White British Ethnicity Research Articles

FP2.6 - Opportunities for Improvement in Venous Thromboprophylaxis (VTE) of High-Risk Patients Hospitalized for Inflammatory Bowel Disease (IBD) Related Bowel Resection

Abstract Background IBD had a relative risk of 2.2 for VTE compared to the normal population. In May 2020, an international consensus created a statement on VTE prevention in IBD patients. 28days of extended thromboprophylaxis was recommended after discharge only in high risk patients. We aimed to identify high-risk patients for VTE post-IBD-related bowel resection. Methods Retrospective review of 131 patients over 5 years of surgical admissions for IBD-related resection at DGH. Examined factors included patients’ demographics, risk factors for VTE, disease history, and compliance with extended thromboprophylaxis. SPSS22 and Chi-square test were used for analysis. Results The median age was37years.76(58%) were female,74(56.5%) were white-British, Chron’s disease (CD) was98(74.8%), median disease duration was65 months, 101(77.1%) were done laparoscopically, 87(66.4%) were elective, and the median LOS was7days. 5 patients (3.7%) had VTE events. No postoperative stroke happened. DVT and PE were associated with failure of extended thromboprophylaxis prescription (P=0.004,0.000). All VTE events were seen in the 1st 10 days post-discharge. Occurrence of DVT was associated with white-British ethnicity(P=0.000), CD> ulcerative colitis (P=0.001), emergency > elective surgery (P=0.026), bowel anastomosis >stoma formation (P=0.029), ITU admission (P=0.000), Post-operative leak (0.0001), postoperative wound complications(P=0.000). Surgical approach, previous VTE event, and site of diseases weren’t associated with VTE occurrence (P=0.8,0.97,0.94). Conclusion IBD patients are vulnerable to VTE events more than the normal population. Bowel resection in this group of people needs attention for extended VTE prophylaxis, particularly in patients with CD, ITU admission, postoperative leak, and wound complications. These data outline opportunities for improvement, particularly in regard to the extended VTE prophylaxis for 28 days in the before-mentioned high-risk patients.

Does mindfulness-based cognitive therapy with tapering support reduce risk of relapse/recurrence in major depressive disorder by enhancing positive affect? A secondary analysis of the PREVENT trial.

Mindfulness-based cognitive therapy (MBCT) is a viable alternative to maintenance antidepressant medication (M-ADM) to reduce risk of relapse/recurrence (RR) in recurrent depression, but its mechanism of action is not yet fully articulated. This secondary analysis of the PREVENT trial examined if MBCT with support to taper medication (MBCT-TS) reduces risk of RR in part by enhancing positive affect (PA). In a single-blind, parallel, group randomized controlled trial, adults with ≥3 prior depressive episodes, but not currently in episode and who were taking M-ADM, were randomized to receive either MBCT-TS or ongoing maintenance M-ADM. The primary outcome was RR over 24-month follow-up. Levels of positive affect were assessed at intake and posttreatment. The original PREVENT trial was preregistered (ISRCTN 26666654), but this secondary analysis was not. Four hundred and twenty-four individuals (predominantly female and of White British ethnicity) were recruited, with 212 randomized to each arm. MBCT-TS led to significantly greater PA relative to M-ADM at posttreatment assessment (Δ = 2.78, 95% CI [1.47, 4.08], p < .001). RR was experienced during follow-up by 194 individuals (100 M-ADM; 94 MBCT-TS). Greater intake PA predicted a reduced hazard of RR across treatments (p < .001; hazard ratio = .96, 95% CI [0.94, 0.98]). In individuals who had not relapsed by posttreatment with complete data (121 M-ADM; 145 MBCT-TS), greater increase in PA from intake to posttreatment mediated reduced risk of subsequent RR (p = .04). These findings suggest that greater levels of PA predict reduced risk of RR and that MBCT-TS in part acts to protect from RR when withdrawing from M-ADM by increasing PA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The acceptability of wearable technology for long-term respiratory disease: A cross-sectional survey

