London Population Research Articles

Severe hyponatremia in obstetrics: Presentations and outcome. Retrospective cohort over 10 years.

Hyponatremia in labor and the postpartum period is generally underreported. In this study we aimed to identify attributable causes of severe hyponatremia in an obstetric population and define maternal outcomes. This was a retrospective cohort study, in a single center over a period of 10 years. The study setting was an NHS maternity trust serving a multi-ethnic population in southwest London. The hospital cared for 53 649 pregnant women in the study period. All patients with severe hyponatremia in labor and immediate postpartum period from January 2011 until December 2020 were identified from the laboratory database. Individual case notes were analyzed for fluid use, use and duration of oxytocin, medical conditions, and delivery details. Severe peripartum hyponatremia was identified in 77 patients. A total of 28% of those analyzed required ITU admission for electrolyte correction, of whom 6% presented with severe neurologic symptoms, making symptoms a poor marker of severity (P = 0.051). The main association was to oxytocin and intravenous fluid infusions (80% and 86%, respectively), only one-third of patients had pre-eclampsia. Other associated medical conditions did not appear to have a significant influence on disease course nor prognosis (P = 0.359). Hyponatremia during labor can have detrimental effect on maternal outcomes. Lower threshold for testing and diligent maintenance of fluid balance charts during labor can help with primary prevention.

Maternal And preGnancy hEalth duriNg elevaTed heAt – MAGENTA: Novel data linkages and methods to understand the impacts of climate change on deprived communities in Wales and London.

Background and ObjectivesThe health impacts from changing climate, including increasing frequency, severity, and duration of heat are projected to worsen. The MAGENTA study will explore the impact of heat on pregnancy-related outcomes for deprived communities in Wales and London. ApproachMAGENTA will create linked data cohorts capturing some of the most deprived and diverse communities in Europe to analyse the impact deprivation, ethnicity, heatwaves, and urban heat islands have on pregnancy-related health. A consented data-linked cohort of pregnant women will provide biological samples and undergo direct measurement of themselves and their home environments to understand the heat stress response of pregnant women not acclimatised to heat during their pregnancy. Core to the study is our public involvement strategy which includes pregnant women and women who have recently delivered a baby, co-producing the research and how results are communicated. ResultsOur electronic cohorts cover >10 years of climate and health data and capture all births in Wales >300,000 and >1.1 million in London. We will present how the novel data linkages can work in multiple trusted research environments, approaches for sharing methods in geospatial modelling and statistics across the project and preliminary findings from the study. Findings and ImplicationsThe MAGENTA study will help inform expectant parents, families and policy makers how to prepare for climate change in temperate regions. The comparison between different populations in Wales and London will give insight on where policies and interventions can be generally applied and where they need to be contextually adapted.

Colour-evasive racial ideologies underpinning the hidden curriculum of a majority-minority occupational therapy school in London, England: an analysis of minoritised undergraduate students’ experiences

ABSTRACT The concept of ethnoracial ‘majority-minority’ was introduced to describe changing population demographics where racial or ethnic groups traditionally in the majority have become a numerical minority. Despite their increase in recent years, very little is known of how hidden curricula manifests in these settings. Hence, this study sought to interrogate the hidden curriculum of race at an Occupational Therapy school with a majority-minority student-educator population in London, England. We conducted a secondary analysis of qualitative data from a larger action research project. The main data source was derived from two group interviews involving 11 racially minoritised student participants, and thematically analysed through a hidden curriculum lens. Trustworthiness of the analysis was enforced through crystallisation. The hidden curriculum of race was identified as embedded within (1) formal learning, (2) the null curriculum, (3) the informal curriculum, and (4) administrative structure and functioning. It is underpinned by pervasive colour-evasive racial ideologies which perpetuate health and workforce inequities. This paper concludes that majority-minority population demographics are insufficient to mitigate the impact of wider societal norms of oppression on hidden curricula. Thus, concerted and collective efforts involving all professional stakeholders are needed to embed intersectional, critical race-conscious approaches throughout formal learning across the academic curriculum.

