Over recent years, public awareness of ADHD has increased, alongside a rise in assessment referrals. There is urgent need for large-scale evidence on the prevalence and incidence of recorded ADHD to understand diagnostic coverage in England. Data were used from CPRD Aurum, a large longitudinal database of records from primary care practices across England. Point prevalence of recorded ADHD was estimated at a fixed index date (30.06.2025). Estimates of ADHD population prevalence from previous research were used as reference values to contextualise recorded diagnosis rates. Crude incidence of recorded ADHD per 1000 person-years was calculated overall. Annual incidence over the study period (2000-2024) was also calculated to understand trends in ADHD recording over time. Data from 3,536,476 to 42,241,788 patients were used for prevalence and incidence analyses respectively. Point prevalence of recorded ADHD was 1.19% (95%CI = 1.18-1.21), with higher prevalence in males than females, and decreasing prevalence with age. Comparisons of these estimates with documented population prevalence of ADHD showed that ADHD diagnosis rates in England remain substantially lower than published estimates of prevalence. The gap between recorded diagnosis rates and published reference prevalence estimates varied across groups, ranging from 28.71% (males aged 18-24) to 93.51% (males and females aged 65+). Crude incidence of recorded ADHD was 0.61 per 1000 person-years (95%CI = 0.61-0.61). Annual incidence rates increased markedly over the study period, with an acceleration of ADHD recording from 2020. Highest incidence was observed in males aged <18, and lowest incidence was in males and females aged 65+, for whom rates of ADHD remained stable and low across follow-up. Findings provide a detailed picture of current diagnostic coverage and temporal change. Results indicate that although ADHD diagnoses have increased substantially over the past decade, recorded ADHD diagnosis rates in England remain substantially lower than published estimates of ADHD prevalence, particularly in older age, suggesting potential under-recognition. Findings highlight an urgent need for diagnostic services that are accessible across the lifespan and adequately resourced to meet need. Medical Research Foundation (MRF-RGM-MH-24-114); British Academy (PFSS23∖230043).
The global prevalence of dementia is rising rapidly, placing increasing pressure on health and social care systems to deliver coordinated and equitable post-diagnostic support. In England, service fragmentation and workforce constraints limit the delivery of recommended care models. Non-clinical dementia navigator (DN) models have emerged as a potentially scalable approach to improve care coordination and access, yet evidence on their system-level impact remains limited. We estimated the population of people with diagnosed dementia in England eligible for DN support between 2025 and 2030 using NHS data and projected prevalence trends. Eligibility was adjusted for undiagnosed cases, care home residents, and expected uptake. Costs of delivering DN-led care were derived from existing UK service models and unit costs, while potential savings were based on reductions in health-care utilisation observed in the US Care Ecosystem trial. Probabilistic sensitivity analyses were conducted to assess uncertainty. The number of eligible individuals receiving DN support is projected to increase from 300 000 in 2025 to 360 000 in 2030. Delivering this model would require ~940 to 1120 link workers. Annual costs are estimated at £224 million in 2025, rising to £343 million in 2030. These are offset by estimated savings of £1140 million and £1750 million, respectively. Even under conservative assumptions, DN models generate net savings. Scaling up DN-led care in England could support large numbers of people with dementia while generating substantial health system savings. These findings suggest that navigator-based models offer a feasible and cost-saving approach to delivering coordinated post-diagnostic dementia care at scale.
We undertook a statistical modeling study to determine the effect of implementing population-based prostate-specific antigen (PSA) screening in England on overdiagnosis and PSA testing rates in comparison with the current opportunistic testing policy. Our model merged English data on life expectancy, rates of PSA testing and incidence of prostate cancer by stage with epidemiological data on lead time. In the base scenario, introduction of population-based screening led to an approximate 25% reduction in both PSA testing and overdiagnosis in the population compared with the current policy. This was due to the anticipated decrease in PSA testing and overdiagnosis in men aged 70+ years being larger than the projected increase in PSA testing and overdiagnosis in men 50-69 years. The overall incidence of early-stage prostate cancer was similar. Population-based screening was found to detect more early-stage cancers that were not overdiagnosed, and is therefore likely to have a greater impact on prostate-cancer mortality than current policy. Findings were robust in sensitivity analyses including an entirely independent modeling approach based on the UK Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP). In conclusion, opportunistic screening policies in England have led to high rates of overdiagnosis and PSA testing. A risk-adapted, population-based prostate cancer screening program would likely reduce the number of PSA tests and overdiagnoses, and increase benefits of PSA testing from reduced prostate-cancer mortality. Population health in England would be improved by adopting an organized PSA screening program and policies to reduce opportunistic PSA testing.
