White British Research Articles

#3213 PATIENT ACTIVATION STATUS AND PATIENT PERCEIVED FUNCTION IMPAIRMENT IN CKD: A ROUTE TO OPTIMISING LIFE PARTICIPATION THROUGH ENHANCED SELF-MANAGEMENT?

Abstract Background and Aims Chronic kidney disease (CKD), even at earlier stages where kidney replacement therapy is not required, is associated with significant health and symptom burdens which negatively impact on an individual's functional status and ability to fully engage with work, leisure, and social activities. Life participation can be maximized with optimal day-to-day management of CKD. A strong partnership between the healthcare team and patient is required to support effective self-management. Central to this partnership is patient activation, defined as the knowledge, skills, and confidence to manage one's own health. Individuals who are highly activated take an active role in their health, whilst those with low activated have a more passive role. Higher activation is associated with better clinical outcomes. As part of a wider survey in people living with non-dialysis CKD (ND-CKD), we explored the relationship between patient activation and perceived functional impairment as a result of CKD. Method 14 hospital sites across England invited patients with ND-CKD to complete a survey on health and lifestyle factors including demographic and clinical information, the SF-12 health-related quality of life (QoL) questionnaire, Chalder Fatigue Scale, Patient Activation Measure (PAM-13), and Work and Social Adjustment Scale (WSAS). Participants were classified as having ‘low’ or ‘high’ activation based on their PAM-13 level (Levels 1&2 ‘low’; 3&4 ‘high’). Higher WSAS scores indicated greater perceived functional impairment due to CKD. To compare perceived impairment in WSAS domains between low and high activated participants, Mann-Whitney tests were conducted. To determine the relationship between participant characteristics (i.e., age, gender, ethnicity, eGFR, patient activation, fatigue, physical and mental QoL) and WSAS score, linear regression was performed. Results 828 ND-CKD patients completed the survey [mean age 67.9 (±13.8) years, 60% (n = 501) male, 92% White British (n = 771), eGFR 33.1 (±19.7) ml/min/1.732, total number of additional comorbidities 2.0 (±1.5)]. 64% (n = 529) of participants were classified as having ‘low’ activation. The mean WSAS score was 7.8 (±9.9) indicating mild functional impairment. Both high and low PAM groups perceived social and leisure activities (with other people e.g., outings/dating/parties) to be their most impaired functional activities, and close relationships with others as least impaired. Low activated participants perceived greater impairment on work (P = 0.035), home management (P<0.001), social leisure activities (P<0.001), private leisure activities (P<0.001) and close relationships (P<0.001) as a result of their CKD compared to those with higher activation. Individuals who perceived greater functional impairments were younger (P<0.001), had lower levels of activation (P = 0.036), poorer physical (P<0.001) and mental (P = 0.043) QoL, and greater levels of fatigue (P = 0.001). Conclusion People with lower patient activation perceived greater functional impairment to work, leisure, and social activities as a result of their CKD. Younger people may have greater expectations as to what they can functionally achieve and the marked impact in comparison to their peers without CKD may be greater and more prominent. Conversely, older individuals may be more likely to attribute functional impairments to other age-associated comorbidities or to the effects of aging itself than to CKD. Interventions designed to increase patient activation and improve psychosocial adjustment have the potential to help individuals manage their CKD and reduce the perceived impairment on life participation.

#4011 LESSONS LEARNT FROM VIRTUAL RECRUITMENT TO A MULTICENTRE RANDOMISED CONTROLLED TRIAL EVALUATING A DIGITAL HEALTH INTERVENTION FOR CKD