Diagnosis and management of tuberculosis infection in inclusion health populations in London

BackgroundTuberculosis in the UK is more prevalent in people with social risk factors– e.g. previous incarceration, homelessness - and in migrants from TB endemic countries. The management of TB infection is part of TB elimination strategies, but is challenging to provide to socially excluded groups and the evidence base for effective interventions is small.MethodsWe evaluated a TB infection screening and treatment programme provided by a peer-led service (Find&Treat) working in inclusion health settings (e.g. homeless hostels) in London. IGRA (interferon-gamma release assay) testing and TB infection treatment were offered to eligible adults using a community-based model. The primary outcome was successful progression through the cascade of care. We also evaluated socio-demographic characteristics associated with a positive IGRA.Results42/312 (13.5%) participants had a positive IGRA and no one had evidence of active TB. 35/42 completed a medical evaluation; 22 started treatment, and 17 completed treatment. Having a positive IGRA was associated with previous incarceration and being born outside of the UK.DiscussionProvision of TB infection diagnosis and management to this socially excluded population has several challenges including maintaining people in care and drug-drug interactions. Peer-support workers provided this service safely and effectively with appropriate support. Further work to generate data to inform risks and benefits of treatment for TB infection in this group is needed to facilitate joint decision making.

Lack of awareness and ethnic polarity is a major cause of metabolic associated fatty liver disease in high-risk diabetes population in South London.

Metabolic associated fatty liver disease (MAFLD) stands as the leading cause of chronic liver disease globally. Notably, individuals with metabolic risk factors, such as diabetes and obesity, exhibit a staggering prevalence of MAFLD, with estimates reaching up to 70%. However, despite its widespread occurrence, there's a noticeable gap in understanding and awareness about MAFLD among these high-risk groups. The main objective of this study was to assess the awareness and prevalence of MAFLD among diabetic patients who regularly receive secondary care focusing particularly on how multiethnic backgrounds and associated lifestyle preferences influence these health outcomes. Cross-sectional study. Patients with type 2 diabetes (T2D) who regularly attend Lambeth Diabetes Intermediate Care Team clinics were invited to undergo MAFLD screening using FibroScan. Those who agreed to participate were provided with structured questionnaires on diet, physical activity, and MAFLD knowledge by a hepatologist. For each participant, anthropometric data, medical history, liver stiffness measurement, and controlled attenuation parameter (CAP) were documented. Steatosis was identified with a CAP value of ⩾275 dB/m, and advanced fibrosis was flagged at values of ⩾8 kPa. The FibroScan data was valid in 96.4% (215), 53.5% (115/215) had steatosis and 26.2% (58/215) had liver fibrosis in this multiethnic high-risk group. Awareness of MAFLD was notably low at 30.9%. Alarmingly, 69% of patients diagnosed with liver fibrosis were unfamiliar with the condition. Additionally, understanding of MAFLD showed variation among different ethnic groups with highest levels were demonstrated in the Caucasian/White population (46%). Majority (96%) of these subjects were receiving specific lifestyle advice from healthcare professionals due to metabolic conditions and comorbidities. However, most patients preferred diets that were rich in carbohydrates (65.8%) and only 43% subjects performed moderate exercise daily highlighting lack of understanding regarding MAFLD and lifestyle management. There's a pressing need for increased awareness of MAFLD, especially in multiethnic high-risk groups. Additionally, the development of cost-effective strategies to stratify risk is essential to address this growing health concern.

Determinants of lipid clinic referral and attendance in a multi-ethnic adult population in South London

Determinants of lipid clinic referral and attendance in a multi-ethnic adult population in South London

Association of age at antiretroviral therapy initiation with CD4 + : CD8 + ratio recovery among virally suppressed people with HIV.

