UK Public Health Research Articles

A conceptual framework for analysing partnership and synergy in a global health alliance: case of the UK Public Health Rapid Support Team.

Partnerships have become increasingly important in addressing complex global health challenges, a reality exemplified by the COVID-19 pandemic and previous infectious disease epidemics. Partnerships offer opportunities to create synergistic outcomes by capitalizing on complimentary skills, knowledge and resources. Despite the importance of understanding partnership functioning, research on collaboration is sparse and fragmented, with few conceptual frameworks applied to evaluate real-life partnerships in global health. In this study, we aimed to adapt and apply the Bergan Model of Collaborative Functioning (BMCF) to analyse partnership functioning in the UK Public Health Rapid Support Team (UK-PHRST), a government–academic partnership, dedicated to outbreak response and research in low- and middle-income countries. We conducted a literature review identifying important elements to adapt the framework, followed by a qualitative case study to characterize how each element, and the dynamics between them, influenced functioning in the UK-PHRST, exploring emerging themes to further refine the framework. Elements of the BMCF that our study reinforced as important included the partnership’s mission, partner resources (skills, expertise and networks), leadership, the external environment, management systems and communication. Additional elements identified in the literature and critical to partnership functioning of the UK-PHRST included governance and financial structures adopted, trust and power balance, organizational culture, strategy and evaluation and knowledge management. Because of the way the UK-PHRST was structured, fostering team cohesion was an important indicator of synergy, alongside collaborative advantage. Dividing the funding and governance equally between organizations was considered crucial for maintaining institutional balance; however, diverse organizational cultures, weak communication practices and perceived power imbalances compromised team cohesion. Our analysis allowed us to make recommendations to improve partnership functioning at a critical time in the evolution of the UK-PHRST. The analysis approach and framework presented here can be used to evaluate and strengthen the management of global health partnerships to realize synergy.

Spatiotemporal droplet dispersion measurements demonstrate face masks reduce risks from singing

COVID-19 has restricted singing in communal worship. We sought to understand variations in droplet transmission and the impact of wearing face masks. Using rapid laser planar imaging, we measured droplets while participants exhaled, said ‘hello’ or ‘snake’, sang a note or ‘Happy Birthday’, with and without surgical face masks. We measured mean velocity magnitude (MVM), time averaged droplet number (TADN) and maximum droplet number (MDN). Multilevel regression models were used. In 20 participants, sound intensity was 71 dB for speaking and 85 dB for singing (p < 0.001). MVM was similar for all tasks with no clear hierarchy between vocal tasks or people and > 85% reduction wearing face masks. Droplet transmission varied widely, particularly for singing. Masks decreased TADN by 99% (p < 0.001) and MDN by 98% (p < 0.001) for singing and 86–97% for other tasks. Masks reduced variance by up to 48%. When wearing a mask, neither singing task transmitted more droplets than exhaling. In conclusion, wide variation exists for droplet production. This significantly reduced when wearing face masks. Singing during religious worship wearing a face mask appears as safe as exhaling or talking. This has implications for UK public health guidance during the COVID-19 pandemic.

Normal Island: COVID-19, Border Control, and Viral Nationalism in UK Public Health Discourse.

In this contribution, I present emergent analysis of a preoccupation with managing COVID-19 through border control, among non-Governmental public health actors and commentators. Through a reading of statements, tweets, and interviews from the 'Independent Sage' group - individually and collectively - I show how the language of border control, and of maintaining immunity within the national boundaries of the UK, has been a notable theme in the group's analysis. To theorize this emphasis, I draw comparison with the phenomenon of 'green nationalism', in which the urgency of climate action has been turned to overtly nationalistic ends; I sketch the outlines of what I call 'viral nationalism,' a political ecology that understands the pandemic as an event occurring differentially between nation states, and thus sees pandemic management as, inter alia, a work of involuntary detention at securitized borders. I conclude with some general remarks on the relationship between public health, immunity, and national feeling in the UK.

