety, were assessed. RESULTS The UK sample showed linear relationships, whereas the Japanese sample showed significant nonlinear relationships. The quadratic terms of the Camouflaging Autistic Traits Questionnaire slightly explained generalised anxiety (β = .168, p = .007), depression (β = .121, p = .045), and well-being (β = - .127, p = .028). However, they did not explain the association between social anxiety and the Camouflaging Autistic Traits Questionnaire. LIMITATIONS Participants had self-reported diagnoses, and while the autism-spectrum quotient provides a cut-off value for screening, it does not enable confirming diagnoses. Mean scores of the Japanese version of the Camouflaging Autistic Traits Questionnaire were lower as compared to the original CAT-Q, which implies that the social camouflage strategy types used by autistic people in Japan and the UK could differ. The cross-sectional design limits causal inferences. CONCLUSION In the UK, more social camouflage was associated with poorer mental health scores, whereas too little or too much social camouflage was associated with a low mental health score in Japan. The Japanese population is seemingly less aware of and educated on autistic characteristics and considers 'average' behaviour a good thing. This could influence Japanese autistic people's social camouflage use, differing from that of autistic people in the UK. The differences in the relationship between social camouflage and mental health between Japan and the UK could be associated with national-level divergence regarding the culture of autism.
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Affiliation(s)
- Fumiyo Oshima
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan.
- United Graduate School of Child Development, Osaka University, Kanazawa University; Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan.
| | - Toru Takahashi
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masaki Tamura
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Siqing Guan
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
- Graduate School of Human Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Mikuko Seto
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
| | - Laura Hull
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William Mandy
- Research Department for Clinical, Educational & Health Psychology, University College London, London, UK
| | - Kenji Tsuchiya
- United Graduate School of Child Development, Osaka University, Kanazawa University; Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University; Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Osaka, Japan
- Graduate School of Human Sciences, Waseda University, Tokorozawa, Saitama, Japan
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30
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Guest JF, Apelqvist J. Cost-effectiveness of ChloraSolv in treating hard-to-heal venous leg ulcers. J Wound Care 2024; 33:4-13. [PMID: 38197275 DOI: 10.12968/jowc.2024.33.1.4] [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] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To estimate whether the topical, amino acid-buffered hypochlorite debriding gel ChloraSolv (RLS Global AB, Sweden) could potentially afford the UK's health services a cost-effective intervention for hard-to-heal venous leg ulcers (VLUs). METHOD A Markov model representing the management of hard-to-heal VLUs with ChloraSolv plus standard care (SC) or SC alone was populated with inputs from an indirect comparison of two propensity score-matched cohorts. The model estimated the relative cost-effectiveness of ChloraSolv in terms of the incremental cost per quality-adjusted life year (QALY) gained at 2021/2022 prices. RESULTS Addition of ChloraSolv to an SC protocol was found to increase the probability of healing by 36% (from 0.14 to 0.19) after 12 weeks, and by 79% (from 0.24 to 0.43) after 24 weeks. This led to a marginal increase in health-related quality of life. Treatment with ChloraSolv plus SC instead of SC alone reduced the total cost of wound management by 8% (£189 per VLU) at 12 weeks and by 18% (£796 per VLU) at 24 weeks. Use of ChloraSolv was estimated to improve health outcomes at reduced cost. Sensitivity analysis showed that use of ChloraSolv plus SC remained a cost-effective treatment with plausible variations in costs and effectiveness. CONCLUSION Within the limitations of the study, the addition of ChloraSolv to an SC protocol potentially affords a cost-effective treatment to the UK's health services for managing hard-to-heal VLUs.
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Affiliation(s)
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Sweden
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31
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Saleem UA, Karimi AS, Ehsan H. A Systematic Review on Pulmonary TB Burden and Associated Factors Among Immigrants in the UK. Infect Drug Resist 2023; 16:7835-7853. [PMID: 38162319 PMCID: PMC10757787 DOI: 10.2147/idr.s441536] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Background The rapid growth of international human migration has positioned the UK in the top five countries in the world with 9.4 million immigrants in 2022. These immigrants originate from low- and middle-income countries and remain particularly at risk of developing TB. In the UK, the number of TB cases has been increasing, and the influx of immigrants could be a contributing factor. Objective This review aims to map the burden of pulmonary TB among immigrants in the UK and investigate associated factors. It also reviews the TB management approaches among immigrants in the UK. Design The study utilized PRISMA guidelines to search electronic databases (PubMed and EMBASE) for articles published from 2000 to 2022 on TB prevalence and factors in immigrants and explored government websites for TB management strategies. Results Nineteen out of 530 initially identified articles were included. The included studies reported a prevalence rate of TB among immigrants ranging from 0.04 to 52.1%, showing a decrease in the burden over time. Additionally, a higher number of TB cases were observed among immigrants from the Asian region, particularly immigrants from South Asia, followed by those from sub-Saharan Africa. Stigma, misconception about the disease, language barrier, lack of confidentiality, and unfriendly healthcare system for immigrants were the main drivers of the TB burden among immigrants. The TB management approaches in the UK include pre-entry screening for active TB, LTBI testing for a specific population group, and antibacterial therapy for 3-6 months for TB patients. Conclusion The UK's control and prevention efforts in reducing tuberculosis prevalence among immigrants show optimism, but challenges persist. Key improvements include healthcare delivery, TB improvement programs, and policies addressing stigma and patient confidentiality.