Few studies have investigated the acceptability of wearable technology in patients with long-term respiratory disease. We conducted a 24-item cross-sectional survey (September 2022–February 2023), developed using four common themes universal to previously described models of technology acceptance and social behavioural therapy, to explore the acceptability of wearable technology spanning the breadth of chronic respiratory disease. A total of 74 valid survey responses were analysed with 50 % aged 51–70years; 72 % female; 63 % white British ethnicity; 79 % having an income less than £50,000, and 93 % having at least obstructive airways disease. A third of participants current used wearables with 85 % using smart watches. Most of these participants used wearables to monitor their symptoms (69 %) and as a general health measurement device (85 %). Likert scale questions (ranked 1–7) showed that participants valued accuracy and approval of wearables by regulatory bodies (median (IQR) rank score 7 (Huberty et al., 2015; Preusse et al., 2016) 6–76–7 and felt that wearables would increase their confidence in managing their long-term health condition (median (IQR) rank score 6 (Huberty et al., 2015; Preusse et al., 2016) 6–76–7. Favourable product characteristics for wearables were accuracy (73 %), easy to learn (63 %) and easy to use (50 %). They were less concerned about aesthetics (23 %) and battery life (27 %). This survey will guide future developers to produce a wearable for a population with chronic respiratory disease which will improve acceptability, usability and longevity.

Trends in weight gain recorded in English primary care before and during the Coronavirus-19 pandemic: An observational cohort study using the OpenSAFELY platform.

Obesity and rapid weight gain are established risk factors for noncommunicable diseases and have emerged as independent risk factors for severe disease following Coronavirus Disease 2019 (COVID-19) infection. Restrictions imposed to reduce COVID-19 transmission resulted in profound societal changes that impacted many health behaviours, including physical activity and nutrition, associated with rate of weight gain. We investigated which clinical and sociodemographic characteristics were associated with rapid weight gain and the greatest acceleration in rate of weight gain during the pandemic among adults registered with an English National Health Service (NHS) general practitioner (GP) during the COVID-19 pandemic. With the approval of NHS England, we used the OpenSAFELY platform inside TPP to conduct an observational cohort study of routinely collected electronic healthcare records. We investigated changes in body mass index (BMI) values recorded in English primary care between March 2015 and March 2022. We extracted data on 17,742,365 adults aged 18 to 90 years old (50.1% female, 76.1% white British) registered with an English primary care practice. We estimated individual rates of weight gain before (δ-prepandemic) and during (δ-pandemic) the pandemic and identified individuals with rapid weight gain (>0.5 kg/m2/year) in each period. We also estimated the change in rate of weight gain between the prepandemic and pandemic period (δ-change = δ-pandemic-δ-prepandemic) and defined extreme accelerators as the 10% of individuals with the greatest increase in their rate of weight gain (δ-change ≥1.84 kg/m2/year) between these periods. We estimated associations with these outcomes using multivariable logistic regression adjusted for age, sex, index of multiple deprivation (IMD), and ethnicity. P-values were generated in regression models. The median BMI of our study population was 27.8 kg/m2, interquartile range (IQR) [24.3, 32.1] in 2019 (March 2019 to February 2020) and 28.0 kg/m2, IQR [24.4, 32.6] in 2021. Rapid pandemic weight gain was associated with sex, age, and IMD. Male sex (male versus female: adjusted odds ratio (aOR) 0.76, 95% confidence interval (95% CI) [0.76, 0.76], p < 0.001), older age (e.g., 50 to 59 years versus 18 to 29 years: aOR 0.60, 95% CI [0.60, 0.61], p < 0.001]); and living in less deprived areas (least-deprived-IMD-quintile versus most-deprived: aOR 0.77, 95% CI [0.77, 0.78] p < 0.001) reduced the odds of rapid weight gain. Compared to white British individuals, all other ethnicities had lower odds of rapid pandemic weight gain (e.g., Indian versus white British: aOR 0.69, 95% CI [0.68, 0.70], p < 0.001). Long-term conditions (LTCs) increased the odds, with mental health conditions having the greatest effect (e.g., depression (aOR 1.18, 95% CI [1.17, 1.18], p < 0.001)). Similar characteristics increased odds of extreme acceleration in the rate of weight gain between the prepandemic and pandemic periods. However, changes in healthcare activity during the pandemic may have introduced new bias to the data. We found female sex, younger age, deprivation, white British ethnicity, and mental health conditions were associated with rapid pandemic weight gain and extreme acceleration in rate of weight gain between the prepandemic and pandemic periods. Our findings highlight the need to incorporate sociodemographic, physical, and mental health characteristics when formulating research, policies, and interventions targeting BMI in the period of post pandemic service restoration and in future pandemic planning.

