Black Ethnic Backgrounds Research Articles

Exploring learning development from the perspectives of black students

There has been little research into student perceptions of learning development tutorials despite learning development having existed in most institutions for over twenty years. Analysis from annual demographic data from tutorial attendance at the University of Northampton shows that over 25% of tutorials are attended by students identifying as Black. More Black women use the LD provision than Black males and even fewer Black males under the age of 20 use the service. This mirrors the findings of Coulson and Loddick (2020) who acknowledged, in research on learning development and student attainment, that students from a Black ethnic background, particularly females, were more likely to attend tutorials. However, there has been little research into the reasons for this. This presentation concluded the findings of an internally funded collaborative project to explore the perceptions of Black students and learning development. Due to the nature of investigating a sensitive topic, it was deemed essential that a project assistant was employed who has lived experience and identifies as Black. The project assistant predominantly conducts the research with Black students and gains their perspectives during focus groups or interviews. The project has been planned to ensure that the project assistant influences the research by offering autonomy to design the project and recruit participants. It is hoped that this project will offer a unique perspective to inform learning development practice and provision. By the time of the conference the project will have finished and we will be able to offer an insight into the findings.

Is obesity more likely among children sharing a household with an older child with obesity?

ObjectivesWe used a dynamic method of identifying household members from Electronic Health Records (EHRs) linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of children with obesity sharing a household with an older child with obesity, accounting for individual and household characteristics.
 MethodsWe included 126,829 NCMP participants in four London boroughs and assigned households from encrypted Unique Property reference Numbers (UPRNs) at NCMP date for 115,466 (91%). We categorised the ethnic-adjusted body mass index of the youngest and oldest household child (underweight/healthy weight<91st, ≥91st to <98th overweight, obesity≥98th centile) and explored associations of the youngest child’s weight status with: oldest child’s weight status, number of household children (two, three or ≥4), youngest child’s sex, ethnicity and school year of NCMP participation (reception or year 6). We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of obesity in the youngest child.
 Results19,702 UPRNs were shared by two or more NCMP participants (youngest children: 51.2% male, 69.5% reception). 10.4% of youngest (95% CI: 10.0,10.9) and 13.0% of oldest (12.5,14.3) children were living with obesity. One third of youngest children with obesity shared a household with another child with obesity (33.2%; 31.2,35.2), compared with 9.2% (8.8,9.7) of those with a healthy weight. Youngest children living with an older child with overweight (aOR: 2.33; 95% CI: 2.06,2.64) or obesity (4.59, 4.10,5.14), those from South Asian ethnic backgrounds (1.89; 1.64,2.19) or taking part in NCMP in year 6 (2.21; 2.00,2.43) were more likely, and girls (0.73; 0.67,0.81), children living with just one other child (0.87; 0.77,0.98) and from Black ethnic backgrounds (0.78; 0.66,0.93) less likely, to be living with obesity.
 ConclusionLinked EHRs can provide novel insights into the shared weight status of children sharing the same household. Further qualitative research is needed to understand how household food practices may vary by other household characteristics to improve our understanding of how the home environment influences childhood obesity.

Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and vaccine antibody prevalence in a multi-ethnic inner-city antenatal population: A cross-sectional surveillance study.

To determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in pregnancy in an inner-city setting and assess associations with demographic factors and vaccination timing. Repeated cross-sectional surveillance study. London maternity centre. A total of 906 pregnant women attending nuchal scans, July 2020-January 2022. Blood samples were tested for IgG antibodies against SARS-CoV-2 nucleocapsid (N) and spike (S) proteins. Self-reported vaccination status and coronavirus disease 2019 (COVID-19) infection were recorded. Multivariable regression models determined demographic factors associated with seroprevalence and antibody titres. Immunoglobulin G N- and S-protein antibody titres. Of the 960 women, 196 (20.4%) were SARS-CoV-2 seropositive from previous infection. Of these, 70 (35.7%) self-reported previous infection. Among unvaccinated women, women of black ethnic backgrounds were most likely to be SARS-CoV-2 seropositive (versus white adjusted risk ratio [aRR] 1.88, 95% CI 1.35-2.61, p < 0.001). Women from black and mixed ethnic backgrounds were least likely to have a history of vaccination with seropositivity to S-protein (versus white aRR 0.58, 95% CI 0.40-0.84, p = 0.004; aRR 0.56, 95% CI 0.34-0.92, p = 0.021, respectively). Double vaccinated, previously infected women had higher IgG S-protein antibody titres than unvaccinated, previously infected women (mean difference 4.76 fold-change, 95% CI 2.65-6.86, p < 0.001). Vaccination timing before versus during pregnancy did not affect IgG S-antibody titres (mean difference -0.28 fold-change, 95% CI -2.61 to 2.04, p = 0.785). This cross-sectional study demonstrates high rates of asymptomatic SARS-CoV-2 infection with women of black ethnic backgrounds having higher infection risk and lower vaccine uptake. SARS-CoV-2 antibody titres were highest among double-vaccinated, infected women.