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Affiliation(s)
- Uzair Ahmad Saleem
- Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, the Netherlands
| | - Ali Sina Karimi
- Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
| | - Hedayatullah Ehsan
- Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
- Kabul University of Medical Sciences, Kabul, Afghanistan
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32
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Pearson M, Barnes MP, Brown KF, Hawthorn K, Stevens SW, Kizhakke Veetil R, Weston S, Whitbourn JR. IPEM topical report: results of a 2022 UK survey on the use of linac manufacturer integrated quality control (MIQC). Phys Med Biol 2023; 68:245018. [PMID: 37988759 DOI: 10.1088/1361-6560/ad0eb3] [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: 07/28/2023] [Accepted: 11/21/2023] [Indexed: 11/23/2023]
Abstract
In recent years Radiotherapy linear accelerator (linac) vendors have developed their own integrated quality control (QC) systems. Such manufacturer-integrated-quality-control (MIQC) has the potential to improve both the quality and efficiency of linac QC but is currently being developed and utilised in the absence of specific best-practice guidance. An Institute of Physics and Engineering in Medicine working party was commissioned with a view to develop guidance for the commissioning and implementation of MIQC. This study is based upon a survey of United Kingdom (UK) radiotherapy departments performed by the working party. The survey was distributed to all heads of radiotherapy physics in the UK and investigated availability and uptake, community beliefs and opinions, utilisation, user experience and associated procedures. The survey achieved a 95% response rate and demonstrated strong support (>95%) for its use and further development. MIQC systems are available in 79% of respondents' centres, and are in clinical use in 66%. The most common MIQC system was Varian MPC, in clinical use in 58% of responding centres, with CyberKnife AQA\E2E in 11%, TomoTherapy TQA in 8% and no users of Elekta Machine QA. A majority of users found their MIQC to be easy to use, reliable, and had five or more years of experience. Most users reported occasions of discrepancy in results between MIQC and conventional testing, but the majority considered this acceptable, indicating a false reporting frequency of quarterly or less. MIQC has shown value in preventative maintenance and early detection of machine deviations. There were inconsistent approaches in the utilisation and commissioning tests performed. Fewer than half of users perform QC of MIQC. 45% of responders have modified their QC processes with the introduction of MIQC, via replacement of conventional tests or reduction in their frequency. Future guidance is recommended to assist in the implementation of MIQC.
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Affiliation(s)
- Michael Pearson
- Medical Physics Department, Guys and St Thomas' Hospital, London, United Kingdom
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Michael P Barnes
- Department of Radiation Oncology, Calvary Mater Hospital Newcastle, Waratah, NSW, Australia
| | - Kirstie F Brown
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Karen Hawthorn
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | | | - Rakesh Kizhakke Veetil
- Radiotherapy Department, Southend University Hospital NHS Trust, Westcliff-on-Sea, United Kingdom
| | - Steven Weston
- Medical Physics and Engineering, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J R Whitbourn
- Department of Medical Physics, The James Cook University Hospital, Middlesbrough, United Kingdom
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Pidgeon TE, Morley R, Rose V. Exposure of plastic surgery and urology registrars in the United Kingdom to gender affirming care of transgender patients: A cross-sectional survey of training programme directors. J Plast Reconstr Aesthet Surg 2023; 87:41-45. [PMID: 37804646 DOI: 10.1016/j.bjps.2023.09.024] [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: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To assess the expected duration of exposure of United Kingdom urology and plastic surgery trainees to the provision of gender affirming healthcare to transgender patients. This observational, cross-sectional survey asked UK training programme directors (TPDs) to report the volume of training in gender affirming care of transgender patients that urology and plastic surgery trainees are expected to receive. METHODS A Google Form online questionnaire was distributed to each regional TPD in the UK both for plastic surgery and urology. RESULTS Eleven of 14 TPDs in plastic surgery and 13 of 19 urology TPDs completed the survey with responses representing 487 trainees. The total estimated exposure of UK trainees to any aspect of gender affirming healthcare was a median of one hour of training per trainee per year (clinical or didactic). Thirteen deaneries reported that trainees received some (didactic or clinical) training in transgender care each year. Only eight of these deaneries reported provision of direct clinical training. The remaining eleven deaneries reported that trainees received no training in gender affirming care. No training was expected to take place for any trainee of either speciality within multi-disciplinary team meetings or in masculinising genital surgery. CONCLUSION The above evidence demonstrates the low exposure of plastic surgery and urology registrar trainees to gender affirming care during their training years in the UK.
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Affiliation(s)
| | - Roland Morley
- Imperial College Healthcare Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Victoria Rose
- Guy's and St Thomas's NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
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Stöger R, Choi M, Begum K, Leeman G, Emes RD, Melamed P, Bentley GR. Childhood environment influences epigenetic age and methylation concordance of a CpG clock locus in British-Bangladeshi migrants. Epigenetics 2023; 18:2153511. [PMID: 36495138 PMCID: PMC9980690 DOI: 10.1080/15592294.2022.2153511] [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] [Indexed: 12/14/2022] Open
Abstract
Migration from one location to another often comes with a change in environmental conditions. Here, we analysed features of DNA methylation in young, adult British-Bangladeshi women who experienced different environments during their childhoods: a) migrants, who grew up in Bangladesh with exposure to comparatively higher pathogen loads and poorer health care, and b) second-generation British-Bangladeshis, born to Bangladeshi parents, who grew up in the UK. We used buccal DNA to estimate DNA methylation-based age (DNAm age) from 14 migrants and 11 second-generation migrants, aged 18-35 years. 'AgeAccel,' a measure of DNAm age, independent of chronological age, showed that the group of women who spent their childhood in Bangladesh had higher AgeAccel (P = 0.028), compared to their UK peers. Since epigenetic clocks have been proposed to be associated with maintenance processes of epigenetic systems, we evaluated the preference for concordant DNA methylation at the luteinizing hormone/choriogonadotropin receptor (LHCGR/LHR) locus, which harbours one of the CpGs contributing to Horvath's epigenetic clock. Measurements on both strands of individual, double-stranded DNA molecules indicate higher stability of DNA methylation states at this LHCGR/LHR locus in samples of women who grew up in Bangladesh. Together, our two independent analytical approaches imply that childhood environments may induce subtle changes that are detectable long after exposure occurred, which might reflect altered activity of the epigenetic maintenance system or a difference in the proportion of cell types in buccal tissue. This exploratory work supports our earlier findings that adverse childhood environments lead to phenotypic life history trade-offs.