Interventions and guidelines for promoting maternal and child health in the interconception period: a literature and policy review

BackgroundInterconception is defined as the period of time between pregnancies or the first 24 months post partum. During interconception, visits for maternal and child health offer the opportunity for parents to be engaged with health messages, and the health-care professionals involved are more easily identifiable than in the preconception period. Beneficial outcomes, such as improved weight management and nutritional intake, might be reached in a shorter timescale in the interconception period than in the preconception period. We aimed to synthesise articles and guidelines on interconception care to develop recommendations for research, public health policy, and practice. MethodsIn this literature review and policy analysis, we searched four academic databases (Cochrane library, Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature), using MeSH and free-text terms (including but not limited to “interconception”, “post-partum”, “nutrition”, “diet”, and “primary care”), for reviews published in English on nutrition for parents in the interconception and post-partum period between Jan 1, 2010, and Jan 21, 2021. Outcomes related to maternal nutrition and weight management were considered. A scoping search on interconception pilot studies and a review of guidelines published by UK public health organisations and government agencies were also conducted online. Strength of evidence was assessed for review articles by two reviewers using Health Evidence guidelines developed by McMaster University, Canada. Findings were analysed as a narrative synthesis. FindingsWe included 47 documents from a scoping search of grey literature and websites, 29 full-text review articles (after screening 1780 titles and abstracts), and six pilot studies from our database search on interconception and post-partum care. 535 (30%) of 1780 titles and abstracts, and 23 (33%) of 70 full-text papers, were double-screened by another reviewer to ensure consistency. Most reviews were of strong quality (20 [69%]), followed by moderate (seven [24%]), and weak (two [7%]). Interconception care opportunities for parents include the post-partum period, family planning, routine practice, and risk assessment. Various stakeholders have a role in interconception care including general practitioners, health visitors, dieticians, nutritionists, health psychologists, community groups, local authorities, and charities. The guidelines advise increased utilisation of existing community-based services. InterpretationInterconception offers an opportunity for health-care professionals to promote maternal health through routine appointments, but training in communication skills based on empowering behaviour-change principles will be required. Risk assessments should be conducted on the basis of previous pregnancy outcomes—eg, follow-up care following gestational diabetes. Although we found little evidence on interventions in the interconception period, this review provides recommendations for UK health-care systems that could improve life-course health for mothers and potentially their offspring—eg, by reducing childhood obesity. FundingRANK Foundation and Public Policy Southampton.

Children's perspectives and experiences of the COVID-19 pandemic and UK public health measures.

BackgroundThe COVID‐19 pandemic has had profound impacts on how we live our lives; yet, the implications for children and the effects on children's everyday lives have been relatively underacknowledged. Understanding children's views on COVID‐19 and related restrictions on their lives provides an important opportunity to understand how children have responded to the pandemic, including the impacts on their social and emotional well‐being.ObjectiveThis study explored the experiences and perspectives of children in relation to the COVID‐19 pandemic and related restrictions on everyday life.MethodA qualitative study using semistructured online interviews with participatory drawings was undertaken between May and July 2020. Eighteen children from England and Wales, aged 7–11 years, participated in interviews.FindingsThemes included children's reflections on (1) COVID‐19 as a deadly contagion; (2) fears and sadness and (3) social responsibility and opportunities to respond positively.ConclusionsYoung children offer insightful reflections on their experiences during the first wave of the COVID‐19 pandemic in the United Kingdom. Children and young people's perspectives must be considered in future public health discourse.Patient or Public ContributionThis work was informed by conversations with my own three primary school‐aged children and the children of friends. A formal Patient and Public Involvement (PPI) group was not established due to the speed with which the project was undertaken. Any future research in this area would benefit from formal PPI in the design, methods and questions.

An innovative and integrated model for global outbreak response and research -\xa0a case study of the UK Public Health Rapid Support Team\xa0(UK-PHRST)

BackgroundDespite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013–16 West African Ebola epidemic, the United Kingdom’s Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission.MethodsWe conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team’s design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST’s creation, establishment and initial 2 years of operations.ResultsAccording to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team’s activities reinforced the existing global health architecture.ConclusionThe UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities.

Neuraminidase inhibitor use in adults presenting to hospital with suspected influenza: A questionnaire-based survey of practice among hospital physicians

Abstract Background UK Public Health England (PHE) guidelines recommend the liberal use of neuraminidase inhibitors (NAIs) in hospitalised adults with suspected influenza and are aligned with international guidelines. NAI use is recommended to start as early as possible and empirical use is recommended whilst awaiting laboratory results. Current UK hospital physician knowledge, attitudes, and practises regarding the use of NAIs, and levels of adherence to guideline recommendations are not known. Methods This online, cross-sectional questionnaire-based survey of self-reported prescribing practice using clinical scenarios, was distributed to secondary care physicians involved in the assessment of adults presenting to hospital with suspected influenza. The primary outcome measure was adherence to PHE guidelines. Results There were 237 respondents to the survey. 157 (67%) of 233 respondents reported awareness of PHE guidelines. Adherence to guidelines in the clinical scenarios ranged from 56% (95% CI 49–63%) to 72% (95% CI 66–79%) with considerable variability between specialities (p = 0.0008). Not treating suspected cases was common as was withholding of NAIs whilst awaiting laboratory results, despite the acknowledgment of prolonged turnaround times. 73 of 220 (33%) respondents reported that concerns about NAI efficacy influenced their prescribing. Conclusions Concordance with national guidelines for the treatment of influenza is sub-optimal. Lack of guideline awareness and concerns over the effectiveness of NAIs are contributing factors. This study highlights a disparity between public health policy and clinical practice and suggests that strategies that promote rapid diagnostic testing and adherence to treatment guidelines are required. Study registration This study is registered with the ISRCTN:18249297.