Exploring access and engagement with Improving Access to Psychological Therapies (IAPT) services, before, during, and after the COVID-19 lockdown: A service evaluation in the Northwest of England

Objective: The purpose of this study was to compare clients’ prevalence and explore the characteristics that predicted access and engagement with IAPT treatment before, during, and after Lockdown. Method: We conducted a retrospective observational service evaluation, using routinely collected IAPT data from n = 13,019 clients who entered treatment between March and September in 2019, 2020, and 2021. Chi-square and multiple logistic regression were used to explore associations and potential predictors of access and engagement with IAPT treatment. Results: The number of people accessing and engaging with IAPT treatment was significantly higher after lockdown compared to before. Unemployed clients were less likely to access treatment during and after lockdown. Yet, perinatal clients and people from a black ethnic background were more likely to access treatment during lockdown. Being young and being unemployed were predictors of treatment disengagement across all three time points, whereas perinatal clients were less likely to engage only before and during lockdown. Clients who were not prescribed medication and clients with a long-term condition were more likely to engage during lockdown. Conclusion: The demonstrated changes in access and engagement with IAPT treatment after the introduction of remote therapy urges the services to further consider the individual needs of specific client groups.

Experiences of adults from a Black ethnic background detained as inpatients under the Mental Health Act (1983).

People from a Black ethnic (BE) background in England and Wales are disproportionately detained as inpatients under the United Kingdom's Mental Health Act (MHA). Qualitative research into the lived experiences of this group is sparse. This study, therefore, aims to explore the experiences of people from a BE background detained under the MHA. Semistructured interviews were conducted with 12 self-identified adults from a BE background who were currently detained as inpatients under the MHA. Thematic analysis was used to identify themes across the interviews. Four themes emerged from the interviews: "Help is decided by others, not tailored to me"; "I am not a person-I am a Black patient"; "Mistreated or neglected instead of cared for"; and "Sectioning can be a space for sanctuary and support." People from a BE background report inpatient detention to be a racist and racialized experience, inseparable from a wider context of systemic racism and inequality. Experiences of detention were also discussed in terms of stigma within BE families and communities, as well as social support that appeared to be lacking outside of the hospital. Systemic racism must be addressed across mental health care, led by the lived experiences of BE people. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Critical reflections on the racialised hierarchies of an ethnically diverse staff-student scholarship project team

This case study article reports on the reflections of the authors who were part of a staff-student collaborative scholarship project investigating the learning experiences of Black distance-learning students. Although there is a growing body of research on the nature, experiences, power dynamics and benefits of staff-student collaborations in higher education contexts, there is much less discussion about how wider racialised hierarchies can influence such collaborations. The project discussed in this article consisted of an ethnically diverse team – including the authors of this piece who are a white male academic staff member and a female PhD student from a Black ethnic background. This case study offers a critically reflective account of the racialised hierarchy inherently present within our relationship. We briefly consider the ways in which the collaborative project was framed by potentially exploitative racialised hierarchies including the privileging of white staff members, before considering how we tried to mitigate these hierarchies by finding ways to involve and empower the ethnic minority student members of the team. These reflections might help those who are embarking upon ethnically diverse staff-student collaborations in higher education to ensure that ethnic minority students feel empowered and to help facilitate their role in promoting institutional change and disrupting exclusionary practice.

