10957 research outputs found
Sort by
Care provision and social participation among older adults in Europe: longitudinal evidence from the Survey of Health, Ageing and Retirement in Europe and the English Longitudinal Study of Ageing
Get PDFProviding care to family members and friends in older age is common, but it can impact the carers’ time and energy for social participation. This study explores the relationship between care and social participation in 16 European countries, considering factors like care status, care frequency, relationship to the care recipient, gender, socioeconomic status, and country care regimes. The study utilised pooled data from the Survey of Health Ageing and Retirement in Europe and the English Longitudinal Study of Ageing. Multiple regression models assessed the association between care status (non-carer, carer, and former carer) and social participation measured through volunteering frequency and group membership. The models adjusted for various demographic and socioeconomic covariates. The study found that carers, especially those doing so more frequently (daily and weekly care), were more likely to volunteer and belong to groups compared to non-carers. Furthermore, compared to non-carers individuals caring for their partner, parent, or non-relatives were more likely to engage in social participation. The association between care and social participation appeared stronger for carers in countries with supportive care regimes. The findings support the idea that care and social participation are complementary activities, where engagement in one represents an avenue for greater participation in the other
Quality of Care for Hypertension in Primary Health Care in South Africa: Cross-Sectional Feasibility Study
Get PDFIntroduction: Little is known about the quality of care for patients with hypertension in primary health care (PHC) facilities in South Africa, where most people receive care. Objectives: To test 46 quality indicators, developed previously, to assess and improve care; to assess the indicators’ clinimetric properties; and to recommend improvement strategies. Methods: A descriptive cross-sectional clinical audit in a purposive sample of 12 South African PHC clinics involving a retrospective review of 295 patient medical records. Results: A total of 45 of the 46 indicators were tested in the main sample (n = 295), of which 9 indicators could not be applied. Of the 36 applicable indicators, 22 could be applied and measured for ≥75% of the sample, while 14 were applicable to ≤50% of the sample. Only five indicators showed a quality of care score for ≥75% of patients. Overall, 82% and 92% of the sample had their blood pressure (BP) recorded in the last 12 months or in the previous 5 years for those aged >40, respectively, and 53.2% had a controlled BP. In the last 12 months, 30% of patients had a cholesterol record, 30% had their BMI recorded, 17% had a hypertension review with a medical practitioner, and 12% had received lifestyle advice. Only 38% received all clinically indicated antihypertensive medicines at their last visit. Conclusion: There were gaps in the quality of care for patients with hypertension, demonstrating the need for greater adherence to evidence-based guidelines, better data quality, and the use of electronic health information systems. Twenty-two indicators are recommended to address these gaps and improve the quality of care, patient outcomes, and the health care system
Patient experiences of gender identity and inflammatory bowel disease: a focus group study
Get PDFObjective
Individuals who identify as transgender or gender non-conforming (TGNC) number approximately 262 000 in England and Wales. However, they are under-represented in healthcare research and little is known about their experiences managing a chronic health condition and their unique needs. Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract which can lead to long-term complications such as surgery and colorectal cancer. Ensuring a positive patient experience is crucial to maintaining good adherence with medical therapy and compliance with regular invasive surveillance procedures to reduce the risks of these occurring. However, there is no data on the experiences of people who identify as TGNC and who suffer from IBD (TGNC-IBD) when engaging with IBD healthcare services. Our focus group aimed to provide qualitative data on the experiences of this population.
Methods
Following established qualitative research processes, and through work with Crohn’s and Colitis UK, we held a focus group with TGNC-IBD to gain, for the first time in the UK, patient-centred insight into their experiences engaging with IBD services and highlight areas that need improving.
Results
Common themes identified were healthcare professionals making assumptions regarding gender identity, poor mental health support, a lack of research into TGNC-IBD and poor facilities.
Conclusion
The findings underscore the need for improved training for healthcare providers and modification to IBD services as well as further research to address the unique needs of TGNC-IBD
Paediatric type I open tibia fractures: are antibiotics alone sufficient?
Get PDFAims
The conventional management of the soft-tissue component of an open fracture involves emergent debridement. There is, however, evidence that questions this approach in the management of Gustilo-Anderson type I open fractures in paediatric patients. This systematic review aims to explore differences in infection rates between nonoperative management with antibiotics and operative debridement in children with type I open lower limb tibial fractures that do not require surgical fixation.
Methods
A systematic review following the PRISMA guidelines was conducted. Patients aged under 18 years with Gustilo-Anderson type I open tibia fractures treated with either antibiotics alone or operative debridement were included. Polytrauma patients and those requiring operative fracture stabilization were excluded. Study bias was assessed with the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool.