How do you develop systems leadership in public health? Insights from a scoping study

ObjectivesSystems leadership is widely acknowledged to be needed to address the many ‘wicked issues’ challenging public health systems. However, there is a lack of evidence on how to develop public health professionals into effective systems leaders. This study scoped the possibilities for developing the systems leadership capacity of public health specialists in England. Study designThis was a mixed-methods qualitative scoping study design. MethodsThe study involved three stages. In the first, a rapid literature review mapped key documents in three relevant areas: systems leadership theory and practice, the changing context of public health in the UK, and training and development for UK public health professionals. In the second, 29 stakeholders were consulted to understand the context and needs for systems leadership development in public health. A third phase involved stakeholders codesigning a potential development framework for the project commissioners. ResultsFour main themes were identified: the nature and purpose of systems leadership; development needs and opportunities for public health specialists; the enabling environment; and wider contextual factors impacting public health. ConclusionsKey principles of, and a framework for, a systems leadership development approach are identified, which could be applied to any public health system.

A Dissenter's Journey.

After I studied medicine, my career took an early and unusual course when I was offered a clinical research post in Jamaica dealing with childhood malnutrition, of which I knew nothing. My subsequent nutritional explorations allowed gastrointestinal and metabolic analyses to have an impact on several public health policies. The biggest challenges came from unexpected political demands: coping with poor school performers in the Caribbean; addressing UK public health initiatives in health education; breaking the siege of Sarajevo; developing a Food Standards Agency as a sudden need for Tony Blair as incoming prime minister; dealing with widespread bovine spongiform encephalopathy in Europe; and responding to a United Nations request to assess global malnutrition. This last task revealed the need for a lifelong approach to nutrition, which also encompassed pregnancy. But perhaps the biggest challenge was establishing the criteria for obesity assessment, management, and prevention for policy makers across the globe.

Personalise vitamin D3 using physiologically based pharmacokinetic modelling.

Plasma concentration of vitamin D3 metabolite 25‐hydroxyvitamin D3 (25(OH)D3) is variable among individuals. The objective of this study is to establish an accurate model for 25(OH)D3 pharmacokinetics (PKs) to support selection of a suitable dose regimen for an individual. We collated vitamin D3 and 25(OH)D3 plasma PK data from reported clinical trials and developed a physiologically‐based pharmacokinetic (PBPK) model to appropriately recapitulate training data. Model predictions were then qualified with 25(OH)D3 plasma PKs under vitamin D3 and 25(OH)D3 dose regimens distinct from training data. From data exploration, we observed the increase in plasma 25(OH)D3 after repeated dosing was negatively correlated with 25(OH)D3 baseline levels. Our final model included a first‐order vitamin D3 absorption, a first‐order vitamin D3 metabolism, and a nonlinear 25(OH)D3 elimination function. This structure explained the apparent paradox. Remarkably, the model accurately predicted plasma 25(OH)D3 following repeated dosing up to 1250 μg/d in the test set. It also made sensible predictions for large single vitamin D3 doses up to 50,000 μg in the test set. Model predicts 10 μg/d regimen may be ineffective for achieving sufficiency (plasma 25(OH)D3 ≥ 75 nmol/L) for a severely deficient individual (baseline 25(OH)D3 = 10 nmol/L), and it might take the same person over 200 days to reach sufficiency at 20 μg/d dose. We propose to personalize vitamin D3 supplementation protocol with this PBPK model. It would require measuring 25(OH)D3 baseline levels, which is not routinely performed under the current UK public health advice.Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? Vitamin D PK exhibits substantial inter‐individual variability. Different officially recommended daily doses are confusing.​ WHAT QUESTION DID THIS STUDY ADDRESS? Is the UK’s recommended 10 µg daily dose sufficient? Should everyone be given same dose?​ WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? Our model accurately predicts plasma 25(OH)D under daily oral administration of vitamin D3. The 10 µg daily vitamin D3 dose is insufficient for prophylaxis (plasma 25(OH)D at 75 nmol/L).​ HOW MIGHT THIS CHANGE DRUG DISCOVERY, DEVELOPMENT, AND/OR THERAPEUTICS? Combining blood test to measure 25(OH)D baseline with this PBPK model will help inform dosage selection and select follow‐up date to improve effectiveness of Hypovitaminosis D treatment.