Mental health, loneliness and stress of Asian, Black and White UK university students before and during the COVID-19 pandemic

The COVID-19 pandemic has negatively impacted the mental health of UK university students. However, the knowledge on the impact on students from different ethnic groups is limited. We investigated mental health, loneliness, and perceived stress in 656 university students with an Asian, Black and White ethnic background across three cohorts, before (2019-2020), during (2020-2021), and at the end of the pandemic (2021-2022). Students at City, University of London completed an online study, including the Counseling Center Assessment of Psychological Symptoms, the UCLA loneliness scale, the perceived stress scale, and questions about COVID-19. Substance-use concerns were highest before the pandemic compared to during the pandemic. Academic distress and loneliness were higher during the pandemic than before. COVID-19 related anxiety was significantly related with poor mental health across groups. Students with an Asian or Black ethnic background had slightly lower reported mental health difficulties than White students, which appeared to be partly driven by lower substance-use concerns. However, students from an Asian or Black ethnic background reported being more financially impacted by the pandemic and reported more loneliness than White students. The findings reflect pandemic-related changes in student life, characterized by reduced socializing with fellow students and suggest that overall students adapted well to these changes in terms of their mental health.

Are children who do not receive their first Measles Mumps and Rubella (MMR1) vaccination by 24 months more likely to share a household with older non-vaccinated children? Linked household-level analysis of primary care electronic health records (EHRs).

ObjectivesOnly 89.4% of UK children receive MMR1 by age 24 months. We investigated whether children not receiving MMR1 by this age were more likely to share a household with children also not vaccinated by this age, and its variation by sex, ethnic background and area-level deprivation.&#x0D; ApproachWe identified 208,907 children born between 2013-2019 and eligible for MMR1 from the primary care EHRs of 1,192,630 children registered to a general practitioner in North East London between 2001-2021. We estimated the proportion of children and 95% Confidence Interval (CI) receiving MMR1 between 12 and 24 months of age. We calculated prevalence ratios (PR) by sex, ethnicity, and deprivation (Index of Multiple Deprivation (IMD) quintiles). We identified all children with the same pseudonymised Unique Property Reference Numbers (pUPRNs) at the MMR1 date. We are completing analyses to calculate mutually adjusted PRs and examine household-level associations in timeliness of MMR1.&#x0D; ResultsOverall, 172,319 (82.5%) of 208,907 eligible children received an MMR1 between age 12-24 months. Non-receipt of MMR1 by 24 months was less likely in children from South Asian ethnic backgrounds (PR 0.74; 95% CI: 0.68,0.79), and more likely in those from Black ethnic backgrounds (1.43;1.31,1.56) and in those living in the most deprived IMD quintile (1.83;1.49,2.23). We identified 137,919 children with the same pUPRNs at the MMR1 date, comprising 69,892 boys (50.7%) and 41,846 (30.3%), 32,631 (23.7%), 10,793 (7.8%), 12,246 (8.9%) and 40,403 (29.3) from White, South Asian, Black, Mixed/Other and Missing ethnic backgrounds respectively. We are calculating adjusted PRs and will estimate associations between non-receipt of MMR1 in the youngest and oldest children within a household.&#x0D; ConclusionOur findings suggest that non-receipt of MMR1 by 24 months is ethnically patterned and more likely in areas of higher deprivation. Household-level analyses provide actionable insights into the characteristics of measles-susceptible households and opportunities for data-enabled primary care interventions to reduce vaccination inequalities and prevent measles outbreaks.

Are children living with obesity more likely to consult their general practitioner for knee pain? Longitudinal analysis of linked primary care and National Child Measurement Programme (NCMP) records.