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Affiliation(s)
- Reinhard Stöger
- School of Biosciences, University of Nottingham, Nottingham, UK
| | - Minseung Choi
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Gregory Leeman
- School of Biosciences, University of Nottingham, Nottingham, UK
| | - Richard D Emes
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.,Advanced Data Analysis Centre, University of Nottingham, Nottingham, UK
| | - Philippa Melamed
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gillian R Bentley
- Department of Anthropology, Durham University, Durham, UK.,Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK
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Aceves-Martins M, Bates RL, Craig LCA, Chalmers N, Horgan G, Boskamp B, de Roos B. Consumption of foods with the highest nutritional quality, and the lowest greenhouse gas emissions and price, differs between socio-economic groups in the UK population. Public Health Nutr 2023; 26:3370-3378. [PMID: 37905562 PMCID: PMC10755419 DOI: 10.1017/s1368980023002355] [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: 04/28/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To establish a baseline understanding of whether consuming food with the highest nutritional quality, lowest greenhouse gas emissions (GHGE) and cost differs between different UK demographic and socio-economic population groups. DESIGN Multiple linear regression models were fitted to evaluate the relationship between predictor socio-demographic variables in this study (i.e. sex, ethnic group, age, BMI and level of deprivation) and the response variables (i.e. consumption of items considered most nutritious, with a low GHGE and price, as a proportion of total items consumed). SETTING The UK. PARTICIPANTS 1374 adult (18-65 years) participants from the National Diet and Nutrition Survey latest waves 9-11 (2016-2017 and 2018-2019). RESULTS Based on the total energy consumption in a day, the average diet-based GHGE was significantly higher for participants with a higher BMI. Non-white and most deprived participants spent significantly (P < 0·001) less money per total energy consumption. Participants with a BMI between 18·6 and 39·9 kg/m2 and those living in the least deprived areas consumed a significantly (P < 0·001) higher amount of those items considered the most nutritious, with the lowest GHGE and cost per 100 kcal. CONCLUSIONS Consumption of food with the highest nutritional quality, lowest GHGE and cost in the UK varies among those with different socio-demographic characteristics, especially the deprivation level of participants. Our analysis endorses the consideration of environmental sustainability and affordability, in addition to the consideration of nutritional quality from a health perspective, to make current dietary guidelines more encompassing and equitable.
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Affiliation(s)
| | - Ruth L Bates
- The Rowett Institute, University of Aberdeen, Foresterhill, AberdeenAB25 2ZD, UK
| | - Leone CA Craig
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Neil Chalmers
- The Rowett Institute, University of Aberdeen, Foresterhill, AberdeenAB25 2ZD, UK
| | - Graham Horgan
- Biomathematics & Statistics Scotland, Rowett Institute, Aberdeen, UK
| | - Bram Boskamp
- Biomathematics & Statistics Scotland, The King’s Buildings, Edinburgh, UK
| | - Baukje de Roos
- The Rowett Institute, University of Aberdeen, Foresterhill, AberdeenAB25 2ZD, UK
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McCabe R, Donnelly CA. Public awareness of and opinions on the use of mathematical transmission modelling to inform public health policy in the United Kingdom. J R Soc Interface 2023; 20:20230456. [PMID: 38113928 PMCID: PMC10730285 DOI: 10.1098/rsif.2023.0456] [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: 08/04/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
Mathematical modelling is used to inform public health policy, particularly so during the COVID-19 pandemic. As the public are key stakeholders, understanding the public perceptions of these tools is vital. To complement our previous study on the science-policy interface, novel survey data were collected via an online panel ('representative' sample) and social media ('non-probability' sample). Many questions were asked twice, in reference to the period 'prior to' (retrospectively) and 'during' the COVID-19 pandemic. Respondents reported being increasingly aware of modelling in informing policy during the pandemic, with higher levels of awareness among social media respondents. Modelling informing policy was perceived as more reliable during the pandemic than in reference to the pre-pandemic period in both samples. Trust in government public health advice remained high within both samples but was lower during the pandemic in comparison with the (retrospective) pre-pandemic period. The decay in trust was greater among social media respondents. Many respondents explicitly made the distinction that their trust was reserved for 'scientists' and not 'politicians'. Almost all respondents believed governments have responsibility for communicating modelling to the public. These results provide a reminder of the skewed conclusions that could be drawn from non-representative samples.