Neuroendocrine prostate cancer (NEPC) is a rare and aggressive variant of prostate cancer (PC) that can be de-novo (d-NEPC) or transform from prior prostate adenocarcinoma (PCa) as treatment-emergent NEPC (t-NEPC). This study aimed to study the clinical characteristics and overall survival (OS) of NEPC using data from the SEER and NCRAS registries, and to compare their OS. A total of 1,465 patients with NEPC were extracted from SEER (N=990, 2010-2022) and NCRAS (N=475, 2010-2021). Patients were classified as t-NEPC if preceded by a documented PCa. The primary outcome is OS measured from the date of NEPC diagnosis. Kaplan-Meier analysis, log-rank test, and Cox regression were performed for SEER, NCRAS, and pooled cohorts. t-NEPC represented 9.9% in NCRAS and 15.2% in SEER. Small cell carcinoma was the most common subtype (80.2% NCRAS, 74.7% SEER). Median time to transformation was 4.63 years in NCRAS and 5.0 years in SEER. In the pooled cohort, median OS was 9 months for d-NEPC and 7 months for t-NEPC (log-rank p<0.001). The 60-month OS was 7.9% for d-NEPC and 4.0% for t-NEPC. In the pooled multivariable Cox regression, t-NEPC was independently associated with worse OS (aHR 1.30, 95% CI 1.11-1.53, p=0.001). Data source was not associated with OS (aHR 1.08, p=0.206), indicating comparable OS between the USA and England. In this bi-national, population-based study, t-NEPC was associated with worse OS than d-NEPC. OS for NEPC was comparable between the USA and England. These findings support distinguishing d-NEPC from t-NEPC.
Preterm Births (PTBs) are viewed as one of the major causes of neonatal morbidity, mortality and health-system cost in England. The incidence of preterm is persistently greatest among those experiencing socioeconomic and ethnic inequalities. This study aims to quantify deprivation and ethnicity gradients, using the available dataset, in PTBs and subsequently to translate deprivation-related inequality into policy-relevant priority bands. It analyses aggregated live-birth data for England (2020-2021), stratified separately by gestational age × Index of Multiple Deprivation (IMD), and gestational age × maternal ethnicity. Socioeconomic inequalities are summarised using the Slope Index of Inequality (SII), Relative Index of Inequality (RII), deprivation-attributable excess cases, and the population attributable fraction (PAF) with the least deprived quintile as reference. Subsequently, a two-axis rule combining relative risk and share of excess burden is applied to derive the prioritised target bands. The data analysed comprises 1,179,195 live births in 2020-2021, demonstrating a monotonic increment across populations, from 6.39% in the least deprived quintile to 8.71% in the most deprived. The most deprived quintile accounted for 57.7% of deprivation-attributable excess PTBs. Differences across ethnic disparities were also evident, with the highest PTB rate being among Black Caribbeans (10.22%; RR 1.37 vs White British births). Translation of inequalities into deprivation-based priority bands provides an empirical bridge between surveillance and targeted universalist prevention policy, thus supporting proportionate resource allocation in high-burden populations.
An update to the NICE Type 2 diabetes (T2DM) guideline in February 2022 recommended an SGLT2 inhibitor be offered to people with cardiovascular disease (CVD) or heart failure (HF) as comorbidities and considered for people at high CVD risk. We report uptake of this guideline in England 18 months after its publication. Observational cohort study using Clinical Practise Research Data Link records linked to hospital admissions. Presence of a current prescription for an SGLT2 inhibitor was evaluated in people with T2DM on 1 September 2023, stratified by CVD category (CVD only; HF only; both; high CVD risk; low CVD risk) and chronic kidney disease status, and by age, gender, ethnicity, deprivation and T2DM duration. Adjusted associations between patient characteristics and uptake were evaluated using logistic regression. In the cohort of 587 826 people with T2DM, the percentage with a current prescription was 19.5% for people with CVD, 29.4% for people with HF, 30.5% for people with both CVD and HF, and 19.9% and 20.2% respectively for people at high and low CVD risk. In age-stratified analyses, uptake was higher in people with more comorbidities. In adjusted models, uptake was lower in people aged > 60, women, Black people and people living in areas of higher deprivation. Whilst prescribing of SGLT2 inhibitors continues to rise in England, recent trends indicate an opportunity remains to increase uptake. Action is necessary to address inequalities by ethnicity and deprivation, and lower uptake for people with T2DM and CVD without HF.