ObjectivesMore than one in four 11-year-old children in England are living with obesity. The implications for future musculoskeletal health remain unclear. We assessed whether general practitioner consultations for knee pain were more likely among children with obesity, and how this varied by sex, ethnic background, and area-level deprivation. ApproachOf 61,478 11-year-old NCMP participants (2013-19), we linked 60,723 (98.8%) to their primary care records. 58,761 children (50.9% male) had no recorded knee pain consultation (including arthralgia and Osgood-Schlatter’s disease) prior to the NCMP measurement date. We calculated the proportion with a consultation for knee pain by ethnic-adjusted weight status (underweight&lt;2nd; overweight≥91st; obese≥98th centile), sex, ethnic background and Index of Multiple Deprivation quintile. We studied time to first general practitioner consultation for knee pain after the NCMP date by fitting Cox proportional hazards models, estimating mutually-adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for boys and girls separately. ResultsWe identified 2503 (4.3%) children with at least one consultation for knee pain after the NCMP date. Boys were more likely to consult than girls (mean difference 1.5%; 95% CI: 1.2,1.9). Median time to first knee pain consultation was 1.88 years (IQR: 0.94,2.93). In adjusted analyses, boys with underweight (aHR 0.16; 95% CI: 0.05,0.51), from South Asian ethnic backgrounds (0.80; 0.69,0.92) and living in less deprived areas (Wald test statistic: 11.41; p-value=0.0223) were less likely, and those from Black ethnic backgrounds (1.31; 1.13,1.51) more likely, to consult with knee pain. Girls from South Asian ethnic backgrounds (0.70; 0.59,0.84) and those living in less deprived areas (15.44; p-value=0.0039) were less likely, and those with a BMI considered obese (1.30; 1.10,1.54) more likely to do so. ConclusionAdolescent girls, but not boys, living with obesity are more likely to consult their general practitioner with knee pain. Ethnic differences in knee pain consultations merit further study. Linkage of primary care and NCMP records enables greater understanding of health service utilisation by children by weight status and demographic characteristics.

Who lives in overcrowded households in north-east London? Cross-sectional study of linked electronic health records and Energy Performance Certificate register data.

ObjectivesHousehold overcrowding is associated with adverse health outcomes, including increased risk of infectious diseases, mental health problems, and poor educational attainment. We investigated inequalities in overcrowding in an urban, ethnically diverse, and disadvantaged London population by pseudonymously linking electronic health records (EHR) to Energy Performance Certificates (EPC) data. ApproachWe used pseudonymised Unique Property Reference Numbers to link EHRs for 1,066,156 currently registered patients from 321,318 households in north-east London to EPC data. We measured household occupancy and derived the bedroom standard overcrowding definition (number of rooms relative to occupants’ sex and ages) to estimate overcrowding prevalence. We examined associations with: household composition (adults only, single adult+children, ≥2 working-age adults+children, ≥1 retirement-age adults+children, three-generational household); ethnic background (White, South Asian, Black, Mixed, Other, missing); and Index of Multiple Deprivation (IMD) quintile. We used multivariable logistic regression to estimate the adjusted odds (aOR) and 95% Confidence Intervals (CI) of overcrowding. ResultsOverall, 243,793 (22.9%) people were overcrowded. People living in households with children, or three-generational households were more likely (aOR [95% CI] 3.79 [3.74 - 3.84]; 6.53 [6.41 - 6.66] respectively), and single adults or retirement age adults with children less likely (0.36 [0.35 - 0.38]; 0.36 [0.23 - 0.57] respectively), to be overcrowded. Overcrowding was more likely among people from Asian or Black ethnic backgrounds (1.24 [1.22 - 1.25] and 1.17 [1.15 - 1.19] respectively). There was a dose-response relationship between IMD quintile and overcrowding: OR 0.20 [0.20 - 0.21] in the least deprived compared to most deprived quintile. ConclusionOne in five people in north-east London live in overcrowded households with marked inequalities by ethnicity, household generational composition, and deprivation. Up-to-date estimates of household overcrowding can be derived from linked housing and health records and used to evaluate the impact of economic policies on health and housing inequalities.

What do women living with HIV think about research on children born HIV-free in the UK?

ObjectiveWe are analysing linked public health surveillance data on pregnancies to women living with HIV in the UK and vital registration data on all their children born HIV-free, an under-researched group. We sought to engage women living with HIV to elicit their feedback on our work and set research priorities. ApproachIn partnership with 4M Net, a national peer-support network for mothers living with HIV, we co-designed and held two online workshops (one workshop a week over two weeks) in March 2022. We designed the workshops to be highly interactive, using a combination of online tools and created a safe space for open discussion. All participants received a preparatory booklet in advance, comprising questions, activities, and space for reflections during the workshops. We also prompted participants to discuss their research priorities with peers and/or family members if they felt comfortable with this. ResultsIn total, 6 participants attended the two 2-hour long workshops. All participants were from Black ethnic backgrounds, aged 30 years or older and were mothers of children or young adults born HIV-free. Overall, participants were positive about the programme of research and identified pregnancy, birth, and long-term outcomes in children (especially regarding HIV medication in pregnancy) as being of key importance. They supported the use of linked mental health, hospital, general practice (GP), health visiting and education data to explore pregnancy, health and developmental outcomes among children born HIV-free. Linkage to GP data was identified as a priority by participants, and there was particular interest in addressing knowledge gaps on the mental health of children and young adults born HIV-free. ConclusionWomen living with HIV are often involved in research around pregnancy, but rarely in research about their children. By working with trusted community partners, we can engage this often marginalised group of parents who understand the value of linked data research exploring the health and wellbeing of their children born HIV-free.

