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Azzopardi PS, Kerr JA, Francis KL, et al., 2023, The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019, LANCET, Vol: 402, Pages: 313-335, ISSN: 0140-6736
GBD 2021 Diabetes Collaborators, 2023, Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021., The Lancet, Vol: 402, Pages: 203-234, ISSN: 0140-6736
BACKGROUND: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the com
El-Osta A, Riboli Sasco E, Barbanti E, et al., 2023, Tools for measuring individual self-care capability: a scoping review, BMC Public Health, Vol: 23, Pages: 1-31, ISSN: 1471-2458
BackgroundOur ability to self-care can play a crucial role in the prevention, management and rehabilitation of diverse conditions, including chronic non-communicable diseases. Various tools have been developed to support the measurement of self-care capabilities of healthy individuals, those experiencing everyday self-limiting conditions, or one or more multiple long-term conditions. We sought to characterise the various non-mono-disease specific self-care measurement tools for adults as such a review was lacking.ObjectiveThe aim of the review was to identify and characterise the various non-mono-disease specific self-care measurement tools for adults. Secondary objectives were to characterise these tools in terms of their content, structure and psychometric properties.DesignScoping review with content assessment.MethodsThe search was conducted in Embase, PubMed, PsycINFO and CINAHL databases using a variety of MeSH terms and keywords covering 1 January 1950 to 30 November 2022. Inclusion criteria included tools assessing health literacy, capability and/or performance of general health self-care practices and targeting adults. We excluded tools targeting self-care in the context of disease management only or indicated to a specific medical setting or theme. We used the Seven Pillars of Self-Care framework to inform the qualitative content assessment of each tool.ResultsWe screened 26,304 reports to identify 38 relevant tools which were described in 42 primary reference studies. Descriptive analysis highlighted a temporal shift in the overall emphasis from rehabilitation-focused to prevention-focused tools. The intended method of administration also transitioned from observe-and-interview style methods to the utilisation of self-reporting tools. Only five tools incorporated questions relevant to the seven pillars of self-care.ConclusionsVarious tools exist to measure individual self-care capability, but few consider assessing capability against all seven pillars of s
Lai HTM, Chang K, Sharabiani MTA, et al., 2023, Twenty-year trajectories of cardio-metabolic factors among people with type 2 diabetes by dementia status in England: a retrospective cohort study, European Journal of Epidemiology, Vol: 38, Pages: 733-744, ISSN: 0393-2990
To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia). 23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16-19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades prior to dementia diagnosis. Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken.
Woodcock T, Greenfield G, Lalvani A, et al., 2023, Patient outcomes following emergency admission to hospital for COVID-19 compared with influenza: retrospective cohort study, Thorax, Vol: 78, Pages: 706-712, ISSN: 0040-6376
Background We examine differences in posthospitalisation outcomes, and health system resource use, for patients hospitalised with COVID-19 during the UK’s first pandemic wave in 2020, and influenza during 2018 and 2019.Methods This retrospective cohort study used routinely collected primary and secondary care data. Outcomes, measured for 90 days follow-up after discharge were length of stay in hospital, mortality, emergency readmission and primary care activity.Results The study included 5132 patients admitted to hospital as an emergency, with COVID-19 and influenza cohorts comprising 3799 and 1333 patients respectively. Patients in the COVID-19 cohort were more likely to stay in hospital longer than 10 days (OR 3.91, 95% CI 3.14 to 4.65); and more likely to die in hospital (OR 11.85, 95% CI 8.58 to 16.86) and within 90 days of discharge (OR 7.92, 95% CI 6.20 to 10.25). For those who survived, rates of emergency readmission within 90 days were comparable between COVID-19 and influenza cohorts (OR 1.07, 95% CI 0.89 to 1.29), while primary care activity was greater among the COVID-19 cohort (incidence rate ratio 1.30, 95% CI 1.23 to 1.37).Conclusions Patients admitted for COVID-19 were more likely to die, more likely to stay in hospital for over 10 days and interact more with primary care after discharge, than patients admitted for influenza. However, readmission rates were similar for both groups. These findings, while situated in the context of the first wave of COVID-19, with the associated pressures on the health system, can inform health service planning for subsequent waves of COVID-19, and show that patients with COVID-19 interact more with healthcare services as well as having poorer outcomes than those with influenza.