Results
Ten retrospective studies of 123 patients with Gustilo-Anderson type I open tibial fractures were included. Nonoperative management in the emergency department with antibiotics was used in 41 patients, with two infections reported (4.87%). Operative debridement was performed in 82 patients, with two infections reported (2.33%).
Conclusion
The optimum management for paediatric Gustilo-Anderson type I open tibia fractures remains unclear. There may be selected cases, with true low-energy injury without operative fixation requirements, which can be managed in the emergency department. However, there is not sufficient high-quality evidence to advocate for regular deviation from current guidelines in open tibia fractures in paediatric patients. Decision-making must take into account the energy absorbed, as this factor can be misleading within the current classification system.
Cite this article: Bone Jt Open 2025;6(8):905–914
The SLC58A Na+-Monocarboxylate Transporter—Can It Scavenge Lung Metabolites to Prevent Airway Infections?
No full textPerinatal outcomes and uptake of RSV vaccine during pregnancy in South London: a cross-sectional study
Get PDFBackground
Maternal respiratory syncytial virus (RSV) vaccination has been introduced to protect infants from severe respiratory infections. However, its uptake and impact on perinatal outcomes are unknown in the UK.
Objectives
To evaluate uptake of RSV vaccine during pregnancy in a UK population.
Methods and analysis
This cross-sectional study was conducted at a tertiary maternity hospital in London. The participants included pregnant women who delivered between 1 September and 17 December 2024 (n=1157). For the analysis of vaccine uptake, the cohort included women eligible for vaccination who delivered beyond 28 weeks’ gestation and were at 36 weeks or less on 1 September 2024 (n=911). The main outcome measures were RSV vaccine uptake and its association with sociodemographic factors, perinatal outcomes including preterm birth (PTB), hypertensive disorders of pregnancy and stillbirth.
Results
Of 911 eligible women, 19% (n=173) received the RSV vaccine during pregnancy. Uptake increased significantly from 4% in September to 32% in December (p<0.001). Vaccinated women were older (median age 35 vs 32 years, p<0.001), more likely to be white (66.3% vs 46.5%, p<0.001), and from higher socioeconomic quintiles (Index of Multiple Deprivation quintile 5: 18.5% vs 11.2%, p=0.029). Smoking during pregnancy was less common in vaccinated women (0.6% vs 5.0%, p=0.016). Multivariable logistic regression identified older maternal age (p=0.001), higher socioeconomic status (IMD quintile 1 vs 5; adjusted OR (aOR) 0.28, 95% CI 0.08 to 0.81, p=0.030) and ethnicity (Asian: aOR 0.56, 95% CI 0.35 to 0.88, p=0.015, black: aOR 0.52, 95% CI 0.28 to 0.95, p=0.040, mixed: aOR 0.12, 95% CI 0.02 to 0.39, p=0.004) as independent predictors of vaccine uptake. PTB rates at <37 weeks were comparable between groups (9.6% vs 10.0%, p=0.980), but no vaccinated women experienced PTB<34 weeks compared with 3.2% of unvaccinated women (p=0.032). Caesarean section rates were higher among vaccinated women (52.0% vs 35.5%, p<0.001). No significant differences were observed in other perinatal outcomes.
Conclusions
RSV vaccine uptake shows significant increases over time, with disparities in uptake by ethnicity and socioeconomic status. Further research is needed to increase vaccination rates, particularly in disadvantaged groups, and evaluate perinatal outcomes
Abnormal electrocardiogram findings in athletes
Get PDFAthletes commonly exhibit a series of electrical, structural, and functional physiological changes which may overlap with cardiac pathology. The last two decades have witnessed a progressive improvement in understanding what can be considered benign for athletes and what may be deemed as potentially pathological and require further investigations. However, diagnostic uncertainties in the cardiac assessment of athletes are often encountered. In particular, the clinical significance of some electrocardiogram (ECG) findings may be uncertain. While uncommon and suggestive of an underlying cardiac condition, they may be identified among healthy athletes without additional pathological findings to support a unifying clinical diagnosis. This creates significant dilemmas for clinicians charged with determining sports eligibility and those who have the responsibility to help athletes in the decision-making process regarding future competitive sports participation. Current guidelines, recommendations, and position papers provide a roadmap for the differential diagnosis between ‘athlete's heart’ and cardiac disease. However, managing ECG findings of uncertain clinical significance, especially when initial diagnostic evaluation reveals no supportive signs of pathology, has received comparatively less attention, in particular, the type of cardiac investigations, the extent of diagnostic work-up and the need for follow-up require clarification. This document aims to provide guidance based on published evidence and expert opinions to assist in the clinical decision-making regarding ECG anomalies that are common sources of uncertainty when managing asymptomatic athletes
Exploring diversity and inclusion in surgery: Insights from the 2025 Dutch Surgical Society Symposium