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Affiliation(s)
- Ruth McCabe
- Department of Statistics, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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Mari G. Parental unemployment and children's educational attainment: How big is the role of aspirations? Br J Sociol 2023; 74:799-807. [PMID: 37277944 DOI: 10.1111/1468-4446.13037] [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: 10/14/2022] [Revised: 03/23/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023]
Abstract
Children exposed to parental unemployment have been found to lag behind in school, but research has struggled to pin down the underlying explanation. One hypothesis is that parental unemployment may dampen children's aspirations to do well and go far in school. Yet, few studies on parental unemployment have relied on actual measures of children's aspirations or devised a formal analysis of this mechanism. Using the UK Household Longitudinal Study (Waves 1-12, N = 1067), I investigate the role of educational aspirations in children's General Certificate of Secondary Education (GCSE) attainment. I compare adolescents exposed to parental unemployment before or only after the typical age at which GCSE exams are taken. In adjusted models, children exposed to parental unemployment before their GCSEs are around 6 percentage points less likely to attain any GCSE qualification by age 17. On average, children have high educational aspirations, although intentions to enrol in college or university are relatively lower among children exposed to an early spell of parental unemployment. Nevertheless, a hypothetical intervention setting these aspirations to the same level for all children only accounts for a modest portion of the educational penalty tied to an early spell of parental unemployment. Several sensitivity and robustness tests support this conclusion. This note seeks to stimulate more research on the mechanisms underpinning the intergenerational effects of unemployment. Findings cast doubts on the idea that children's aspirations, the target of broader policy discourse and interventions, are a crucial part of the equation.
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Affiliation(s)
- Gabriele Mari
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Rothnie KJ, Numbere B, Gelwicks S, Lu Y, Sharma R, Compton C, Ismaila AS, Quint JK. Risk Factors Associated with a First Exacerbation Among Patients with COPD Classified as GOLD A and B in Routine Clinical Practice in the UK. Int J Chron Obstruct Pulmon Dis 2023; 18:2673-2685. [PMID: 38022832 PMCID: PMC10676117 DOI: 10.2147/copd.s413947] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Risk factors for exacerbations of chronic obstructive pulmonary disease (COPD) have been previously characterized for patients with more severe cases of COPD. It is unclear how the risk of first exacerbation may best be identified in patients with less severe disease. This study investigated risk factors for first exacerbation among English patients with COPD classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A or B. Patients and Methods A retrospective cohort study using data from the UK Clinical Practice Research Datalink (CPRD) AURUM linked to Hospital Episode Statistics. Patients with COPD aged ≥35 years and classified as GOLD group A or B (2020 criteria) from January 2013-December 2019 were eligible. Patients were required to have 24 months history in CPRD (baseline). Two cohorts were defined: cohort 1 included patients with no severe exacerbations during baseline; cohort 2 included patients with no moderate or severe exacerbations during baseline. Risk factors associated with severe, or combined moderate and severe exacerbation were examined for up to 5 years of follow-up. Results Overall, 194,948 patients were included in cohort 1 (mean age 66.2 years; 55.2% male), and 148,396 patients in cohort 2 (mean age 66.1 years; 56.6% male). Identified risk factors for exacerbation (and associated 1-year absolute risk of severe, or combined moderate and severe exacerbation, respectively) included: Medical Research Council dyspnea scale score (15.9%/28.4%); COPD Assessment Test score (9.6%/25.3%); GOLD grade of airflow limitation (forced expiratory volume in 1 second % predicted; 13.6%/27.5%); and lung cancer (8.1%/23.6%). After adjustment for risk factors, these factors remained independently associated with severe exacerbation at 1, 3, and 5 years of follow-up. Conclusion The identified risk factors may aid physicians in the early recognition of patients with COPD classified as GOLD group A or B at risk of first exacerbation.
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Affiliation(s)
- Kieran J Rothnie
- Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK
| | - Beade Numbere
- Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK
| | - Steven Gelwicks
- Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA
| | - Yifei Lu
- Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Pralat R, Anderson J, Burns F, Barber TJ. Asked to be a sperm donor: disclosure dilemmas of gay men living with HIV. Culture, Health & Sexuality 2023:1-15. [PMID: 37982670 DOI: 10.1080/13691058.2023.2276804] [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: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023]
Abstract
Previous research has documented the various challenges people living with HIV face as they navigate intimate relationships, including what is often referred to as disclosure. In studies of gay, bisexual and other men who have sex with men, the issue of telling or not telling others about an HIV-positive status has been examined primarily in relation to communication with sexual partners, with few studies focusing on other aspects of intimacy. Drawing on interviews with gay men living with HIV, conducted in four clinics in London, this article explores the narratives of men who have been asked by female friends about the possibility of being a sperm donor. The narratives highlight layers of complexity which have received little attention, not only in research on HIV but also in studies of sperm donation and co-parenting. The article advances dialogue between these two largely separate bodies of work. Our data suggest that reluctance to share an HIV-positive status with others can be an important factor in deciding how to answer the 'sperm donor question'. Examining reproductive relationships of a specific kind - those based on friendships between women and gay men - the article develops the understanding of how secrecy about HIV shapes intimate lives.
