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Evaluating the role of community-based multi-disciplinary teams in integrated health and social care in England: Overview of findings from the Pioneer evaluation and their implications for health and social care integration.
Get PDFObjectives: This paper synthesises the findings of an evaluation of community-based multi-disciplinary teams (MDTs), primarily serving older people with long-term conditions, undertaken as part of a wider evaluation (2015-2022) of the Integrated Care and Support Pioneer Programme (2013-2018) in England. The MDT evaluation was undertaken in two contrasting Pioneers with 11 MDTs covering four models of MDT functioning.
Methods: The synthesis, set against our conceptual framework of MDT functioning, draws principally on the findings of semi-structured interviews with local strategic level health and care leaders, frontline MDT staff, and patients and their informal carers, observations of MDT meetings, and an online survey of MDT staff.
Results: MDTs were seen as an essential means of working towards local health and care integration. While local contexts shaped the precise aims, structure, composition and ways of working of the different MDT models studied, there were strong similarities across the teams in how staff viewed the nature and benefits of MDT working. MDTs were perceived as having the potential to provide more holistic care to patients, speed up access to care, improve access to a wider range of services and enhance care at home. Benefits to staff included better information sharing; reduced duplication of tasks; enhanced collective responsibility and problem-solving, which enriched decision-making; opportunities to learn from, and about, the remits of other professional groups and services; and the erosion of traditional professional hierarchies. However, barriers to MDT working, including the absence of shared patient records, inadequate infrastructure and resources, and concerns about the ability to measure and demonstrate the value of MDT working, were also identified. Patients and their informal carers reported valuing good communication with their health and care providers but often appeared unaware of an MDT's involvement in planning their care. This suggests there is some distance to travel in terms of how MDTs communicate their roles to those they serve.
Conclusions: At the service delivery level, our findings' implications for policy and practice include the need for greater integration across patient records and data systems, and greater investment in specialist services (e.g., housing) currently absent from MDTs. However, our research also highlighted challenges to evaluating the outcomes of 'integration' both as a concept and at the service delivery level. Changes to both the research environment and the approach to evaluation are also warranted
Transforming Agricultural Water Management Through the Water–Energy–Food Nexus: Trends, Opportunities, Barriers and Solutions
Get PDFAgricultural water management (AWM) is increasingly transitioning towards transformative thinking, where interconnected sectors, including water, energy and food, are managed holistically. Trends point towards cross‐sectoral and harmonised strategies to optimise water use efficiency and productivity, integrate renewable energy, promote sustainable food production and strengthen ecological resilience while considering economic incentives for farmers. However, the main challenge of AWM has been managing water and energy for food production amidst the scarcity, degradation and depletion of water resources. This requires a shift from the current AWM practices, which focus on single‐factor productivity and resource use efficiency at the expense of equity, conservation, consumption and the circular economy. This entails reducing water consumption, increasing environmental flows, minimising waste and reusing resources in agriculture. This systematic review identifies pathways to transition traditional AWM practices to a water–energy–food (WEF) nexus‐informed system that is equitable, inclusive, integrated and resilient, balancing the socio‐ecological systems. This review establishes the interlinkages of WEF resources as drivers of resource use efficiency in sustainable crop production, highlighting the trends, opportunities, barriers and solutions of a smart AWM system. The recommendations propose shifting from the current production‐centric AWM to one that is transformative, equitable, sustainable and resilient for human and natural systems
Microbial Signatures Mapping of High and Normal Blood Glucose Participants in the Generation 100 Study
Get PDFIntestinal dysbiosis has been linked to metabolic disorders, including insulin resistance and type 2 diabetes mellitus (T2DM). T2DM typically follows a prediabetic stage, during which insulin resistance develops. During the early stages of T2DM, its development can be corrected, thus potentially preventing or delaying the onset of the disease. This secondary, exploratory, cross-sectional comparison study aimed to contrast the gut microbiome of individuals with elevated fasting blood glucose to that of individuals with glucose levels within the normal range. This study involved 65 older adults (ages 76–83 years) enrolled from the randomized controlled trial entitled the “Generation 100 Study”, all of whom consented to provide their gut microbiome samples. We employed a high-throughput sequencing of the bacterial 16S rRNA gene to obtain metagenomic microbial profiles for all participants. These profiles were then correlated with clinical measures. Overall, microbial alpha diversity was significantly reduced in the high glucose group. We have also observed distinct patterns of microbial beta diversity between high and normal glucose groups. At the phylum level, we found that Synergistes, Elusimicobia, Euryarchaeota, Verrucomicrobia, and Proteobacteria were all significantly decreased in participants with high blood glucose. Additionally, P. copri (ASV 909561) was significantly elevated (10-fold increase) in the high glucose groups, suggesting that it may serve as an early T2DM marker. In contrast to prior reports on the Fusobacterium genus, we found that it was significantly increased in the normal glucose group, with a significant 151-fold increase compared to the high glucose group. Directly linking gut microbiota profiles with clinical indicators such as fasting blood glucose and T2DM diagnosis allows the identification of specific microbial features associated with glucose dysregulation, providing preliminary population-level evidence to guide future translational research. Our results indicate significant changes in the microbiome that may provide valuable insights for early intervention in pre-diabetic states
Lethal Heat and Humidity Events.