Toumpakari Z, Valerino-Perea S, Willis K, et al., 2023, Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study, INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY, Vol: 20
Hassard F, Vu M, Rahimzadeh S, et al., 2023, Wastewater monitoring for detection of public health markers during the COVID-19 pandemic: Near-source monitoring of schools in England over an academic year, PLOS ONE, Vol: 18, ISSN: 1932-6203
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Bene B, Ibeneme S, Fadahunsi KP, et al., 2023, Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Africa: Scoping Review (Preprint), Journal of Medical Internet Research
Palladino R, Marrie RA, Majeed A, et al., 2023, Management of vascular risk in people with multiple sclerosis at the time of diagnosis in England: a population-based study, Multiple Sclerosis Journal, Vol: 29, Pages: 671-679, ISSN: 1352-4585
BACKGROUND: Vascular management in People with Multiple Sclerosis (PwMS) is important given the higher vascular burden than the general population, associated with increased disability and mortality. OBJECTIVES: We assessed differences in the prevalence of type 2 diabetes and hypertension; and the use of antidiabetic, antihypertensive and lipid-lowering medications at the time of the MS diagnosis. METHODS: This is a population-based study including PwMS and matched controls between 1987 and 2018 in England. RESULTS: We identified 12,251 PwMS and 72,572 matched controls. PwMS had a 30% increased prevalence of type 2 diabetes (95% confidence interval (CI) = 1.19, 1.42). Among those with type 2 diabetes, PwMS had a 56% lower prevalence of antidiabetic usage (95% CI = 0.33, 0.58). Prevalence of hypertension was 6% greater in PwMS (95% CI = 1.05, 1.06), but in those with hypertension, usage of antihypertensive was 66% lower in PwMS (95% CI = 0.28, 0.42) than controls. Treatment with lipid-lowering medications was 63% lower in PwMS (95% CI = 0.54, 0.74). PwMS had a 0.4-mm Hg lower systolic blood pressure (95% CI = -0.60, -0.13). 3.8% of PwMS were frail. CONCLUSION: At the time of diagnosis, PwMS have an increased prevalence of vascular risk factors, including hypertension and diabetes though paradoxically, there is poorer treatment. Clinical guidelines supporting appropriate vascular assessment and management in PwMS should be developed.
Shemtob L, Parekh R, Majeed A GP, 2023, Changes to the GP contract do not add up, BMJ: British Medical Journal, Vol: 381, Pages: 770-770, ISSN: 0959-535X
Majeed A, 2023, The covid-19 pandemic three years on., BMJ: British Medical Journal, Vol: 381, Pages: 769-769, ISSN: 0959-535X
Gaitatzis A, Majeed A, 2023, Multimorbidity in people with epilepsy, Seizure: European Journal of Epilepsy, Vol: 107, Pages: 136-145, ISSN: 1059-1311
Multimorbidity is an emerging priority in healthcare due to associations with the ageing population, frailty, polypharmacy, health and social care demands. It affects 60-70% of adults and 80% of children with epilepsy. Neurodevelopmental conditions are commonly seen in children with epilepsy, while cancer, cardiovascular and neurodegenerative conditions often afflict older people with epilepsy. Mental health problems are common across the lifespan. Genetic, environmental, social and lifestyle factors contribute to multimorbidity and its consequences. Multimorbid people with epilepsy (PWE) are at higher risk of depression and suicide, premature death, suffer lower health-related quality of life, and require more hospital admissions and health care costs. The best management of multimorbid PWE requires a paradigm shift from the traditional single disease-single comorbidity approach and a refocus on a person-centred approach. Improvements in health care must be informed by assessing the burden of multimorbidity associated with epilepsy, delineating disease clusters, and measuring the effects on health outcomes.
