White British Ethnicity Research Articles

Uptake of invitations to a lung health check offering low-dose CT lung cancer screening among an ethnically and socioeconomically diverse population at risk of lung cancer in the UK (SUMMIT): a prospective, longitudinal cohort study

Lung cancer screening with low-dose CT reduces lung cancer mortality, but screening requires equitable uptake from candidates at high risk of lung cancer across ethnic and socioeconomic groups that are under-represented in clinical studies. We aimed to assess the uptake of invitations to a lung health check offering low-dose CT lung cancer screening in an ethnically and socioeconomically diverse cohort at high risk of lung cancer. In this multicentre, prospective, longitudinal cohort study (SUMMIT), individuals aged 55-77 years with a history of smoking in the past 20 years were identified via National Health Service England primary care records at practices in northeast and north-central London, UK, using electronic searches. Eligible individuals were invited by letter to a lung health check offering lung cancer screening at one of four hospital sites, with non-responders re-invited after 4 months. Individuals were excluded if they had dementia or metastatic cancer, were receiving palliative care or were housebound, or declined research participation. The proportion of individuals invited who responded to the lung health check invitation by telephone was used to measure uptake. We used univariable and multivariable logistic regression analyses to estimate associations between uptake of a lung health check invitation and re-invitation of non-responders, adjusted for sex, age, ethnicity, smoking, and deprivation score. This study was registered prospectively with ClinicalTrials.gov, NCT03934866. Between March 20 and Dec 12, 2019, the records of 2 333 488 individuals from 251 primary care practices across northeast and north-central London were screened for eligibility; 1 974 919 (84·6%) individuals were outside the eligible age range, 7578 (2·1%) had pre-existing medical conditions, and 11 962 (3·3%) had opted out of particpation in research and thus were not invited. 95 297 individuals were eligible for invitation, of whom 29 545 (31·0%) responded. Due to the COVID-19 pandemic, re-invitation letters were sent to only a subsample of 4594 non-responders, of whom 642 (14·0%) responded. Overall, uptake was lower among men than among women (odds ratio [OR] 0·91 [95% CI 0·88-0·94]; p<0·0001), and higher among older age groups (1·48 [1·42-1·54] among those aged 65-69 years vs those aged 55-59 years; p<0·0001), groups with less deprivation (1·89 [1·76-2·04] for the most vs the least deprived areas; p<0·0001), individuals of Asian ethnicity (1·14 [1·09-1·20] vs White ethnicity; p<0·0001), and individuals who were former smokers (1·89 [1·83-1·95] vs current smokers; p<0·0001). When ethnicity was subdivided into 16 groups, uptake was lower among individuals of other White ethnicity than among those with White British ethnicity (0·86 [0·83-0·90]), whereas uptake was higher among Chinese, Indian, and other Asian ethnicities than among those with White British ethnicity (1·33 [1·13-1·56] for Chinese ethnicity; 1·29 [1·19-1·40] for Indian ethnicity; and 1·19 [1·08-1·31] for other Asian ethnicity). Inviting eligible adults for lung health checks in areas of socioeconomic and ethnic diversity should achieve favourable participation in lung cancer screening overall, but inequalities by smoking, deprivation, and ethnicity persist. Reminder and re-invitation strategies should be used to increase uptake and the equity of response. GRAIL.

Patient and physiotherapist perceptions of the Getting Recovery Right After Neck Dissection (GRRAND) rehabilitation intervention: a qualitative interview study embedded within a feasibility trial

ObjectiveThe Getting Recovery Right After Neck Dissection (GRRAND) intervention is a physiotherapy programme for patients with head and neck cancer who have undergone neck dissection. The aim of this qualitative...

A founder UMOD variant is a common cause of hereditary nephropathy in the British population

BackgroundMonogenic disorders are estimated to account for 10%–12% of patients with kidney failure. We report the unexpected finding of an unusual uromodulin (UMOD) variant in multiple pedigrees within the British...

