Imperial College London

Dr Austen El-Osta

Faculty of MedicineSchool of Public Health

Primary Care Research Manager
 
 
 
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Contact

 

+44 (0)20 7594 7604a.el-osta Website

 
 
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Location

 

323Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

45 results found

El-Osta A, Iman W, Manisha K, Emmanouil B, Aos A, Marie E-A, Eva R, Vasu Set al., 2022, Public perceptions on routine use of screening tools for domestic abuse in health and social care settings: an exploratory cross-sectional study, BMC Public Health, ISSN: 1471-2458

BackgroundDomestic violence and abuse (DVA) is a rising societal concern with increased prevalence since the national lockdowns and remains largely under-detected by the medical community. Although screening increases early detection of abuse, current NICE guidelines which were produced before the advent of COVID-19 do not recommend routine DVA screening in primary care. Little is known about patient views regarding DVA screening in UK primary care. This exploratory survey assesses the public’s experiences and their views on routine DVA screening.MethodsAn open, easily accessible anonymous 27-item eSurvey made available on the Imperial College London Qualtrics platform between 8 March and 27 September 2021 was used to collect data from community dwelling adults. Potentially eligible participants were contacted via email through community groups in Northwest London catchment area, and using adverts on social media. The survey targeted a wider population in the community, including those who were 18 years and over, living in the UK and spoke English. The eSurvey also included information on accessible support services. Data were summarised using frequencies and percentages. Regression analysis explored the association between WAST-short questions and previous exposure to abuse.ResultsData from 298 community-dwelling adults was analysed. A third of respondents confirmed having experienced DVA, and another 6.4% declined disclosure. The univariable analysis suggested that those with a history of abuse compared to those with no history were 11 times more likely to have tension in the relationship and nine times more likely to have difficulty working out arguments. After adjusting for a-priori confounders (age, gender and ethnicity), those who answered ‘would rather not say’ appeared to be 34 times more likely to have tension in the relationship, and 17 times more likely to have difficulty working out arguments. Nearly two-thirds of the study population r

Journal article

El-Osta A, Rowe C, Majeed A, 2022, Developing a shared definition of Self-Driven Healthcare to enhance the current healthcare delivery paradigm

Self-Driven Healthcare (SDH) is an umbrella term introduced by Innovate UK to conceptualise aspects of healthcare delivery that can support people in becoming more engaged in their own health and wellbeing management rather than being passive receivers of healthcare. The defining characteristics of SDH solutions include activities that empower people to play a more effective role in maintaining their own health and wellbeing, including those activities concerned with primary prevention and health promotion (e.g., to detect diseases earlier and proactively collaborate with a growing range of healthcare professionals to manage their illnesses). Innovate UK is interested in developing thought leadership around the emergent concept of SDH, and to determine if this is an area it should in invest in. The commentary introduces the concept of SDH and discusses the possible challenges and barriers that need to be addressed to realise the full potential of this approach.

Working paper

El-Osta A, Kerr G, Alaa A, El Asmar ML, Karki M, Webber I, Riboli-Sasco E, Blume G, Beecken W, Mummery Det al., 2022, Investigating the use and effectiveness of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study, Journal of Sexual Medicine, ISSN: 1743-6095

BackgroundErectile dysfunction (ED) is the most common sexual dysfunction in men. Some types ofED are amenable to treatment using lifestyle medicine approaches with or withoutpharmacotherapy.AimInvestigate the use and perceived effectiveness of lifestyle medicine approaches totackle ED.MethodsA cross-sectional online survey of 1177 community dwelling adults explored theprevalence and methods used to tackle ED in the community setting. We examineddifferences between participants with and without ED. Variables associated with ED inunivariable analyses were included in a multivariable logistic regression to identifyvariables independently associated with the condition.OutcomesSelf-reported measure; perceived effectiveness of lifestyle medicine interventions totackle EDResultsMost respondents (76.5%) had experienced ED, and this was associated with having along-term condition, taking anti-hypertensive medication, hypercholesterolaemia andobesity. Medication was the most common management strategy overall (65.9%),followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) didnot use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferersreceived a mental health assessment and 29.2% received other tests (e.g., blood test,medical imaging) by GPs. Cardiovascular training was identified as the best ratedstrategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity(32.6%) were also positively rated.Clinical implicationsStructured education to general practitioners and community dwelling adults about theimpact of lifestyle behaviour modification and how this could influence the appearanceor trajectory of ED could help improve personal choice when tackling ED.Strengths and LimitationsTo our knowledge, this is the first study to collect eSurvey responses from communitydwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicineapproaches to tackle ED. The principal limitation was t

Journal article

Gibson H, Huang D, Hayhoe B, El-Osta Aet al., 2022, A virtual group consultation model of care for menopause treatment, New England Journal of Medicine, Vol: 3, ISSN: 0028-4793

Journal article

El-Osta A, Webber I, Alaa A, Bagkeris E, Tagavi Azar Sharabiani M, Mian S, Majeed Aet al., 2022, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, BMJ Open, Vol: 12, ISSN: 2044-6055

Objective: Assess the suitability of clinical vignettes in benchmarking the performance of online symptom checkers (OSCs).Design: Observational study using a publicly available free OSC.Participants: Healthily OSC, which provided consultations in English, was used to record consultation outcomes from two lay and four expert inputters using 139 standardised patient vignettes. Each vignette included three diagnostic solutions and a triage recommendation in one of three categories of triage urgency. A panel of three independent general practitioners interpreted the vignettes to arrive at an alternative set of diagnostic and triage solutions. Both sets of diagnostic and triage solutions were consolidated to arrive at a final consolidated version for benchmarking.Main outcome measures: Six inputters simulated 834 standardised patient evaluations using Healthily OSC and recorded outputs (triage solution, signposting, and whether the correct diagnostic solution appeared first or within the first three differentials). We estimated Cohen’s kappa to assess how interpretations by different inputters could lead to divergent OSC output even when using the same vignette or when compared with a separate panel of physicians.Results: There was moderate agreement on triage recommendation (kappa=0.48), and substantial agreement on consultation outcomes between all inputters (kappa=0.73). OSC performance improved significantly from baseline when compared against the final consolidated diagnostic and triage solution (p<0.001).Conclusions: Clinical vignettes are inherently limited in their utility to benchmark the diagnostic accuracy or triage safety of OSC. Real-world evidence studies involving real patients are recommended to benchmark the performance of OSC against a panel of physicians.

Journal article

Dallera G, Alaa A, El-Osta A, Kreindler J, Harris Met al., 2022, Evaluating the feasibility and acceptability of a safety protocol to mitigate SARS-CoV-2 transmission risks when participating in full-capacity live mass events: a cross-sectional survey and interview-based study, BMJ Open, ISSN: 2044-6055

Objectives: To investigate the feasibility and acceptability of a novel COVID-19 safety protocol combining professionally witnessed home-based videoed pre-event testing and a data-driven risk assessment model that was implemented at Standon Calling Festival in July 2021.Design: Observational study using a sequential explanatory mixed-methods design.Setting: Standon Calling Festival, Hertfordshire, England.Participants: 1,093 survey respondents who attended Standon Calling Festival in July 2021, 11 of whom were interviewed.Results: Respondents reported that the videoed lateral flow test (LFT) was straightforward, non-intrusive, inexpensive and improved the ability to self-test. Participants felt safe at the event knowing that everyone had followed a robust testing protocol to mitigate the spread of COVID-19. Participants reported that medically certified home-based testing has the potential for use in other health spheres, although over-reliance on test results alone may create a false sense of security.Conclusions: Our study showed that a protocol that combines professionally witnessed home-based videoed pre-event testing is highly acceptable and feasible, and it can inform decision making and support the safe reopening of live mass events at full capacity. Although COVID-19 is now considered endemic in the UK, this protocol can be of value for other countries where the live events industry remains heavily impacted. Risk-modelling should be tested and evaluated at future events to further increase the robustness of this protocol.

Journal article

Sivarajasingam V, Webber I, Alaa A, El-Osta Aet al., 2022, Investigating public awareness, prevailing attitudes and perceptions towardsdomestic violence and abuse: a qualitative study in the United Kingdom, BMC Public Health, ISSN: 1471-2458

Background:Reported Domestic Violence and Abuse (DVA) cases have increased since the advent of the COVID-19 pandemic and ensuing lockdown. Understanding the general public’s view about DVA is vital, as it would help develop targeted interventions and effective public policies to tackle DVA. We investigated public awareness, attitudes and perceptions towards DVA, and explored mechanisms to tackle DVA in the community setting.Methods: In-depth personal interviews were conducted with 29 participants who responded to study invitations and adverts on social media. A topic guide was used to ensure consistency across the interviews, which were audio-recorded, transcribed and analysed thematically to detect emergent themes concerning DVA.Results:All respondents were aware of the concept of abuse. Thirty-eight percent declared either having experienced DVA directly or that they knew someone close to being abused. More than half of the respondents were not aware of existing DVA supportive services in the UK. Overarching themes generated from the contextual analysis included contributing factors for DVA, challenges and barriers facing victims and proposals for future interventions.Conclusions:The public has a broad understanding of the impacts of DVA. Simultaneously, the public fail to recognise specific instances or events in their daily lives. Raising public awareness, particularly in children through the school curriculum, highlighting existing support services and introducing the routine use of short screening tools for DVA in primary care can increase awareness, early identification and effective interventions. Sustained, multi-level community facing interventions are recommended to reduce stigma and fear associated with DVA.

Journal article

Poe M, Vegas R, El-Osta A, 2022, Empowering self-care: A handbook for pharmacists, International Pharmaceutical Federation (FIP)

Supporting and empowering individuals to responsibly engage in self-care is an important part of pharmacists’ daily practice around the world. Self-care spans the whole wellness spectrum, from disease prevention to the management of symptoms and common ailments. It also encompasses interventions ranging from advice on non-prescription medicines and medical devices (often described as “over the counter”) to education on healthy diets, hygiene and mindfulness practices.1 The ability to engage in self-care empowers individuals to act on their own health and well-being, and it encourages the inclusion of their input and specific needs when making healthcare decisions. Self-care empowers people and societies to transform health. Moreover, to promote health equity, health literacy is needed, and there is significant room for improvement and for greater research in this field.Self-care has been conceptualised through internationally recognised frameworks.2 The Self-Care Matrix is a widely accessible framework that conveys the concept of the “totality” of self-care by highlighting the inter-relationships between four cardinal dimensions of self-care. These dimensions are: 1. Person-centred self-care activities; 2. Self-care behaviours; 3. Self-care in the context of resource utilisation; and4. The prevailing environment as a key enabler of self-care practice.Self-care is an important contributor to universal health coverage (UHC) through savings in healthcare expenditure and the reallocation of resources by means of reduced use and pressure on healthcare systems.For example, patient education and assessment conducted by pharmacists in addition to supporting the informed choice of non-prescription medicines could relieve the burden placed on healthcare systems, such as in primary care facilities or emergency departments, from patients seeking consultation for minor ailments, and lessen the reliance on prescription-only medicines.

Journal article

Poe M, Viegas R, El-Osta A, 2022, Empowering self-care: A handbook for pharmacists, Empowering self-care: A handbook for pharmacists, Publisher: International Pharmaceutical Federation (FIP)

Supporting and empowering individuals to responsibly engage in self-care is an important part of pharmacists’ daily practice around the world. Self-care spans the whole wellness spectrum, from disease prevention to the management of symptoms and common ailments. It also encompasses interventions ranging from advice on non-prescription medicines and medical devices (often described as “over the counter”) to education on healthy diets, hygiene and mindfulness practices.1 The ability to engage in self-care empowers individuals to act on their own health and well-being, and it encourages the inclusion of their input and specific needs when making healthcare decisions. Self-care empowers people and societies to transform health. Moreover, to promote health equity, health literacy is needed, and there is significant room for improvement and for greater research in this field.Self-care has been conceptualised through internationally recognised frameworks.2 The Self-Care Matrix is a widely accessible framework that conveys the concept of the “totality” of self-care by highlighting the inter-relationships between four cardinal dimensions of self-care. These dimensions are:1. Person-centred self-care activities;2. Self-care behaviours;3. Self-care in the context of resource utilisation; and4. The prevailing environment as a key enabler of self-care practice.Self-care is an important contributor to universal health coverage (UHC) through savings in healthcare expenditure and the reallocation of resources by means of reduced use and pressure on healthcare systems. For example, patient education and assessment conducted by pharmacists in addition to supporting the informed choice of non-prescription medicines could relieve the burden placed on healthcare systems, such as in primary care facilities or emergency departments, from patients seeking consultation for minor ailments, and lessen the reliance on prescription-only medicines.

Report

Painter A, Hayhoe B, El-Osta A, 2022, Online symptom checkers:Exploring the need for a standardised clinical validation process, JMIR, ISSN: 2291-5222

The use of online symptom checkers (OSCs) is increasing but their safety, efficacy and impact on healthcare systems remain unclear. The lack of a standardised validation process and the absence of third-party testing requirements have resulted in significant variation in OSC clinical performance. Discrepancy in the findings of comparative studies to date suggests that several steps in OSC evaluation methodology can significantly influence outcomes. A uniform validation process with a clear specification is urgently required to objectively assess the performance of OSCs and help improve patient safety. Careful consideration and clear guidance for each of these steps will be required to create an objective validation standard that is robust and fair. An objective validation process could support the widescale adoption of OSC in the community setting with the potential to reduce pressure on scarce NHS resources, especially for self-limiting conditions.

Journal article

World Health Organisation WHO, 2022, Classification of self-care interventions for health: a shared language to describe the uses of self-care interventions, Publisher: World Health Organization, ISBN: 978 92 4 003946 9

The classification of self-care interventions is health systems focused and aims to promote an accessible and bridging language for researchers, policy-makers, donors and health programme managers in five key areas:synthesizing evidence and research;promoting advocacy and communication;conducting national inventories and landscape analyses;articulating needs based on identified health system challenges;formulating operational considerations for implementation guidance.The classification aligns with a people-centred approach to health and well-being outlined in the WHO conceptual framework for self-care interventions and Guideline on Self-Care Interventions for Health and Well-being.This ‘living’ document will evolve as new models of self-care interventions and evidence-based best practices become available. It has been developed following an extensive consultative process guided by a panel of global experts.

Book

Pickett K, Taylor-Robinson D, Qualter P, El-Osta A, et Aet al., 2021, The Child of the North: Building a fairer future after COVID-19 report.Pickett K., Taylor-Robinson D., et al (2021) The Child of the North: Building a fairer future after COVID-19, the Northern Health Science Alliance and N8 Research Partnership.

The considerable costs to society and the UK’s economy of rising inequality are outlined in The Child of the North: Building a fairer future after COVID-19 report, produced by the N8 Research Partnership and Northern Health Science Alliance (NHSA), and written by over 40 leading academics from across the North of England.The report looks at a wide range of factors, from child poverty to children in care, to build up a picture of the Child of the North. It sets out 18 clear recommendations that can be put in place to tackle the widening gap between the North and the rest of England.

Book

Donnat C, Bunbury F, Liu D, Kreindler J, Filipidis F, El-Osta A, Esku T, Harris Met al., 2021, Predicting COVID-19 transmission to inform the management of mass events: a model-based approach, JMIR Public Health and Surveillance, Vol: 7, ISSN: 2369-2960

Background:Modelling COVID-19 transmission at live events and public gatherings is essential to control the probability of subsequent outbreaks and communicate to participants their personalised risk. Yet, despite the fast-growing body of literature on COVID transmission dynamics, current risk models either neglect contextual information on vaccination rates or disease prevalence or do not attempt to quantitatively model transmission.Objective:This paper attempts to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty.Methods:Building upon existing models, our approach ties together three main components: (a) reliable modelling of the number of infectious cases at the time of the event, (b) evaluation of the efficiency of pre-event screening, and (c) modelling of the event’s transmission dynamics and their uncertainty along using Monte Carlo simulations.Results:We illustrate the application of our pipeline for a concert at the Royal Albert Hall and highlight the risk’s dependency on factors such as prevalence, mask wearing, or event duration. We demonstrate how this event held on three different dates (August 20th 2020, January 20th 2021, and March 20th 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widen in the upper tails of the distribution of number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3 for our three dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event.Conclusions:Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to as

Journal article

Harris M, Kreindler J, Donnat C, El-Osta A, Filippidis F, Tonu Eet al., 2021, Rapid response to BMJ: Are vaccine passports and covid passes a valid alternative to lockdown?, BMJ: British Medical Journal, Vol: 375, ISSN: 0959-535X

Journal article

El-Osta A, Hennessey C, Pilot C, Tahir M, Bagkeris E, Akram M, Alboksmaty A, Barbanti E, Bakhet M, Vos V, Banarsee R, Majeed Aet al., 2021, A digital solution to streamline access to smoking cessation interventions in England; findings from a primary care pilot (STOPNOW study), Public Health in Practice, Vol: 2, ISSN: 2666-5352

Objectives:Despite the proven efficacy of several smoking cessation medications that have been shown to improve long-term abstinence rates, approximately two-thirds of smokers report not having used medication in their most recent quit attempt. A main barrier could be delayed access to pharmacological interventions. This study investigated the utility of a primary care linked online portal to streamline timely access to pharmacological support to patients who want to quit smoking by making an asynchronous request for treatment to their general practitioner.Study design:Prospective cohort study.Methods:An online portal with added functionality was developed, which allowed patients with a unique link to make an asynchronous request for treatment. Two GP practices identified a total of 4337 eligible patients who received an SMS or email invite to engage with an online portal including an electronic survey to capture information about smoking behaviours and to request treatment. Portal informatics and patient level data were analysed to measure the efficacy of the online system in reducing the time between making a formal request to treatment and access to pharmacological support. The primary outcome measure was the time between making a formal request for treatment and access to pharmacological support from a designated community pharmacy.Results:323 patients (7.4%) initiated the survey, but only 56 patients completed the survey and made a formal request for treatment. 94% of participants did not return to use the portal to make a second or follow-up request for treatment. Only 3 participants completed the 12-week pathway. A total of 75 medication items were prescribed and collected by 56 patients. The time difference between the formal request to treatment and GP review ranged between 20 h and 1 week. The time difference between approval of prescription by the GP and access to medication was 5 days ± 2.1 days (range = 1.9–7.0 days).Conclusion:The widespre

Journal article

Powell RA, Kendall K, Cislaghi B, El-Osta Aet al., 2021, Self-care, social norms and anomie during COVID-19: from contestation of the greater good to building future normative resilience in the UK, Journal of Epidemiology and Community Health, Vol: 75, Pages: 925-926, ISSN: 0143-005X

Journal article

El-Osta A, Webber I, Alaa A, Bagkeris E, Mian S, Sharabiani M, Majeed Aet al., 2021, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, Publisher: Cold Spring Harbor Laboratory

Objective To assess the suitability of primary care vignettes in benchmarking the performance of online symptom checkersDesign Observational study using publicly available, free online symptom checkersParticipants Three symptom checkers (Healthily, Ada and Babylon) that provided consultations in English. 139 standardized patient vignettes were compiled by RCGP. Three independent GPs interpreted the vignettes to arrive at a “Gold Standard” consisting of 3 dispositions and divided into one of three categories of triage urgency: (1) emergency care required, (2) primary care required and (3) self-care.Main outcome measures Six professional non-medical and lay inputters simulated 2774 standardized patient evaluations using 3 online symptom checkers (OSC). We recorded when OSC provided a triage recommendation and whether it correctly recommended the appropriate triage recommendation across three categories of triage urgency (emergency care, primary care or self-care). We collected data on whether the solution appeared within the first 3 dispositions in each of the standards across 2774 standardized patient evaluations.Results When benchmarked against the Gold Standard, Healthily provided an appropriate triage recommendation 61.9% of the time compared to 45.3% and 42.4% of the time for Babylon and Ada respectively. There was poor agreement between OSC consultation outcome and Gold Standard dispositions. When compared to the Gold Standard, Healthily gave an unsafe “under-triage” recommendation 28.6% of the time overall across the three categories compared to 43.3% for Ada and 47.5% for Babylon (P<0.001).Conclusions OSCs recommended ‘very unsafe’ triages only <4% of the time suggesting that the online consultation tools are generally working at a safe level of risk. Primary care vignettes are a helpful tool to support development of OSC, but not ideally suited to benchmark the performance of different OSC. Real-world evidence studies

Working paper

Symington E, El-Osta A, Birrell F, 2021, Supported self-care is integral to lifestyle medicine: Can virtual group consultations promote them both?, Lifestyle Medicin Journal, Vol: 2, Pages: 1-5, ISSN: 2688-3740

Journal article

WHO, 2021, WHO Guideline on Self-Care Interventions for Health and Well-Being, https://www.ncbi.nlm.nih.gov/books/NBK572699/

Self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions.The World Health Organization (WHO) uses the following working definition of self-care: Self-care is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker. The scope of self-care as described in this definition includes health promotion; disease prevention and control; self-medication; providing care to dependent persons; seeking hospital/specialist/primary care if necessary; and rehabilitation, including palliative care. It includes a range of self-care modes and approaches. While this is a broad definition that includes many activities, it is important for health policy to recognize the importance of self-care, especially where it intersects with health systems and health professionals.Worldwide, an estimated shortage of 18 million health workers is anticipated by 2030, a record 130 million people are currently in need of humanitarian assistance, and disease outbreaks are a constant global threat. At least 400 million people worldwide lack access to the most essential health services, and every year 100 million people are plunged into poverty because they have to pay for health care out of their own pockets. There is an urgent need to find innovative strategies that go beyond the conventional health sector response.While “self-care” is not a new term or concept, self-care interventions have the potential to increase choice, when they are accessible and affordable, and they can also provide more opportunities for individuals to make informed decisions regarding their health and health care. In humanitarian settings, for example, due to lack of or limited health infrastructure and medical services in the crisis-affected areas

Journal article

Harris M, Kreindler J, El-Osta A, Esko T, Majeed Fet al., 2021, Safe management of full-capacity live/mass events in COVID19 will require mathematical, epidemiological and economic modelling, Journal of the Royal Society of Medicine, Vol: 114, Pages: 290-294, ISSN: 0141-0768

Journal article

Donnat C, Bunbury F, Kreindler J, Filippos F, El-Osta A, Esko T, Harris Met al., 2021, A Predictive Modelling Framework for COVID-19 Transmission to Inform the Management of Mass Events, Journal of Medical Internet Research, ISSN: 1438-8871

Journal article

El-Osta A, Alaa A, Webber I, Riboli-Sasco E, Emmanouil B, Millar HL, Vidal Hall C, Majeed Aet al., 2021, How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the United Kingdom? A cross-sectional online survey, BMJ Open, Vol: 11, Pages: 1-11, ISSN: 2044-6055

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age childrenDesignCross sectional online survey of parents of primary and secondary school-age childrenSettingCommunity settingParticipants 1214 parents of school-age children in the United KingdomMethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA three-item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression modelsMain outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.Results Half of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single-parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study-space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. Two modifiable health seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) were identified as key factors in reducing feelings of social isolation and loneliness during lockdown.

Journal article

El-Osta A, Alaa A, Karki M, Riboli-Sasco E, Majeed Aet al., 2021, Assessing implementation levels of the WHO consolidated guideline on self-care interventions in policy and practice (In Kenya, Nigeria & Uganda)

Report

Bloom C, Ramsey H, Alter M, Lakhani S, Wong E, Hickman K, Elkin S, Majeed A, El-Osta Aet al., 2020, Qualitative study of practices and challenges of stepping down asthma medication in primary care across the UK, Journal of Asthma and Allergy, Vol: 13, Pages: 429-437, ISSN: 1178-6965

Background: Guidelines recommend that asthma treatment should be stepped down to the minimally effective dose that achieves symptom control to prevent medication side effects and reduce unnecessary costs. Little is known about the practice of stepping down and the challenges in primary care, where most asthma patients are managed.Objective: To explore views, experiences, barriers and ideas, of doctors, nurses and pharmacists working in primary care, related to step down of asthma medication.Methods: Primary care practitioners from across the UK participated in a survey and/or semi-structured interview. Questions explored four main areas: how asthma medication is reviewed, views on asthma guidelines, perceived barriers faced by healthcare workers and facilitators of stepping down. Qualitative content analysis enabled data coding of interview transcripts to identify major themes.Results: A total of 274 participants responded to the survey, 29 participated in an interview (12 doctors, 9 nurses, and 8 pharmacists), working in GP practices from across the UK. Nearly half of the survey participants infrequently step down asthma medication (doctors=42.7%, nurses=46.3%). Four major themes related to barriers to stepping down were (i) lack of awareness of the need to step down, (ii) inertia to step down, driven by low confidence in ability, fear of consequences, and concern for who is responsible for stepping down, (iii) self-efficacy of ability to step down, influenced by lack of clear, applied guidance and limited training, and (iv) feasibility of step down, driven by a lack of systematic acceptance of stepping down and time. Strategies proposed to reduce overtreatment included education and training, improved gathering of evidence and guidance, and integrating step down into routine asthma care.Conclusion: Failure to implement this guideline recommendation into everyday asthma management is influenced by several contributing factors. Future directions should include addre

Journal article

Wang C, Bakhet M, Roberts D, Gnani S, El-Osta Aet al., 2020, The efficacy of microlearning in improving self-care capability: a systematic review of the literature, PUBLIC HEALTH, Vol: 186, Pages: 286-296, ISSN: 0033-3506