To investigate the association of age at antiretroviral therapy (ART) initiation with CD4 + : CD8 + T-cell ratio in virally suppressed people with HIV on long-term ART, and to characterize potential CD4 + : CD8 + ratio recovery in this population by age. A longitudinal study of people attending an HIV clinic at the Royal Free Hospital NHS Trust, London, who initiated ART between 2001 and 2015, and achieved and maintained HIV-1 viral suppression (viral load <1,000 copies/ml). The association of age group at ART initiation with CD4 + : CD8 + ratio at 5 and 10 years was assessed. Multivariable linear regression was used to investigate the relationship between age at ART initiation and log CD4 + : CD8 + ratio, adjusting for demographic factors (gender/HIV transmission route, ethnicity), baseline CD4 + count and calendar year. The sample included 1859 people aged 20-78 (75% men, 56% white ethnicity). Overall, median CD4 + : CD8 + T-cell ratio increased from 0.24 at baseline to 0.77 at year 5 and 0.88 at year 10. Ratios increased among all age groups in unadjusted and adjusted models but increased less among older ages (baseline ages 60-69 and 70-79). Median ratios at year 5 were 0.85, 0.80, 0.72, 0.76, 0.6, and 0.44, respectively, among people aged 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years at baseline. In a virally suppressed London population, age had a substantial impact on CD4 + : CD8 + ratio recovery, especially for those starting ART after age 60 years. Results may indicate the level of CD4 + : CD8 + ratio recovery possible in an HIV-positive, virally suppressed, aging population.

Assessment of ethnic inequalities in diagnostic coding of familial hypercholesterolaemia (FH): A cross-sectional database study in Lambeth, South London

Background and aimsDifferences in the perceived prevalence of familial hypercholesterolemia (FH) by ethnicity are unclear. In this study, we aimed to assess the prevalence, determinants and management of diagnostically-coded FH in an ethnically diverse population in South London. MethodsA cross-sectional analysis of 40 practices in 332,357 adult patients in Lambeth was undertaken. Factors affecting a (clinically coded) diagnosis of FH were investigated by multi-level logistic regression adjusted for socio-demographic and lifestyle factors, co-morbidities, and medications. ResultsThe age-adjusted FH % prevalence rate (OR, 95%CI) ranged from 0.10 to 1.11, 0.00–1.31. Lower rates of FH coding were associated with age (0.96, 0.96–0.97) and male gender (0.75, 0.65–0.87), p < 0.001. Compared to a White British reference group, a higher likelihood of coded FH was noted in Other Asians (1.33, 1.01–1.76), p = 0.05, with lower rates in Black Africans (0.50, 0.37–0.68), p < 0.001, Indians (0.55, 0.34–0.89) p = 0.02, and in Black Caribbeans (0.60, 0.44–0.81), p = 0.001. The overall prevalence using Simon Broome criteria was 0.1%; we were unable to provide ethnic specific estimates due to low numbers.Lower likelihoods of FH coding (OR, 95%CI) were seen in non-native English speakers (0.66, 0.53–0.81), most deprived income quintile (0.68, 0.52–0.88), smokers (0.68,0.55–0.85), hypertension (0.62, 0.52–0.74), chronic kidney disease (0.64, 0.41–0.99), obesity (0.80, 0.67–0.95), diabetes (0.31, 0.25–0.39) and CVD (0.47, 0.36–0.63). 20% of FH coded patients were not prescribed lipid-lowering medications, p < 0.001. ConclusionsInequalities in diagnostic coding of FH patients exist. Lower likelihoods of diagnosed FH were seen in Black African, Black Caribbean and Indian ethnic groups, in contrast to higher diagnoses in White and Other Asian ethnic groups. Hypercholesterolaemia requiring statin therapy was associated with FH diagnosis, however, the presence of cardiovascular disease (CVD) risk factors lowered the diagnosis rate for FH.

Determinants of lipid clinic referral and attendance in a multi-ethnic adult population in south London: a cross-sectional study