Differences in Remote Mental Healthcare: Minority Ethnic Service User Experiences and Perceptions During COVID-19

AimsCOVID-19 has resurfaced health inequalities but also provides new opportunities for remote healthcare. Minority ethnic service users (SUs) are substantially under-represented in secondary mental health services due to gaps in understanding needs of this priority group. We aimed to assess and identify any differences in characteristics and acceptability, with a focus on minority ethnic mental health SUs.MethodsA prospective, online feedback questionnaire was developed with the help of SUs. This was built into video consultations (VCs), using the secure Attend Anywhere platform through a survey link. We present results between July 2020 and January 2022, during which, a total of 2,565 SUs completed the online questionnaire after VCs. SPSS (version 27) was used for descriptive statistical analysis. Chi-squared test, using 5% level of significance, was conducted to test differences between the two (minority Vs majority ethnic) SU groups.ResultsOf 2,565 SUs, 119 (4.6%) were from minority ethnic groups (Asian British, Mixed/multiple, Black British, and Other), 2,398 (93.5%) were White British, and 48 (1.9%) preferred not to disclose. A higher percentage of SUs were females from both minority (55.6%) and White British (66.1%) ethnic groups (ϰ2=5.476, p &lt; 0.05). By age group, almost half (48.7%) of minority ethnic SUs were less than 25 years old, compared with those from White British ethnicity (29.2%). In contrast, only 2.5% minority ethnic SUs were aged ≥65 years with none ≥80 years old (ϰ2 Likelihood Ratio = 27.11, p &lt; 0.001).No significant differences were found for video technical quality, such as waiting area, joining the video call, sound, and video quality. Similar findings were observed for video care delivery aspects with no significant differences between (minority ethnic and White British) SUs. Overall, both groups felt comfortable during the video call (ϰ2=0.137, p &gt; 0.05), their needs were met (ϰ2=0.384, p &gt; 0.05) and felt supported (ϰ2=0.164, p &gt; 0.05). However, according to care team, a significantly higher percentage of minority ethnic SUs (43%) had remotely consulted Specialist (Eating disorders, Well-being/IAPT) services compared with those of majority ethnicity (29%) (ϰ2 Likelihood Ratio = 21.936, p &lt; 0.05).ConclusionBoth minority ethnic and White British SUs found video care to be acceptable, with positive experiences. A significantly high proportion of minority ethnic SUs was younger and had remotely consulted Specialist services, with none in the 80-plus age group. These findings highlight priority areas to address among this massively underrepresented group in mental healthcare services.

The Psychological Impact of COVID-19 Pandemic on Suicidal Thoughts in the United Kingdom

AimsBackground: The impact of the pandemic and resultant restrictions on suicidal thoughts may vary across populations, geographical areas, between high and low socio-economic groups and vulnerable populations. Aim: To investigate the psychological impact of COVID-19 and resultant restrictions on suicidal thoughts in the United Kingdom.MethodsThe study group conducted a cross sectional survey using a questionnaire based on published approaches (Generalised Anxiety Disorder 7, Patient Health Questionnaire 9, Impact of Events Scale-Revised) to understand the psychological impact of COVID-19 and the resultant restrictions on suicidal thoughts. The study was conducted in 3 phases to capture the different phases of the pandemic restrictions: Phase 1: 1st May 2020 to 31st July 2020Phase 2: 12th November 2020 to 12th February 2021Phase 3: 1st July 2021 to 30th September 2021Inclusion: All individuals above 16 years of age who wanted to participate were eligible.Analysis strategy: Descriptive analysis and logistic regression is applied in this study.ResultsThe study recruited 29133 participants in phase 1; 83851 participants in phase 2 and 75204 participants in phase 3. The largest age group of participants was 45–64 years. About two thirds of respondents were female. Majority of participants were of White British ethnicity. 31% participants in phase 1, 30% in phase 2 and 19% in phase 3 reported suicidal thoughts.The preliminary regression analysis indicates that younger and male participants reported more suicidal thoughts among other findings which will be reported in the presentation.Limitations: The non-probability sample design and time limited surveys meant that longitudinal changes were not possible to elicit.ConclusionThere is mixed evidence on whether rates of suicidal thoughts increased during the pandemic. The results of this study will add to the evidence base and influence future pandemic planning and efforts to developing resilience and good mental health in society.