Abstract Background and Aims The post-COVID era has seen an escalation in the use of digital health interventions (DHIs), which have the potential to provide a widely accessible and cost-efficient approach to aspects of health service delivery such as patient education. Robust effectiveness evaluation is essential for all novel interventions to enable appropriate and sustained implementation. We have developed an education/self-management DHI named “My Kidneys & Me” (MK&M) for chronic kidney disease (CKD). A multi-centre randomised controlled trial (RCT) (SMILE-K) with virtual study processes allowing for minimal face-to-face participant contact was conducted to pragmatically deliver and evaluate MK&M. Here we report the recruitment metrics of SMILE-K to inform and improve future design of virtual trials and delivery of DHIs. Method The SMILE-K virtual study design involved outcome measures collected via an online survey, and 2:1 randomisation to intervention or control group The recruitment process is summarised in Figure 1. Briefly, eligible adult CKD patients were identified by their clinical teams and given or sent a study invitation. If interested, patients emailed the study team, who then sent sequential emailed links to: 1) the information sheet and consent form; 2) the baseline outcome measure survey; and 3) (if randomised to intervention), MK&M. Results 26 hospital sites in England recruited to SMILE-K between May 2021 and December 2022. 6693 invitations were issued: 4942 (74%) by mail, 883 (13%) in-person, 616 (9%) by mail following remote consultation; and 252 (4%) by email. 13% (875/ 6693 invited) invitees expressed interest, of which 60% (533/875) consented. Of the 533 consented, 5% (265/4942) had been invited via mail, 14% (120/883) in-person, 17% (103/616) via mail following remote appointment, and 2% (5/252) via email. Of those consented, 80% (424/533) completed the baseline survey and were subsequently randomised. The mean age of recruited participants was 74 years (±9.0; range:20-88) and 94% were White British. The median time from expression of interest to consent was 1 day (IQR:0-5), and consent to randomisation was 6 days (IQR:2.5-11). Conclusion Our experience shows that a virtual strategy for DHI RCT recruitment provides the opportunity to reach a high number of eligible participants. However, only 13% of invited patients expressed interest, and just 7% were recruited into the study. Most invitations were sent via mail with no prior approach or explanation. This method resulted in a markedly lower response rate than invitations issued after discussion with a healthcare professional, either remotely or in-person, underlining the importance of personal contact. Substantial attrition occurred at the consent stage, indicating that reading the information sheet and completing the online consent form unassisted was a barrier. Despite the need for internet access and digital skills, there was a wide participant age range, including those in their 80s. However, we noted a disproportionate representation of White ethnicity. This highlights the need to embed specific strategies to engage minority ethnic communities and other disadvantaged groups in the design of DHIs and future virtual trials to maximise reach and access to their potential benefits.

Increasing ethnicity reporting to better understand cultural needs accessing a primary care talking therapy service.

The COVID-19 pandemic highlighted the under-utilisation of statutory mental health care services by minority ethnic groups in the United Kingdom (UK). To improve ethnicity reporting to better understand the needs of patients accessing a primary care talking therapies service. We conducted a clinical audit to observe outcomes from pre-COVID (2019), first wave of COVID-19 (2020) and 2021 for three broad ethnic categories: black African/Caribbean, Asian and white British. Intervention was conducted on staff to improve data recording of ethnicity. A patient survey was sent to those identified as dropped out from treatment from May 2020 to April 2021. A total of 229 patients responded to the survey. The survey asked for reasons that impacted on not continuing with sessions. Quantitative analysis showed a statistically significant difference on discharge outcome between white British and black African/Caribbean (p=<0.0001), with black African/Caribbean patients most likely to drop out of treatment, and in 2020 the Asian population was below the recovery target of 50%. Qualitative analysis revealed therapist factors included lack of confidence in therapist and not being listened to, patient factors included neurodiversity, being unsure whether it would be helpful and confidentiality concerns, and service factors included being notified of discharge from the service, remote delivery of therapy, treatment options, and treatment materials. Services must work towards improving service provision by capturing hidden disparities and socialising treatment to meet the needs of minority ethnic groups in the UK. The present study recommends culturally adapted treatment and co-producing therapy materials.

CONSENT: Randomized controlled trial of enhanced informed consent compared to standard informed consent to improve patient understanding of early phase oncology clinical trials.

6560 Background: Early phase oncology clinical trials have become increasingly complicated in terms of patient selection and trial procedures. Informed consent has been contentious due to potential ethical issues associated with performing experimental research on patients with advanced cancer who lack standard treatment options. Prior research has shown significant gaps in patient understanding regarding the nature and intent of these trials. CONSENT aimed to test whether enhanced informed consent can improve clinical trial comprehension. Methods: We randomized patients eligible to participate in one of four investigator-initiated early phase oncology clinical trials at the Royal Marsden Drug Development Unit to either a control arm or an experimental arm, stratified by age and educational level. The control arm received the full-length trial PIS, followed by electronic or paper administration of the Quality of Informed Consent Questionnaire Parts A (QuIC-A). The experimental arm received the full-length trial PIS, exposure to a two-page study specific aid and 10 online educational videos (both co-designed with patients and clinicians), followed by administration of the QuIC-A. The primary endpoint was the difference in the QuIC-A score between the control and experimental arm. The accrual target was at least 17 evaluable patients per arm to detect an 8-point difference (80% power, alpha 0.05). Results: 23 patients were accrued to the control arm (17 evaluable) and 22 patients (18 evaluable) were accrued to the experimental arm. Patients were evaluable if they had completed the QuIC-A. 38% of the participants were over the age of 65, 91% identified as White, 56% had completed a university degree and 97% spoke English at home. We did not observe a significant improvement in the primary endpoint in evaluable patients – control (QuIC-A - 76.5/100) vs experimental arm (QuIC-A - 77.4/100), p value = 0.39 (one sided, two sample t-test). 20 participants provided feedback on the enhanced consent materials via a study questionnaire –75% found both the 2-page study aid and the videos not at all distressing or uncomfortable and 85% found them either quite useful or very useful. Conclusions: This is the first prospective randomized trial evaluating the impact of communication interventions on informed consent in advanced cancer patients considering early phase oncology clinical trials. The co-designed interventions were deliverable online and were acceptable and useful for patients. We did not demonstrate an improvement in the primary endpoint with a high QuIC-A score observed in the control arm- this could be explained by the study population which was highly educated, White and spoke English at home. Future studies should focus on groups with lower literacy and from culturally and linguistically diverse backgrounds. Clinical trial information: NCT04407676 .