Get PDFClimate change increasingly threatens global health as more frequent extreme heat events, combined with varying humidity levels, exacerbate both direct and indirect health risks, strain energy resources, and lead to economic loss. Vulnerable populations, including the elderly, young children, and those with preexisting health conditions, face greater risks due to lower physiological adaptive capacity. Those from socioeconomically disadvantaged communities are also vulnerable because of increased exposure and reduced capacity. While research has expanded our understanding of the physiological effects of extreme heat and humidity, challenges persist, including inconsistent data, lack of unified heat wave definitions, and limited knowledge of their impact on mortality and morbidity especially in specific populations. Addressing these challenges requires enhanced data and a comprehensive evaluation of humidity's modifying effects. Global collaboration to strengthen heat health action plans is essential, with future efforts focusing on enhancing the accessibility and effectiveness of interventions, especially in underresourced regions
Tropical Data: supporting health ministries worldwide to conduct high-quality trachoma surveys.
Get PDFMonitoring and evaluation are key to tracking progress towards achieving the 2030 targets for neglected tropical diseases (NTDs).(1) Baseline data provide a reference point against which subsequent progress towards targets can be measured. For trachoma, the leading infectious cause of blindness worldwide, the Global Trachoma Mapping Project (GTMP) was the largest series of infectious disease surveys ever conducted. Baseline surveys were completed in 905 evaluation units (EUs; which for trachoma elimination purposes are defined as the normal administrative units for healthcare management, generally with populations of 100 000–250 000 people) (2) across 29 countries, examining >2.6 million people.(3) The results enabled trachoma interventions to be targeted and prioritised, with active trachoma (measured through the clinical sign trachomatous inflammation—follicular [TF]) confirmed to be a public health problem in 341 (38%) EUs and the late-stage, blinding, trachomatous trichiasis (TT) a public health problem in 473 (52%) EUs,(3) with the highest burdens in Ethiopia and Nigeria
Exploration of food provision challenges across English nurseries: results from a nationally representative cross-sectional study
Get PDFEarly years' settings play a central role in ensuring children's diets are healthy and they develop good eating habits. There is limited evidence on the barriers and challenges that nurseries face in providing healthy food. To address this, the authors analysed data from a cross-sectional survey of food provision and practices in nurseries across England between October–November 2021.
More than 90% of nurseries reported experiencing at least one challenge, most commonly the cost of healthy food, and the lack of time, facilities, and trained staff to prepare healthy food. Some 87% had unmet training needs. The biggest barriers to training were the direct and indirect costs; training barriers were reported to have increased since the COVID-19 pandemic. Nurseries that provide food have been financially impacted by the introduction of the 30-hour free childcare policy, needing to increase costs either for childcare or meals.
The findings indicate that additional funding is needed to support early years' settings to cover the costs of providing healthy food, as well as the hiring and training of staff with the skills needed to prepare healthy food. Finally, the financial impact of the 30-hour free childcare policy on food provision needs to be reviewed
Measuring and monitoring effective coverage of health services across life stages: a technical manual for monitoring and evaluation managers to guide evidence-based planning and decision-making
Get PDFSexually transmitted infection test positivity and associated factors in individuals tested at anonymous clinics in North Rhine-Westphalia state, Germany, 2021.