Response to Perinatal Psychosis in West Essex During COVID-19 Pandemic

AimsThe aim of this audit is to look at the presentation of women who were pregnant or less than one-year post-partum presenting with psychotic symptoms in the A&amp;E Department, general hospital and calls to crisis line, particularly with the fact that the pandemic impact remains on the nation. Our aim was to ensure that all referred patients were assessed within the first 24 hours, all the assessments were completed face-to-face, a biopsychosocial assessment was completed for each patient and an outcome was agreed on and clearly documented in the notes.MethodsAll referrals to West Essex access and assessment team from the A&amp;E department, the general hospital and calls logged to crisis line were included. Data were collected prospectively over a six-month period from mid-November 2020 to mid-April 2021. For the purpose of this audit, an identification form was designed and disseminated to access and assessment and crisis teams to identify illegible patients. Our data collectors then used the main audit tool to gather the data.ResultsIn total, our sample included sixteen patients who met our criteria over the six months period. There was only one patient who was out of area. Most of the patients were of white British ethnicity (ten out of sixteen) and other six patients were five white other and one of Asian origin. The mean maternal age in our sample was 27.3 years old and the majority of the referrals came from the labour ward in Princess Alexandra hospital (57%). The two main outcomes of our audit were to check the response time and the way the initial assessment was carried over. Our results show that the team responded to all referrals on the same day with no delays. All the assessments were carried out in a face-to-face fashion in the general hospital apart from one assessment that came through the crisis line and this was carried out in the patient's home.ConclusionFrom our data we can identify that the access and assessment team met the standards we set for this audit. This fulfills the recommendations of MBRRACE-report and the RCPsych. One of our recommendations was to provide educational sessions to the emergency department in the general hospital to raise awareness on psychotic presentation during perinatal period.

Ethnic inequalities in multiple comorbidities among people with psychosis

IntroductionStudies have shown ethnic inequalities in health, with a higher incidence of illnesses among people of some minoritised ethnic groups. Furthermore, it has been observed that people with severe mental illnesses have a higher risk for multimorbidity. However, no study has investigated ethnic disparities in comorbidity in people with a schizophrenia spectrum disorder.ObjectivesThis study investigates potential ethnic disparities in physical health comorbidity in a cohort of people with psychosis.MethodsUsing a cross-sectional design, we identified service-users of the South London and Maudsley NHS Trust who were diagnosed with a schizophrenia spectrum disorder between 2007 and 2020. We assessed the prevalence of asthma, bronchitis, diabetes, hypertension, low blood pressure, overweight or obesity, and rheumatoid arthritis. Latent class analyses were used to investigate distinct profiles of comorbidity. Multinomial regression was then used to investigate ethnic disparities in these profiles. The regression model was adjusted for gender, age, neighbourhood deprivation, smoking and duration of care.ResultsOn a sample of 23,418 service-users with psychosis, we identified two classes of comorbidity: low comorbidity and multiple comorbidities. Compared to the White British ethnicity, a higher risk for multiple comorbidities was observed for people with any Black background, Indian, Pakistani, Asian British, and mixed-race ethnicities. Furthermore, Black African women had a significantly higher risk for multiple comorbidities than their male counterparts.ConclusionsEthnic disparities are observed in multiple comorbidities among people with psychosis. Further research is needed to understand the impact of these disparities, especially in relation to mortality.DisclosureNo significant relationships.