Orientation effects support specialist processing of upright unfamiliar faces in children and adults.

It is considerably harder to generalize identity across different pictures of unfamiliar faces, compared with familiar faces. This finding hints strongly at qualitatively distinct processing of unfamiliar face stimuli-for which we have less expertise. Yet, the extent to which face selective versus generic visual processes drive outcomes during this task has yet to be determined. To explore the relative contributions of each, we contrasted performance on a version of the popular Telling Faces Together unfamiliar face matching task, implemented in both upright and inverted orientations. Furthermore, we included different age groups (132 British children ages 6 to 11 years [69.7% White], plus 37 British White adults) to investigate how participants' experience with faces as a category influences their selective utilization of specialized processes for unfamiliar faces. Results revealed that unfamiliar face matching is highly orientation-selective. Accuracy was higher for upright compared with inverted faces from 6 years of age, which is consistent with selective utilization of specialized processes for upright versus inverted unfamiliar faces during this task. The effect of stimulus orientation did not interact significantly with age, and there was no graded increase in the magnitude of inversion effects observed across childhood. Still, a numerically larger inversion effect in adults compared to children provides a degree of support for developmental changes in these specialized face abilities with increasing age/experience. Differences in the pattern of errors across age groups are also consistent with a qualitative shift in unfamiliar face processing that occurs some time after 11 years of age. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

CONSTRUCTION OF HYBRID IDENTITY: A CRITICAL STUDY OF HANIF KUREISHI'S THE BUDHA OF SUBURBIA

This research article analyses the authorial perspective and self-reflection in Hanif Kureishi's first novel, The Buddha of Suburbia. The dominant discourses of ethnicity, race, class, and gender are examined in terms of their effects on the categories of subjectivity and identity. The analysis focuses on the novel's protagonist, Karim Amir, tracing his life journey and showing how his self-perception is shaped by forces beyond his control but is malleable thanks to his extraordinary skill of mimicry. Karim mimics white English mainstream society consciously as a way to find his place in society and unconsciously as a political gesture against the forces of colonialism, neocolonialism, and capitalism. Drawing on the work of theorists like Homi K. Bhabha, Stuart, Fanon and others, we see that Karim and his relatives are complex hybrids who question the assumptions underlying Cartesian concepts of identity and subjectivity. Keywords: subjectivity, identity, hybridity, mimicry, colonialism, neocolonialism, capitalism

Transformation of Higher Learning in South Africa: Perceptions and Understanding of Speech-Language Therapy and Audiology Undergraduate Students

The professions of speech-language therapy and audiology in South Africa developed under apartheid and historically consisted of and catered to a predominantly white English- or Afrikaans-speaking minority population. Over 25 years into democracy, there continues to be a stark incongruence between the demographic profile of the South African population and the speech-language and hearing (SLH) professions in terms of “race”, linguistic, and cultural diversity, and this has implications for training as well as clinical service provision within the South African context. This article explores undergraduate students’ perceptions and experiences of transformation within South African SLH university training programmes through a cross-sectional descriptive survey research design. A self-developed questionnaire was used to collect data from students enrolled in SLH programmes at South African universities. Thematic analysis identified two themes: 1) progress towards attainment of transformation and, 2) visibility of transformation. These findings highlight the need for diversity through inclusivity, redressing past injustices and incorporating local knowledge into current training and practice. These findings have global relevance for transformation in higher education, not just in the field of SLH. Implications for translation of theory and/or knowledge into practice, with more visible and deliberate application of policy in curriculum reform and institutional culture, are raised.