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Affiliation(s)
- Robert Pralat
- Department of Sociology, University of Cambridge, Cambridge, UK
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jane Anderson
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Tristan J Barber
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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Brennan N, Langdon N, Gale T, Humphries N, Knapton A, Bryce M. Exploring recent patterns of migration of doctors to the United Kingdom: a mixed-methods study. BMC Health Serv Res 2023; 23:1204. [PMID: 37924092 PMCID: PMC10625180 DOI: 10.1186/s12913-023-10199-y] [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: 07/03/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
INTRODUCTION A shortage of doctors is currently one of the biggest challenges faced by the healthcare workforce in the United Kingdom (UK). While plans are in place to increase the number of medical school places, in the short-term this gap will need to continue to be filled by the international recruitment of doctors. The aim of this study is to identify key factors that explain the patterns of migration of doctors to the UK, in order to aid the development of policies to recruit and retain a sustainable workforce. METHODS We analysed General Medical Council (GMC) secondary data on the patterns of migration of internationally trained doctors (2009-2019). Qualitative interviews were conducted with 17 stakeholders by videoconferencing which were audio-recorded, transcribed and thematically analysed using NVivo. RESULTS In 2019, 34.5% of UK doctors were trained internationally mainly in India, Pakistan, Italy, Nigeria, Greece, Romania and Egypt. Most new registrations by internationally trained doctors from 2009-2019 did not have a specialty at the time of initial registration (96.2% in 2019). Only a relatively small number of these doctors go on to gain specialist or GP registration (11.6% within 5 years and 27.2% within 10 years of registration). The stakeholder interviews highlighted training opportunities and career progression as the main drivers of migration. The barriers internationally trained doctors face regarding specialty training included differences between UK and destination health systems, systematic bias, bureaucracy and selection processes not being accessible. CONCLUSION This study makes a contribution to the literature by identifying recent patterns in the migration of doctors to the UK. The UK's dependence on internationally trained doctors has important global implications as source countries are losing skilled health workers which is undermining their health systems. In keeping with the WHO Global Code on the International Recruitment of Healthcare Personnel, policymakers need to consider how to reduce the UK's reliance on internationally trained doctors, particularly from countries on the safeguard list whilst continuing the drive to increase medical school places. Additional support is required for internationally trained doctors, to ensure that they get on the training programmes they seek, enabling their career progression.
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Affiliation(s)
- N Brennan
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK.
| | - N Langdon
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - T Gale
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - N Humphries
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Knapton
- Strategic Modelling Analysis and Planning Limited (SMAP), Winchester, UK
| | - M Bryce
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
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Rafie A, Kankam HKN, Sandhu A, Chipp E. Patient or Prisoner?: Acute Burn Injuries in Prisoners-The Birmingham Burns Centre Experience. J Burn Care Res 2023; 44:1460-1465. [PMID: 37021549 DOI: 10.1093/jbcr/irad052] [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: 02/14/2023] [Indexed: 04/07/2023]
Abstract
Increased risk of violence and self-harm means prisoners are a vulnerable population with complex health needs. They account for a small proportion of patients with burn injuries; however, present a unique set of challenges. This study investigates the incidence, pattern and outcomes of burn injuries in prison population. Prisoners referred from 2010 to 2021 were identified using the International Burn Injury Database (iBID). Patient demographics, burn injury characteristics and outcomes were collected. Patients were then stratified based on mechanism of injury, treatment modality (surgery/conservative), hospital admission (inpatient/outpatient), and compliance with outpatient follow-up, for subgroup analyses. Sixty-eight prisoners sustained burns during the study period, with a median age of 28.5 years and TBSA of 3%. The majority were male (98.5%) and required hospital admission (75%). Scalds were the most common injury type (77.9%) and assault the most frequent cause of burns (63.2%). Eighteen patients (26.5%) underwent a surgical procedure and there were two mortalities. Of patients for whom follow-up was planned, 22% attended no appointments, with a further 49% of prisoners missing at least one appointment. Relative to patients managed nonoperatively, prisoners undergoing surgery had a longer stay and all attended outpatient follow-up appointments. Prisoners represent a unique population with exceptional challenges. Attention should be given to protecting vulnerable patients at risk of assault, education of prison staff around burn prevention and first aid, and ensuring that prisoners are able to access burns follow-up to minimize long-term sequelae. Opportunities exist to aid this such as the adoption of telemedicine.
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Affiliation(s)
- Arash Rafie
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hadyn K N Kankam
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Amritpal Sandhu
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Chipp
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Di Nallo A, Köksal S. Job loss during pregnancy and the risk of miscarriage and stillbirth. Hum Reprod 2023; 38:2259-2266. [PMID: 37758648 PMCID: PMC10628490 DOI: 10.1093/humrep/dead183] [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: 06/02/2023] [Revised: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
STUDY QUESTION Does the exposure to job loss during pregnancy increase the risk of miscarriage or stillbirth? SUMMARY ANSWER The experience of own or partner's job loss during the pregnancy is associated with an increased risk of miscarriageand stillbirth. WHAT IS KNOWN ALREADY Prior research on the psycho-social aspect of pregnancy loss has investigated the contextual and the individual-level stressors. At the contextual level, natural disasters, air pollution, and economic downturns are associated with higher risk of pregnancy loss. At the individual level, intense working schedules and financial strain are linked with increased risk of pregnancy loss both at early and later stages of the gestation. STUDY DESIGN, SIZE, DURATION This work draws on high-quality individual data of 'Understanding Society', a longitudinal survey that has interviewed a representative sample of households living in the UK annually since 2009. Approximately 40 000 households were recruited. The analyses use all the available survey waves (1-12, 2009-2022). PARTICIPANTS/MATERIALS, SETTING, METHODS The final sample consisted of 8142 pregnancy episodes that contain complete informationon pregnancy outcome and date of conception. Ongoing pregnancies at the time of the interview were excluded from the final sample. The outcome variable indicated whether a pregnancy resulted in a live birth or a pregnancy loss whereas the exposure variable identified the women's or their partner's job loss because of redundancy or a dismissal. Logistic regression models were employed to estimate the relation between job loss during pregnancy and pregnancy loss. The models were adjusted for an array of socio-demographic and economic characteristics following a stepwise approach. Several sensitivity analyses complemented the main findings. MAIN RESULTS AND THE ROLE OF CHANCE Baseline models controlling for women's demographic background and prior experience of miscarriage estimated an increased risk of pregnancy loss when women were exposed to their own or their partner's job loss during their pregnancy (odds ratio (OR) = 1.99, 95% CI: 1.32, 2.99). When the models were adjusted for all socio-economic and partnership-related covariates the association remained robust (OR = 1.81, 95% CI: 1.20, 2.73). LIMITATIONS, REASONS FOR CAUTION First, the pregnancy outcome and the date of conception were self-reported and may besubjected to recall and social desirability bias. Second, although we adjusted for an array socio-demographic characteristics and self-reported health, other contextual factors might be correlated with both job loss and pregnancy loss. Third, owing to the limited sample size, we could not assess if the main finding holds across different socio-economic strata. WIDER IMPLICATIONS OF THE FINDINGS By showing that exposure to a job loss during pregnancy increases the risk of miscarriage and stillbirth, we underline the relevance of pregnancy loss as a preventable public health matter. This result also calls for policy designthat enhances labour market protection and social security buffers for pregnant women and their partners. STUDY FUNDING/COMPETING INTERESTS The authors received the following financial support for the research, authorship, and/or publication of this article: H2020 Excellent Science, H2020 European Research Council, Grant/Award Number: 694262 (project DisCont-Discontinuities in Household and Family Formation) and the Economic and Social Research Centre on Micro-Social Change (MiSoC). There are no conflicts of interest to declare.