MO030: Familial clustering of a rare UMOD variant in undiagnosed hereditary nephropathy suggests the presence of a common ancestral founder mutation

Abstract BACKGROUND AND AIMS ADTKD–UMOD (Autosomal dominant tubulointerstitial kidney disease–UMOD) is a rare genetic disease due to a heterozygous mutation in the UMOD gene encoding uromodulin. It is classically characterized by minimal proteinuria, slowly progressive CKD, hyperuricemia and early-onset gout. With increasing awareness and testing, pathogenic variants in UMOD are being identified more frequently although the nonspecific nature of most symptoms makes clinical diagnosis difficult. We report the surprising finding of a rare UMOD variant in 11 seemingly unrelated families referred to Sheffield or Nottingham renal genetics services over a 15-year period with undiagnosed hereditary kidney disease. METHOD The probands identified were initially referred to renal genetics services based in Sheffield and Nottingham between 2006 and 2021, where they underwent genetic testing and a comprehensive renal workup. All had a family history of ESRD. A pathogenic variant of UMOD, c.278_289delinsCCGCCTCCT was identified in 11 probands by gene or panel-based sequencing. Family members of the affected probands were invited for genetic testing and clinical follow-up. A retrospective review of all patients screened or with ESRD at both renal genetic clinics was conducted. Molecular modeling of the variant was performed using in-silico tools. RESULTS Clinical data from 60 members (11 pedigrees) was obtained. All individuals were born in the United Kingdom and of White British ethnicity. A total of 37 tested positive for the variant, 3 were negative and 19 were not tested due to being deceased (n = 13) and for unknown reasons (n = 6). The median age of ESRD was 52 (range 32, 76) years. More females had ESRD comprising 67% (20/30). Of patients with available data, 68% (30/44) had hypertension, 7.3% (3/41) had proteinuria &amp;gt;30 mg/g and 18% (7/40) had mild hematuria. A total of 11% (6/57) had experienced ≥1 episode of gout with a median onset of 42.5 (range 29–61) years. Only one patient had asymptomatic renal calculi. All patients with CKD who carried the UMOD mutation (n = 22) had hypertension, apart from two who had unknown hypertensive status (n = 1) or reflux nephropathy causing kidney scarring (n = 1). Renal histology where available (8) showed glomerulosclerosis and tubulointerstitial fibrosis. Ultrasound kidney lengths were normal or reduced and renal cysts were only occasionally detected. Molecular modeling of the variant showed structural changes in the cysteine-rich (C6) with EGFII-like Ca2+ binding domain of UMOD, predicted to disrupt disulfide-bond formation (fifth cysteine C94–sixth cysteine C106) as well as by altering the loop (93–97) between two β-sheets of EGFII domain (AlphaFold), possibly altering calcium ion binding (DeepFRI). This variant was initially reported as a recurrent mutation in four apparently unrelated families [1] and has since been noted in a further 11 families [2], all of White British ethnicity. CONCLUSION We have identified a rare pathogenic UMOD variant shared by 11 apparently unrelated families with familial ESRD within a contiguous geographical region of England. The nonspecific symptoms associated with this variant (especially the rarity of gout) were atypical from those with more classical UMOD variants leading to a delay in diagnosis. Our findings and those of others suggest that this is likely to represent a common ancestral variant rather than a recurrent variant within the UK population. 1. Smith GD, Robinson C, Stewart AP et al. Characterization of a recurrent in-frame UMOD indel mutation causing late-onset autosomal dominant end-stage renal failure. Clin J Am Soc Nephrol 2011; 6: 2766–2774. 2. Kidd K, Vylet'al P, Schaeffer C et al. Genetic and clinical predictors of age of ESKD in individuals with autosomal dominant tubulointerstitial kidney disease due to UMOD mutations. Kidney Int Rep 2020; 5:1472–1485.