Between December 2022 and July 2024, the English National Health Service (NHS) experienced 27 periods of industrial action spanning 78 days, involving hospital and ambulance staff. We examined the direct and indirect impacts of these strikes on emergency department (ED) performanceDesign:A retrospective causal mediation analysis. Effects were estimated using mixed effects accelerated failure time, linear and generalised linear regression models with patient- and hospital-level covariates within a causal mediation framework. 20 major (Type 1) EDs in England with high-quality linkage across ED, inpatient, and imaging data. Patients attending these EDs between August 2022 and July 2024. A patient's time in ED analysed in relation to strike activity at the mid-point of attendance by one or more staff groups: (1) resident/junior doctors, (2) consultants, (3) both resident and consultant doctors, (4) paramedics and (5) nurses. Average duration of ED attendances reduced on days affected by residents' strikes (-12.6%, 95% CI -10.4% to -14.8%), consultant strikes (-5.6%, 95% CI -2.7% to -8.4%), paramedic strikes (-4.5%, 95% CI -2.0% to -6.8%), but increased when residents and consultants were on strike simultaneously (+7.2%, 95% CI 3.8%-10.7%). There were no significant changes to ED durations during nurse strikes (-1.7%, 95% CI -1.5% to 4.7%). Changes in emergency inpatient occupancy explained a proportion of the change in average ED durations (resident doctor 10.4%, consultants 53.3%, combined doctors 5.4% and paramedics 14.3%). The impact of strikes on ED attendance volumes was mixed. The net effect of these changes explained 1.5%, 16.8% and 28.8% of the change in average ED durations observed during residents, combined doctor and paramedic strikes, respectively. During the residents' strikes, patients were more likely to receive treatments in ED (adjusted incident risk ratio 1.013, 95% CI 1.008-1.018), but less likely to be admitted (adjusted odds ratio 0.963, 95% CI 0.946-0.980). Efforts to meet the 4-h target intensified during the resident, consultant and combined doctors strike, but reduced during the nurse and paramedic strikes. This explained 2.7% and 17.1% of the changes in average ED durations observed during the resident and consultant strikes, respectively. There were substantial reductions in many forms of planned hospital care during the resident, consultant and combined doctor strikes, but these did not contribute to the observed reductions in ED durations. Industrial action - particularly by resident and consultant doctors - was associated with shorter ED stays, partly mediated by greater emergency bed availability, lower demand and intensified throughput efforts. However, much of the reduction during resident strikes remained unexplained, suggesting unmeasured operational or behavioural adaptations. Substantial reductions in planned care did not significantly affect ED performance.
Non-English-speaking migrant women who need interpreters face healthcare barriers, exacerbating maternal health inequalities. Primary care-based preconception interventions can reduce preconception risk factors but require patient engagement, which has been affected by COVID-19. We aimed to identify whether women interact with general practice (GP) and accident and emergency (A&E) in the year pre-pregnancy, differences between interpreter-users and non-interpreter-users, and changes during COVID-19. English population-wide linked patient-level administrative data including primary, secondary and maternity care were used. Women with estimated pregnancy start dates from 1 March 2019 to 29 February 2024, aged 18-49 were included.Outcomes were interactions with GP and A&E in the year pre-pregnancy (yes/no) according to interpreter-use. Outcomes were recorded according to pregnancy start date: 1 March 2019 to 29 February 2020 (pre-pregnancy-year pre-COVID-19-onset), 1 March 2020 to 28 February 2021 (pre-pregnancy-year overlapping with COVID-19-onset) or 1 March 2020 to 29 February 2024 (pre-pregnancy-year after COVID-19-onset). Logistic regression compared GP/A&E interaction pre-pregnancy among interpreter-users versus non-interpreter-users. Among 2 182 280 women, 61 140 (2.8%) used interpreters. Median age was 31.0 among interpreter-users and 30.9 among non-interpreter-users. 49.7% (n=30 370) of interpreter-users were in the most deprived quintile versus 22.7% (n=480 470) of non-interpreter-users, and 62.5% (n=38 150) were of ethnic minorities (excluding white minorities) versus 22.1% (n=468 530) of non-interpreter-users.79.5% (n=48 625) of interpreter-users interacted with their GP pre-pregnancy, versus 85.0% (n=1 802 925) of non-interpreter-users. Interpreter-use was associated with lower adjusted odds of GP interaction (aOR 0.74 (95% CI 0.72 to 0.75)), with lower odds among women whose pre-pregnancy year was post-COVID-onset.Adjusted odds of A&E interaction in the year pre-pregnancy were lower among interpreter-users, with minimal change during COVID-19. Although interpreter-users were less likely to interact with GP, indicating barriers to healthcare access, most still did, making GP a promising avenue for addressing preconception health. Ensuring interpreter-need is recorded at GP registration is important. Widening inequalities since COVID-19 suggest a proactive approach is required to reduce inequalities.