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Affiliation(s)
- Alessandro Di Nallo
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Selin Köksal
- Institute for Social and Economic Research, University of Essex, Colchester, UK
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Paton C. The NHS in the UK at 75: On life support or death watch?: It's the politics, stupid (to misquote Bill Clinton). Int J Health Plann Manage 2023; 38:1601-1612. [PMID: 37528528 DOI: 10.1002/hpm.3699] [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: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023] Open
Abstract
This Perspective argues that the NHS in the UK is facing a critical 'tipping point' which means that its very survival is at stake. The article considers the political responses to this crisis-(briefly) from the Conservative government; (briefly) from the 'anti-NHS' Right in politics; (briefly) from the 'centre' in politics in the form of the Tony Blair Institute for Global Change; and (in depth) from the left-of-centre, the Labour Party. Labour is likely to form the next government, which is why its approach (in terms of both political strategy and the substance of health policy) is considered in depth. It is argued that Labour's approach, derived from an understandable desire by leader Sir Keir Starmer to disown its 'unelectable' recent past, is currently inadequate for the task of putting the NHS on a secure footing for the future.
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Affiliation(s)
- Calum Paton
- School of Politics and Global Studies, Keele University, Keele, Staffordshire, UK
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Hunter MS, El-Haj M, Thorne E, Griffiths A, Hardy C. #Menopause: Examining the frequency of communications about menopause on twitter between 2014 and 2022. Maturitas 2023; 177:107806. [PMID: 37536172 DOI: 10.1016/j.maturitas.2023.107806] [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: 10/17/2022] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
This study explored the use of Twitter to communicate about menopause. Tweets in English posted between January 2014 and December 2022 with the hashtag "menopause" were extracted. Total global tweets and those from the UK, USA, Australia and Canada were examined. Globally, there were 314,974 tweets about menopause over this period, with an annual average of 34,997. There were notable differences between countries, with a large increase in use in the UK in 2018 and 2019, a reducing trend in use in the USA with a smaller increase in 2018 and 2019, and low stable usage in Australia and Canada.
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Almeida J, Brocklehurst J, Sharples A. Intersectionality, vulnerability and foot health inequity. J Foot Ankle Res 2023; 16:73. [PMID: 37884971 PMCID: PMC10601163 DOI: 10.1186/s13047-023-00647-7] [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: 05/15/2023] [Accepted: 07/20/2023] [Indexed: 10/28/2023] Open
Abstract
Foot health and wellbeing in the UK are often overlooked in healthcare. Foot health outcomes are strongly interlinked to the social determinants of health, in that the way these determinants intersect can impact an individual's vulnerability to foot pain and disorders. In this commentary we explore some social determinants that hinder individuals from improving their foot health behaviour and ultimately reducing foot pain and foot disorder vulnerability. We focus on socioeconomic status, gender, disability, age, culture and ethnicity, and footwear quality; we also highlight the potential impact of the Covid-19 pandemic and the cost-of-living crisis on foot health inequities; rises in inflation have resulted in footcare becoming less affordable among vulnerable groups, like those with intellectual disabilities and chronic illness, older people, those living in rural and inner-city communities, and the ethnically and linguistically diverse population living in the UK. There is an urgent need to raise awareness of the social determinants of foot health, their intersectionality, and their impact on foot pain and disorder vulnerability. Despite the Black Report and both Marmot Reviews, little progress has been made in raising this awareness. It is recommended to widen the range of foot health interventions, by including it in GP consultations, developing cultural sensitivity within foot health services, creating more comprehensive educational foot health programmes, and developing a more sustainable footwear industry.