“The European family? Wouldn’t that be the white people?”: Brexit and British ethnic minority attitudes towards Europe

ABSTRACT Though ethnic minorities were significantly more likely to vote to Remain in the European Union in the 2016 Referendum than the white British, there has been scant analysis of ethnic minority attitudes towards the EU. Using focus group and interview data, this article analyses support for EU membership and Euroscepticism among British ethnic minorities. As the Leave campaigns drew criticism for anti-immigration messages, the article demonstrates how ethnic minority Remain support was more a vote against Brexit. Whilst Remain was framed as the progressive, even anti-racist alternative to Leave, ethnic minority Brexiteers criticized the EU’s border politics of free movement for (white) Europeans while borders around Europe are fortified and policed. The article finds weak identification with Europe among ethnic minority Remain and Leave voters, with perceptions of “European” as a white identity, other European countries as more racist and Islamophobic than Britain, and Europe itself a white racial formation.

Socioeconomic Factors Associated with Delay of Minimally Invasive Benign Gynecologic Surgery and Impact of the COVID-19 Pandemic

Objective: The effects of demographic and socioeconomic characteristics on delay of minimally invasive gynecologic surgery (MIGS) before and during the COVID-19 pandemic were studied. The primary outcome was interval between first MIGS appointment and date of surgery. Materials and Methods: This retrospective cohort study used electronic medical record data of a historical cohort who had benign MIGS in 2014–2016 (n = 370) and a cohort in 2020 during the COVID pandemic (n = 249). Included procedures were laparoscopic hysterectomy, myomectomy, adnexal surgery, or endometriosis excision. Patient demographics (race, ethnicity, age, marital status, language, insurance, and socioeconomic factors) were evaluated for associations with surgery delay (> 90 days from initial consultation to operating room date). Results: Median time to surgery was 21 days faster during the pandemic. In the historical cohort, 61% patients waited >90 days, and in the pandemic cohort, 47% patients waited >90 days. In the pandemic cohort, race and primary language were new factors associated with surgery delays. During the pandemic, a greater proportion of patients having surgery delays were Black or other races, compared to White, and a greater proportion did not speak English. After adjusting for referral indications, in multivariable logistic regression, patients who reported Other race had 3 times the odds of surgery delay, compared to White patients. Black patients had higher odds of surgery delay, although this estimate was less precise. Patients with a non-English primary language had >4 times the odds of surgery delay. Ethnicity, insurance and employment status, median household income, neighborhood segregation, and distance to hospital were not associated with surgery delay. Telemedicine accounted for 71% of visits in the pandemic cohort and was associated with a significant decrease in surgery delays with a median wait time of 87 days for patients seen via telemedicine, compared to 101 days for patients seen in-person. A higher proportion of patients using telemedicine were White and spoke English. Hispanic/Latino ethnicity, non-English primary language, and unemployment were associated with in-person versus telemedicine visits. Visit type was not correlated with insurance status, median household income, neighborhood segregation, and distance from the hospital. A risk score was calculated to summarize the estimated effect of intersectionality of multiple identities; multiple minority characteristics were correlated with surgery delays. Time to benign MIGS decreased from historical baselines during the pandemic, indicating improved access to surgical care. This benefit did not apply equally. Disproportionately, White patients who spoke English had no delays and used telemedicine; racial minority patients who did not speak English had greater odds of surgery delays and in-person appointments. Conclusions: Telemedicine can improve access to both MIGS care and surgical outcomes; additional strategies are needed to ensure that all patients receive care advances equitably. (J GYNECOL SURG 20XX:000)

Investigating effect modification between childhood maltreatment and genetic risk for cardiovascular disease in the UK Biobank.