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Healthcare services in England often support cigarette smoking cessation, yet little is known about how healthcare professionals support people to quit who use other non-cigarette tobacco products, such as cigars, cigarillos, shisha and different forms of chewing tobacco. This study explored healthcare professionals' (1) experiences of providing cessation support for non-cigarette tobacco, (2) perceived barriers and facilitators and (3) suggestions for improving service provision. Four semistructured focus groups and interviews were conducted with (N=19) specialist (tobacco dependence advisors) and non-specialist (eg, pharmacist, nurse) healthcare professionals who have experience in providing smoking cessation support across England. Data were analysed using iterative categorisation with thematic analysis. Healthcare professionals vary in their experiences supporting people to stop using non-cigarette tobacco products, usually depending on the demographic composition of the local community. Professionals who regularly engage with people who use non-cigarette tobacco described a range of tailored support provided, such as behavioural support, nicotine replacement therapy and vapes. Structural barriers to providing support included screening tools that only ask about 'smoking', commissioning that restricts services to cigarette use, and limited training and resources for non-cigarette products. Professional barriers included low confidence in supporting cessation due to a lack of official guidance on these products. Recommendations to improve services included adapting screening tools to capture non-cigarette tobacco use, expanding service eligibility to all tobacco users, developing culturally tailored resources and strengthening community partnerships to improve outreach. In a sample of healthcare professionals in England, there was substantial variation in the provision of, and healthcare professionals' confidence in providing, support for non-cigarette tobacco cessation. Amending screening tools, developing clinical training and guidelines and expanding access to services for all types of tobacco use could improve support provision and improve treatment equity.
Alcohol and tobacco are risk factors for non-communicable disease and deaths in England. People using both substances have increased health risks. While increasing tax on each product has been shown to reduce consumption and harm, little research has examined effects of changing both taxes together. Work package 1: describe potential tobacco and alcohol tax policies; work package 2: analyse purchasing patterns across population subgroups; work package 3: estimate industry tax-pass-through; consumer response to price changes for 12 products; work package 4: simulate impact of 33 policy options, United Kingdom Government 2021 proposals to restructure alcohol duty and (after project end date) 2023 alcohol duty reform. Work package 1 reviewed literature and interviewed stakeholders to identify policy options. Work package 2 analysed repeat cross-sectional survey data on purchasing. Work package 3 used quantile regression on market research data to estimate tax pass-through and a two-stage Tobit model to estimate consumer responses (own-price and cross-price elasticities) for 12 products (beer, cider, wine, spirits and ready-to-drinks, split off-trade/on-trade; cigarettes, roll-your-own tobacco). Work package 4 developed tax modelling for the Sheffield Tobacco and Alcohol Policy Model (v2.1.0) to analyse work package 1 policy options. Later, version v2.4.2 was used to analyse emerging policy on alcohol duty reforms. Effects of United Kingdom tax policies in England, covering 2017-50. Life course simulation of individuals aged 18-89; 2017-50. Tax policies changes: (1) specific duty per product, (2) duty escalators for alcohol and tobacco, and Minimum Excise Tax on tobacco, (3) hypothetical strength-based alcohol taxes, (4) United Kingdom Government's 2021 proposals for alcohol duty reform and (5) analysis of United Kingdom Government's implemented Alcohol Duty Reform 2023. Changes in participation in drinking or smoking, amounts consumed, expenditures, Government tax revenues, retailer revenues, risks of hospitalisation and death from over 60 clinical conditions, National Health Service secondary costs, quality-adjusted life-years, mortality and health inequalities. Work package 1 identified policy options. Work package 2 showed variations in expenditure by subgroup. Work package 3 showed that retailers increased prices of expensive products by more than expected after tax rises, keeping cheap product prices lower. Work package 3 showed statistically significant participation and consumption price responsiveness for all 12 products. Work package 4 compared 33 policies, showing that higher tax increases, especially for cider and hand-rolled tobacco, are effective at reducing smoking rates, drinking and deaths over 20 years. Effects were largest for people living in more deprived areas. Tailored modelling (after project end date) examined United Kingdom Government's 2023 implemented alcohol duty reform, estimating a small reduction in alcohol consumption and deaths. In contrast, a policy to increase cider taxes to be in line with beer could result in a 30 times larger reduction in deaths. Uncertainty in estimates remains. Data used were collected pre-coronavirus disease discovered in 2019. Sales data were from legal retailers; illicit tobacco was not examined. Each sub-study has its own data