Get PDFDiversity and inclusion are increasingly recognized as critical components of effective surgical practice and team dynamics. Despite growing awareness, structural barriers continue to limit the entry and advancement of individuals from underrepresented groups in surgery. At the annual meeting of the Dutch Surgical Society in 2025, a dedicated symposium on diversity and inclusion was organized to explore the relevance, urgency, and potential impact of these topics in surgery. Drawing from lived experience, research evidence, and a multidisciplinary panel discussion, this event underscored the necessity of shifting from performative diversity toward meaningful inclusion. Key insights from the symposium and actionable strategies to foster sustainable change within surgical education and practice are discussed in this paper. Future directions would include concrete policy development by the Dutch Surgical Society to achieve sustainable change, incorporating these topics in national education programs and development of structured mentorship networks and facilitating a continuous open dialogue
Patterns of antidepressant prescribing around pregnancy: a descriptive analysis in CPRD
Get PDFBackground Antidepressant use is increasing during pregnancy but estimates of prevalence and patterns of prescribing are outdated. Aim To describe the prevalence and patterns of antidepressant prescribing in and around pregnancy. Design and setting Drug utilisation study in the UK’s Clinical Practice Research Datalink (CPRD) GOLD Pregnancy Register. Methods Using primary care prescription records, we identified individuals who had been prescribed antidepressants in and around pregnancy between 1996–2018 and described prevalence of prescribing during pregnancy over time. We defined ‘prevalent’ or ‘incident’ antidepressant prescribed, where ‘prevalent’ individuals were prescribed antidepressants both before and during pregnancy, and ‘incident’ individuals were newly prescribed antidepressants during pregnancy, then qualitatively compared patterns of prescribing between these two groups. We also investigated post-pregnancy prescribing, as well as characteristics associated with antidepressant discontinuation anytime during pregnancy. Results A total of 1,033,783 pregnancies were eligible: 79,144 (7.7%) were prescribed antidepressants during pregnancy and 15,733 of these (19.9%) were ‘incident’. Antidepressant prescribing during pregnancy increased from 3.2% in 1996 to 13.4% in 2018. Most women, both ‘prevalent’ and ‘incident’ prescribed, discontinued antidepressants anytime during pregnancy (54.8% and 59.9%, respectively). Over half of those who discontinued during pregnancy were prescribed antidepressants in the 12 months after pregnancy (53.0%). Younger age, previous stillbirth, and higher deprivation were associated with more frequent discontinuation anytime during pregnancy. Conclusions Antidepressant prescribing during pregnancy has been increasing in the UK. Over half of the sample discontinued antidepressants at some point before the end of pregnancy, but post-pregnancy resumption of antidepressants was common
Sex Specific Differences in Abdominal Aortic Aneurysm Morphology Based on Fully Automated Volume Segmented Imaging: A Multicentre Cohort Study and Propensity Score Matched Analysis
Get PDFOBJECTIVE: Sex specific anatomical differences may contribute to observed disparities in outcomes and suitability for endovascular aneurysm repair (EVAR) between men and women with abdominal aortic aneurysms (AAAs). This study aimed to assess these differences using fully automated volume segmentation (FAVS) and explore implications for EVAR suitability. METHODS: This was a retrospective, multicentre cohort study of patients undergoing elective AAA repair between 2013 and 2023 in three UK tertiary centres. Pre-operative computed tomography scans were analysed using FAVS software. Demographic and clinical outcome data were obtained from the National Vascular Registry. Propensity score matching (1:4 women:men) was performed, adjusting for age, cardiovascular risk, aortic size index (ASI), treatment modality, and centre. Morphological features and device specific likelihood to meet instructions for use (IFU) were compared by sex. RESULTS: Of 1 455 eligible patients, 145 women were matched to 580 men. Despite similar ASI and cardiovascular risk profiles, women had statistically significantly narrower, shorter, and more angulated aneurysm necks (p < .001), smaller visceral and access vessel diameters, and greater thoracic aorta and thrombus index (p < .050). However, no statistically significant differences were found in calcification volume or vessel tortuosity. Women were statistically significantly less likely to meet IFU criteria across proximal, distal, and access vessel parameters (p < .001). CONCLUSION: FAVS offers a scalable approach to pre-operative anatomical assessment and could guide future device design. Even after adjusting for body size and cardiovascular risk, women with AAA exhibit distinct vascular morphology that adversely impacts EVAR suitability. The development of low profile, durable stent grafts and strategies targeting hostile neck anatomy are critical to improving EVAR access and outcomes for women
Access Repository Dashboard
Do you manage St George's Online Research Archive? Access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard!