Publications
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Onanuga S, Saraki T, Grace B, et al., 2023, PP.0188 Factors influencing black maternal mortality in the United Kingdom: a systematic review, RCOG World Congress 2023, Publisher: Wiley, Pages: 87-88, ISSN: 1470-0328
Bury F, Rao M, Pinder R, 2023, Differential attainment in Public Health specialty training recruitment in the United Kingdom: an observational analysis of applicants from 2018 to 2020, Journal of Public Health, Vol: 45, Pages: 330-337, ISSN: 1741-3842
BackgroundDifferential attainment has been widely observed in United Kingdom (UK) medical training, with minority ethnicity being associated with reduced success in recruitment and progression through training. Specialty training in Public Health in the UK recruits candidates with medical as well as non-medical backgrounds. At the request of the UK Faculty of Public Health and Health Education England, we sought to examine whether differential attainment may or may not be occurring in the multi-stage recruitment process. MethodsWe analysed three-years of national recruitment data into Public Health specialty training to identify whether demographic characteristics including age, sex, ethnicity and professional background were associated with successful recruitment.ResultsIn total 2252 applications between 2018 and 2020 were analysed. Candidates who were older, Asian, black, or from backgrounds other than medicine were significantly less likely to progress from the psychometric testing stage than the white British group. Fewer statistically significant differences were observed at the final stage of recruitment involving interviews, group work and a written task. ConclusionsThe findings suggest that older candidates, those from some ethnic minority backgrounds and those from backgrounds other than medicine are disadvantaged by the current recruitment process, with differential attainment associated with the psychometric testing stage.
Onanuga S, Grace B, Saraki T, et al., 2023, Equity in reproductive health: a systematic review of factors influencing higher maternal mortality among Black Women in the United Kingdom, 39th Hybrid Annual Meeting of the European Society of Human Reproduction and Embryology, Publisher: Oxford University Press, Pages: i400-i401, ISSN: 0268-1161
Onanuga S, Saraki T, Grace B, et al., 2023, Factors influencing black maternal mortality in the United Kingdom: A systematic review, Publisher: WILEY, Pages: 87-88, ISSN: 1470-0328
Pinder R, 2023, Embedding lifestyle medicine in undergraduate medical training: dividends for patients, society and our NHS workforce, Royal College of Physicians, Medicine 2023, Publisher: Royal College of Physicians of London
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
Cardoso Pinto AM, Malone E, Ramesh N, et al., 2022, Community partnerships in medical education: Narratives of medical students, Public Health Challenges, Vol: 1, Pages: 1-6, ISSN: 2769-2450
While medical education has traditionally been designed, led and delivered exclusively by clinicians and academics, there has been an increasing shift towards diversifying actors involved in training future generations of health professionals. Public and patient involvement in learning increases the likelihood that learning is relevant to the communities we purport to serve. This article explores the experiences of medical students who were partnered with a community-based organisation (CBOs) as part of the intercalated Global Health BSc at Imperial College London. Students involved in this programme highlight opportunities to understand the needs of communities they were placed with, beyond what is possible to understand in clinical practice; this is essential to support them in becoming holistic, patient-centred practitioners. Students also found this opportunity helpful to gain insight into the role and value of the voluntary sector in healthcare and develop transferrable skills in project leadership and management. It is hypothesised that the benefits of this partnership extend to community-organisations; they gain experience working with students, who provide an external view of their services and may be helpful in the delivery of quality-improvement projects. Communities could also benefit from interactions with students by sharing insight into their needs and priorities, and in turn, shaping students’ priorities as future health professionals and co-designers of voluntary-sector initiatives within the community. Whilst the establishment of these partnerships does not come without its challenges, this article also highlights lessons for students and institutions undergoing similar programmes, including clarification of goals, stakeholder consultation, sustainability of interventions, voicing the community, timetable flexibility and funding.
Bury F, Pinder R, 2022, Equality, diversity and inclusion in recruitment to Public Health specialty training in the United Kingdom, London, Publisher: Faculty of Public Health
Silk Z, Wong J, Pinder R, et al., 2022, Reducing Blood Transfusion In Paediatric Scoliosis Surgery: Reporting Twenty Years Of A Multidisciplinary, Evidenced Based, Quality Improvement Project, BSS2022
Ahmad A, Wong J, Pinder R, et al., 2022, Surgical Site Infections (SSIs) in Growing Rod Systems for management of Early Onset Scoliosis in 53 patients undergoing 135 procedures: An 8 year prospective audit., BSS2022
Sharpe C, Boshari T, Alvarez-Madrazo S, et al., 2022, Preparing students for effective professional practice in public health: authenticity and application in the Massive Online Open Course (MOOC) space, Transform MedEd 2022
Pinder R, Budhathoki S, Qavi A, et al., 2022, Developing partnerships for learning in Global Health: medical students in community-based organisations, Transform MedEd 2022
Ijaz A, Patel N, Chen S, et al., 2022, Addressing lifestyle and the wider determinants of health in undergraduate medicine: an interdisciplinary and partnership-based approach to curriculum development, Transform MedEd 2022
Wright H, Mutlow F, Harvey C, et al., 2022, The student perspective: Summative assessment of Lifestyle Medicine and Population Health​, Virtual Medical Education Research Unit Conference 2022
Harvey C, Maile E, Baptista A, et al., 2022, Teaching and learning lifestyle medicine during COVID-19: how has living during a pandemic influenced students’ understanding and attitudes to self-care and population health? A qualitative analysis, BMC Medical Education, Vol: 22, ISSN: 1472-6920
Background: In 2019 a new Lifestyle Medicine (LM) module was introduced to the undergraduate medical curriculum at Imperial College London. Lifestyle Medicine is an emergent discipline which aims to tackle the increasing burden of non-communicable disease. Previous work has suggested that students value clinical teaching over traditional Public Health topics. Taking a constructivist view of learning, this paper assesses changes in medical students’ attitudes towards Public Health and LM in response to living through a pandemic. We then make suggestions as to how this lived experience might be useful in teaching LM, and discuss the interaction between teaching, behaviour, and experience with consideration of self-determination theories in learning. Methods: First-year medical students were surveyed at the end of their first year of teaching and asked if living during the COVID-19 pandemic had changed the value they place on LM and if so, how. Thematic analysis was conducted on responses representing 71% (n=216) of the year group. Results: Four themes were defined in the data: acknowledging importance; impact on behaviour; health inequalities and the wider determinants; and promoting Public Health and prevention. These themes highlight the distinct levels through which the pandemic has had an impact: from personal behaviour to population health.Conclusions: This is the first study to look at the impact of living through a pandemic on attitudes to LM. Our results suggest that the pandemic has led to increased reflection on health behaviours. The lived-experience of COVID-19 may facilitate a better understanding of health inequalities and their impact, alongside the opportunities presented by effective LM interventions.
Basnet B, Chapagain P, Subedi S, et al., 2022, Experiences of nurses providing maternity care in a public hospital during the COVID-19 pandemic in Nepal: a qualitative study, PLOS Global Public Health, Vol: 2, ISSN: 2767-3375
Maternity service providers have struggled to provide high-quality services to women and newborns during the ongoing COVID-19 pandemic which has substantially impacted health systems and disrupted maternity services globally. Nepal is a resources-limited country that reported a significant impact of the pandemic on maternal health services. It is therefore important to understand better the perspective of health care professionals in this context. This study intends to explore the experiences of nurses providing maternity care in the public sector during the COVID-19 pandemic in Nepal. A qualitative study using a phenomenological design was conducted. Altogether ten nurses working in maternity services were selected using purposive sampling technique. Data were collected by face-to-face in-depth interviews using a semi-structured interview guide. Thematic analysis was conducted using Clarke and Braun 2006 technique. The findings of the study were organized into codes, sub-themes and themes. The six themes identified were fear of COVID-19 at work, challenges at work, changes at work and services, motivations to work, stigma due to COVID-19, and impact on services. Participants described how maternity services could not be stopped during the pandemic. They had experienced decreased utilization of antenatal services as a consequence of ‘lockdown’ thereby leading to an increase in maternal and neonatal mortality. Respondents reported ineffective human resource management compromising the quality of care. The professional responsibility to cope with adverse circumstances and serve society is a major source of motivation that health workers relied upon to get them through the pandemic period. A wide range of challenges were faced by service providers during the pandemic which requires action and support of all levels of government, institutions and society-at-large to assure the continued provision of safe maternity care during such a protracted period of chal
Wright H, Mutlow F, Harvey C, et al., 2022, How do we best summatively assess Lifestyle Medicine and Population Health in the Undergraduate Medical Curriculum? The Student Perspective., Ottawa 2022
Mutlow F, Wright H, Harvey C, et al., 2022, Student perceptions of Lifestyle Medicine and Population Health: the value they place on it as early years Medical Students., AMEE 2022
Pinder R, Bauld L, Findlater H, et al., 2022, Is it time to embed Lifestyle Medicine in undergraduate and postgraduate curricula?, Lifestyle Medicine, Vol: 3, ISSN: 2688-3740
Basnet LB, Budhathoki SS, Adhikari B, et al., 2022, Compliance with the smoke-free public places legislation in Nepal: A cross-sectional study from Biratnagar Metropolitan City, PLoS One, Vol: 17, Pages: 1-15, ISSN: 1932-6203
BackgroundSmoke-free legislation banning tobacco smoking in public places was implemented across Nepal in 2014 with the ambition to reduce the impact of second-hand smoking. As part of a comprehensive policy package on tobacco control, the implementation of the legislation has seen a marked reduction in tobacco consumption. Yet there remains uncertainty about the level of compliance with smoke-free public places.ObjectivesThis study assesses the compliance with smoke-free laws in public places and the factors associated with active smoking in public places in Biratnagar Metropolitan City, Nepal.MethodsA cross-sectional study was conducted in the Biratnagar metropolitan city in Province 1 of Nepal from July to December 2019. A total of 725 public places within the metropolitan city were surveyed using a structured survey tool. Active smoking was the primary outcome of the study which was defined as smoking by any person during the data collection time at the designated public place.ResultsThe overall compliance with smoke-free legislation was 56.4%. The highest compliance (75.0%) was observed in Government office buildings. The lowest compliance was observed in eateries, entertainment, and shopping venues (26.3%). There was a statistically significant association between active smoking and the presence of ‘no smoking’ notices appended at the entrance and the odds of active smoking in eateries, entertainment, hospitality, shopping venues, transportations and transits was higher compared to education and health care institutions. None of the ‘no smoking’ notices displayed fully adhered to the contents as prescribed by the law.ConclusionAs more than half of the public places complied with the requirements of the legislation, there was satisfactory overall compliance with the smoke-free public places law in this study. The public venues (eateries, shopping venues and transportations) that are more frequently visited and have a high turnover of the
Bhatt N, Nepal S, Pinder RJ, et al., 2022, Challenges of hospital oxygen management during the COVID-19 pandemic in rural Nepal, The American Journal of Tropical Medicine and Hygiene, Vol: 106, Pages: 997-999, ISSN: 0002-9637
Oxygen support remains essential for treatment of acute and severe manifestations of COVID-19. In Nepal, like many other low-resource settings, medical oxygen availability was inadequate before the pandemic. The mid-2021 wave of COVID-19 transmission starkly exposed the supply–demand imbalance of medical oxygen across the country. Pre-pandemic, more complex cases were typically referred to hospitals with better resources; however, during the pandemic, these hospitals were overrun. Therefore, resource-poor health facilities have been attempting to provide greater levels of care. However, we are faced with numerous challenges to provide a proper oxygen supply in these health settings. At a logistical level, complex geographies, sparse infrastructure, and inadequate electricity supply pose challenges. On a provider level, a shortage of trained staff and equipment necessary to administer and monitor medical oxygen creates additional pressures. Recognizing the end of the pandemic is still a long way off in many parts of the world, it is imperative that scalable, sustainable approaches to provisioning oxygen to those in greatest need are considered at a policy level.
Pinder R, 2022, Learning from Lifestyle Medicine in the undergraduate curriculum: dividends for patients, society and our NHS workforce, BSLM 2022
Pinder R, Bannerman A, Soundararajan V, et al., 2021, Mainstreaming Lifestyle Medicine education in the UK: reflections and lessons on three years of innovation, Lifestyle Medicine 2021
Adhikari B, Devkota A, Budhathoki SS, et al., 2021, COVID-19 crisis in Nepal: a case of systems and governance failure in a low-income country, Journal of Global Health Economics and Policy, Vol: 1, ISSN: 2806-6073
Jumbe S, Milner A, Clinch M, et al., 2021, A qualitative evaluation of Southwark Council’s public health response to mitigating the mental health impact of the 2017 London Bridge and Borough Market terror attack, BMC Public Health, Vol: 21, ISSN: 1471-2458
BackgroundOver recent years there have been several major terror attacks in cities across Europe. These attacks result in deaths, physical injuries, and pose long-term threats to mental health and wellbeing of large populations. Although psychologists have completed important work on mental health responses to disaster exposure including terrorist attacks, the mental health impacts of such attacks have been comparatively less examined in academic literature than the acute health response to physical injuries. This paper reflects on Southwark Council’s pioneering public mental health response to the June 2017 terror attack at London Bridge and Borough Market. It aims to explore perceptions of the mental health impact of the incident by those living and working in the borough.MethodsA rapid qualitative evaluation informed by the logic underpinning Southwark Council’s response was conducted. Seven formative interviews were undertaken with individuals involved in the response planning and/or delivery, enabling the evaluation team to establish the response’s theoretical basis. Subsequently, nineteen semi-structured interviews with consenting Council employees, residents, business owners, and workers from the Borough were conducted to understand perceived mental health impacts of the attack and the success of the Council response. Thematic analysis of transcribed interviews was undertaken to evaluate the extent to which the response was implemented successfully.ResultsParticipants reported feeling the attack had a wide-reaching negative impact on the mental health of residents, those working in the borough and visitors who witnessed the attack. Delivering the response was a challenge and response visibility within the community was limited. Participants suggested a comprehensive systematic approach to health needs assessment informed by knowledge and relationships of key Council workers and community stakeholders is imperative when responding to terroris
Birrell FN, Pinder RJ, Lawson RJ, 2021, Lifestyle medicine is no Trojan horse: it is an inclusive, evidence-based, and patient-focused movement, British Journal of General Practice, Vol: 71, Pages: 300-300, ISSN: 0960-1643
Williams R, Alessi C, Alexander G, et al., 2021, New dimensions for hospital services and early detection of disease: a Review from the Lancet Commission into liver disease in the UK., The Lancet, Vol: 397, Pages: 1770-1780, ISSN: 0140-6736
This Review, in addressing the unacceptably high mortality of patients with liver disease admitted to acute hospitals, reinforces the need for integrated clinical services. The masterplan described is based on regional, geographically sited liver centres, each linked to four to six surrounding district general hospitals-a pattern of care similar to that successfully introduced for stroke services. The plan includes the establishment of a lead and deputy lead clinician in each acute hospital, preferably a hepatologist or gastroenterologist with a special interest in liver disease, who will have prime responsibility for organising the care of admitted patients with liver disease on a 24/7 basis. Essential for the plan is greater access to intensive care units and high-dependency units, in line with the reconfiguration of emergency care due to the COVID-19 pandemic. This Review strongly recommends full implementation of alcohol care teams in hospitals and improved working links with acute medical services. We also endorse recommendations from paediatric liver services to improve overall survival figures by diagnosing biliary atresia earlier based on stool colour charts and better caring for patients with impaired cognitive ability and developmental mental health problems. Pilot studies of earlier diagnosis have shown encouraging progress, with 5-6% of previously undiagnosed cases of severe fibrosis or cirrhosis identified through use of a portable FibroScan in primary care. Similar approaches to the detection of early asymptomatic disease are described in accounts from the devolved nations, and the potential of digital technology in improving the value of clinical consultation and screening programmes in primary care is highlighted. The striking contribution of comorbidities, particularly obesity and diabetes (with excess alcohol consumption known to be a major factor in obesity), to mortality in COVID-19 reinforces the need for fiscal and other long delayed regulatory
