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  • 1
    Online Resource
    Online Resource
    Socioeconomic inequalities of Long COVID: a retrospective population-based cohort study in the United Kingdom
    SAGE Publications ; 2023
    In:  Journal of the Royal Society of Medicine Vol. 116, No. 8 ( 2023-08), p. 263-273
    Details
    In: Journal of the Royal Society of Medicine, SAGE Publications, Vol. 116, No. 8 ( 2023-08), p. 263-273
    Abstract: To estimate the risk of Long COVID by socioeconomic deprivation and to further examine the inequality by sex and occupation. Design We conducted a retrospective population-based cohort study using data from the ONS COVID-19 Infection Survey between 26 April 2020 and 31 January 2022. This is the largest nationally representative survey of COVID-19 in the UK with longitudinal data on occupation, COVID-19 exposure and Long COVID. Setting Community-based survey in the UK. Participants A total of 201,799 participants aged 16 to 64 years and with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Main outcome measures The risk of Long COVID at least 4 weeks after SARS-CoV-2 infection by index of multiple deprivation (IMD) and the modifying effects of socioeconomic deprivation by sex and occupation. Results Nearly 10% ( n = 19,315) of participants reported having Long COVID. Multivariable logistic regression models, adjusted for a range of variables (demographic, co-morbidity and time), showed that participants in the most deprived decile had a higher risk of Long COVID (11.4% vs. 8.2%; adjusted odds ratio (aOR): 1.46; 95% confidence interval (CI): 1.34, 1.59) compared to the least deprived decile. Significantly higher inequalities (most vs. least deprived decile) in Long COVID existed in healthcare and patient-facing roles (aOR: 1.76; 95% CI: 1.27, 2.44), in the education sector (aOR: 1.68; 95% CI: 1.31, 2.16) and in women (aOR: 1.56; 95% CI: 1.40, 1.73) than men (aOR: 1.32; 95% CI: 1.15, 1.51). Conclusions This study provides insights into the heterogeneous degree of inequality in Long COVID by deprivation, sex and occupation. These findings will help inform public health policies and interventions in incorporating a social justice and health inequality lens.
    Type of Medium: Online Resource
    ISSN: 0141-0768 , 1758-1095
    URL: Article
    DOI: 10.1177/01410768231168377
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2046643-2
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  • 2
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    Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review
    MDPI AG ; 2022
    In:  International Journal of Environmental Research and Public Health Vol. 19, No. 18 ( 2022-09-13), p. 11492-
    Details
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 19, No. 18 ( 2022-09-13), p. 11492-
    Abstract: Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinants in the MLTC sequelae is unclear. Aim: the aim of this review was to summarise and collate existing evidence on environmental determinants on established MLTC. Methods: comprehensive search of Medline, Embase, Cochrane, CINAHL and Bielefeld Academic Search Engine (BASE), from inception to 4th June 2022 in addition to grey literature. Two authors independently screened and extracted papers. Disagreements were resolved with a third author. Results: searches yielded 9079 articles, 12 of which met the review’s inclusion criteria. Evidence of correlations between some environmental determinants and increased or decreased risks of MLTC were found, including the quality of internal housing/living environments, exposure to airborne environmental hazards and a beneficial association with socially cohesive, accessible and greener neighbourhood environments. Conclusions: The majority of the 12 included papers focused on the built and social environments. The review uncovered very limited evidence, indicating a need for further research to understand the role of environmental determinants in MLTC.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    URL: Article
    DOI: 10.3390/ijerph191811492
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2175195-X
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  • 3
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    COVID-19 mortality: a complex interplay of sex, gender and ethnicity
    Oxford University Press (OUP) ; 2020
    In:  European Journal of Public Health Vol. 30, No. 5 ( 2020-10-01), p. 847-848
    Details
    In: European Journal of Public Health, Oxford University Press (OUP), Vol. 30, No. 5 ( 2020-10-01), p. 847-848
    Type of Medium: Online Resource
    ISSN: 1101-1262 , 1464-360X
    URL: Article
    DOI: 10.1093/eurpub/ckaa150
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2033525-8
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  • 4
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    Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study
    Public Library of Science (PLoS) ; 2023
    In:  PLOS ONE Vol. 18, No. 8 ( 2023-8-29), p. e0290791-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 8 ( 2023-8-29), p. e0290791-
    Abstract: Biochemical remission of type 2 diabetes is achievable through dietary changes, physical activity and subsequent weight loss. We aim to identify distinct diabetes remission trajectories in a large population-based cohort over seven-years follow-up and to examine associations between remission trajectories and diabetes complications. Group-based trajectory modelling examined longitudinal patterns of HbA 1c level (adjusting for remission status) over time. Multivariable Cox models quantified the association between each remission trajectory and microvascular complications, macrovascular complications, cardiovascular (CVD) events and all-cause mortality. Four groups were assigned. Group 1 (8,112 [13.5%]; achieving HbA 1c 〈 48 mmol/mol (6.5%) followed by increasing HbA 1c levels); Group 2 (6,369 [10.6%]; decreasing HbA 1c levels 〉 48 mmol/mol (6.5%)); Group 3 (36,557 [60.6%]; stable high HbA 1c levels); Group 4 (9,249 [15.3%]; stable low HbA 1c levels ( 〈 48mmol/mol or 〈 6.5%)). Compared to Group 3, Groups 1 and 4 had lower risk of microvascular complications (aHRs (95% CI): 0.65 (0.61–0.70), p-value 〈 0.001;0.59 (0.55–0.64) p-value 〈 0.001, respectively)), macrovascular complications (aHRs (95% CI): 0.83 (0.75–0.92), p-value 〈 0.001; 0.66 (0.61–0.71), p-value 〈 0.001) and CVD events (aHRs (95% CI): 0.74(0.67–0.83), p-value 〈 0.001; 0.67(0.61–0.73), p-vlaue 〈 0.001). Risk of CVD outcomes were similar for Groups 2 and 3. Compared to Group 3, Group 1 (aHR: 0.82(95% CI: 0.76–0.89)) had lower risk of mortality, but Group 4 had higher risk of mortality (aHR: 1.11(95% CI: 1.03–1.19)). Risk of CVD outcomes vary by pattern of remission over time, with lowest risk for those in remission longer. People who achieve remission, even for shorter periods of time, continue to benefit from this lower exposure to hyperglycaemia, which may, in turn, lower the risk of CVD outcomes including mortality.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0290791