Majeed A, 2023, Author's reply to Sundar., BMJ: British Medical Journal, Vol: 380, Pages: 1-1, ISSN: 0959-535X
Shemtob L, Beaney T, Norton J, et al., 2023, How can we improve the quality of data collected in general practice?, BMJ: British Medical Journal, Vol: 380, Pages: 1-4, ISSN: 0959-535X
Pinder R, Bury F, Sathyamoorthy G, et al., 2023, Differential attainment in specialty training recruitment in the United Kingdom: an observational analysis of the impact of psychometric testing assessment in Public Health postgraduate selection, BMJ Open, Vol: 13, Pages: 1-9, ISSN: 2044-6055
Objectives To determine how current psychometric testing approaches used in selection of postgraduate training in UK Public Health are associated with socioeconomic and sociocultural background of applicants (including ethnicity).Design Observational study using contemporaneous data collected during recruitment and psychometric test scores.Setting Assessment centre of UK national Public Health recruitment for postgraduate Public Health training. The assessment centre element of selection comprises three psychometric assessments: Rust Advanced Numerical Reasoning, Watson-Glaser Critical Thinking Assessment II and Public Health situational judgement test.Participants 629 applicants completed the assessment centre in 2021. 219 (34.8%) were UK medical graduates, 73 (11.6%) were international medical graduates and 337 (53.6%) were from backgrounds other than medicine.Main outcome measure Multivariable-adjusted progression statistics in the form of adjusted OR (aOR), accounting for age, sex, ethnicity, professional background and surrogate measures of familial socioeconomic and sociocultural status.Results 357 (56.8%) candidates passed all three psychometric tests. Candidate characteristics negatively associated with progression were black ethnicity (aOR 0.19, 0.08 to 0.44), Asian ethnicity (aOR 0.35, 0.16 to 0.71) and coming from a non-UK medical graduate background (aOR 0.05, 0.03 to 0.12); similar differential attainment was observed in each of the psychometric tests. Even within the UK-trained medical cohort, candidates from white British backgrounds were more likely to progress than those from ethnic minorities (89.2% vs 75.0%, p=0.003).Conclusion Although perceived to mitigate the risks of conscious and unconscious bias in selection to medical postgraduate training, these psychometric tests demonstrate unexplained variation that suggests differential attainment. Other specialties should enhance their data collection to evaluate the impact of differential attainment
Sekhon Inderjit Singh HK, Lal N, Majeed A, et al., 2023, A systematic review of ethnic disparities in the uptake of colorectal cancer screening, Perspectives in Public Health, Vol: 143, Pages: 105-120, ISSN: 1466-4240
AIMS: Colorectal cancer (CRC) screening reduces mortality, but variation exists in uptake. Ethnicity is suggested to play a role; however, there is no high-level evidence to support this. We aim to clarify the impact of Ethnicity on CRC screening uptake and our barriers to its understanding. METHODS: A systematic review to identify studies reporting on the participation of ethnic minorities in CRC screening worldwide was performed. MEDLINE, Embase, Scopus and Google Scholar databases up until 31 May 2019 were searched. Compliance with screening according to ethnic groups and screening modality was evaluated compared to the 'White' control group. RESULTS: Twenty-two studies were included in the review reporting on 2,084,213 patients. Substantial variation in categorisation of ethnicities (40 sub-categories), screening modality studied and confounding factors accounted for was observed. 8/15 studies for 'Blacks', 10/13 for 'Hispanics', 2/2 for 'Asians' and 1/1 for 'South East Asians' suggest a less likely or significantly decreased compliance with screening for all screening modalities (p < .05) compared to 'Whites'. Interestingly 'Japanese', 'Vietnamese' and 'Filipino' groups consistently show no difference in the uptake of CRC screening compared to the 'White' majority. CONCLUSION: This is the only systematic review on this topic. It highlights the inconsistency in screening uptake behaviour in different ethnic minority groups and identifies barriers like variation in ethnicity categorisation, screening modality and study design utilised to understanding the intricacies of this relationship. Further collaboration and action needs to be undertaken internationally to clarify and improve inequity in the uptake of screening.