BackgroundPrimary dyslipidaemias, including familial hypercholesterolaemia, are underdiagnosed genetic disorders that substantially increase risk for premature coronary artery disease in adults. Early identification of primary dyslipidaemias via lipid clinic referral optimises patient management and enables cascade screening of relatives. Improving the identification of primary dyslipidaemias, and understanding disparities in ascertainment and management, is an NHS priority. We aimed to assess determinants of lipid clinic referral or attendance (LCR) in ethnically diverse adults. MethodsWe did a retrospective cross-sectional study using the Lambeth DataNet containing anonymised data from 41 general practitioner (GP) practices in south London. We looked at referral data for adult patients aged 18 years and older from Jan 1, 1995, until May 14, 2018. LCR was the main outcome. We used sequential multilevel logistic regression models adjusted for practice effects to estimate the odds of LCR assessed across six ethnic groups (reference group White) and patient-level factors (demographic, socioeconomic, lifestyle, comorbidities, total cholesterol [TC] >7·5mmol/L, statin prescription, and practice factors). The study was approved by NHS South East London Clinical Commissioning Group (CCG) and NHS Lambeth CCG. Findings780 (0·23%) of 332 357 adult patients were coded as referred (n=538) or seen (n=252) in a lipid clinic. 164 487 (46·49%) were women (appendix). The fully adjusted model for odds of LCR showed the following significant associations for age (odds ratio [OR] 0·96, 95% CI 0·96–0·97, p<0·001); Black, African, Caribbean, or Black-British ethnicity (0·67, 0·53–0·84, p=0·001); ex-smoker status (1·29, 1·05–1·57, p=0·014); TC higher than 7·5 mmol/L (12·18, 9·60–15·45, p<0·001); statin prescription (14·01, 10·85–18·10, p<0·001); diabetes (0·72, 0·58–0·91, p=0·005); high-frequency GP attendance at seven or more GP consultations in the past year (1·49, 1·21–1·84, p<0·001); high GP-density (0·5–0·99 full-time equivalent GPs per 1000 patients; 2·70, 1·23–5·92, p=0·013). Sensitivity analyses for LCR restricted to familial hypercholesterolaemia-coded patients (n=581) found associations with TC higher than 7·5 mmol/L (4·26, 1·89–9·62, p<0·001), statin prescription (16·96, 2·19–131·36, p=0·007), and high GP-density (5·73, 1·27–25·93, p=0·023), with no significant associations with ethnicity. The relative contribution of GP practices to LCR was 6·32% of the total variance. There were no significant interactions between ethnicity and deprivation, age, or obesity. InterpretationWhile interpretation is limited by the accuracy and completeness of coded records, the study showed factors associated with a higher likelihood of LCR included individuals recorded as having TC higher than 7·5 mmol/L, statin prescription, ex-smoker status, high-frequency GP attendance, and registration at a GP practice with 0·5–0·99 GP density. Patients with increasing age; Black, African, Caribbean, or Black-British ethnicity patients; and patients with diabetes had lower odds of LCR. Finally, the difference in odds of LCR between Black and White patients highlights potential health inequalities. FundingNHS Race & Health Observatory.

Russian Nihilists in British Periodicals, 1880–1900

Abstract The late-nineteenth-century Russian nihilist movement was popularized by the portrait of Bazarov in Ivan Turgenev’s Fathers and Sons. But despite Turgenev’s nuanced and poignant portrayal, nihilism became associated with Russian revolutionary activities and especially terrorism. Discussions of the nihilist ethos were not limited to Russia but pervaded print culture in Western Europe. The orientalizing rhetoric of British journalism placed Russia firmly in the Eastern camp, so that it offered both the spectacle of exotic, retrograde monarchy and the equally fascinating or threatening vision of revolution in Europe. Revolutionary activities in Russia became part of the “dynamite theme” in British fiction of the fin de siècle, when terrorism also accompanied anarchist movements in continental Europe and Fenian bombings in support of Irish independence. Additionally, Russians became part of the London population through the immigration of Jews, a movement that increased significantly after around 1880. Russian dissidents themselves were welcomed in Britain after the Extradition Act of 1870. This article surveys a range of periodical writings, both reportage and fiction, in the last two decades of the nineteenth century. Periodical articles and stories reflect the pervasiveness and varied presentation of Russian revolutionary movements and ideas in late Victorian British publications.

Validation of a dynamic method of measuring households and populations from primary care Electronic Health Records: Cross-sectional comparison with Office for National Statistics Census 2021 estimates