Reconstructing the Symptomatic-Case Epidemic from COVID-19-Related Deaths in England: A Spatiotemporal Modelling Study

Background: The COVID-19 epidemic has differentially impacted communities across England, with regional variation in rates of confirmed cases, hospitalisations and deaths. Measurement of this burden changed substantially over the first months, as surveillance was expanded to accommodate the escalating epidemic. Laboratory confirmation was initially restricted to clinical need (“pillar 1”) before expanding to community-wide symptomatics (“pillar 2”). This study aimed to ascertain whether biases in case data resulting from varying testing coverage could be addressed by drawing inference from COVID-19-related deaths. Methods: We fit a Bayesian spatio-temporal model to weekly COVID-19-related deaths per local authority (LTLA) throughout the first wave (1 January - 30 June 2020), with respect to the local epidemic timing and the age, deprivation and ethnic composition of its population. We drew predictions averaging these sources of case-fatality variation, and back-translated according to a population case fatality ratio estimated under community-wide testing. Results: A model including temporally- and spatially-correlated random effects best accommodated the observed variation in mortality, after accounting for local population characteristics. Final predictions suggest a total of 276,219-420,491 cases over the first wave - an increase of 19-81% from the reported. Conclusions: Limitations in testing capacity biased the observed trajectory of COVID-19 cases throughout the first wave. Basing inference on COVID-19-related mortality and higher-coverage testing later in the time period, we could explore the extent of this bias more explicitly. Evidence points towards substantial under-representation of initial growth and peak magnitude of symptomatic infections nationally, to which different parts of the country contribute unequally.Funding Information: The following funding sources are acknowledged as providing funding for the named authors:This research was partly funded by the Bill & Melinda Gates Foundation (NTD Modelling Consortium OPP1184344: GFM; OPP1183986: ESN). Royal Society (Dorothy Hodgkin Fellowship: RL). Wellcome Trust (206250/Z/17/Z: TWR; 206471/Z/17/Z: OJB; 210758/Z/18/Z: SA). The following funding sources are acknowledged as providing funding for the working groupauthors:This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: JYL, KP, MJ, YL; INV-016832: SRP; NTD Modelling Consortium OPP1184344: CABP; OPP1139859: BJQ; OPP1191821: KO'R). BMGF (INV-016832; OPP1157270: KA). CADDE MR/S0195/1 & FAPESP 18/14389-0 (PM). EDCTP2 (RIA2020EF-2983-CSIGN: HPG). Elrha R2HC/UK FCDO/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: MQ). ERC (SG 757688: CJVA, KEA). This project has received funding from the European Union's Horizon 2020 research and innovation programme - project EpiPose (101003688: AG, KP, MJ, RCB, WJE, YL). FCDO/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP, KvZ). This research was partly funded by the Global Challenges Research Fund (GCRF) project 'RECAP' managed through RCUK and ESRC (ES/P010873/1: CIJ, TJ). HDR UK (MR/S003975/1: RME). HPRU (NIHR200908: NIB). Innovation Fund (01VSF18015: FK). MRC (MR/N013638/1: EF, NRW; MR/V027956/1: WW). Nakajima Foundation (AE). NIHR (16/136/46: BJQ; 16/137/109: BJQ, FYS, MJ, YL; 1R01AI141534-01A1: DH; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; NIHR200908: AJK, RME; NIHR200929: CVM, FGS, MJ, NGD; PR-OD-1017-20002: AR, WJE). Singapore Ministry of Health (RP). UK DHSC/UK Aid/NIHR (PR-OD-1017-20001: HPG). UK MRC (MC_PC_19065 - Covid 19: Understanding the dynamics and drivers of the COVID-19 epidemic using real-time outbreak analytics: NGD, RME, SC, TJ, WJE, YL; MR/P014658/1: GMK). Authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). UKRI Research England (NGD). UKRI (MR/V028456/1: YJ). Wellcome Trust (206250/Z/17/Z: AJK; 208812/Z/17/Z: SC, SFlasche; 210758/Z/18/Z: JDM, JH, SFunk, SRM; 221303/Z/20/Z: MK; UNS110424: FK). No funding (AMF, DCT, YWDC).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: Approval for the use of anonymised linelist data was granted by Public Health England and the Department for Health and Social Care. Consent of individuals was not required as no patient identifiable information was used.