Children's behavioural and emotional wellbeing during the COVID-19 pandemic: Findings from the Born in Bradford COVID-19 mixed methods longitudinal study.

The COVID-19 pandemic led to a multitude of immediate social restrictions for many across the world. In the UK, the lives of children and young people were quickly impacted when COVID-19 restrictions led to school closures for most children and restrictions on social interactions. The Born in Bradford COVID-19 longitudinal research study explored the impact of the COVID-19 pandemic on the lives of children and their families living in Bradford. Surveys were administered during the first wave of the pandemic (March to June 2020) and compared to findings from before the pandemic. The current study examined the social and emotional wellbeing of children from before to during the pandemic, measured using the parent completed Strengths and Difficulties questionnaire (SDQ). Regression analyses looked at associations between a range of social determinants of health and changes in SDQ scores. The results showed that those children most likely to experience difficulties during the pandemic were boys, younger children, those from White British ethnicity (compared to Pakistani heritage children) and those living in the most deprived areas. There were associations between experiencing difficulties and: food insecurity; financial worry; getting below recommended levels of physical activity; and having less than the recommended amount of sleep. The effect of COVID-19 restrictions are likely to have had negative consequences on children that could, in time, have long-lasting impacts on the health, wellbeing and development of children in the UK.

Risk factors for deaths of despair in England: An ecological study of local authority mortality data

Deaths of Despair (DoD) are socially patterned fatalities encompassing those attributable to drug and alcohol misuse and suicide. DoD occur much more frequently in socially deprived communities. This ecological study aimed to yield new knowledge on the spatial distribution of DoD, and socioeconomic factors that predict DoD risk in England.Via ICD-10 coding, deaths nationally during 2019–2021 were classified to non-overlapping categories of drug-related death, alcohol-specific death, and suicide. The proportion of DoD from each of these causes was calculated and age standardised DoD rates were generated for local authorities. A multivariable regression model for DoD risk was developed using 25 socioeconomic indicators.In 2019–2021, an estimated 46,200 people lost their lives due to DoD. Rates were higher in the North and in coastal areas (p < 0.001), ranging regionally from 25.1/100,000 (SD 6.3) in London to 54.7/100,000 (SD 9.5) in the North East. Alcohol-specific deaths were the largest contributor of DoD, accounting for 44.1% (95%CI 43.5–44.8%) of all such deaths. Living in the North, unemployment, White British ethnicity, living alone, economic inactivity, employment in elementary occupations, and living in urban areas were significantly associated with elevated DoD risk.DoD in England are spatially patterned, with northern regions experiencing a much higher burden of mortality from these avoidable causes. This study provides novel insights into the area-level factors associated with DoD in England. Potential ecological error is a key limitation.