Quoted text in the mental healthcare electronic record: an analysis of the distribution and content of single-word quotations

ObjectiveTo investigate the distribution and content of quoted text within the electronic health records (EHRs) using a previously developed natural language processing tool to generate a database of quotations.Designχ2 and...

Deaths in children and young people in England after SARS-CoV-2 infection during the first pandemic year.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rarely fatal in children and young people (CYP, <18 years old), but quantifying the risk of death is challenging because CYP are often infected with SARS-CoV-2 exhibiting no or minimal symptoms. To distinguish between CYP who died as a result of SARS-CoV-2 infection and those who died of another cause but were coincidentally infected with the virus, we undertook a clinical review of all CYP deaths with a positive SARS-CoV-2 test from March 2020 to February 2021. The predominant SARS-CoV-2 variants were wild-type and Alpha. Here we show that, of 12,023,568 CYP living in England, 3,105 died, including 61 who were positive for SARS-CoV-2. Of these deaths, 25 were due to SARS-CoV-2 infection (mortality rate, two per million), including 22 due to coronavirus disease 2019-the clinical disease associated with SARS-CoV-2 infection-and 3 were due to pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. In total, 99.995% of CYP with a positive SARS-CoV-2 test survived. CYP older than 10 years, Asian and Black ethnic backgrounds and comorbidities were over-represented in SARS-CoV-2-related deaths compared with other CYP deaths. These results are important for guiding decisions on shielding and vaccinating children. New variants might have different mortality risks and should be evaluated in a similar way.

Ethnic differences in COVID-19 mortality during the first two waves of the Coronavirus Pandemic: a nationwide cohort study of 29 million adults in England

Ethnic minorities have experienced disproportionate COVID-19 mortality rates in the UK and many other countries. We compared the differences in the risk of COVID-19 related death between ethnic groups in the first and second waves the of COVID-19 pandemic in England. We also investigated whether the factors explaining differences in COVID-19 death between ethnic groups changed between the two waves. Using data from the Office for National Statistics Public Health Data Asset, a linked dataset combining the 2011 Census with primary care and hospital records and death registrations, we conducted an observational cohort study to examine differences in the risk of death involving COVID-19 between ethnic groups in the first wave (from 24th January 2020 until 31st August 2020) and the first part of the second wave (from 1st September to 28th December 2020). We estimated age-standardised mortality rates (ASMR) in the two waves stratified by ethnic groups and sex. We also estimated hazard ratios (HRs) for ethnic-minority groups compared with the White British population, adjusted for geographical factors, socio-demographic characteristics, and pre-pandemic health conditions. The study population included over 28.9 million individuals aged 30–100 years living in private households. In the first wave, all ethnic minority groups had a higher risk of COVID-19 related death compared to the White British population. In the second wave, the risk of COVID-19 death remained elevated for people from Pakistani (ASMR: 339.9 [95% CI: 303.7–376.2] and 166.8 [141.7–191.9] deaths per 100,000 population in men and women) and Bangladeshi (318.7 [247.4–390.1] and 127.1 [91.1–171.3] in men and women) background but not for people from Black ethnic groups. Adjustment for geographical factors explained a large proportion of the differences in COVID-19 mortality in the first wave but not in the second wave. Despite an attenuation of the elevated risk of COVID-19 mortality after adjusting for sociodemographic characteristics and health status, the risk was substantially higher in people from Bangladeshi and Pakistani background in both the first and the second waves. Between the first and second waves of the pandemic, the reduction in the difference in COVID-19 mortality between people from Black ethnic background and people from the White British group shows that ethnic inequalities in COVID-19 mortality can be addressed. The continued higher rate of mortality in people from Bangladeshi and Pakistani background is alarming and requires focused public health campaign and policy changes.

