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  • 1
    Online Resource
    Online Resource
    Mortality in COVID-19 among women on hormone replacement therapy: a retrospective cohort study
    Oxford University Press (OUP) ; 2022
    In:  Family Practice Vol. 39, No. 6 ( 2022-11-22), p. 1049-1055
    Details
    In: Family Practice, Oxford University Press (OUP), Vol. 39, No. 6 ( 2022-11-22), p. 1049-1055
    Abstract: Limited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease. Our aim was to investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19. Methods We undertook a retrospective cohort study using routinely collected computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. We identified a cohort of 1,863,478 women over 18 years of age from 465 general practices in England. Mixed-effects logistic regression models were used to quantify the association between HRT or COCP use and all-cause mortality among women diagnosed with confirmed or suspected COVID-19 in unadjusted and adjusted models. Results There were 5,451 COVID-19 cases within the cohort. HRT was associated with a reduction in all-cause mortality in COVID-19 (adjusted OR 0.22, 95% CI 0.05 to 0.94). There were no reported events for all-cause mortality in women prescribed COCPs. This prevented further examination of the impact of COCP. Conclusions We found that HRT prescription within 6 months of a recorded diagnosis of COVID-19 infection was associated with a reduction in all-cause mortality. Further work is needed in larger cohorts to examine the association of COCP in COVID-19, and to further investigate the hypothesis that oestrogens may contribute a protective effect against COVID-19 severity.
    Type of Medium: Online Resource
    ISSN: 1460-2229
    URL: Article
    DOI: 10.1093/fampra/cmac041
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1484852-1
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  • 2
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    Drug treatments affecting ACE2 in COVID-19 infection: a systematic review protocol
    Royal College of General Practitioners ; 2020
    In:  BJGP Open Vol. 4, No. 3 ( 2020-08), p. bjgpopen20X101115-
    Details
    In: BJGP Open, Royal College of General Practitioners, Vol. 4, No. 3 ( 2020-08), p. bjgpopen20X101115-
    Abstract: The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs that up- or down-regulate ACE2 expression are, therefore, of critical research interest as agents that might promote or reduce risk of COVID-19 infection in a susceptible population. Aim To collate evidence on routinely prescribed drug treatments in the UK that could up- or down-regulate ACE2, and thus potentially affect COVID-19 infection. Design & setting Systematic review of studies published in MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library, and Web of Science from inception to 1 April 2020. Method A systematic review will be conducted in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Inclusion criteria will be: (1) assesses the effect of drug exposure on ACE2 level of expression or activity; (2) the drug is included in the British National Formulary ( BNF ) and, therefore, available to prescribe in the UK; and (3) a control, placebo, or sham group is included as comparator. Exclusion criteria will be: (1) ACE2 measurement in utero; (2) ACE2 measurement in children aged 〈 18 years; (3) drug not in the BNF ; and (4) review article. Quality will be assessed using the Cochrane risk of bias tool for human studies, and the SYstematic Review Center for Laboratory animal Experimentation (SYRCLE) risk of bias tool for animal studies. Results Data will be reported in summary tables and narrative synthesis. Conclusion This systematic review will identify drug therapies that may increase or decrease ACE2 expression. This might identify medications increasing risk of COVID-19 transmission, or as targets for intervention in mitigating transmission.
    Type of Medium: Online Resource
    ISSN: 2398-3795
    URL: Article
    DOI: 10.3399/bjgpopen20X101115
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2020
    detail.hit.zdb_id: 2881009-0
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  • 3
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    Postal methods for monitoring HbA1c in diabetes mellitus: a protocol for systematic review
    Royal College of General Practitioners ; 2022
    In:  BJGP Open Vol. 6, No. 4 ( 2022-12), p. BJGPO.2021.0240-
    Details
    In: BJGP Open, Royal College of General Practitioners, Vol. 6, No. 4 ( 2022-12), p. BJGPO.2021.0240-
    Abstract: Worldwide there are an estimated 463 million people with diabetes. In the UK people with diabetes are offered annual review, which includes monitoring of haemoglobin A1c (HbA1c). This can identify people with diabetes who are not meeting their glycaemic targets, enabling early intervention. Those who do not attend these reviews often have poorer health outcomes. During the COVID-19 pandemic, there was a 77% reduction in monitoring of HbA1c in the UK. Aim It is hypothesised that people with diabetes could take finger-prick samples at home for measurement of HbA1c. This study will examine the agreement and correlation of capillary HbA1c values compared with a venous reference standard. It will explore reliability and repeatability of capillary HbA1c testing methods, as well as the direction of effect of storage variables. The study will also explore patient acceptability and safety. It will look at capillary blood methods that would be suitable for posting. Design & setting A systematic review will be undertaken. Method The core terms of ‘Diabetes’, ‘HbA1c’ and ‘Capillary sampling’ will be used to search MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Core Collection, Google Scholar, OpenGrey, and other grey literature, from database inception until 2021. Risk of bias will be assessed using the ‘COSMIN Risk of Bias tool to assess the quality of studies on reliability and measurement error’. Conclusion A narrative synthesis will be produced to explore whether there are viable postal alternatives to venous sampling, as well as exploring acceptability and safety of patient self-collection.
    Type of Medium: Online Resource
    ISSN: 2398-3795
    URL: Article
    DOI: 10.3399/BJGPO.2021.0240
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2022
    detail.hit.zdb_id: 2881009-0
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  • 4
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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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  • 5
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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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  • 6
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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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  • 7
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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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  • 8
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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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  • 9
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    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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  • 10
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    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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