BS P02 Equitable access to bariatric surgery: an exploration of trends in health inequalities and patient profiles over the last 15-years

Abstract Background Bariatric surgery is a safe and effective treatment for obesity and associated co-morbidities. Equality of access to bariatric surgery in the NHS has long posed a serious challenge with significant variation in eligibility criteria between different regions. Obesity disproportionately affects more deprived groups and some ethnic minorities, who have also been shown to experience a worse quality of healthcare and poorer health outcomes. This study aimed to understand the profile of patients accessing bariatric surgery and explore changes in trends over a 15-year period to identify important areas of development for obesity-related healthcare services in our region. Methods This was a retrospective study of all patients undergoing primary and revisional bariatric surgery (gastric band, sleeve gastrectomy, RNY and single anastomosis bypass) for weight loss at our regional bariatric surgical centre since its inception in 2008 until the end of 2022. Data was extracted from a combination of electronic records and a surgical database. Variables included gender demographic and procedure related data, baseline characteristics including height, weight, deprivation scores, co-morbidities, bloods, and micronutrient levels. Changes in patient profiles were mapped over the 15-year period and compared to population-level data derived from the national census and other publicly available sources. Results 2062 (mean age 47) patients were included. 11 (0.5%) patients were aged over 70 and 155 (7.5%) were less than 30 years of age. 75% patients were women; 42% of patients in 2013 were men which steadily decreased to 17% in 2022 (p &amp;lt; 0.05). The mean BMI of patients undergoing surgery was 54 in 2010 and gradually decreased to 48 in 2022 (p&amp;lt;0.05). White British patients represented 93% of all patients. This decreased from 96.5% in 2009 to 86% in 2022. White British ethnicity was estimated to make up 81% of patients with obesity in the NW of England. Conclusions Several major groups who are likely to significantly benefit from bariatric surgery are disproportionately under-represented by patients accessing treatments for obesity. This includes those at the extremes of ages, men, lower BMI patients and ethnic minority groups. Trends over the last 15 years have either worsened or have insufficiently improved to bridge the gap in health inequalities. The findings from our study underscore the urgent need for wider-scale targeted approaches which aim to address obesity and increase more equitable access to these life-changing treatments.

Deaths of despair in England: an observational study of local authority mortality data

BackgroundDeaths of Despair (DoD) are socially patterned causes of death encompassing drug and alcohol misuse and suicide. DoDs are strongly associated with socioeconomic disadvantage. England has high levels of inequalities, so we hypothesised the existence of marked geographical variations in DoD. We aimed to yield new knowledge on the spatial distribution of DoD, and area-level socioeconomic factors that predict DoD risk in England. MethodsThis observational study was conducted using ICD-10 coded deaths for 307 local authorities in England during 2019–21. Deaths were grouped to non-overlapping categories of drug-related death, alcohol-specific death, and suicide. The mean contributions of each of these causes to the total number of DoD in England were calculated with Poisson exact confidence intervals. Standardised mortality ratios (SMRs) for DoD were generated for each local authority population. A multivariable regression model for DoD risk was developed using 25 socioeconomic variables. FindingsAn estimated 46 200 people lost their lives due to DoD between Jan 1, 2019, and Dec 31, 2021. Regional SMRs ranged from 57·4 (SD 16·1) in London to 144·1 (SD 26·8) in the northeast of England (p<0·0001). Alcohol-specific deaths were the largest contributor of DoD, accounting for 44·1% of DoD (95% CI 43·5–44·8), followed by drug-related death (28·1%, 27·7–28·6) and suicide (27·7%, 27·2–28·2). Living in the North, living alone, White British ethnicity, lower inward migration, economic inactivity, income deprivation in older people, employment in elementary occupations, unemployment, and education deprivation in adults were significantly associated with higher DoD rates in England. InterpretationDoD in England are spatially patterned, with northern regions experiencing a considerably higher burden of mortality from these avoidable causes. A key limitation is ecological bias. This study provides novel insights into area-level risk factors for DoD in England. FundingNational Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM).

Patient experiences of the Long COVID-Optimal Health Programme: a qualitative interview study in community settings.