COVID-19 vaccination intent among London healthcare workers.

BackgroundThe 10-month timeline from conception to regulatory approval of the Pfizer–BioNTech vaccine against SARS-CoV-2 is unprecedented in modern medicine. However, the climate of the pandemic has also seen anti-vaccination sentiments flourish.AimsTo determine the intent to accept COVID-19 vaccination among healthcare workers at a London Hospital Trust and examine variation in uptake between demographic groups.MethodsWe conducted a cross-sectional survey open to staff working at the trust. Staff rated on a five-point scale the likelihood of them accepting COVID-19 vaccination.ResultsWe received 514 responses, representing 16% of the workforce. About 59% of staff intended to seek vaccination, 24% to reject and 17% were unsure. There was significantly reduced intended uptake in females, younger age groups, healthcare assistants, nurses, staff of black ethnic backgrounds and those who rejected influenza vaccination. Safety was the dominant concern.ConclusionsOur study finds COVID-19 vaccinate hesitancy is prevalent among healthcare workers at a London Hospital Trust. It is particularly concerning that hesitancy was highest amongst groups most exposed to COVID-19 and most at risk of severe disease. Reasons behind disparities in uptake must be addressed to protect staff and prevent deepening inequalities within the healthcare workforce.

The impact of Learning Development tutorials on student attainment

University Learning Development teams provide expert advice to learners regarding the development and enhancement of academic skills such as essay writing, dissertations, critical analysis, mathematics, and statistics. The majority of universities have set up Learning Development or similar academic support services in recent years. However, little research has been conducted to understand the effect of such help on student attainment. At the University of Northampton, this service is perceived as pivotal in supporting students through their studies. The impact on student grades and future attainment was examined using three and a half years of student assessment data (over 16,000 students and 175,000 assessments) which was connected to information gathered from the Learning Development one-to-one tutorials database. Although causality cannot be claimed, there was an average rise of one to two sub grades for learners who attended at least one Learning Development tutorial compared to those who did not use this assistance. Furthermore, historical tutorials positively affected grades of students with an additional two percent increase in their future assignments. Students from the faculties of Business and Law and Education and Humanities saw the largest increase in attainment compared to students within their faculties who did not have tutorials. Furthermore, students from a black ethnic background and aged 25 years or below also gained the most in terms of attainment compared to other ethnic groups and more mature students.

Long-term trends in death and dependence after ischaemic strokes: Aretrospective cohort study using the South London Stroke Register (SLSR).

There have been reductions in stroke mortality over recent decades, but estimates by aetiological subtypes are limited. This study estimates time trends in mortality and functional dependence by ischaemic stroke (IS) aetiological subtype over a 16-year period. The study population was 357,308 in 2011; 50.4% were males, 56% were white, and 25% were of black ethnic backgrounds. Population-based case ascertainment of stroke was conducted, and all participants who had their first-ever IS between 2000 and 2015 were identified. Further classification was concluded according to the underlying mechanism into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). Temporal trends in survival rates were examined using proportional-hazards survival modelling, adjusted for demography, prestroke risk factors, case mix variables, and processes of care. We carried out additional regression analyses to explore patterns in case-fatality rates (CFRs) at 30 days and 1 year and to explore whether these trends occurred at the expense of greater functional dependence (Barthel Index [BI] < 15) among survivors. A total of 3,128 patients with first-ever ISs were registered. The median age was 70.7 years; 50.9% were males; and 66.2% were white, 25.5% were black, and 8.3% were of other ethnic groups. Between 2000-2003 and 2012-2015, the adjusted overall mortality decreased by 24% (hazard ratio [HR] per year 0.976; 95% confidence interval [CI] 0.959-0.993). Mortality reductions were equally noted in both sexes and in the white and black populations but were only significant in CE strokes (HR per year 0.972; 95% CI 0.945‒0.998) and in patients aged ≥55 years (HR per year 0.975; 95% CI 0.959‒0.992). CFRs within 30 days and 1 year after an IS declined by 38% (rate ratio [RR] per year 0.962; 95% CI 0.941‒0.984) and 37% (RR per year 0.963; 95% CI 0.949‒0.976), respectively. Recent IS was independently associated with a 23% reduced risk of functional dependence at 3 months after onset (RR per year 0.983; 95% CI 0.968-0.998; p = 0.002 for trend). The study is limited by small number of events in certain subgroups (e.g., LAA), which could have led to insufficient power to detect significant trends. Both mortality and 3-month functional dependence after IS decreased by an annual average of around 2.4% and 1.7%, respectively, during 2000‒2015. Such reductions were particularly evident in strokes of CE origins and in those aged ≥55 years.

