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Multimorbidity clusters and their associations with health-related quality of life in two UK cohorts
Get PDFBackground: Identifying clusters of multiple long-term conditions (MLTCs), also known as multimorbidity, and their associated burden may facilitate the development of effective and cost-effective targeted healthcare strategies. This study aimed to identify clusters of MLTCs and their associations with long-term health-related quality of life (HRQoL) in two UK population-based cohorts. Methods: Age-stratified clusters of MLTCs were identified at baseline in UK Biobank (n = 502,363, 54.6% female) and UKHLS (n = 49,186, 54.8% female) using latent class analysis (LCA). LCA was applied to people who self-reported ≥ 2 LTCs (from n = 43 LTCs [UK Biobank], n = 13 LTCs [UKHLS]) at baseline, across four age-strata: 18–36, 37–54, 55–73, and 74 + years. Associations between MLTC clusters and HRQoL were investigated using tobit regression and compared to associations between MLTC counts and HRQoL. For HRQoL, we extracted EQ-5D index data from UK Biobank. In UKHLS, SF-12 data were extracted and mapped to EQ-5D index scores using a standard preference-based algorithm. HRQoL data were collected at median 5 (UKHLS) and 10 (UK Biobank) years follow-up. Analyses were adjusted for available sociodemographic and lifestyle covariates. Results: LCA identified 9 MLTC clusters in UK Biobank and 15 MLTC clusters in UKHLS. Clusters centred around pulmonary and cardiometabolic LTCs were common across all age groups. Hypertension was prominent across clusters in all ages, while depression featured in younger groups and painful conditions/arthritis were common in clusters from middle-age onwards. MLTC clusters showed different associations with HRQoL. In UK Biobank, clusters with high prevalence of painful conditions were consistently associated with the largest deficits in HRQoL. In UKHLS, clusters of cardiometabolic disease had the lowest HRQoL. Notably, negative associations between MLTC clusters containing painful conditions and HRQoL remained significant even after adjusting for number of LTCs. Conclusions: While higher LTC counts remain important, we have shown that MLTC cluster types also have an impact on HRQoL. Health service delivery planning and future intervention design and risk assessment of people with MLTCs should consider both LTC counts and MLTC clusters to better meet the needs of specific populations
The outcome of ongoing adult endocrine engagement following transition from paediatric care
Get PDFObjective:
Transition is important for continuity of care for patients with chronic health conditions. The aim of this service evaluation was to determine the effectiveness of a transition clinic at a tertiary hospital with long-term attendance in the adult endocrine service.
Design:
Retrospective case notes review of patients seen by paediatric endocrinology at the Royal Hospital for Children, Glasgow, at the time of transition to adult services, between 2012 and 2022. Patients with type 1 diabetes were excluded.
Measurements:
Engagement was measured through clinic attendance and dropout rate. The ‘dropped out patients’ were those who were seen in the transition clinic with a transition plan but did not attend appointments in the adult service.
Results:
Of the 267 individuals offered a transition clinic, data on discharge status were available for 248 (94%). Of these, 52% (n = 129) remained in the same tertiary centre, 29% (n = 61) were transferred to other endocrine centres in the West of Scotland; 17% (n = 42) were discharged to primary care. Overall, 91% (172/190) of young patients remained engaged with the adult service. Male patients had a higher drop out rate compared to females (14% vs. 4%, p < 0.05). Those from more deprived areas also had higher drop out rates compared to those from more affluent areas (17% vs. 3%, p < 0.05).
Conclusion:
Our clinic model for transitioning from paediatric to adult endocrine care is effective in introducing and retaining patients to the adult service with only a 9% drop out rate. Factors associated with poor attendance in adult services include deprivation and being male. Additional support may be required for these individuals to improve engagement in adult services
Antipsychotic management in general practice: serial cross-sectional study (2011–2020)
Get PDFBackground: Long-term use of antipsychotics confers increased risk of cardiometabolic disease. Ongoing need should be reviewed regularly by psychiatrists.
Aim: To explore trends in antipsychotic management in general practice, and the proportions of patients prescribed antipsychotics receiving psychiatrist review.