Long COVID (LC) symptoms persist 12 weeks or more beyond the acute infection. To date, no standardised diagnostic or treatment pathways exist. However, a holistic approach has been recommended. This study explored participants' experiences of a Long COVID-Optimal Health Programme (LC-OHP); a psychoeducational self-efficacy programme. To explore perceptions and experiences of people with LC regarding the LC-OHP and identify suggestions to further improve the programme. Qualitative study with patients with LC recruited through community settings. This study is part of a wider randomised controlled trial. Eligible participants were aged ≥18 years, have LC, and attended a minimum of five LC-OHP sessions plus a booster session. We interviewed those randomised to the intervention group. Interviews were conducted by an independent researcher and thematically analysed to identify common, emerging themes. Eleven participants were interviewed, mostly women from a White British ethnic group (n = 10). Four main themes were identified, reflecting programme benefits and suggestions for improvement. The programme demonstrated potential for assisting patients in managing their LC, including physical health and mental wellbeing. Participants found the programme to be flexible and provided suggestions to adapting it for future users. Findings support the acceptability of the LC-OHP to people living with LC. The programme has shown several benefits in supporting physical health and mental wellbeing. Suggestions made to further adapt the programme and improve its delivery will be considered for future trials.

Patient decision aids in mainstreaming genetic testing for women with ovarian cancer: A prospective cohort study.

To evaluate patient preference for short (gist) or detailed/extensive decision aids (DA) for genetic testing at ovarian cancer (OC) diagnosis. Cohort study set within recruitment to the Systematic Genetic Testing for Personalised Ovarian Cancer Therapy (SIGNPOST) study (ISRCTN: 16988857). North-East London Cancer Network (NELCN) population. Women with high-grade non-mucinous epithelial OC. A more detailed DA was developed using patient and stakeholder input following the principles/methodology of IPDAS (International Patients Decision Aids Standards). Unselected patients attending oncology clinics evaluated both a pre-existing short and a new long DA version and then underwent mainstreaming genetic testing by a cancer clinician. Appropriate inferential descriptive and regression analyses were undertaken. Satisfaction, readability, understanding, emotional well-being and preference for long/short DA. The mean age of patients was 66 years (interquartile range 11), and 85% were White British ethnicity. Of the participants, 74% found DAs helpful/useful in decision-making. Women reported higher levels of satisfaction (86% versus 58%, p < 0.001), right amount of information provided (76.79% versus49.12%, p < 0.001) and improved understanding (p < 0.001) with the long DA compared with the short DA. There was no statistically significant difference in emotional outcomes (feeling worried/concerned/reassured/upset) between 'short' and 'long' DA; 74% of patients preferred the long DA and 24% the short DA. Patients undergoing treatment (correlation coefficient (coef) = 0.603; 95% CI 0.165-1.041, p = 0.007), those with recurrence (coef = 0.493; 95% CI 0.065-0.92, p = 0.024) and older women (coef = 0.042; 95% CI 0.017-0.066, p = 0.001) preferred the short DA. Ethnicity did not affect outcomes or overall preference for long/short DA. A longer DA in OC patients has higher satisfaction without increasing emotional distress. Older women and those undergoing treatment/recurrence prefer less extensive information, whereas those in remission preferred a longer DA.

Associations between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma: a multisite cross-sectional study in the UK and South Korea