Characteristics associated with COVID-19 vaccine uptake among adults aged 50 years and above in England (8 December 2020–17 May 2021): a population-level observational study

ObjectiveTo determine characteristics associated with COVID-19 vaccine coverage among individuals aged 50 years and above in England since the beginning of the programme.DesignObservational cross-sectional study assessed by logistic regression and...

Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings

Telemedicine is accelerating the remote detection and monitoring of medical conditions, such as vision-threatening diseases. Meaningful deployment of smartphone apps for home vision monitoring should consider the barriers to patient uptake and engagement and address issues around digital exclusion in vulnerable patient populations. To quantify the associations between patient characteristics and clinical measures with vision monitoring app uptake and engagement. In this cohort and survey study, consecutive adult patients attending Moorfields Eye Hospital receiving intravitreal injections for retinal disease between May 2020 and February 2021 were included. Patients were offered the Home Vision Monitor (HVM) smartphone app to self-test their vision. A patient survey was conducted to capture their experience. App data, demographic characteristics, survey results, and clinical data from the electronic health record were analyzed via regression and machine learning. Associations of patient uptake, compliance, and use rate measured in odds ratios (ORs). Of 417 included patients, 236 (56.6%) were female, and the mean (SD) age was 72.8 (12.8) years. A total of 258 patients (61.9%) were active users. Uptake was negatively associated with age (OR, 0.98; 95% CI, 0.97-0.998; P = .02) and positively associated with both visual acuity in the better-seeing eye (OR, 1.02; 95% CI, 1.00-1.03; P = .01) and baseline number of intravitreal injections (OR, 1.01; 95% CI, 1.00-1.02; P = .02). Of 258 active patients, 166 (64.3%) fulfilled the definition of compliance. Compliance was associated with patients diagnosed with neovascular age-related macular degeneration (OR, 1.94; 95% CI, 1.07-3.53; P = .002), White British ethnicity (OR, 1.69; 95% CI, 0.96-3.01; P = .02), and visual acuity in the better-seeing eye at baseline (OR, 1.02; 95% CI, 1.01-1.04; P = .04). Use rate was higher with increasing levels of comfort with use of modern technologies (β = 0.031; 95% CI, 0.007-0.055; P = .02). A total of 119 patients (98.4%) found the app either easy or very easy to use, while 96 (82.1%) experienced increased reassurance from using the app. This evaluation of home vision monitoring for patients with common vision-threatening disease within a clinical practice setting revealed demographic, clinical, and patient-related factors associated with patient uptake and engagement. These insights inform targeted interventions to address risks of digital exclusion with smartphone-based medical devices.

Pre-treatment inflammatory parameters predict survival from endometrial cancer: A prospective database analysis

PurposeInflammation predisposes to tumorigenesis by damaging DNA, stimulating angiogenesis and potentiating pro-proliferative and anti-apoptotic processes. The aim of this study was to investigate whether pre-treatment biomarkers of systemic inflammation are associated with survival outcomes in endometrial cancer. Patients and methodsWomen with endometrial cancer were recruited to a prospective database study. Pre-treatment systemic markers of inflammation, including C-reactive protein (CRP), Glasgow Prognostic Score and lymphocyte-based ratios [neutrophil-lymphocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII)], were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox regression. ResultsIn total, 522 women of mostly White British ethnicity, with a median age of 66 years (interquartile range (IQR), 56, 73) and BMI of 32 kg/m2 (IQR 26, 39) were included in the analysis. Most had low-grade (67.2%), early-stage (85.4% stage I/II), endometrioid (74.5%) tumors. Women with pre-treatment CRP ≥5.5 mg/L had a 68% increase in overall (adjusted HR = 1.68, 95% CI 1.00–2.81, p = 0.049) and a two-fold higher cancer-specific mortality risk than those with CRP <5.5 mg/L (adjusted HR = 2.04, 95%CI 1.03–4.02, p = 0.04). Absolute lymphocyte count, NLR, MLR and SII were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis. ConclusionIf confirmed in an independent cohort, CRP may offer a simple, low-cost test to refine pre-treatment risk assessment and guide personalised care in endometrial cancer. Our participants were mostly of White British ethnicity and further studies are needed to confirm the utility of CRP as a prognostic biomarker in other populations.