    DOI: 10.1371/journal.pone.0290791.g001
    DOI: 10.1371/journal.pone.0290791.t001
    DOI: 10.1371/journal.pone.0290791.t002
    DOI: 10.1371/journal.pone.0290791.t003
    DOI: 10.1371/journal.pone.0290791.t004
    DOI: 10.1371/journal.pone.0290791.s001
    DOI: 10.1371/journal.pone.0290791.s002
    DOI: 10.1371/journal.pone.0290791.r001
    DOI: 10.1371/journal.pone.0290791.r002
    DOI: 10.1371/journal.pone.0290791.r003
    DOI: 10.1371/journal.pone.0290791.r004
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2023
    detail.hit.zdb_id: 2267670-3
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  • 5
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    Change in treatment burden among people with multimorbidity: Protocol of a follow up survey and development of efficient measurement tools for primary care
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 11 ( 2021-11-29), p. e0260228-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 11 ( 2021-11-29), p. e0260228-
    Abstract: Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. It is likely treatment burden changes over time as circumstances change for patients and health services. However, there are a lack of population-level studies of treatment burden change and factors associated with this change over time. Furthermore, there are currently no practical screening tools for treatment burden in time-pressured clinical settings or at population level. Methods and analysis This is a three-year follow-up of a cross-sectional survey of 723 people with multimorbidity (defined as three or more long-term conditions; LTCs) registered at GP practices in in Dorset, England. The survey will repeat collection of information on treatment burden (using the 10-item Multimorbidity Treatment Burden Questionnaire (MTBQ) and a novel single-item screening tool), sociodemographics, medications, LTCs, health literacy and financial resource, as at baseline. Descriptive statistics will be used to compare change in treatment burden since the baseline survey in 2019 and associations of treatment burden change will be assessed using regression methods. Diagnostic test accuracy metrics will be used to evaluate the single-item treatment burden screening tool using the MTBQ as the gold-standard. Routine primary care data (including demographics, medications, LTCs, and healthcare usage data) will be extracted from medical records for consenting participants. A forward-stepwise, likelihood-ratio logistic regression model building approach will be employed in order to assess the utility of routine data metrics in quantifying treatment burden in comparison to self-reported treatment burden using the MTBQ. Impact To the authors’ knowledge, this will be the first study investigating longitudinal aspects of treatment burden. Findings will improve understanding of the extent to which treatment burden changes over time for people with multimorbidity and factors contributing to this change, as well as allowing better identification of people at risk of high treatment burden.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pone.0260228
    DOI: 10.1371/journal.pone.0260228.s001
    DOI: 10.1371/journal.pone.0260228.s002
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 6
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    Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England
    Royal College of General Practitioners ; 2020
    In:  British Journal of General Practice Vol. 70, No. 698 ( 2020-09), p. e668-e675
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 70, No. 698 ( 2020-09), p. e668-e675
    Abstract: There is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses. Aim To explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses. Design and setting A qualitative primary care interview study in the East of England. Method Semi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed. Results The authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met. Conclusion Type 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp20X710945
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
    detail.hit.zdb_id: 2097982-4
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  • 7
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    Online Resource
    Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study
    Annals of Family Medicine ; 2019
    In:  The Annals of Family Medicine Vol. 17, No. 4 ( 2019-07), p. 311-318
    Details
    In: The Annals of Family Medicine, Annals of Family Medicine, Vol. 17, No. 4 ( 2019-07), p. 311-318
    Type of Medium: Online Resource
    ISSN: 1544-1709 , 1544-1717
    URL: Article
    DOI: 10.1370/afm.2421
    Language: English
    Publisher: Annals of Family Medicine
    Publication Date: 2019
    detail.hit.zdb_id: 2114291-9
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  • 8
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    Clustering populations by health and social care with multiple long-term conditions: a cohort study — the English Longitudinal Study of Ageing (ELSA)
    Royal College of General Practitioners ; 2023
    In:  British Journal of General Practice Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X734337-
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X734337-