Childhood maltreatment is a risk factor for the development of post-traumatic stress disorders and psychosis. However, the association between post-traumatic stress disorder (PTSD), including complex PTSD, and psychotic symptoms is unknown. We investigated whether the presence of PTSD and complex PTSD was associated with psychotic symptom severity within survivors of developmental trauma. As part of the Investigating Mechanisms underlying Psychosis Associated with Childhood Trauma (IMPACT) study, from Aug 20, 2020, to Jan 24, 2021, and from Sept 9, 2022, to Feb 21, 2023, using study advertisement on online platforms we recruited adult (≥18 years) participants who had experienced developmental trauma without a psychiatric diagnosis in the UK and South Korea. We measured whether participants met diagnostic thresholds for PTSD and complex PTSD using the self-reported International Trauma Questionnaire, and psychotic symptoms using the self-reported Community Assessment of Psychic Experiences. We used linear regression, adjusting for sociodemographic variables such as age, sex, ethnicity, educational attainment, and socioeconomic status, to examine whether there was an association between PTSD and complex PTSD and psychotic symptoms. The study is registered in the UK (University College London Research Ethics Committee [14317/001] and the National Health Service Research Ethics Committee [22/YH/0096]) and South Korea (Institutional Review Board of Seoul National University Bundang Hospital [B-2011-648-306]), and is ongoing. Of the 2675 participants who took part in the study, 1273 had experienced developmental trauma and were included in the study in the UK (n=475) and South Korea (n=798), comprising 422 (33%) men and 851 (67%) women with a mean age of 26·9 years (SD 6, range 18-40), mostly of White British (n=328) or South Korean (n=798) ethnicity. We found no significant association between PTSD and psychotic symptom severity (total severity β=-2·40 [SE 3·28], p=0·47), compared with participants who did not meet PTSD or complex PTSD caseness. We found a significant relationship between complex PTSD and psychotic symptom severity (total severity β=22·62 [SE 1·65], p<0·0001), including for positive (β=12·07 [SE 0·99], p<0·0001) and negative symptoms (β=10·5 [SE 0·95], p<0·0001), compared with participants who did not meet PTSD or complex PTSD caseness. Health systems must assess individuals with previous developmental trauma for complex PTSD and treat those affected. These individuals should also be assessed for psychotic symptoms, and if necessary, preventative measures should be taken to reduce risk of conversion. Further work should assess whether treating complex PTSD modifies the risk of conversion to psychosis. UKRI Future Leaders Fellowship, British Medical Association Margaret Temple Award for Schizophrenia Research, and the National Research Foundation of Korea-Korea Government.

SP4.1 Outcomes of Patient Reported Experience Measures (PREM) in Diabetic foot clinic

Abstract Aims No PREMs exist for diabetic foot (DF) patients. The aim of the study was to develop and validate a DF PREM questionnaire and assess the outcomes in a Diabetic foot clinic. Methods PREM Questionnaire was developed through consensus using pre validated questionnaire from other specialty PREMS. Suitable questions were chosen and modified for use in the DF care. The questionnaire was piloted on 10 patients in the multi disciplinary Diabetic foot clinic (DFC) and results were evaluated and presented to the core group and trust Patient experience and involvement team. The suggested changes were incorporated and again piloted on 10 patients and the results were re-presented to the core team. The final version was then approved for use among patients. The questionnaire consisted of 12 sections and had 37 questions with 7 point grading system (1 being the lowest and 7 being the highest ranking). The patients attending the DFC were then offered the questionnaire. Results Among those offered, 85% (68/80) accepted to fill the questionnaire either themselves or with help. Majority were aged 41-74 years, with 60% White British ethnicity. The M:F ratio was 1.3:1. Among the 12 domains the highest scoring domains were ‘Access to the clinic’, ‘information provided’, ‘privacy and dignity’ and ‘scheduling and planning’. The worst scoring domains were ‘hospital parking’ and ‘provision of transport’ over which the clinic had no direct control. Conclusions The DF treatment process is long and tedious and patients are required to make multiple visits to the DFC. PREMs allow us to measure their experience and target service improvement.

Clinical behaviour and mortality in idiopathic vs secondary nonspecific interstitial pneumonia.