Jumbe S, Milner A, Clinch M, et al., 2021, A qualitative evaluation of Southwark Council’s public health approach for mitigating the mental health impact of the 2017 London Bridge and Borough Market terror attack
<jats:title>Abstract</jats:title> <jats:p>BackgroundOver recent years there have been several major terror attacks in cities across Europe. These attacks result in deaths, physical injuries, and pose long-term threats to mental health and wellbeing of large populations. Although psychologists and psychiatrists have completed important work on mental health responses to disaster exposure including terrorist attacks, the mental health and wellbeing impacts of such attacks have been comparatively less examined in academic literature than the acute health response to physical injuries. This paper reflects on Southwark Council’s pioneering public health response to the June 2017 terror attack at London Bridge and Borough Market. It aims to explore the perceptions of mental health and wellbeing impact of the incident, and evaluate Council led efforts to minimise mental health and wellbeing sequelae following the attack.Methods A rapid qualitative evaluation informed by the logic underpinning Southwark Council’s response was conducted. Nineteen in-depth semi-structured interviews with consenting Southwark Council employees, residents, business owners, and workers from the London Borough of Southwark were conducted. Seven formative interviews were conducted with members of Southwark Council and other individuals directly involved in the planning and/or delivery of the mental health and wellbeing response. Twelve subsequent interviews were then conducted with residents, business owners and council employees to examine the mental health and wellbeing impacts of the attack and the effectiveness of the response. A thematic analysis of transcribed interviews was undertaken. Results The main theme found was that the attack had a wide-reaching negative impact and the main subthemes found that delivering the response was a challenge, that there was multifacted damage botha cross and within communities, and there was limited visibility of the res
Boshari T, Sharpe C, Poots A, et al., 2020, An observational study of the association between diverse licensed premises types and alcohol-related violence in an inner-London borough, Journal of Epidemiology and Community Health, Vol: 74, Pages: 1016-1022, ISSN: 0143-005X
Background: An ecological correlation has been observed between licensed premises and alcohol-related violence (ARV). In the United Kingdom to date, no evidence directly connects alcohol-related harm to a single premises type. Recent policies have called for a diversified alcohol offer yet quantitative evidence in support remains sparse. This study aims to inform policy by determining whether diversification of the alcohol economy is desirable, and to inform the licensing process and submission of public health evidence. Methods: Using 11-years of local licensing data from the London Borough of Southwark, alcohol availability over time was approximated by the number of extant alcohol licences, categorised by outlet type: drinking establishments, eateries, takeaways, off-sales, and ‘other’. Harm was quantified drawing on law enforcement intelligence that recorded ARV. A linked dataset was analysed using negative binomial regression, contrasting cumulative impact zones (CIZ) – a common alcohol control policy – with non-CIZ geographies. Results: Each licensed drinking establishment was associated with a 1.6% (95% CI 0.7% to 2.6%; p=0.001) increase in ARV, respectively. ‘Other’ outlets had a protective effect and were associated with a 1.8% (95% CI 1.0% to 2.5%; p<0.001) decrease in ARV. Conclusion: This study provides direct evidence for an association between alcohol-related harm and licensed premises. The varying associations between outlet type and ARV provide local public health stakeholders with an evidence base upon which to advocate for licensing policies that diversify alcohol availability.
Harvey C, Bannerman A, Pinder R, et al., 2020, Teaching lifestyle medicine in the undergraduate curriculum, The Clinical Teacher, Vol: 17, Pages: 133-133, ISSN: 1743-4971
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