Journal article

Bakhet M, Ul-Haq Z, Kamalati T, Lucas A, Majeed A, El-Osta Aet al., 2020, Blood tests in general practice: the use of routine data to characterise venous blood testing in North West London, 2016–2018, British Journal of General Practice, Vol: 70, ISSN: 0960-1643

Background Laboratory testing is an integral diagnostic tool, contributing to 70% of diagnoses in the NHS today. Its use has been steadily increasing despite estimates that ≤40% of blood tests ordered are unnecessary. Understanding blood-testing patterns is a fundamental step to tackling overuse.Aim To characterise the volume, type, and per patient frequency (PPF) of venous blood testing reported in general practice in North West London, 2016–2018.Method Following ethics clearance, aggregate data of blood tests reported in general practice in North West London between 2016 and 2018 were extracted from the Discover database. Non-venous blood test codes and codes not used within the designated time period were excluded. Codes reporting the same analyte were aggregated. Overall volume and PPF were calculated per analyte.Results Three hundred and thirty-six individual analytes were reported and grouped into 35 recognised panels or groupings. Blood testing increased by 16.5% over the 3-year period. Full blood count, urea and electrolytes, liver function tests, and lipid profile accounted for 80.4% of all venous blood tests. Requests for HbA1c increased by 52.8% and non-HDL cholesterol by 148.7%, whereas glucose decreased by 13.3% and urea by 15.7%. The PPF remained unchanged over the 3-year period at 1.29 blood tests per person per year. The coagulation assay had the highest PPF at 3.0.Conclusion Routine general practice data revealed important trends in blood testing. Trends uncovered can inform innovative and targeted solutions to reduce unnecessary blood testing.

Journal article

Pang HY, Bakhet M, Gnani S, Majeed A, El-Osta Aet al., 2019, Leveraging community assets to tackle social isolation and loneliness: a needs assessment of the London Borough of Hammersmith & Fulham, Imperial SCARU, Publisher: Imperial College Business School, #19IC538

This study is an investigation of factors that influence the routine adoption and diffusion of evidence-based asset-based community development (ABCD) initiatives to combat social isolation and loneliness in the contemporary setting (using LBH&F as a case study)

Report

El-Osta A, Webber D, Majeed A, 2019, The Self-Care Academic Research Unit (SCARU), Imperial College London – Written evidence (INQ0037), The House of Lords Science and Technology Committee Inquiry into Ageing: Science, Technology and Healthy Living, Publisher: UK Parliament

Report

El-Osta A, Webber D, Gnani S, Banarsee R, Mummery D, Majeed A, Smith Pet al., 2019, The Self-Care Matrix: a unifying framework for self-care, Self-Care, Vol: 10, Pages: 38-56, ISSN: 2042-7018

backgroundThere is resurgent interest in the concept and practice of self-care as a means to improve the health, wellness and wellbeing of individuals, and as an avenue to mitigate financial pressures and growing demands on health and social care systems worldwide. An ongoing challenge has been the lack of clarity on the specific nature and entire scope of self-care, coupled to a lack of a universal or widely accepted framework that could support the conceptualisation and study of self-care in its totality, in all settings and from different perspectives.objectivesTo advance a comprehensive yet pragmatic and widely accessible framework to support the conceptualisation of self-care in its totality, in order to facilitate the development, commissioning, evaluation and study of self-care initiatives across a variety of settings.Method and framework developmentA pragmatic review of the academic and lay literature was undertaken to identify extant theories and conceptual models of self-care. Following a content analysis, the models were characterised, and a configuration matrix was constructed to illustrate the key components and main themes of each model. These themes were organised into a number of domains which were grouped together into cardinal dimensions of self-care. The dimensions of self-care were consolidated in an inclusive framework and visually depicted on a schema to illustrate their inter-relationship.resultsWe identified a total of 32 candidate models, theories and frameworks of self-care. Characterising these models led to the identification of various themes and domains. These were found to naturally group into four cardinal dimensions of self-care: (1) Activities, (2) Behaviours, (3) Context, and (4) Environment. A new model was synthesised to illustrate the relationship between each dimension on a configuration matrix resulting in the creation of the Self-Care Matrix (SCM).conclusionThe Self-Care Matrix (SCM) is a useful framework that can be used to

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