Design and setting: Serial cross-sectional study using linked general practice and hospital data in Wales (2011–2020).
Method: Participants were adults (aged ≥18 years) registered with general practices in Wales. Outcome measures were prevalence of patients receiving ≥6 antipsychotic prescriptions annually, the proportion of patients prescribed antipsychotics receiving annual psychiatrist review, and the proportion of patients prescribed antipsychotics who were registered on the UK serious mental illness, depression, and/or dementia registers, or not on any of these registers.
Results: Prevalence of adults prescribed long-term antipsychotics increased from 1.055% (95% confidence interval [CI] = 1.041 to 1.069) in 2011 to 1.448% (95% CI = 1.432 to 1.464) in 2020. The proportion receiving annual psychiatrist review decreased from 59.6% (95% CI = 58.9 to 60.4) in 2011 to 52.0% (95% CI = 51.4 to 52.7) in 2020. The proportion of overall antipsychotic use prescribed to patients on the serious mental illness register decreased from 50.0% (95% CI = 49.4 to 50.7) in 2011 to 43.6% (95% CI = 43.0 to 44.1) by 2020.
Conclusion: Prevalence of long-term antipsychotic use is increasing. More patients are managed by GPs without psychiatrist review and are not on monitored disease registers; they thus may be less likely to undergo cardiometabolic monitoring and miss opportunities to optimise or deprescribe antipsychotics. These trends pose risks for patients and need to be addressed urgently
Conceptual and evidence update on incidental physical activity: a scoping review of experimental and observational studies
Get PDFPromoting incidental physical activity (IPA) can help reduce sedentary lifestyles and physical inactivity levels in the population. However, there is heterogeneity in the definition of IPA, and studies have yet to synthesize the empirical findings on this topic. This review aimed to (1) Synthesize the definitions of the IPA used in the scientific literature, (2) Identify the behaviors part of the IPA, and (3) Synthesize the main findings on IPA. The review followed PRISMA guidelines. A systematic search was performed in July 2023, and an update was made in February 2024 in the CINAHL databases by EBSCOhost, Cochrane Library, Pubmed, ScienceDirect, Scopus, and Web of Science. The search phrase was (“incidental physical activity” OR “incidental physical activity of daily living” OR “incidental movement” OR “vigorous intermittent lifestyle physical activity” OR “VILPA” OR “physical activity of daily living”). Fifty-five studies were included, with non-experimental (40), experimental (12), qualitative studies (2), and mixed design (1). Ten different terms for IPA were identified, and a conceptual definition was included in 33 articles. Behaviors measured as part of the IPA were reported in 41 articles. These definitions describe unstructured, unplanned, and unintentional physical activities of daily living that are performed as a by-product of an activity with a different primary purpose during free or occupational time and without specific fitness, sport, or recreation goals. Include light and vigorous intensities ranging from short sessions of < 1 min to prolonged ones. They include home activities, self-care, gardening, occupation, active transportation, and walking. Furthermore, evidence on IPA suggests an association with a lower risk of all-cause mortality. The findings of this review contribute to the updated study of IPA. Advances in data processing methods are needed to capture the diversity of behaviors and deepen the understanding of IPA
The role of universal health coverage in secondary prevention: a case study of Ghana’s National Health Insurance Scheme and early-onset hypertension
Get PDFBackground:
Launched in 2003, Ghana’s National Health Insurance Scheme (NHIS) was a move towards Universal Health Coverage. There is a dearth of studies that have since investigated the effect of the scheme on non-communicable diseases (NCDs) like hypertension. While a major cause of mortality and morbidity, hypertension remains mostly undiagnosed in Ghana. Secondary prevention comprising early detection and prompt treatment is, hence, important in reducing disease burden. This study assessed the association between active NHIS membership and the likelihood of having early-onset hypertension detected and treated.
Methods:
A cross-sectional analysis of the 2014 Ghana Demographic and Health Survey (male dataset) was conducted. Unadjusted analysis used binary logistic regression with active NHIS membership as the independent variable and detection of early-onset hypertension as the dependent variable. Early-onset hypertension was defined as the onset of hypertension at 55 years or younger. Covariates for the adjusted regression models were age, BMI, smoking status, place of residence, wealth, and education level. The association between membership and treatment was also assessed.