Cardiovascular disease (CVD) is influenced by genetic and environmental factors. Childhood maltreatment is associated with CVD and may modify genetic susceptibility to cardiovascular risk factors. We used genetic and phenotypic data from 100,833 White British UK Biobank participants (57% female; mean age = 55.9 years). We regressed nine cardiovascular risk factors/diseases (alcohol consumption, body mass index [BMI], low-density lipoprotein cholesterol, lifetime smoking behaviour, systolic blood pressure, atrial fibrillation, coronary heart disease, type 2 diabetes, and stroke) on their respective polygenic scores (PGS) and self-reported exposure to childhood maltreatment. Effect modification was tested on the additive and multiplicative scales by including a product term (PGS*maltreatment) in regression models. On the additive scale, childhood maltreatment accentuated the effect of genetic susceptibility to higher BMI (Peffect modification: 0.003). Individuals not exposed to childhood maltreatment had an increase in BMI of 0.12 SD (95% CI: 0.11, 0.13) per SD increase in BMI PGS, compared to 0.17 SD (95% CI: 0.14, 0.19) in those exposed to all types of childhood maltreatment. On the multiplicative scale, similar results were obtained for BMI though these did not withstand to Bonferroni correction. There was little evidence of effect modification by childhood maltreatment in relation to other outcomes, or of sex-specific effect modification. Our study suggests the effects of genetic susceptibility to a higher BMI may be moderately accentuated in individuals exposed to childhood maltreatment. However, gene*environment interactions are likely not a major contributor to the excess CVD burden experienced by childhood maltreatment victims.

Babel; or The Necessity of Violence: An Arcane History of the Oxford Translators' Revolution by R. F. Kuang

Reviewed by: Babel; or The Necessity of Violence: An Arcane History of the Oxford Translators' Revolution by R. F. Kuang Rachel S. Cordasco R. F. KUANG Babel; or The Necessity of Violence: An Arcane History of the Oxford Translators' Revolution New York. Harper Voyager. 2022. 560 pages. GIVEN THE SUBTITLE of this alternate-history novel about language, translation, colonialism, and war, one would be forgiven for spending most of one's time analyzing each of the novel's events to gauge whether or not said violence will indeed be necessary. It is this kind of leading (or perhaps distracting) element that mars what is otherwise a unique, if not wholly convincing, take on what the Industrial Revolution in Britain would have wrought had silver, rather than steam and other technologies, driven innovation. In R. F. Kuang's take on early nineteenth-century England, translators, rather than inventors, are the major force behind industrial innovations, with bridges, factories, banks, carriages, and more operating at beyond-peak efficiency thanks to pairs of silver bars activated by language. For example, a silver bar with the Chinese word wuxing ("formless, shapeless, incorporeal") engraved on one side and the English word invisible on the other could be activated if both words are spoken aloud by someone fluent in both languages—thus the speaker would be able to hide from view for several minutes. Throughout England, such bars are buried in gardens to facilitate growth and beauty, installed in bridges to strengthen them, placed in boats to expedite travel, all to improve British lives. Of course, upperclass Britons reap many more of the benefits of silver than the working class and poor, many of whom were thrown out of jobs as the Industrial Revolution passed them by. Into this world of translation and silver come four Oxford students (Robin, Ramy, Victoire, and Letty) who have been admitted to the prestigious translation program at a tower called Babel. Within this structure, professors and students work on using ancient and modern languages to plumb the depths of "match-pairs" to keep industry humming. [End Page 85] Wealthy and powerful, thanks to this magical silver, Britain has amped up its colonial program by the 1830s, focusing especially on China, due to its silver. As Robin and his friends eventually learn, China's resistance to Britain's pursuit of its silver through opium trafficking (Kuang's reference to the Opium Wars of the mid-nineteenth century) will eventually lead to war, which Britain will likely win. Robin, Ramy, and Victoire are especially concerned because they see themselves as pawns in this colonial game, used for their fluency in Chinese, Arabic, Kreyol, and other languages. As natives of China and India, Robin and Ramy resent how differently they are treated by white Britons (Victoire, as a black Frenchwoman, feels the same). Robin soon meets a half-brother he never knew he had—one who works for a clandestine organization that siphons off Babel translators to work against the British colonial program. Griffin insists that violent resistance is the answer and eventually steers Robin to the same conclusion, one that will (as Robin admits) disproportionately hurt lower- and middle-class Britons who won't be able to escape their cities once sanitation collapses, bridges fall, and food can no longer find its way to markets. The goal, though, is to stop Britain's secret planned invasion of China—planned, that is, by the heads of Babel and not the British government (think India and the British East India Company). Babel is creative in its exploration of the power of language and how translators can be used both to bring the people of the world together and to exploit other countries in pursuit of colonialist domination. Nonetheless, the novel often becomes bogged down in discussions about exploitation and injustice that would be better communicated by a more dynamic plot. The footnotes that Kuang includes are interesting asides, except when they, once again, tell instead of show. Ultimately, Babel offers an intriguing take on an Industrial Revolution driven by silver and language, and its fluid mix of actual and fictional history make it a compelling read. Rachel S. Cordasco Madison, Wisconsin Copyright © 2023 World...