ObjectivesWe have developed a dynamic method for identifying household members from Electronic Health Records (EHR). We compared the 2021 Census estimates of household number and demography with similar estimates derived from primary care EHRs on the Census date using primary care EHRs for the population of north east London (NEL).&#x0D; MethodWe included 2,115,017 patients registered with a general practitioner on the 2021 Census date in NEL and assigned households from encrypted Unique Property Reference Numbers. We compared household number and size by Local Authority (LA), Middle Layer Super Output Area (MSOA) and area’s Index of Multiple Deprivation quintiles (IMDq) to Office for National Statistics (ONS) 2021 Census estimates and by LA to ONS Admin Based Housing Stock (ABHS) 2020 estimates. We assessed differences in EHR and Census 2021 populations by sex, age, LA, MSOA and IMDq. Sensitivity analyses will exclude those without a recent recorded clinical encounter.&#x0D; ResultsEHR population estimates (2,115,017) were 116,346 (5.8%) higher than Census estimates (1,998,671), higher among men (9.2%) than women (2.5%) in almost all age groups, especially men aged 30-50 years and higher in the most (8.7%), than in the least (2.5%) deprived IMDq. EHR household estimates (660,789) were 68,047 (9.3%) lower than Census estimates (728,836), and 19,719 (3.1%) higher than ABHS occupied addresses (641,070). EHR household size estimates were 15.6%, 29.2%,12.5% and 8.4% lower for household sizes 1,2 3 and 4, and 13.3%, 42.1%, 82.1% and 195.8% higher for household sizes 5, 6,7 and 8 respectively when compared to Census estimates. EHR population and household estimates were respectively 5-10% higher and 5-11% lower for almost all NEL local authorities.&#x0D; ConclusionEHR- and Census-derived population and household estimates differ, mainly in the prevalence of larger households. While data were extracted on the same date, person-level validation was not possible. Differences may reflect deregistration delay in EHR when changing residence. Analyses based on clinical encounters recency may identify registered patients who are no longer residents.

Testing the accuracy of Foti’s dental age estimation methods on a London UK sample

Background and aimTooth development and eruption are widely used in assessing dental age estimation, and one of the methods in using tooth development and eruption is Foti’s method. However, the population used in the original study was French. Therefore, the aim of this study was to test the accuracy of Foti’s four dental age estimation regression models against the East London population, mainly of the Bangladeshi and Caucasian ethnicity. These count the number of erupted teeth and tooth germs using a radiograph (Foti 1), absence of a radiograph (Foti 2), maxillary erupted teeth (Foti 3) and mandibular erupted teeth (Foti 4). MethodsThe test sample was archived panoramic radiographs of 754 healthy patients aged 6–20 years (380 males and 374 females). The difference between dental and chronological ages was tested using a t-test. The mean absolute difference was also calculated for all models. The most accurate method was defined as the smallest mean difference, smallest standard deviation (SD) and mean absolute difference between dental and chronological ages. ResultsFoti model 2 was most accurate with a mean difference of 0.11 years (SD 1.70 years) and a mean absolute difference of 1.33 years. Models 3 (maxillary erupted teeth) and 4 (mandibular erupted teeth) were marginally less accurate, whilst model 1 (radiograph) overestimated age on average by more than 5 years. ConclusionOur findings show that estimating age using erupting teeth was most accurate using Foti model 2 (least bias).

The Impact of Legislative Reform on Baptisms, Marriages and Burials 1836–52, with particular reference to London

This article considers, with particular reference to London, the impact of legislation during the second quarter of the nineteenth century on the churches’ practice of rites of passage in relation to births, marriages and deaths. It investigates the religious, political and social reasons for legislation relating to these rites which many contemporaries and subsequent historians considered an attack on the Church of England and evidence of advancing secularization. It shows that despite significant constitutional, social and religious changes during these years, religiously motivated politicians, sympathetic to the established church, achieved legislation introducing general registration of births, marriages and deaths, and providing for more satisfactory burial of London's rapidly growing population in the context of a high death rate. While satisfying some grievances of religious Dissenters, this protected the established church's interests, and evidence suggests that a high proportion of London's population continued to access its rites of passage for baptism, marriage and burial.

P014 Experience of baricitinib in a real-world population with efficacy and side effects: a South London regional analysis