Shemtob L, Asanati K, Pahl N, et al., 2023, What needs to be done to address staffing shortages in health and social care?, British Journal of General Practice, Vol: 73, Pages: 102-103, ISSN: 0960-1643
England’s NHS does not have an adequate workforce strategy. Staffing shortages in health and adult social care are limiting the delivery of services. Adult social care, which is more organisationally heterogeneous than the NHS, also has a staffing crisis. There are over 250 000 vacant posts across both sectors.1,2 The two systems are symbiotic, and their staffing issues must be addressed together. As the main gateway for patient access to the rest of the NHS, general practice teams hold responsibility for providing care for patients in the community. General practice is hit by the staffing deficit twice over, soaking up additional demand caused by shortfalls in secondary care and social care while grappling with its own staffing crisis. What is the relationship between staff levels, financial cost, and staff and patient welfare across the NHS and social care, and what are the potential solutions?
Global Burden of Disease 2021 Health Financing Collaborator Network, 2023, Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026, The Lancet Global Health, Vol: 11, Pages: e385-e413, ISSN: 2214-109X
BACKGROUND: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. METHODS: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. FINDINGS: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1-9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2-7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3-25·3) spent by low-income countries in 20
Cornforth F, Webber L, Kerr G, et al., 2023, Impact of COVID-19 vaccination on COVID-19 hospital admissions in England during 2021: an observational study., Journal of the Royal Society of Medicine, Vol: 116, Pages: 167-176, ISSN: 0141-0768
OBJECTIVES: To examine the impact of COVID-19 vaccination on hospital admissions in England in 2021. DESIGN: Observational study of emergency admissions for COVID-19 by vaccination status in people 16 years and over in England. SETTING: Hospitals in England. PARTICIPANTS: A total of 48.1 million people registered with an English GP, aged ≥16 years with a recent NHS contact. MAIN OUTCOME MEASURES: Emergency hospital admissions with a primary diagnosis of COVID-19 between 1 January and 31 December 2021. Monthly admission rates were directly standardised for age, sex, risk category and vaccination dose to estimate vaccine effectiveness (VE) over time, between vaccine doses, age groups and risk groups. RESULTS: A total of 192,047 hospital admissions were included. The unvaccinated admission rate was higher in December 2021 (6.1 admissions per 100,000 person-days; 95% CI: 5.9 to 6.3) than January 2021 (4.9; 95% CI: 4.9 to 5.0). Vaccinated admission rates were ≤1 per 100,000 from February to December. Doses 1 and 2 VE waned over time, particularly in older and clinically vulnerable groups (although this may reflect that they were vaccinated earlier). Dose 3 VE remained above 93%. CONCLUSIONS: COVID-19 hospitalisations were consistently highest in the unvaccinated. Despite high case rates at the end of 2021, overall admission rates remained stable, driven by low admission rates among vaccinated people. There is population-level waning in VE, recovering after subsequent doses, potentially more marked in older and at-risk groups. The findings support JCVI (Joint Committee on Vaccination and Immunisation) guidance for an ongoing booster programme, especially in older people and higher clinical risk groups.