Forensic identity SNPs: Characterisation of flanking region variation using massively parallel sequencing.

Single nucleotide polymorphisms (SNPs) can be analysed for identity or kinship applications in forensic genetics to either provide an adjunct to traditional STR typing or as a stand-alone approach. The advent of massively parallel sequencing technology (MPS) has provided a useful opportunity to more easily deploy SNP typing in a forensic context, given the ability to simultaneously amplify a large number of markers. Furthermore, MPS also provides valuable sequence data for the targeted regions, which enables the detection of any additional variation seen in the flanking regions of amplicons. In this study we genotyped 977 samples across five UK-relevant population groups (White British, East Asian, South Asian, North-East African and West African) for 94 identity-informative SNP markers using the ForenSeq DNA Signature Prep Kit. Examination of flanking region variation allowed for the identification of 158 additional alleles across all populations studied. Here we present allele frequencies for all 94 identity-informative SNPs, both including and excluding the flanking region sequence of these markers. We also present information on the configuration of these SNPs in the ForenSeq DNA Signature Prep Kit, including performance metrics for the markers and investigation of bioinformatic and chemistry-based discordances. Overall, the inclusion of flanking region variation in the analysing workflow for these markers reduced the average combined match probability 2175 times across all populations, with a maximum reduction of 675,000-fold in the West African population. The gain due to flanking region-based discrimination increased the heterozygosity of some loci above that of some of the least useful forensic STR loci; thus demonstrating the benefit of enhanced analysis of currently targeted SNP markers for forensic applications.

E008 I feel a bit happier about going on it now: exploring the information needs of people starting methotrexate

Abstract Background/Aims Methotrexate (MTX) is recommended as initial disease-modifying anti-rheumatic drug (DMARD) therapy for people with rheumatoid arthritis (RA). Rheumatology nurses provide information about benefits, risks and safety monitoring requirements for methotrexate during DMARD counselling, which may be provided in different formats. This study sought to explore the information needs and experiences of people with RA commencing MTX. Methods Seventy-six adults with RA referred for MTX DMARD counselling attending two rheumatology units in the West Midlands were invited to take part in qualitative semi-structured interviews (either by phone or video) before and after receiving information about MTX. Research partners with RA helped to develop interview topic guides. Interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. Results Nineteen participants, (11 male, 8 female, White British, age 45-76 years, disease duration 6 weeks - 35 years) took part in telephone (n17) or video (n2) interviews (duration 34-82 minutes). Three main themes were identified: information delivery, necessity of MTX and concerns about MTX. Information delivery: most participants received telephone DMARD counselling which was helpful for people with mobility issues or work commitments. However, most acknowledged a preference for, and the importance of face-to-face communication. Information tended to be provided in a generic manner, using a checklist, and could feel rushed. Written MTX leaflets were received but not used by all participants. Some participants felt well informed whilst others felt overwhelmed with information. Many had difficulty recalling important safety information. Unmet information needs about monitoring, prescribing and follow-up arrangements were frequently reported. Inconsistent information about MTX from different sources could increase concerns. Rheumatology helplines were valued as a direct route to information and care. Necessity of MTX: most participants wanted more information on why they should take MTX, how and when MTX would help them and how long they would be required to take MTX for. Some wanted to know about other drug treatment options. Concerns about MTX: all participants had concerns about the likelihood and severity of side-effects including mouth ulcers, nausea and hair loss. Worries about the use of MTX as a cancer treatment were frequently reported. Whilst concerns remained about MTX most participants accepted the risk of side-effects because of the need to improve their symptoms. Conclusion DMARD counselling was valued by people with RA when starting MTX but was not always responsive to information needs. Addressing individual concerns about the necessity for MTX, concerns about side-effects and prioritising essential safety information is recommended. Practical issues around obtaining supplies of MTX, monitoring, follow-up arrangements and a follow-up telephone call may help address unmet information needs for some. Disclosure S.J. Logan: None. S. Hider: None. J. Green: None. S. Ryan: None.