    Abstract: The integration of health and social care services is a potential solution for improving care, despite monetary constraints and increasing demand. How two or more multiple long-term conditions (MLTC) cluster, interact and associate with socioeconomic factors, and affect access to unscheduled primary healthcare services is understudied. Aim To cluster an MLTC population by health and social care, examine clusters, and quantify associations with health outcomes. Method A retrospective cohort study was conducted using the ELSA database (2002 to 2019) on 19802 participants aged ≥50 years. Ten major health conditions, and social care need, including difficulty in activities of daily living (ADL) and mobility, for example, were used to cluster MLTC by latent class modelling. Multivariate logistic regression models were used to establish further association. Results The mean age of the participants at baseline (wave 2) was about 66 years and 55% of participants were female, with more than 60% developing MLTC in their lifetime (waves 2 to 9). Of the five distinct latent clusters, cluster 5 was the most significant cluster composed of lung diseases, stroke, dementia, and high ADL and mobility difficulty scores. The majority of the participants were aged 70–79 years, female, and married. The odds of having a longer nursing home stay were 8.97 (95% confidence interval = 4.36 to 18.45), and death was 10% higher in this cluster compared to the highest probability cluster 4 in the maximally adjusted regression model. Conclusion This study identified MLTC clusters by social care need with the highest primary care demand. Targeting clinical practice to prevent MLTC progression for these groups may lessen future pressures on primary care demand.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp23X734337
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2023
    detail.hit.zdb_id: 2097982-4
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  • 9
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    The diabetes annual review in a postal box: a qualitative study exploring views of people with diabetes
    Royal College of General Practitioners ; 2023
    In:  British Journal of General Practice Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X733605-
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 73, No. suppl 1 ( 2023-07), p. bjgp23X733605-
    Abstract: People with diabetes who do not attend their annual review appointments often have poorer glycaemic control and increased complication rates. A postal kit for self-collection of blood tests, urine samples, and anthropometric data may facilitate remote annual reviews and improve uptake. Aim To explore views on a postal kit for annual review among people with diabetes and to collaborate with people living with diabetes to design and expand the scope of an annual review postal kit. Method We conducted semi-structured interviews and focus groups with adults with type 1 and type 2 diabetes. Purposive sampling was used to ensure 50% of study invites went to infrequent attenders of annual review appointments. Transcripts were collated and analysed thematically. Results Twenty-two participants took part, including nine infrequent attenders. All infrequent attenders and the majority of regular attenders responded positively to a postal kit, with convenience being the most prominent value described. Concerns raised related to personal capability of self-collection and the accuracy of results. Participants were asked for suggestions to improve the kit. The most common themes related to communication; participants wanted clearer information regarding the purpose of each test; they wanted feedback of their results through either a website or app with tailored advice for each result; and they wanted to utilise the kit to communicate their priorities for discussion at future consultations. Conclusion Postal kits for annual reviews were well-received by people living with diabetes. Designed well, they have the potential to overcome far more than just the physical barriers to annual review attendance.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp23X733605
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2023
    detail.hit.zdb_id: 2097982-4
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  • 10
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    Quantifying empathy levels among UK undergraduate medical students: an online survey
    Royal College of General Practitioners ; 2020
    In:  British Journal of General Practice Vol. 70, No. suppl 1 ( 2020-06), p. bjgp20X711293-
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 70, No. suppl 1 ( 2020-06), p. bjgp20X711293-
    Abstract: Empathy is a key health care concept and refers to care that incorporates understanding of patient perspective’s, shared decision making, and consideration of the broader context in which illness is experience. Evidence suggests experiences of doctor empathy correlate with improved health outcomes and patient satisfaction. It has also been linked to job satisfaction, and mental wellbeing for doctors. To date, there is a paucity of evidence on empathy levels among medical students. This is critical to understand given that it is a key point at which perceptions and practices of empathy in the longer term might be formed. Aim To quantify the level of empathy among UK undergraduate medical students Method An anonymised cross-sectional online survey was distributed to medical students across three universities. The previously validated Davis’s Interpersonal Reactivity Index was used to quantify empathy. The survey also collected information on age, sex, ethnicity, year of medical school training and included a free-text box for ‘any other comments’. Results Data analysis is currently underway with high response rates. Mean empathy scores by age, sex, year of study and ethnic group are presented. A correlation analysis will examine associations between age and year of study, and mean empathy sores. Conclusion These data will help to provide a better understanding of empathy levels to inform the provision of future empathy training and medical school curriculum design. Given previous evidence linking experiences of empathy to better health outcomes, the findings may also be significant to future patient care
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/bjgp20X711293
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
    detail.hit.zdb_id: 2097982-4
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