Stay home and stay active? The impact of stay-at-home restrictions on physical activity routines in the UK during the COVID-19 pandemic

ABSTRACT We investigated which population groups were impacted most in terms of physical activity levels during the restrictions applied during the COVID-19 pandemic. We surveyed UK residents, sampled through users of a rewards-for-exercise app (Sweatcoin; n = 749) and an online panel (Prolific; n = 907). Of the app users, n = 487 further provided daily step-count data collected by the app, prior to, and during the periods of restrictions in the UK between March-June 2020. Regression models were used to investigate factors associated with self-reported change in physical activity and change in daily step-count during the periods of restrictions. Significant factors associated with self-reported change in physical activity included rural residents (positive, b = 0.87, p < 0.001), relative to urban dwellers, people classed as obese (negative, b = −0.51, p = 0.008, relative to healthy weight) and gym users (negative, b = −1.10, p < 0.001, relative to walkers). All groups had reduced step counts during restrictions, with Black, Asian and minority ethnic groups showing greater reductions compared to White British ethnicity (negative, b = −0.18, p = 0.008). Targeted interventions are required to ensure that physical and mental health impacts of sedentary behaviour are not exacerbated over the long-term by significant reductions in physical activity identified in these groups particularly those who are also more vulnerable to COVID-19.

Original observational study on disparate treatments for achalasia experienced by patients of white British and South Asian ethnicity

Original observational study on disparate treatments for achalasia experienced by patients of white British and South Asian ethnicity

Priorities for research during the Coronavirus SARS-CoV-2 (COVID-19) pandemic and beyond: a survey of nurses, midwives and health visitors in the United Kingdom

The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a significant burden on global healthcare systems. Nurses, midwives and health visitors remain critical to the rapid responses and innovative solutions required. Their views, however, on priorities for research is mainly muted, necessitating greater clarity to inform research that benefits patients and families across the life course. To identify priorities for research in relation to the COVID-19 pandemic and 'beyond', as recommended by nurses, midwives and health visitors across the four countries of the United Kingdom (UK). A cross-sectional, web-based survey design was conducted (5th May-4th June 2020). In addition to the completion of demographic information, respondents identified up to three research areas important to their clinical care/practice in the context of COVID-19 and beyond. Data were imported for analysis into NVivo 12 (QSR International). Descriptive analysis was used to summarise the demographic variables. Free text responses were analysed using a semantic, inductive thematic analysis approach. In total 1,296 responses were received from a self-selected sample of predominantly of female, registered nurses of white British ethnicity, located in England and working for acute care providers, providing 3,444 research priority recommendations. Four higher-order themes emerged, (1) New and unknown frontiers; (2) Care and treatment solutions; (3) Healthcare leadership and inclusive workforce; and (4) Emotional and mental health impact. At a time of significant global uncertainty, the collective voice of nursing, midwifery and health visiting is never more important to inform clinical research. Whilst generalisability is limited by the homogeneity of the sample, this is the first survey to elicit the priorities for research in relation to the COVID-19 pandemic and beyond from nurses, midwives and health visitors in the UK. Novel findings developed through a rigorous analytical approach illuminate areas that require both urgent and long-term attention and provide a platform to direct priority refinement, future research and the basis for evidence translation.