E047 I felt like I’d been given a new lease of life: Exploring the information needs and experiences of people with rheumatoid arthritis receiving bridging glucocorticoids when starting methotrexate

Abstract Background/Aims Many people diagnosed with rheumatoid arthritis (RA) receive intramuscular (IM) or oral bridging glucocorticoids whilst methotrexate (MTX) takes effect. Little is known about the information needs and experiences of people with RA receiving glucocorticoids when starting MTX. Methods Seventy-six adults with RA referred for MTX counselling attending two rheumatology units in the West Midlands were invited to take part in qualitative semi-structured interviews (either by phone or video). Research partners with RA helped to develop interview topic guides. Interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. Results Nineteen participants, (11 male, 8 Female, White British, age 45-76 years, disease duration 6 weeks - 35 years) took part in telephone (n17) and video (n2) interviews (duration 34-82 minutes). Most received IM glucocorticoids (n14) before starting MTX. Three themes were identified; trusting the rheumatologist; provision of information; the benefits of glucocorticoids. Trusting the rheumatologist: Several people accepted the rheumatologist’s decision to have a glucocorticoid injection following diagnosis. Some people did not understand the purpose of the injection, and wanted information about the rationale for the injection, including how long the benefit would last and whether the injection could be repeated. Provision of information: Some people were informed by the nurse that the glucocorticoid injection should help their condition. The majority of people did not receive any written information. This left people wondering whether glucocorticoid injections could be repeated. Whereas most treated with oral glucocorticoids recalled receiving written information. Some people were issued with a steroid card. Few reported concerns about side-effects from IM glucocorticoids and did not seek information on the internet. One declined IM glucocorticoids reporting not receiving enough information to make an informed decision. Benefit of glucocorticoids: Most people reported significant benefit from glucocorticoids, experiencing relief of pain, swelling and stiffness in joints. Many found it easier to manage personal care needs and noted improved sleep and reduced levels of fatigue. This allowed many to resume their roles. Several reported that relief of symptoms gave them hope for treatment with MTX and a better quality of life with RA. Conclusion Treatment with IM glucocorticoids often provides rapid relief of symptoms for people with RA whilst waiting for MTX treatment to be established. Most people recalled receiving little or no information about IM glucocorticoids. Many people wanted to know the likely duration of benefit and how often they could receive IM glucocorticoids. Few people reported concerns about side-effects. Tailored information including the rationale for IM glucocorticoid treatment, duration of IM glucocorticoid treatment and RA treatment plan should be considered. Disclosure S.J. Logan: None. S. Hider: None. J. Green: None. S.J. Ryan: None.

Powellite nostalgia and racialised nationalist narratives: Connecting Global Britain and Little England

This article explores how a Powellite form of nostalgia – named for the anti-immigration politics of former British MP Enoch Powell – connects seemingly contradictory nationalist narratives known as Global Britain and Little England. While the former is typically aligned with an expansive and buccaneering national biography, the latter is held to operate via a more defensive and exclusionary imaginary. This article challenges such a binary distinction by demonstrating how the two discursive strands are intimately connected by nostalgic views about white English racial dominance, cultivated during Britain’s pursuit of empire. Drawing on a qualitative analysis of verbal and visual sources from the Brexit referendum, plus 13 interviews with Leave campaigners, the article shows how Powellite nostalgia reproduces gendered and racialised colonial images of the nation amid immigration ‘crisis’. Despite the detoxifying effects of much post-referendum Brexit analysis, the article also demonstrates how Powellite nostalgia is shared across the Eurosceptic spectrum and within broader English culture, persisting into the post-Brexit era.

Barriers to colonoscopy in UK colorectal cancer screening programmes: Qualitative interviews with ethnic minority groups.

People from ethnic minority backgrounds are less likely to attend colonoscopy, following faecal immunochemical test screening, and are more likely to be diagnosed with colorectal cancer at an advanced stage as a result. The aim of this research was to explore the barriers and facilitators to attending colonoscopy, perceived by ethnic minority groups living in the United Kingdom. Semi-structured online and telephone interviews were conducted with thirty men and women of Black-African (n=5), Black-Caribbean (n=5), South Asian (n=10) and White British (n=10) descent. Participants were eligible for screening, but had not necessarily been invited for colonoscopy. All interviews were conducted in the participant's first language and were assessed using Framework-analysis, in line with a conceptual framework developed from previous interviews with healthcare professionals. Five thematic groups of barriers and facilitators were developed: 'Locus of control', 'Cultural attitudes and beliefs', 'Individual beliefs, knowledge and personal experiences with colonoscopy and cancer', 'Reliance on family and friends' and 'Health concerns'. Differences were observed, between ethnic groups, for: 'Locus of control', 'Cultural attitudes and beliefs' and 'Reliance on family and friends'. Black and South Asian participants frequently described the decision to attend colonoscopy as lying with 'God' (Muslims, specifically), 'the doctor', or 'family' (Locus of control). Black and South Asian participants also reported relying on friends and family for 'language, transport and emotional support' (Reliance on family and friends). Black-African participants, specifically, described cancer as 'socially taboo' (Cultural attitudes and beliefs). The results highlight several targets for culturally-tailored interventions to make colonoscopy more equitable.