Abstract Background/Aims Baricitinib is the most common Janus Kinase inhibitor (JAKi) used in the treatment of rheumatological conditions. Whilst randomised controlled trials have demonstrated the efficacy and safety profile of baricitinib, real-world data on the experience of JAKi use in clinical practice is lacking. The aim of this analysis was to evaluate baricitinib use in a real-world patient population in South London. Methods We looked at two rheumatology departments in South London (St George’s Hospital; a tertiary teaching centre and Kingston Hospital; a district general hospital). All patients prescribed baricitinib between January 2017 to June 2022 were included. A retrospective assessment of electronic patient notes was performed to evaluate disease activity (determined by DAS-28 scores at baseline, 3-6 months and presently); adverse effects including side effects, rates of and reasons for discontinuation; and prescribing practice, including previous use of other biological disease modifying anti-rheumatic drugs (bDMARDs). Baseline data including age, gender, co-morbidities and rheumatological diagnoses were also included. Results 233 patients were included in this evaluation, with seropositive rheumatoid arthritis being the most common diagnosis (58%) and with a significant female population (87%). Baricitinib improved average DAS-28 scores from 5.75 (range 3.57-8.3) at baseline to 3.23 (range 0.28-7.49) at 3-6 months post-baricitinib, with the most recent DAS-28 score of 2.90 (range 0.56-6.77). Rates of adverse effects were low as shown in Table 1. Baricitinib was discontinued in 60/233 patients, with average duration to discontinuation of 9.5 months. The most common reasons for discontinuation were: ineffective disease control (28/60), recurrent bacterial infection (5/60), deranged liver function (3/60) and venous thromboembolism (2/60). Eight patients died whilst taking baricitinib. Where documented, the causes of death were Covid-19 (4/8) and malignancy (1/8). 110 out of 233 patients had received other bDMARDs before starting baricitinib. Documented reasons for baricitinib choice over tumour necrosis factor inhibitors (TNFi) included: previous lack of response to TNFi (89/233), contra-indication to TNFi (11/233) and preference of oral route (10/233). Conclusion Our real-world study of JAKi use shows that baricitinib is efficacious in the treatment of rheumatological conditions. Moreover, baricitinib is well tolerated, with low rates of adverse effects and subsequent discontinuation. Disclosure O. Buckeldee: None. K. Biddle: None. A. Latheef: None. I. Al-Shakarchi: None. N. Sofat: None.

Development and international validation of custom-engineered and code-free deep-learning models for detection of plus disease in retinopathy of prematurity: a retrospective study

Retinopathy of prematurity (ROP), a leading cause of childhood blindness, is diagnosed through interval screening by paediatric ophthalmologists. However, improved survival of premature neonates coupled with a scarcity of available experts has raised concerns about the sustainability of this approach. We aimed to develop bespoke and code-free deep learning-based classifiers for plus disease, a hallmark of ROP, in an ethnically diverse population in London, UK, and externally validate them in ethnically, geographically, and socioeconomically diverse populations in four countries and three continents. Code-free deep learning is not reliant on the availability of expertly trained data scientists, thus being of particular potential benefit for low resource health-care settings. This retrospective cohort study used retinal images from 1370 neonates admitted to a neonatal unit at Homerton University Hospital NHS Foundation Trust, London, UK, between 2008 and 2018. Images were acquired using a Retcam Version 2 device (Natus Medical, Pleasanton, CA, USA) on all babies who were either born at less than 32 weeks gestational age or had a birthweight of less than 1501 g. Each images was graded by two junior ophthalmologists with disagreements adjudicated by a senior paediatric ophthalmologist. Bespoke and code-free deep learning models (CFDL) were developed for the discrimination of healthy, pre-plus disease, and plus disease. Performance was assessed internally on 200 images with the majority vote of three senior paediatric ophthalmologists as the reference standard. External validation was on 338 retinal images from four separate datasets from the USA, Brazil, and Egypt with images derived from Retcam and the 3nethra neo device (Forus Health, Bengaluru, India). Of the 7414 retinal images in the original dataset, 6141 images were used in the final development dataset. For the discrimination of healthy versus pre-plus or plus disease, the bespoke model had an area under the curve (AUC) of 0·986 (95% CI 0·973-0·996) and the CFDL model had an AUC of 0·989 (0·979-0·997) on the internal test set. Both models generalised well to external validation test sets acquired using the Retcam for discriminating healthy from pre-plus or plus disease (bespoke range was 0·975-1·000 and CFDL range was 0·969-0·995). The CFDL model was inferior to the bespoke model on discriminating pre-plus disease from healthy or plus disease in the USA dataset (CFDL 0·808 [95% CI 0·671-0·909, bespoke 0·942 [0·892-0·982]], p=0·0070). Performance also reduced when tested on the 3nethra neo imaging device (CFDL 0·865 [0·742-0·965] and bespoke 0·891 [0·783-0·977]). Both bespoke and CFDL models conferred similar performance to senior paediatric ophthalmologists for discriminating healthy retinal images from ones with features of pre-plus or plus disease; however, CFDL models might generalise less well when considering minority classes. Care should be taken when testing on data acquired using alternative imaging devices from that used for the development dataset. Our study justifies further validation of plus disease classifiers in ROP screening and supports a potential role for code-free approaches to help prevent blindness in vulnerable neonates. National Institute for Health Research Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and the University College London Institute of Ophthalmology. For the Portuguese and Arabic translations of the abstract see Supplementary Materials section.