Results:
Unadjusted and adjusted results showed that the odds of early-onset hypertension being detected in participants with active NHIS membership were respectively 2.4 (95% CI:1.56 – 3.59, p=0.000) and 2.2 (95% CI 1.43 – 3.24, p=0.000) that of those without active membership. There was no significant association between membership and treatment.
Conclusion:
This study suggests that NHIS membership may play a beneficial role in the secondary prevention of NCDs in Ghana. Further research is, nevertheless, needed to understand how membership, NCDs, and other contextual factors are interrelated
Higher Education, Community Connections and Collaborations
No full textThis book innovatively explores the policy, practice and pedagogy of community engagement in higher education settings. It contributes to the evaluation of adaptive practice and responses in addressing inequalities further exposed by the pandemic, and the role of higher education institutions within this. By exploring such themes, contributors highlight implications for future practice and suggest areas for further pedagogical development. The book also includes perspectives on the patterns of change in higher education asking crucial questions pertaining to its role in regeneration and recovery as it seeks to work for, within, and between communities and constituencies. While it foregrounds youth and community work, it makes wider and systemic connections between communities and higher education institutions
Understanding the transfer and persistence of antimicrobial resistance in aquaculture using a model teleost gut system
Get PDFBackground:
The development, progression, and dissemination of antimicrobial resistance (AMR) are determined by interlinked human, animal, and environmental drivers, which pose severe risks to human and livestock health. Conjugative plasmid transfer drives the rapid dissemination of AMR among bacteria. In addition to the judicious use and implementation of stewardship programs, mitigating the spread of antibiotic resistance requires an understanding of the dynamics of AMR transfer among microbial communities, as well as the role of various microbial taxa as potential reservoirs that promote long-term AMR persistence. Here, we employed Hi-C, a high-throughput, culture-free technique, combined with qPCR, to monitor carriage and transfer of a multidrug-resistent (MDR) plasmid within an Atlantic salmon in vitro gut model during florfenicol treatment, a benzenesulfonyl antibiotic widely deployed in fin-fish aquaculture.
Results:
Microbial communities from the pyloric ceaca of three healthy adult farmed salmon were inoculated into three bioreactors simulating the teleost gut, which were developed for the SalmoSim gut system. The model system was then inoculated with the Escherichia coli strain ATCC 25922 carrying the plasmid pM07-1 and treated with florfenicol at a concentration of 150 mg/L in fish feed media for 5 days prior to the washout/recovery phase. Hi-C and metagenomic sequencing identified numerous transfer events, including those involving gram-negative and gram-positive taxa, and, crucially, the transfer and persistence of the plasmid continued once florfenicol treatment was withdrawn.
Conclusions:
Our findings highlight the role of the commensal teleost gut flora as a reservoir for AMR even once antimicrobial selective pressure has been withdrawn. Our system also provides a model to study how different treatment regimens and interventions may be deployed to mitigate AMR persistence
DURLLCON: Deep Reinforcement Learning for URLLC Optimization in Multi-Edge Networks
Get PDFUltra-Reliable and Low Latency Communications (URLLC) is crucial for enabling next-generation applications, particularly in areas that require stringent delay constraints, such as healthcare and vehicular networks. Multi-access Edge Computing (MEC) enhances URLLC applications by bringing computation closer to end users, maximizing resource utilization and minimizing latency. This paper introduces Deep Reinforcement Learning for URLLC Optimization in Multi-Edge Networks (DURLLCON), a Deep Reinforcement Learning (DRL)-based framework for efficient task offloading in a hybrid MEC environment, specifically targeting both URLLC and non-URLLC applications. By leveraging DRL and Long Short Term Memory (LSTM) networks, the proposed method dynamically adjusts the offloading decisions based on user energy levels, task priority, and network congestion. The simulation results show that the proposed DURLLCON framework achieves up to 30% improvement in energy efficiency and 20% reduction in average delay compared to existing methods, significantly extending user device battery life while maintaining high Quality of Service (QoS)
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