Nonspecific interstitial pneumonia (NSIP) is a subtype of interstitial lung disease which can either be idiopathic or secondary to other conditions. Idiopathic NSIP is a relatively rare entity and diagnosis should be considered carefully as it is mainly a diagnosis of exclusion. The aim of this retrospective study was to evaluate a cohort of NSIP patients with a view to identifying any clinical and mortality differences between idiopathic and secondary varieties. We screened 700 patients from our interstitial lung disease database and identified 44 cases of NSIP retrospectively. Statistical analysis was conducted to evaluate if there was a difference in demographics such as gender and ethnicity, physiological parameters including forced vital capacity, diffusing capacity, average oxygen saturations, and immunology profile between two groups. Furthermore, a difference in mortality was evaluated between idiopathic and secondary NSIP. The data analysis showed that 63.6% (28 of 44) of patients had idiopathic NSIP versus 36.4% (16 of 44) of patients had secondary NSIP. Majority of the secondary NSIP patients had an underlying connective tissue disease. In the idiopathic variety, there was a male preponderance (64.2%, P = .02) which was statistically different compared to relatively equal gender divide in secondary NSIP which was statistically insignificant (male vs. female: 43.8% vs. 56.3%, respectively, P = .42). The mean age of the idiopathic group was 74 years compared to 64 years in the secondary group which was statistically different (P = .01). In both groups (idiopathic and secondary NSIP), more than two-thirds (68%) were of White British ethnicity. Immunology profile was similar across both groups with no statistical difference in IgM, IgG, or IgA levels. At the time of analysis, there were 17.9% deaths (5 of 28) in the idiopathic NSIP group versus 6.3% (1 of 16) in the secondary NSIP group but this was not statistically significant (P = .14). Similarly, there was no statistically significant difference in the forced vital capacity (P = .59), diffusing capacity (P = .88), and resting oxygen saturations (P = .28) between idiopathic and secondary NSIP varieties. Our analysis showed that there was a statistically significant difference in gender (male preponderance in idiopathic NSIP only) and mean age difference among both varieties. There were no statistically significant differences in the clinical features and outcomes including mortality, physiological, and immunological parameters between idiopathic and secondary NSIP. Idiopathic NSIP was more common than secondary NSIP and secondary NSIP is mostly due to underlying connective tissue disease.

Weeds, wildflowers, and White privilege: Why recognizing nature’s cultural content is key to ethnically inclusive urban greenspaces

ABSTRACT Many studies provide evidence of health and well-being benefits gained from contact with nature. In the United Kingdom, people who claim Black, Asian and UK minority ethnic (UKBAME) backgrounds are less likely to have a garden, or live near quality greenspace, and are often under-represented as park users, compared with White British people. Placemakers in the UK predominantly claim White British ethnicity. We find cultural biases support unfair advantage for White British people in provision of, and access to healthy nature in London. We propose insufficient attention is given to the cultural content of nature and find that inequality is sustained by White privilege in design or management, even in “best practice” exemplars. We propose action to increase equity in access to healthy nature in cities, responding to variation we find in Viability, Interest and perceived Healthfulness of greenspaces in London for people along lines of ethnicity, race and religion.

A retrospective analysis of the ethnicity of individuals referred to a tertiary neuropsychology service in the United Kingdom

Objective: Ethnic minorities comprise approximately 18% of the UK population and are at high risk of developing neurological conditions. Despite this, there is little information regarding their access to neuropsychology services. This study evaluated whether ethnic minorities were proportionally represented in a tertiary neuropsychology department in the UK in accordance with census data for the region. We also aimed to highlight which ethnic groups were over- and underrepresented. Method: Anonymised demographic data of 3429 outpatient and 3304 inpatient referrals to an adult UK neuropsychology department was collected. These data were compared to the 2021 UK census data for the region. Results: Ethnicities in both the outpatient referrals (χ2(15) = 24066.55, p < .001) and inpatient referrals (χ2(15) = 35940924.75, p < .001) are significantly different from the Census. All ethnic minorities were underrepresented in adult neuropsychology referral data for both outpatient settings (−0.06% to −4.66%) and inpatient settings (−0.01% to −4.99%). Pakistani individuals were the most underrepresented across all settings, followed by individuals from an African background. Conversely, individuals of White British ethnicity were overrepresented in both outpatient settings (+10.73%) and inpatient settings (+15.68%). Conclusions: The UK ethnic minorities were not referred to a neuropsychology service relative to regional population prevalence. This contradicts their increased susceptibility for risk of neurological conditions but may also indicate the inaccessibility of neuroscience services for ethnic minorities. Replicating this study across different regions and gathering data on prevalence rates for different neurological conditions across ethnicity is recommended. Additionally, improving accessibility of neuropsychology services for British ethnic minorities should be prioritised.