Get PDFBackgroundSexually transmitted infections (STIs) are increasing globally. To improve understanding of the epidemiology of STIs in key populations, we analysed sentinel surveillance data on STI test positivity among individuals tested using subsidised tests at anonymous walk-in clinics in North Rhine-Westphalia (NRW), Germany.MethodsThis was a cross-sectional analysis of sentinel surveillance data from all 53 local health authority anonymous walk-in clinics in NRW during 2021. Test positivity for HIV, syphilis, chlamydia, and gonorrhoea was analysed by key population group. We used univariable and multivariable logistic regression to examine factors associated with each infection.ResultsAmong 11,560 consultations, overall STI test positivity was 6.6%. Chlamydia was the most frequently detected (6.4%), followed by gonorrhoea (2.7%), syphilis (0.9%), and HIV (0.6%). We observed disparities in STI test positivity among key population groups. Men-who-have-sex-with-men (MSM) (aOR 1.93; 95%CI 1.38-2.68), sex work (aOR 2.77; 95%CI 1.9-3.96), and having an STI-positive partner (aOR 1.71; 95%CI 1.30-2.22) were associated with increased STI risk. Coinfections were rare (0.4%) and predominantly occurred among MSM.ConclusionsAnonymous walk-in clinics reach diverse high-risk populations with substantial STI burdens. Findings support targeted prevention strategies for key populations and highlight the importance of comprehensive STI screening in anonymous settings for surveillance and case detection
Trends in ovarian cancer net survival in a northeastern Brazilian state (1996-2017).
Get PDFBACKGROUND: Ovarian cancer survival in low- and middle-income countries is lower than in high-income countries, due to disparities in healthcare access and socioeconomic factors. This study aimed to describe trends in ovarian cancer survival in Sergipe, Northeast Brazil, by histological group. METHODS: We analysed data on 948 women aged 15-99 years diagnosed with a cancer of the ovary between 1996 and 2017, in Sergipe, Brazil. One- and five-year net survival were estimated by histological group and calendar periods of diagnosis (1996-1999, 2000-2004, 2005-2009, 2010-2014, 2015-2017) using the Pohar-Perme estimator. Survival estimates were age-standardised using International Cancer Survival Standard weights. RESULTS: Between 1996 and 2017, one-year and five-year net survival for ovarian cancer were 63.4 % and 37.4 %, respectively. Five-year net survival trends increased from 30.9 % (2000-2004) to 46.8 % (2015-2017). Epithelial type I tumours comprised roughly a quarter of cases, while type II tumours constituted over half. Both types exhibited similar one-year survival, ranging from 67 % to 68.5 % during 1996-2017. However, five-year net survival for type II tumours was remarkably lower at 32.5 %, compared to 52 % for type I tumours. CONCLUSION: Despite a minor improvement in five-year net survival over the 22 years, survival for women with ovarian cancer remains unfavourable, particularly for those diagnosed with Type II epithelial tumours, which have remarkably lower five-year survival than Type I
Dynamics of SARS-CoV-2 infection over two epidemic waves in Manaus, Brazil: A serological study of seven thousand blood donors.
Get PDFBACKGROUND: Most longitudinal studies of COVID-19 incidence have used unlinked samples. The city of Manaus, Brazil, has a blood donation program which allows sample linkage, and was struck by two large COVID-19 epidemic waves between mid-2020 and early 2021. METHODS: We estimated the changing force of infection, i.e. incidence in susceptible individuals. Seroconversion was inferred by a mixture model for serial values from the Abbott Architect SARS-CoV-2 nucleocapsid (N) IgG assay. We estimated the number of suspected COVID-19 hospitalizations arising from each infection over calendar time. RESULTS: Whole blood donations between April 2020 and March 2021 were included from 6734 people, 2747 with two or more donations. The inferred criterion for seroconversion, and thus an incident infection, was a 6.07 fold increase in N IgG reactivity. The overall force of infection was 1.19 per person year (95% confidence interval 1.14-1.24) during the two main waves. The estimated number of suspected hospitalizations per infection, was approximately 4.1 times higher in the second wave than in the first. CONCLUSIONS: Serial values from this assay can be used to infer seroconversion over time, and in Manaus show a higher number of suspected COVID-19 hospitalizations per infection in the second wave relative to the first