Investing in support for the first 1001 days of life

In March 2021, the UK government and Public Health England published reports recognising the importance of the first 1001 days and the health visiting service. What does this mean for health visitors working in practice?

UK Public Health Science 2021: a call for abstracts

We invite abstract submissions for Public Health Science: A National Conference Dedicated to New Research in UK Public Health, which is to be held as a virtual conference on Nov 26, 2021. This annual conference aims to showcase the diversity, quality, and impact of public health research in the UK and Ireland. The conference provides a platform for researchers, practitioners, and policy makers, including those early in their careers, to discuss important public health issues and the implications of the latest public health perspectives and science for public health practice, policy, health services, and research.

Looking Beyond the Provision of Injecting Equipment to People Who Use Anabolic Androgenic Steroids: Harm Reduction and Behavior Change Goals for UK Policy

Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS) for muscular enhancement has increased greatly in the past thirty years, along with understanding of a wide range of health harms associated with this form of drug use in the community. During this period the predominant public health intervention for this population in the UK has consistently remained the provision of injecting equipment to prevent blood borne virus (BBV) transmission. The study explored the health professionals’ and other stakeholders’ perceptions on: whether the current UK public health response is sufficient to address the needs of people who use AAS, and if not, what other needs they might have. This included an exploration of whether there were gaps in harm reduction strategies or other behavioral outcomes and interventions that were needed. Interviews with 27 stakeholders who provide support to people who use AAS in a variety of roles established consensus on the need for a range of interventions to reduce harm and risk in those that choose to use AAS, to prevent initiation, to motivate and support cessation, and to prevent relapse. Study findings indicate that while providing sterile injecting equipment remains essential, it should be considered a bare minimum. The challenge is to develop and deliver a range of harm reduction interventions that look beyond BBV prevention to provide appropriate support to who choose to use AAS at all points in their cycles of use and ultimately for those choosing the temporary or permanent cessation of use.

Patients' experiences of behaviour change interventions delivered by general practitioners during routine consultations: A nationally representative survey.

BackgroundConsistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions.MethodsCross‐sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression.Results94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%‐87.4% across behaviours) and helpful (range 82.8%‐85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long‐term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions.ConclusionsPatients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients.Patient or public contributionThe questionnaire was piloted among a convenience sample prior to distribution.

Robin Shattock: novel vaccine developer

Robin Shattock: novel vaccine developer

Evaluating patient education resources for supporting treatment decisions in latent tuberculosis infection

Objective: People with latent tuberculosis infection (LTBI) are required to make complex treatment decisions, which require an understanding of personal risk and associated benefits. However, many people with LTBI in the United Kingdom are at risk of low health literacy and can also experience language barriers, which can affect decision making. Patient education resources can support understanding but must meet the needs of the target population. The aim of this study was to evaluate the accessibility, readability and content of LTBI patient education resources. Design: Review and descriptive analysis of online LTBI patient education resources. Setting: UK-based online patient education resources. Method: We searched UK public health and charitable organisations for online LTBI patient education resources. Resources were evaluated in terms of accessibility (availability of translated versions); readability (Flesch–Kincaid Reading Ease [FKE], Flesch–Kincaid Grade Level [FKG] and Simplified Measure of Gobbledygook [SMOG]), theoretical content (Extended Common-Sense Model) and principles of shared decision making. Results: Seventeen out of 60 articles identified in the search met the prespecified criteria for inclusion. Translated materials were available for 7 of them. The overall mean ± SD readability scores and corresponding reading ages were FKE 63.51 ± 8.81 (13–15 years), FKG 9.14 ± 8.95 (13–15 years) and SMOG 8.27 ± 1.51 (13–14 years). No resources met Health Education England recommended readability levels for health-related information. Dimensions of cognitive representations of illness and treatment most commonly addressed included treatment control, cause and identity (symptom and label); no resources addressed emotional identity. Conclusion: Current and future LTBI patient education resources would benefit from greater consideration of the needs of non-English language speakers, readability and theoretical content to improve patient illness experience and support informed treatment decision making.

Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barré syndrome.