Experience of a District General Hospital With a Diverse Community in Operated Colorectal Cancers According to Ethnic Background.

Background This study aimed to investigate disparities in colorectal cancer (CRC) patients' demographics according to the five major ethnicities of patients living in the catchment area of North Middlesex Hospital. Methodology This retrospective study included CRC patients operated on between January 1, 2010, and December 31, 2014. Records dating to the end of the five-year follow-up were extracted anonymously from a database of CRC outcomes at the North Middlesex University Hospital NHS Trust. Comparisons were made according to ethnicity, patient demographics, type of presentation, cancer location, stage at diagnosis, recurrence, and mortality. Results A total of 176 adult patients were operated on for CRC between January 1, 2010, and December 31, 2014. The majority of the patients were referred as two-week wait target referrals. Emergency presentation of CRC was the highest in White non-UK patients. The White British Irish patients had their tumors mostly in the cecum, followed by the sigmoid colon, while the rectum followed by the sigmoid colon were the most common sites in the Black population. All study populations mainly presented with stage I disease, and the next highest incidence of cancers according to stage and ethnicity was stage IIIb in the Black population. Conclusions Differences in the ethnic background are important factors, especially in a diverse community, which can impact the age and mode of presentation of the disease, as well as the stage it starts to present. The location of the primary tumor, metastases, and recurrence sites are all affected by the ethnic background, which, subsequently, affect the survival of the patient.

Ethnicity and survival after a dementia diagnosis: a retrospective cohort study using electronic health record data

BackgroundIndividuals from minority ethnic groups in the UK are thought to be at higher risk of developing dementia while facing additional barriers to receiving timely care. However, few studies in the UK have examined if there are ethnic disparities in survival once individuals receive a dementia diagnosis.MethodsWe conducted a retrospective cohort study using electronic health record data of individuals diagnosed with dementia from a large secondary mental healthcare provider in London. Patients from Black African, Black Caribbean, South Asian, White British, and White Irish ethnic backgrounds were followed up for a 10-year period between 01 January 2008 and 31 December 2017. Data were linked to death certificate data from the Office of National Statistics to determine survival from dementia diagnosis. Standardised mortality ratios were calculated to estimate excess deaths in each ethnicity group as compared to the gender- and age-standardised population of England and Wales. We used Cox regression models to compare survival after dementia diagnosis across each ethnicity group.ResultsMortality was elevated at least twofold across all ethnicity groups with dementia compared to the general population in England and Wales. Risk of death was lower in Black Caribbean, Black African, White Irish, and South Asian groups as compared to the White British population, even after adjusting for age, gender, neighbourhood-level deprivation, indicators of mental and physical comorbidities. Risk of death remained lower after additionally accounting for those who emigrated out of the cohort.ConclusionsWhile mortality in dementia is elevated across all ethnic groups as compared to the general population, reasons for longer survival in minority ethnic groups in the UK as compared to the White British group are unclear and merit further exploration. Implications of longer survival, including carer burden and costs, should be considered in policy and planning to ensure adequate support for families and carers of individuals with dementia.

:Race and Affect in Early Modern English Literature

:<i>Race and Affect in Early Modern English Literature</i>

Ideologically‐based contact avoidance during a pandemic: Blunt or selective distancing from ‘others’?

AbstractThis project sought to understand when ideology is relevant (or not) to predicting contact avoidance of ‘others’ during the COVID‐19 pandemic. Right‐leaning ideologies (political conservatism, right‐wing authoritarianism, social dominance orientation) were not expected to predict greater contact avoidance per se, but rather exhibit selective avoidance of outgroup (vs. ingroup) members. White British participated in one exploratory (Study 1 N = 364) and two pre‐registered (Study 2 N = 431, Study 3 N = 700) studies. As expected, right‐leaning ideologies were significantly stronger predictors of greater preferred personal distance and contact discomfort regarding foreign outgroups (vs. British ingroup) in Studies 1 and 3 (partially supported in Study 2). Ideology rarely predicted ingroup reactions. This Ideology × Target pattern was itself not moderated by the perceived COVID‐19 threat. Pre‐pandemic theorizing that heightened behavioural immune system responses are associated with heightened right‐leaning ideologies appear insufficient for use in actual pandemic contexts, especially when highly politicized.