Unravelling the potential of social prescribing in individual-level type 2 diabetes prevention: a mixed-methods realist evaluation

BackgroundSocial prescribing (SP) usually involves linking patients in primary care with services provided by the voluntary and community sector. Preliminary evidence suggests that SP may offer a means of connecting patients with community-based health promotion activities, potentially contributing to the prevention of long-term conditions, such as type 2 diabetes (T2D).MethodsUsing mixed-methods realist evaluation, we explored the possible contribution of SP to individual-level prevention of T2D in a multi-ethnic, socio-economically deprived population in London, UK. We made comparisons with an existing prevention programme (NHS Diabetes Prevention Programme (NDPP)) where relevant and possible. Anonymised primary care electronic health record data of 447,360 people 18+ with an active GP registration between December 2016 and February 2022 were analysed using quantitative methods. Qualitative data (interviews with 11 primary care clinicians, 11 social prescribers, 13 community organisations and 8 SP users at high risk of T2D; 36 hours of ethnographic observations of SP and NDPP sessions; and relevant documents) were analysed thematically. Data were integrated using visual means and realist methods.ResultsPeople at high risk of T2D were four times more likely to be referred into SP than the eligible general population (RR 4.31 (95% CI 4.17–4.46)), with adjustment for socio-demographic variables resulting in attenuation (RR 1.33 (95% CI 1.27–1.39)). More people at risk of T2D were referred to SP than to NDPP, which could be explained by the broad referral criteria for SP and highly supportive (proactive, welcoming) environments. Holistic and sustained SP allowed acknowledgement of patients’ wider socio-economic constraints and provision of long-term personalised care. The fact that SP was embedded within the local community and primary care infrastructure facilitated the timely exchange of information and cross-referrals across providers, resulting in enhanced service responsiveness.ConclusionsOur study suggests that SP may offer an opportunity for individual-level T2D prevention to shift away from standardised, targeted and short-term strategies to approaches that are increasingly personalised, inclusive and long-term. Primary care-based SP seems most ideally placed to deliver such approaches where practitioners, providers and commissioners work collectively to achieve holistic, accessible, sustained and integrated services.

The incidence and prevalence of recurrent corneal erosion syndrome in London, UK.

Recurrent corneal erosion syndrome (RCES) is caused by repeated episodes of corneal epithelial breakdown due to improper adherence of the corneal epithelium to the underlying basement membrane. The most common aetiologies are corneal dystrophy or previous superficial ocular trauma. The incidence and prevalence of the condition is currently unknown. This study aimed to determine the incidence and prevalence of RCES within the London population over a 5-year period in order to better inform clinicians and evaluate how this condition affects ophthalmic service provision. A retrospective cohort study over a 5-year period reviewed 487,690 emergency room patient attendances at Moorfields Eye Hospital (MEH) London between 1 January 2015 and 31 December 2019. MEH caters for a local population comprising of around ten regional clinical commissioning groups (CCGs). The data for this study were collected using OpenEyesTM electronic medical records including demographics and comorbidities. The CCGs encompass 41% (3,689,000) of London's total 8,980,000 inhabitants. Using these data the crude incidence and prevalence rates of disease were estimated with results reported per 100,000 population. Out of 330,684 patients, 3623 patients were given a new diagnosis of RCES by the emergency ophthalmology services, and from these, 1056 patients attended outpatient follow-up. The crude annual incidence of RCES was estimated at 25.4 per 100,000, with a crude prevalence rate of 0.96%. There was no statistical difference in annual incidence across the 5-year period. The period prevalence of 0.96% shows that RCES is not uncommon. There was also a stable annual incidence over the 5-year period, showing no changing trend over the study period. However, identifying the true incidence and period prevalence is a challenging task, as minor cases may heal prior to examination by an ophthalmologist. It is highly likely that RCES is underdiagnosed and therefore underreported.