Assessing maternal alcohol consumption in pregnancy: comparison of confidential postnatal maternal interview and measurement of alcohol biomarkers in meconium

ObjectiveKnowledge of alcohol consumption in pregnancy is important for early identification of children with fetal alcohol spectrum disorder. We investigated whether alcohol biomarkers fatty acid ethyl esters (FAEEs) and ethyl...

Case–control study of serum vitamin D concentrations in hospitalised patients with COVID-19 and hospitalised controls suffering with respiratory tract infections of differing aetiology

This study explored the prevalence of low serum vitamin D in patients admitted with acute respiratory tract infections (ARTIs) such as COVID-19. This study investigated whether patients with COVID-19 had...

Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England

BackgroundCOVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19. PurposeTo use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England. MethodsAn online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making. ResultsOf the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs London). ConclusionsPublic health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.

Exploring the Cross-cultural Acceptability of Digital Tools for Pain Self-reporting: Qualitative Study.

Culture and ethnicity influence how people communicate about their pain. This makes it challenging to develop pain self-report tools that are acceptable across ethnic groups. We aimed to inform the development of cross-culturally acceptable digital pain self-report tools by better understanding the similarities and differences between ethnic groups in pain experiences and self-reporting needs. Three web-based workshops consisting of a focus group and a user requirement exercise with people who self-identified as being of Black African (n=6), South Asian (n=10), or White British (n=7) ethnicity were conducted. Across ethnic groups, participants shared similar lived experiences and challenges in communicating their pain to health care professionals. However, there were differences in beliefs about the causes of pain, attitudes toward pain medication, and experiences of how stigma and gender norms influenced pain-reporting behavior. Despite these differences, they agreed on important aspects for pain self-report, but participants from non-White backgrounds had additional language requirements such as culturally appropriate pain terminologies to reduce self-reporting barriers. To improve the cross-cultural acceptability and equity of digital pain self-report tools, future developments should address the differences among ethnic groups on pain perceptions and beliefs, factors influencing pain reporting behavior, and language requirements.

Atrial fibrillation in UK South Asian hospitalized ischemic stroke patients: The BRAINS study.

South Asian diaspora comprise one of the largest ethnic minority groups in the world yet data about atrial fibrillation (AF) in this demographic is understudied. Our aim is to identify differences in AF prevalence and treatment between South Asians and white British stroke patients. The UK arm of a prospective ongoing large international repository on stroke was analysed. Ethnic differences in AF prevalence and management in those with ischemic stroke were analysed. Of the 3515 individuals recruited with ischemic stroke, 1482 (men: 972, women: 510) were South Asian and 2033 (men:1141, women:892) of white British ethnicity. AF was present in 462 white British and 193 South Asians stroke patients, with South Asians displaying a lower prevalence of AF (South Asians: 13.0% vs white British 22.7%, P<0.001). Despite adjustment for traditional AF risk factors, South Asians had a significantly lower OR of AF compared to white British stroke patients (OR: 0.40, 95%CI: 0.33:0.49, P<0.001). Among confirmed AF cases, 31.8% of South Asians and 41.4% of white British were untreated at admission (P = 0.02). Antiplatelet treatment was significantly higher among South Asians at both admission (South Asian: 47.4% vs. white British: 29.9%, P<0.001) and discharge (South Asian: 49.5% vs. white British: 34.7%, P = 0.001), although anticoagulation treatment was similar across both ethnic groups at admission (South Asian: 28.5% vs white British: 28.1%, P = 0.93), and discharge (South Asian: 45.1% vs white British: 43.1%, P = 0.64). Stroke patients of South Asian descent are at significantly lower risk of AF but more likely to be on antiplatelet treatment compared to their white British counterparts.