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Affiliation(s)
- Joana Almeida
- School of Applied Social Sciences, Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
| | | | - Adrienne Sharples
- School of Applied Social Sciences, Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
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Kaur K, Mutanda D, Almond P, Pandey A, Young P, Levitan T, Bibby-Jones AM. A co-produced service evaluation of ethnic minority community service user experiences of a specialist mental health service during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:1107. [PMID: 37848874 PMCID: PMC10583414 DOI: 10.1186/s12913-023-10115-4] [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: 12/29/2022] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND For ethnic minority communities in the UK, the COVID-19 pandemic amplified existing health inequalities and created other consequential disadvantages like increased vulnerability to COVID-19, higher rates of hospital admissions, increased mortality and poorer mental health outcomes. While longer-term impacts of COVID-19 are considered, it is crucial for NHS mental health services to understand the specific barriers and needs of ethnic minority communities to provide consistent and equitable access to mental health services. These aspects were the focus of a service evaluation of a Sussex-wide mental health service conducted in co-production with experts-by-experience, public members, health professionals and researchers from ethnic minority communities. METHODS Co-designed creative workshops (n = 13) and semi-structured qualitative interviews (n = 13) were used to explore experiences of accessing specialist mental health services during the COVID-19 pandemic. Participants were: Sussex Partnership NHS Foundation Trust (SPFT) service users recruited between October 2021 and January 2022; aged 16+; from ethnic minority community backgrounds. Data was analysed using Thematic Analysis. RESULTS The analysis yielded five overarching themes contextualising service users' experiences: (1) limited awareness of SPFT mental health services; (2) effects of COVID-19 in gaining access to SPFT; (3) SPFT reaching out to ethnic minorities; (4) being supported, 4a) hiding my mental health status from friends and families, 4b) lack of ethnic diversity in services, and 4c) better provision of information and support services, (5) relationship between childhood experiences and current mental health. These findings led to seven key recommendations for future service developments within SPFT. CONCLUSIONS Although this evaluation was set in the context of COVID-19, findings have highlighted specific mental health service needs for ethnic minorities that are applicable beyond the confines of the pandemic. Many benefited from online sessions seen as more inclusive. Mental health advocates, outreach and joint working with communities could help further reduce stigmatising attitudes and improve engagement with mental health services. Improved service awareness of the impact of childhood or historical traumas experienced by ethnic minority communities on current mental health, the role of cultural awareness training and availability of culturally adapted therapies is also needed. Many service improvement recommendations provided could impact all service users.
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Affiliation(s)
- Kiranpal Kaur
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Palo Almond
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Paris Young
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Tony Levitan
- Sussex Partnership NHS Foundation Trust, Worthing, UK
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Jiang Y, Zhao M, Xi J, Li J, Tang W, Zheng X. Cost-effectiveness analysis of atezolizumab in patients with non-small-cell lung cancer ineligible for treatment with a platinum-containing regimen: a United Kingdom health care perspective. Front Public Health 2023; 11:1282374. [PMID: 37841712 PMCID: PMC10570614 DOI: 10.3389/fpubh.2023.1282374] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Cost-effectiveness of atezolizumab, as a treatment for advanced non-small-cell lung cancer (NSCLC) patients who cannot receive a platinum-containing regimen,was still unknown. Our objective was to evaluate the cost-effectiveness of atezolizumab vs. chemotherapy in this indication from the perspective of UK healthcare system. Methods From the global, randomised, open-label, phase III IPSOS trial, clinical inputs and patient characteristics were obtained. A partitioned survival model with three health states was built: Progression-free survival, progressed disease and death. A lifetime time horizon was applied, with an annual discount rate of 3.5%. Additionally, the willingness-to-pay threshold of £50,000/QALY was utilized. Primary outcomes were quality-adjusted life-year (QALY), costs, and incremental cost-effectiveness ratio (ICER). Sensitivity, scenario, and subgroup analyses were used to assess the reliability of base-case results. Price simulations were carried out in order to provide information for the pricing strategy at specific willingness-to-pay threshold. Results In the base-case analysis, atezolizumab resulted in a gain of 0.28 QALYs and an ICER of £94,873/QALY compared to chemotherapy, demonstrating no cost-effectiveness. Price simulation results revealed that atezolizumab would be preferred at a price lower than £2,215 (a reduction of 41.8%) at the willingness-to-pay threshold of £50,000. Sensitivity, scenario and subgroup analyses revealed these conclusions were generally robust, the model was most sensitive to the price of atezolizumab and subsequent medication. Furthermore, atezolizumab was found to be more cost-effective for patients displaying a positive PD-L1 expression, with an ICER of £72,098/QALY as compared to chemotherapy. Conclusion Atezolizumab is not cost-effective for patients with advanced NSCLC ineligible for platinum-containing regimen, potential price reduction is necessary.
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Affiliation(s)
- Yunlin Jiang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Mingye Zhao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jiayi Xi
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jiaqi Li
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Wenxi Tang
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Xueping Zheng
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
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Hanzlová R, Lynn P. Item response theory-based psychometric analysis of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) among adolescents in the UK. Health Qual Life Outcomes 2023; 21:108. [PMID: 37773069 PMCID: PMC10540427 DOI: 10.1186/s12955-023-02192-0] [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: 07/21/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Middle and late adolescence is the period in a person's life that is most vulnerable to mental health problems. To enable an evidence base that can support policies to prevent such problems, it is crucial to have good quality, reliable, and accurate measurement tools for mental well-being. One of them is the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). This study aimed to test the psychometric properties of the SWEMWBS on a large sample of adolescents aged 16 to 19 from the United Kingdom (UK) (N = 8,090). Data were from four waves of the longitudinal panel study Understanding Society. METHODS The analysis was conducted using Item Response Theory (IRT), which is the most appropriate method for testing psychometric properties. The Graded Response Model (GRM) was applied to the data. The reliability and criterion validity of the SWEMWBS were also examined. RESULTS The presented results confirm the very good psychometric properties of the SWEMWBS amongst adolescents aged 16 to 19 years. The assumptions for the use (unidimensionality, local non-independence, monotonicity) of IRT were met. The results of GRM showed very high discriminant power for all items. The five-category response scale performed optimally; however, differences were found between points on the response scale both between and within items. In general, the scale as a whole showed very good functioning, but particularly in the negative values of mental well-being. CONCLUSIONS The SWEMWBS was confirmed as a concise, reliable, and valid instrument for measuring mental well-being among older UK adolescents.