Evaluating the feasibility and acceptability of home-based urinalysis for albumin-creatinine ratio with smartphone technology: A quality improvement project.

Despite albumin-creatinine ratio (urine) testing being recommended for detection of chronic kidney disease among adults with diabetes, testing rates are suboptimal. We implemented and evaluated a quality improvement project in an inner-city diabetes population in London, UK to assess the feasibility and acceptability of implementing novel home-based urinalysis using smartphone technology. After eligible patients were identified and consented, testing kits were sent to the patient's home. Test results and patient feedback were collected through the smartphone application. Focus group discussions were conducted to evaluate primary care staff perspectives on uptake and delivery of the service. In total 2370 patients agreed to take part. Of these, 1244 completed the test (61% of those eligible) and of these, 465 (37%) had clinically significant albuminuria. 98% of patients found the test easy or very easy to use. Staff in primary care found the service to be beneficial for patients, and reported ease of set up and minimal administrative processes. Concerns regarding barriers among patients with lower digital literacy and non-English speakers were raised although these concerns were not substantiated. Home-based albumin-creatinine ratio urine testing may improve the testing rates of people with diabetes at higher risk of chronic kidney disease. This is important post-pandemic, as healthcare services are trying to return to pre-pandemic levels of care. The study also found that the use of smartphone technology in an underserved (deprived) community is feasible, despite reservations about levels of digital literacy and possible language barriers. Further evaluation of effectiveness and costs is required.

Predicting type 2 diabetes prevalence for people with severe mental illness in a multi-ethnic East London population

Background and aimsPrevalence of type two diabetes mellitus (T2DM) in people with severe mental illness (SMI) is 2–3 times higher than in general population. Predictive modelling has advanced greatly in the past decade, and it is important to apply cutting-edge methods to vulnerable groups. However, few T2DM prediction models account for the presence of mental illness, and none seemed to have been developed specifically for people with SMI. Therefore, we aimed to develop and internally validate a T2DM prevalence model for people with SMI. MethodsWe utilised a large cross-sectional sample representative of a multi-ethnic population from London (674,000 adults); 10,159 people with SMI formed our analytical sample (1,513 T2DM cases). We fitted a linear logistic regression and XGBoost as stand-alone models and as a stacked ensemble. Age, sex, body mass index, ethnicity, area-based deprivation, past hypertension, cardiovascular diseases, prescribed antipsychotics, and SMI illness were the predictors. ResultsLogistic regression performed well while detecting T2DM presence for people with SMI: area under the receiver operator curve (ROC-AUC) was 0.83 (95 % CI 0.79–0.87). XGBoost and LR-XGBoost ensemble performed equally well, ROC-AUC 0.83 (95 % CI 0.79–0.87), indicating a negligible contribution of non-linear terms to predictive power. Ethnicity was the most important predictor after age. We demonstrated how the derived models can be utilised and estimated a 2.14 % (95 %CI 2.03 %-2.24 %) increase in T2DM prevalence in East London SMI population in 20 years’ time, driven by the projected demographic changes. ConclusionsPrimary care data, the setting where prediction models could be most fruitfully used, provide enough information for well-performing T2DM prevalence models for people with SMI. We demonstrated how thorough internal cross-validation of an ensemble of a linear and machine-learning model can quantify the predictive value of non-linearity in the data.

Detrimental network effects in privacy: A graph-theoretic model for node-based intrusions

Despite proportionality being one of the tenets of data protection laws, we currently lack a robust analytical framework to evaluate the reach of modern data collections and the network effects at play. Here, we propose a graph-theoretic model and notions of node- and edge-observability to quantify the reach of networked data collections. We first prove closed-form expressions for our metrics and quantify the impact of the graph's structure on observability. Second, using our model, we quantify how (1) from 270,000 compromised accounts, Cambridge Analytica collected 68.0M Facebook profiles; (2) from surveilling 0.01% of the nodes in a mobile phone network, a law enforcement agency could observe 18.6% of all communications; and (3) an app installed on 1% of smartphones could monitor the location of half of the London population through close proximity tracing. Better quantifying the reach of data collection mechanisms is essential to evaluate their proportionality.