Fundamental Movement Skills of Children Living in England: The Role of Ethnicity and Native English Language

The development of fundamental movement skills (FMS) has been associated with children's general health, and, while there is evidence to suggest that age, gender, physical activity, and socioeconomic status relate to FMS, the relationship of ethnicity and language barriers to FMS competence has been underexplored. These factors may be of particular interest for South Asian (SA) children who have lower physical activity and increased risk of metabolic disease. This cross-sectional study examined ethnic and language differences in FMS among 218 ethnically diverse five-year-old children (61 White ethnic background, 91 SA, 29 Black ethnic background, and 37 other), some with English as a native language ( n = 90) and some with English as an additional language ( n = 75), all recruited from within central England. Each child was assessed performing five locomotor skills (run, gallop, hop, leap, and jump) and six object skills (catch, kick, bounce, strike, underarm roll, and overarm throw) on the Test of Gross Motor Development-2 . A 2 (gender) × 4 (ethnicity) factor analysis of covariance assessed differences in the locomotor and object composite scores and total FMS score, while controlling for body mass index. A two-factor analysis of covariance assessed native language differences in their impact on FMS. We found ethnic and gender differences in FMS ( p < .05) in that SA children had poorer total FMS and locomotor scores than children of either White or Black ethnic backgrounds ( p = .004, p = .001, and p = .008, p = .002, respectively). Girls had poorer total ( p = .001) and locomotor FMS skills ( p < .001). Children with English as an additional language had similar FMS scores compared to children whose native language was English ( p > .05). The findings of low FMS competency in SA children and girls, irrespective of body mass index, suggest that developmentally appropriate interventions targeting SA children and girls are needed in early years. We discuss some unclear factors related to these differences.

Informe de caso sobre cardiomiopatía periparto: rara, desconocida y potencialmente fatal

ObjectivesTo present a clinical case and to conduct a non-systematic review of the literature on peripartum cardiomyopathy, and to describe its incidence, aetiology and pathophysiology. Material and methodsWith the authorization of the Ethics Committee of our institution, we present the case of a patient of mestizo ethnic origin who developed asthenia, adynamia, lower limb asymmetrical pain and functional class deterioration during the post-partum period, and her management in the Intensive Care Unit and final outcome. The search of the literature was conducted in PubMed, Scielo and Bireme. ResultsPeripartum cardiomyopathy is associated with significant morbidity and mortality. The clinical course varies between progressive improvement, heart failure, transplant or death. Some national reports were found. ConclusionsPeripartum cardiomyopathy affects a young and healthy population during a period of time ranging between the end of pregnancy and five months postpartum. The aetiology and pathogenesis are unknown, but several hypotheses have been proposed: viral myocarditis, autoimmune and/or abnormal haemodynamic response to the pregnancy, genetic susceptibility, malnutrition, and apoptosis.The prognosis of recovery of LVEF depends on early detection within seven days of the onset of symptoms, an initial LVEF greater than 30%, and a LVDD smaller than 60mm. Mortality is associated with parity greater than four, older age and black ethnic background (6.4 times higher than in Caucasians).

Private school pupils still disproportionately represented in medical colleges

Private school pupils continue to be disproportionately represented among medical students, show figures from the Higher Education Statistics Authority. A quarter of medical students in the first year of their first degree have had a private school education, despite these schools educating just 7% of pupils across the UK.1 From 2007-08 to 2011-12 the proportion of medical students who had been privately educated fell by just one percentage point, from 26.9% to 25.9%. Over the same period the proportion of students of white ethnic background rose from 71.3% to 72.5% and that of students of Asian ethnic background fell from 20.6% to 18.9%. The proportion of medical students of black ethnic background rose from 2.5% in 2007-08 …