Reports of Guillain-Barré syndrome (GBS) have emerged during the Coronavirus disease 2019 (COVID-19) pandemic. This epidemiological and cohort study sought to investigate any causative association between COVID-19 infection and GBS. The epidemiology of GBS cases reported to the UK National Immunoglobulin Database was studied from 2016 to 2019 and compared to cases reported during the COVID-19 pandemic. Data were stratified by hospital trust and region, with numbers of reported cases per month. UK population data for COVID-19 infection were collated from UK public health bodies. In parallel, but separately, members of the British Peripheral Nerve Society prospectively reported incident cases of GBS during the pandemic at their hospitals to a central register. The clinical features, investigation findings and outcomes of COVID-19 (definite or probable) and non-COVID-19 associated GBS cases in his cohort were compared. The incidence of GBS treated in UK hospitals from 2016 to 2019 was 1.65–1.88 per 100 000 individuals per year. In 2020, GBS and COVID-19 incidences varied between regions and did not correlate with one another (r = 0.06, 95% confidence interval: −0.56 to 0.63, P = 0.86). GBS incidence fell between March and May 2020 compared to the same months of 2016–19. In an independent cohort study, 47 GBS cases were reported (COVID-19 status: 13 definite, 12 probable, 22 non-COVID-19). There were no significant differences in the pattern of weakness, time to nadir, neurophysiology, CSF findings or outcome between these groups. Intubation was more frequent in the COVID-19 affected cohort (7/13, 54% versus 5/22, 23% in COVID-19-negative) likely related to COVID-19 pulmonary involvement. Although it is not possible to entirely rule out the possibility of a link this study finds no epidemiological or phenotypic clues of SARS-CoV-2 being causative of GBS. GBS incidence has fallen during the pandemic, which may be the influence of lockdown measures reducing transmission of GBS inducing pathogens such as Campylobacter jejuni and respiratory viruses.

Systems leadership in practice: thematic insights from three public health case studies

Background‘Systems leadership’ has emerged as a key concept in global public health alongside such related concepts as ‘systems thinking’ and ‘whole systems approaches.’ It is an approach that is well suited to issues that require collective action, where no single organisation can control the outcomes. While there is a growing literature on the theory of systems leadership in a number of fields, there remains a lack of published empirical studies of public health systems leadership for professionals to learn from. The aim of the current project was to conduct cases studies in UK public health to provide empirical evidence on the nature of effective systems leadership practice.MethodsThree system leadership case studies were identified in the key domains of public health: health protection, healthcare public health and health improvement. A total of 27 semi-structured interviews were conducted. Data were thematically analysed to identify the components of effective systems leadership in each case and its impact.ResultsThe thematic analysis identified themes around ‘getting started,’ ‘maintaining momentum’ and ‘indicators of success’ in systems leadership. In terms of getting started, the analysis showed that both a compelling ‘call to action’ and assembling an effective ‘coalition of the willing’ are important. To maintain momentum, the analysis identified themes relating to system structure, culture and the people involved. Regarding culture, the main themes that emerged were the importance of nurturing strong relationships, curiosity and a desire to understand the system, and promoting resilience. The analysis identified three components that could be used as indicators of success; these were a sense of enjoyment from the work, resource gains to the system and shifts in data indicators at the population level.ConclusionsThis study has provided insight into the nature of systems leadership in public health settings in the UK. It has identified factors that contribute to effective public health systems leadership and offers a thematic model in terms of establishing a systems leadership approach, maintaining momentum and identifying key success indicators.

A Framework for Enhancing Access to Equitable Home Care for 2SLGBTQ+ Communities.

Canadian, US, and UK public health and clinical research has identified barriers to health service access for Two-Spirit, lesbian, gay, bisexual, transgender, queer, non-binary, and intersex (2SLGBTQ+) communities. While offering important insight into the health service experiences of 2SLGBTQ+ communities, this body of research only recently, and still only minimally, reports on home care access experiences. Drawing on key findings from the 2SLGBTQ+ Home Care Access Project, a mixed-methods, Ontario-wide study, this paper animates an Access and Equity Framework, using participant stories and perspectives to underscore the relevance and effectiveness of the Framework as a tool to support systematic organizational assessment, evaluation, and implementation of access and equity strategies. Home care organizations can use this tool to assess their programs and services along a continuum of intentionally inviting, unintentionally inviting, unintentionally disinviting, and intentionally disinviting care for 2SLGBTQ+ people. To support this process, the framework includes six indicators of access to care: community engagement, leadership, environment, policies and processes, education and training, and programs and services.