The Impact of Visual Impairment in Stroke (IVIS) Study – Evidence of Reproducibility

ABSTRACT Reporting generalisable data across stroke populations is important. We aimed to evaluate the Impact of Visual Impairment after Stroke (IVIS) visual assessment protocol in a different UK geographical area. This was a single-centre acute stroke unit, prospective study (IVIS-extension (IVIS-e) study) with comparison to a multi-centre acute stroke cohort (IVIS study). Orthoptists reviewed all stroke survivors with a standardised assessment of visual acuity, visual fields, ocular alignment, ocular motility, visual inattention and visual perception including a standardised follow-up strategy. 123 stroke survivors underwent visual screening: 42% women, 58% men, mean age 63.6 years and 86% ischaemic strokes. Ethnicity consisted of 68.3% white British and 28.5% being Pakistani, Indian, Caribbean, Bangladeshi, Black and Chinese. Two died and 28 could not be assessed. Of the 93 remaining, 10 stroke survivors (10.8%) had a normal visual assessment and 83 (89.2%) had visual impairments detected. Fifty-seven stroke survivors were assessed at their first orthoptic visit within 3 days of stroke onset; the remainder being assessed at subsequent orthoptic visits to the stroke unit. The visual profile was similar across the IVIS-e and original IVIS cohorts for most types of visual impairment although, overall, more visual impairment was detected in IVIS-e. Differences between the cohorts were primarily related to lower age and smaller white British ethnicity in the IVIS-e cohort. This likely relates to the differing population demographics for the two cohort geographical areas. Further roll-out of the IVIS assessment protocol to other regions and countries would improve detection of post-stroke visual impairment.

Impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: a cross-sectional study

ObjectivesThe aim of this study was to establish the impact of dementia education and training on the knowledge, attitudes and confidence of health and social care staff. The study also...

Failure of national antenatal vitamin D supplementation programme puts dark skinned infants at highest risk: A newborn bloodspot screening study

To determine the prevalence of vitamin D deficiency on dried blood spots (DBS) obtained at newborn blood spot screening (NBS) and thereby test the efficacy of the UK national antenatal supplementation programme in an increasingly ethnically diverse English population. To evaluate the seasonal and ethnic variation in neonatal plasma 25 hydoxyvitamin D (25OHD) and its determinants. Three thousand random DBS samples received at a single regional newborn screening laboratory (52°N) over two one-week periods, one in winter (February 2019) and one in summer (August 2019), were collected. Data was collected from NBS cards on birth weight, gestational age, maternal age, ethnicity, and post code which was replaced with index of multiple deprivation (IMD). 25OHD concentrations were measured on 6mm sub-punch from DBS using quantitative liquid chromatography tandem mass spectrometry adjusted to equivalent plasma values. 25OHD variation with season was assessed using Mann-Whitney U test and ethnic groups compared using Kruskal-Wallis test. Linear regression was used to assess the determinants of 25OHD concentrations. 25OHD measurements were available in 2999 (1580 males) subjects [1499 winter-born and 1500 summer-born]. The majority were white British (59.1%) and born at term (mean±SD gestational age of 38.8±1.8 weeks) with a mean (±SD) birth weight of 3306 (±565) grams. The overall prevalence of vitamin D deficiency [25OHD<30nmol/L (12μg/L)] was 35.7% (n=1070) and insufficiency [30-50nmol/L (12-20μg/L)] 33.7% (n=1010). The median (IQR) 25OHD concentration was significantly lower in the winter-born compared to summer-born [29.1 (19.8, 40.6) vs 49.2 (34.3, 64.8) nmol/L respectively; p<0.001]. Across both seasons, when compared to white British babies (41.6nmol/L), the median 25OHD concentrations were significantly lower in babies of black (30.3nmol/L; p<0.001), Asian (31.3nmol/L; p<0.001), any other mixed (32.9nmol/L; p<0.001), mixed white and black (33.7nmol/L; p<0.05) and any other white (37.7nmol/L; p<0.05) ethnicity. The proportion of deficiency was also higher in babies of Asian (48%), black (47%) and mixed ethnicity (38-44%) compared to any other white (34%) or white British (30%) ethnicity. Season of birth, ethnicity, gestation and maternal age accounted for almost 24% of the variation in 25OHD concentrations. The current UK antenatal supplementation programme fails to protect newborns from vitamin D deficiency, especially those from minority ethnic groups who are at high risk of vitamin D deficiency. Nearly 70% of all newborns and 85% of winter-borns had 25OHD concentrations below 50nmol/L (20μg/L). Almost 50% of babies of Black or Asian origin were deficient at birth, which explains their high risk of hypocalcaemic complications and rickets if left unsupplemented. Our findings call for an immediate review of the delivery of antenatal and infant vitamin D supplementation programmes and implementation of food fortification in the long term.

Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014

ObjectiveTo describe the population of patients who attend emergency departments (ED) in England for mental health reasons.MethodsCross-sectional observational study of 6 262 602 ED attendances at NHS (National Health Service)...

Achieving equity in diabetes care in BAME communities in Hampshire, UK: the DEBI‐H project

Achieving equity in diabetes care in <scp>BAME</scp> communities in Hampshire, <scp>UK</scp>: the <scp>DEBI‐H</scp> project

SO090EVALUATING PAIN IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract Background and Aims Chronic pain is prevalent in Autosomal Dominant Polycystic Kidney Disease (ADPKD) and is associated with a substantial quality of life burden. Literature describing ADPKD-related chronic pain (ACP) is limited, and generic pain management strategies are suboptimal with patients often reporting inadequate relief. Furthermore, the absence of a validated and widely accepted pain assessment tool (PAT) in ADPKD has posed a significant barrier to better pain management and research. We established an ADPKD PAT (APAT) and confirmed its feasibility and validity through administration to ADPKD patients participating in a randomised high water intake trial (NCT02933268). Method A collaboration of key stakeholders (patients, ADPKD experts, trialists and pain specialists) constructed an ADPKD pain conceptual framework consisting of eight prioritized pain assessment domains. We constructed an APAT from components of previously validated pain assessment tools covering each of the prioritized pain domains. The finalized APAT was administered to participants in a feasibility trial which randomised adult ADPKD patients with an eGFR≥20mls/min/1.73m2 to prescribed high water intake (HW) or ad libitum water intake (AW group) over eight weeks. Participants were asked to complete the APAT at least twice (baseline and week 8), although more frequent submissions were permitted. Results 93% (39/42) of trial participants with CKD stages 1-4 completed a total of 129 questionnaires. Each participant completed a median of 3 (range 1-10) questionnaires. In terms of baseline characteristics; mean age of respondents was 47±13 years, 90% (35) were White British ethnicity, and 59% (23) were female. Median disease duration was 14.2 (IQR 7.0-25.9) years, 69% had enlarged kidneys, 64% had hypertension and hepatic cysts were present in 59%. Pain (52%) and associated analgesic use (29%) were prevalent. Participants with pain were more likey to report interference with mobility (25% vs 0%), self-care (20% vs 0%) and usual activities (31% vs 1%) compared to those with no pain (p&amp;lt;0.001. Pain was also associated with a higher risk of anxiety and depression (RR 2.97, CI 1.70-5.20, p=0.000). Pain severity was predicted by traditional risk factors of disease progression including increasing age (OR 1.07, p=0.009), eGFR&amp;lt;60mls/min/1.73m2 (OR 5.45, p=0.021), and hypertension (OR 12.11, p=0.007), but not kidney size, consistent with findings of previous studies. Neuropathic descriptors were not commonly used, while continuous and intermittent descriptors were more frequently selected by patients to describe their pain quality (figure). The APAT achieved good internal consistency (Cronbach’s alpha coefficient =0.91) and test-retest reliability was demonstrated with domain intra-class correlation coefficients ranging from 0.62-0.90. Conclusion A bespoke APAT including components of previously validated pain assessment tools was reliable in evaluating pain in patients with ADPKD, and was acceptable to participants. Pain was prevalent among participants and associated with a substantial emotional and physical burden. The APAT represents a viable instrument for standardised evaluation of ADPKD pain in observational and interventional research.