Majeed A, 2023, Let's look dispassionately at the arguments for and against user fees for NHS primary care in England, BMJ: British Medical Journal, Vol: 380, Pages: 303-303, ISSN: 0959-535X
Mansour R, Houston A, Majeed A, et al., 2023, Human monkeypox: diagnosis and management, BMJ: British Medical Journal, Vol: 380, Pages: 1-19, ISSN: 0959-535X
Rabe APJ, Loke W, Morris T, et al., 2023, Persistence With Benralizumab Among Patients With Severe Eosinophilic Asthma Participating In The CONNECT 360 Patient Support Program, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB100-AB100, ISSN: 0091-6749
Woodcock T, Novov V, Skirrow H, et al., 2023, Health and socio-demographic characteristics associated with uptake of seasonal influenza vaccination amongst pregnant women: retrospective cohort study, British Journal of General Practice, Vol: 73, Pages: e148-e155, ISSN: 0960-1643
Pregnant women are at increased risk from influenza, yet maternal influenza vaccination levels remain suboptimal. This study aimed to estimate associations between socio-demographic and health characteristics and seasonal influenza vaccination uptake among pregnant women and understand trends over time to inform interventions to improve vaccine coverage. A retrospective cohort study using linked electronic health records of women in North West London with at least one pregnancy overlapping with an influenza season between September 2010 and February 2020. We used a multivariable mixed-effects logistic regression model to identify associations between characteristics of interest and primary outcome of influenza vaccination. 451,954 pregnancies, among 260,744 women, were included. In 85,376 (18.9%) pregnancies women were vaccinated against seasonal influenza. Uptake increased from 8.4% in 2010/11 to 26.3% in 2018/19, dropping again to 21.1% in 2019/20. Uptake was lowest among women: aged 15-19 years (12%) or over 40 years (15%; OR 1.17, 95% CI 1.10 to 1.24); of Black ethnicity (14.1%; OR 0.55, 95% CI 0.53 to 0.57), or unknown ethnicity (9.9%; OR 0.42, 95% CI 0.39 to 0.46), lived in more deprived areas (OR least vs most deprived 1.16, 95% CI 1.11 to 1.21), or with no known risk factors for severe influenza. Seasonal influenza vaccine uptake in pregnant women increased in the past decade, prior to the COVID-19 pandemic, but remained suboptimal. We recommend approaches to reducing health inequalities should focus on women of Black ethnicity, younger and older women, and women living in areas of greater socio-economic deprivation.
Teixeira F, Li E, Laranjo L, et al., 2023, Digital maturity and its determinants in General Practice: A cross-sectional study in 20 countries, Frontiers in Public Health, Vol: 10
<jats:sec><jats:title>Background</jats:title><jats:p>The extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarcely evaluated.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>This study assessed the digital maturity in General Practice (GP) globally and evaluated its association with participants' demographic characteristics, practice characteristics and features of Electronic Health Records (EHRs) use.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>GPs across 20 countries completed an online questionnaire between June and September 2020. Demographic data, practice characteristics, and features of EHRs use were collected. Digital maturity was evaluated through a framework based on usage, resources and abilities (divided in this study in its collective and individual components), interoperability, general evaluation methods and impact of digital technologies. Each dimension was rated as 1 or 0. The digital maturity score was calculated as the sum of the six dimensions and ranged between 0 to 6 (maximum digital maturity). Multivariable linear regression was used to model the total score, while multivariable logistic regression was used to model the probability of meeting each dimension of the score.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>One thousand six hundred GPs (61% female, 68% Europeans) participated. GPs had a median digital maturity of 4 (P25–P75: 3–5). Positive associations with digital maturity were found with: male gender [<jats:italic>B</jats:italic> = 0.
Teixeira F, Li E, Laranjo L, et al., 2023, Digital maturity and its determinants in General Practice: a cross- sectional study in 20 countries, Frontiers in Public Health, Vol: 10, Pages: 1-10, ISSN: 2296-2565
Background: The extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarcely evaluated.Objectives: This study assessed the digital maturity in General Practice (GP) globally and evaluated its association with participants' demographic characteristics, practice characteristics and features of Electronic Health Records (EHRs) use.Methods: GPs across 20 countries completed an online questionnaire between June and September 2020. Demographic data, practice characteristics, and features of EHRs use were collected. Digital maturity was evaluated through a framework based on usage, resources and abilities (divided in this study in its collective and individual components), interoperability, general evaluation methods and impact of digital technologies. Each dimension was rated as 1 or 0. The digital maturity score was calculated as the sum of the six dimensions and ranged between 0 to 6 (maximum digital maturity). Multivariable linear regression was used to model the total score, while multivariable logistic regression was used to model the probability of meeting each dimension of the score.Results: One thousand six hundred GPs (61% female, 68% Europeans) participated. GPs had a median digital maturity of 4 (P25–P75: 3–5). Positive associations with digital maturity were found with: male gender [B = 0.18 (95% CI 0.01; 0.36)], use of EHRs for longer periods [B = 0.45 (95% CI 0.35; 0.54)] and higher frequencies of access to EHRs [B = 0.33 (95% CI 0.17; 0.48)]. Practicing in a rural setting was negatively associated with digital maturity [B = −0.25 (95%CI −0.43; −0.08)]. Usage (90%) was the most acknowledged dimension while interoperability (47%) and use of best practice gen