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Affiliation(s)
- Radka Hanzlová
- Institute of Sociology of the Czech Academy of Sciences, Prague, Czech Republic.
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Harrop E, Medeiros Mirra R, Goss S, Longo M, Byrne A, Farnell DJJ, Seddon K, Penny A, Machin L, Sivell S, Selman LE. Prolonged grief during and beyond the pandemic: factors associated with levels of grief in a four time-point longitudinal survey of people bereaved in the first year of the COVID-19 pandemic. Front Public Health 2023; 11:1215881. [PMID: 37794891 PMCID: PMC10546414 DOI: 10.3389/fpubh.2023.1215881] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 10/06/2023] Open
Abstract
Background The COVID-19 pandemic has been a devastating and enduring mass-bereavement event, with uniquely difficult sets of circumstances experienced by people bereaved at this time. However, little is known about the long-term consequences of these experiences, including the prevalence of Prolonged Grief Disorder (PGD) and other conditions in pandemic-bereaved populations. Methods A longitudinal survey of people bereaved in the UK between 16 March 2020 and 2 January 2021, with data collected at baseline (n = 711), c. 8 (n = 383), 13 (n = 295), and 25 (n = 185) months post-bereavement. Using measures of Prolonged Grief Disorder (PGD) (Traumatic Grief Inventory), grief vulnerability (Adult Attitude to Grief Scale), and social support (Inventory of Social Support), this analysis examines how participant characteristics, characteristics of the deceased and pandemic-related circumstances (e.g., restricted visiting, social isolation, social support) are associated with grief outcomes, with a focus on symptoms of PGD. Results At baseline, 628 (88.6%) of participants were female, with a mean age of 49.5 (SD 12.9). 311 (43.8%) deaths were from confirmed/suspected COVID-19. Sample demographics were relatively stable across time points. 34.6% of participants met the cut-off for indicated PGD at c. 13 months bereaved and 28.6% at final follow-up. Social isolation and loneliness in early bereavement and lack of social support over time strongly contributed to higher levels of prolonged grief symptoms, while feeling well supported by healthcare professionals following the death was associated with reduced levels of prolonged grief symptoms. Characteristics of the deceased most strongly associated with lower levels of prolonged grief symptoms, were a more distant relationship (e.g., death of a grandparent), an expected death and death occurring in a care-home. Participant characteristics associated with higher levels of prolonged grief symptoms included low level of formal education and existence of medical conditions. Conclusion Results suggest higher than expected levels of PGD compared with pre-pandemic times, with important implications for bereavement policy, provision and practice now (e.g., strengthening of social and specialist support) and in preparedness for future pandemics and mass-bereavement events (e.g., guidance on infection control measures and rapid support responses).
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Affiliation(s)
- Emily Harrop
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Silvia Goss
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Mirella Longo
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Anthony Byrne
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Kathy Seddon
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Alison Penny
- National Bereavement Alliance, London, United Kingdom
| | - Linda Machin
- School of Medicine, Keele University, Keele, United Kingdom
| | - Stephanie Sivell
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Lucy E. Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Smith L, López Sánchez GF, Fernandez-Egea E, Ford T, Parris C, Underwood BR, Butler L, Barnett Y, Trott M, Koyanagi A. Eating disorders and physical multimorbidity in the English general population. Eat Weight Disord 2023; 28:72. [PMID: 37676625 PMCID: PMC10485116 DOI: 10.1007/s40519-023-01600-0] [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: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
PURPOSE People with eating disorders may be at increased risk for physical health problems, but there are no data on the relationship between eating disorders and physical multimorbidity (i.e., ≥ 2 physical conditions) and its potential mediators. Thus, we investigated this association in a representative sample of adults from the UK, and quantified the extent to which this can be explained by various psychological and physical conditions, and lifestyle factors. METHODS Cross-sectional data of the 2007 Adult Psychiatric Morbidity Survey were analyzed. Questions from the five-item SCOFF screening instrument were used to identify possible eating disorder. Respondents were asked about 20 physical health conditions. Multivariable logistic regression and mediation analysis were conducted. RESULTS Data on 7403 individuals aged ≥ 16 years were analyzed [mean (SD) age 46.3 (18.6) years; 48.6% males]. After adjustment, possible eating disorder was associated with 2.11 (95%CI = 1.67-2.67) times higher odds for physical multimorbidity. Anxiety disorder explained the largest proportion this association (mediated percentage 26.3%), followed by insomnia (21.8%), perceived stress (13.4%), depression (13.1%), obesity (13.0%), and alcohol dependence (4.3%). CONCLUSION Future longitudinal studies are warranted to understand potential causality and the underlying mechanisms in the association between eating disorder and multimorbidity, and whether addressing the identified potential mediators in people with eating disorders can reduce multimorbidity.
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Affiliation(s)
- Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Christopher Parris
- Medical Technology Research Centre, School of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, Cambridge, UK
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Mike Trott
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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