Neira M, Erguler K, Ahmady-Birgani H, et al., 2023, Climate change and human health in the Eastern Mediterranean and middle east: Literature review, research priorities and policy suggestions, Environmental Research, Vol: 216, Pages: 1-23, ISSN: 0013-9351
Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other.In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region.To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies.Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, t
Razai MS, Kooner P, Majeed A, 2023, Strategies and interventions to improve healthcare professionals' well-being and reduce burnout, Journal of Primary Care and Community Health, Vol: 14, Pages: 1-3, ISSN: 2150-1319
Webb J, Lin Y-T, Ang A, et al., 2023, Feasibility and preliminary outcomes of a mobile intervention combining cognitive behavioral therapy, virtual coaching, and nicotine replacement therapy for nicotine vaping cessation, Telemedicine Reports, Vol: 4, Pages: 48-52, ISSN: 2692-4366
BACKGROUND: Despite research demonstrating that those who use e-cigarettes, also known as vaping, express an interest in quitting, evidence-based vaping cessation interventions are lacking. The purpose of this study was to examine the feasibility and preliminary outcomes of an mHealth vaping cessation intervention. METHODS: Adults (N = 51) who were vaping nicotine were recruited online and enrolled in a 6-week mHealth intervention combining nicotine replacement therapy (NRT), self-guided cognitive behavioral therapy (CBT), and coaching support through telephone and asynchronous messaging. Feasibility and self-reported 7- and 30-day abstinence were assessed at baseline and 1-month postquit date. RESULTS: The majority of participants completed treatment (45/51) and found the intervention helpful in supporting their vaping behavior change objectives. At 1-month postquit date, 48.9% (22/45) of study completers reported 7-day point prevalence abstinence and 28.8% (13/45) reported continuous 30-day abstinence. CONCLUSIONS: Findings provide preliminary support for an mHealth intervention approach to vaping cessation combining remote CBT-based coaching with NRT.
Ikuta KS, Swetschinski LR, Aguilar GR, et al., 2022, Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 400, Pages: 2221-2248, ISSN: 0140-6736
BackgroundReducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes.MethodsWe estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest.FindingsFrom an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (bo
Fadahunsi KP, Wark PA, Mastellos N, et al., 2022, Assessment of clinical information quality in digital health technologies: an international eDelphi study, Journal of Medical Internet Research, Vol: 24, Pages: 1-10, ISSN: 1438-8871
Background:Digital health technologies (DHTs), such as electronic health records and prescribing systems, are transforming health care delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel clinical information quality (CLIQ) framework to assess the quality of clinical information in DHTs.Objective:This study explored clinicians’ perspectives on the relevance, definition, and assessment of information quality dimensions in the CLIQ framework.Methods:We used a systematic and iterative eDelphi approach to engage clinicians who had information governance roles or personal interest in information governance; the clinicians were recruited through purposive and snowball sampling techniques. Data were collected using semistructured online questionnaires until consensus was reached on the information quality dimensions in the CLIQ framework. Responses on the relevance of the dimensions were summarized to inform decisions on retention of the dimensions according to prespecified rules. Thematic analysis of the free-text responses was used to revise definitions and the assessment of dimensions.Results:Thirty-five clinicians from 10 countries participated in the study, which was concluded after the second round. Consensus was reached on all dimensions and categories in the CLIQ framework: informativeness (accuracy, completeness, interpretability, plausibility, provenance, and relevance), availability (accessibility, portability, security, and timeliness), and usability (conformance, consistency, and maintainability). A new dimension, searchability, was introduced in the availability category to account for the ease of finding needed information in the DHTs. Certain dimensions were renamed, and some definitions were rephrased to improve clarity.Conclusions:The CLIQ framework reached a high expert consensus and clarity of language relating to the information quality dimensions. The framework can be used b
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