limitations. Combined increases in tax on tobacco and alcohol could potentially be more effective at reducing disease, National Health Service costs, deaths and health inequalities than raising tax on only one product. Potential trade-offs could exist between health benefits and effects of tobacco and alcohol tax increases on financial burden for those who continue consuming both products. Future tobacco or alcohol tax analyses should factor in inter-linkages between both commodities. We are adapting modelling infrastructure to deliver responsive within-days modelling for new government proposals and budgets. Further work on price elasticities in other countries would be useful. Future analyses will incorporate post-coronavirus disease discovered in 2019 data. We are extending modelling to other United Kingdom countries, and pricing policies beyond tax (e.g. minimum pricing). We are extending analyses to no and low alcohol products and to evaluate observed impacts of the government's alcohol duty reforms. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 16/105/26. Alcohol and tobacco cause many diseases and deaths in England. People who drink heavily are more likely to be smokers. People who smoke and drink heavily are more likely to get ill and die sooner. Increasing alcohol tax has been shown to reduce drinking and increasing tobacco tax has been shown to reduce smoking. But, no research has looked at changing alcohol and tobacco taxes together. We spoke to alcohol and tobacco tax experts to understand tax policy options. We used market research and survey data to examine: how shops pass tobacco tax increases through to consumer prices, how pubs and supermarkets pass through alcohol tax increases to customers, and how much people respond to price changes by quitting smoking or reducing the amount they smoke or drink. We developed a computer model to estimate the effects of 33 possible tax changes, covering the range of changes to tax structures and levels considered to be ‘on the table’. When new United Kingdom Government reforms for alcohol tax were proposed (2021) and implemented (2023), we estimated their effects. When a tax rise happens for alcohol or tobacco, retailers increase prices of expensive products by more than expected and keep cheap product prices lower than expected. When alcohol or tobacco prices rise, some people respond by quitting smoking and reducing their tobacco or alcohol consumption. Computer simulation comparing 33 policies estimates that higher tax increases, especially for cider and hand-rolled tobacco, are likely to be effective at reducing rates of smoking, amount of drinking, and deaths over 20 years. Effects are largest for people in the most deprived areas. The United Kingdom Government’s 2021 proposals and 2023 implemented policy for restructuring alcohol taxes are estimated to result in small reductions in drinking and deaths, but a policy to increase cider taxes in line with beer could substantially reduce deaths. Computer modelling suggests increasing alcohol and tobacco taxes together could be effective in reducing deaths, hospitalisations and National Health Service costs and also reducing inequalities in health between areas. The modelling also enables consideration of the potential unintended consequence of increasing costs for people already with relatively little disposable income if they do not reduce their consumption. It is important for analysis of changes in either alcohol taxes or tobacco taxes to estimate the knock-on effects to consumption and harms from both products. Text in this section reproduces material from HatchardText in this section reproduces material from Hatchard et al.. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The text below includes minor additions and formatting changes to the original text.This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The text below includes minor additions and formatting changes to the original text.
Differential attainment (DA) describes persistent differences in academic and professional outcomes between demographic groups that cannot be explained by differences in ability or effort. In UK public health specialty training, racially minoritised applicants experience lower success rates during recruitment. Peer-led mentoring interventions have shown potential in helping to address inequities by providing access to informal knowledge and support. This study aimed to evaluate the feasibility and early outcomes of a regional peer-led mentoring scheme designed to support racially minoritised applicants applying to UK public health specialty training. Pilot intervention and mixed-methods evaluation. This peer-led pilot intervention was delivered over two public health specialty recruitment cycles in the South-East of England. Applicants from Black and South Asian backgrounds were matched with current public health trainees ("buddies") for informal mentoring. Participation outcomes were tracked, and feedback was collected throughout the scheme alongside anonymous post-scheme surveys of applicants and buddies. In 2023-24, 13% of participants in the buddy scheme were invited to interview, with 4.3% subsequently receiving offers, compared with a national offer rate of approximately 9.8%. In 2024-25, 17.2% of participants were invited to interview and 10.3% received offers, compared with national offer rates of approximately 5.7%. Applicants reported increased confidence and a clearer understanding of the recruitment process. Buddies described mentoring as rewarding but highlighted challenges balancing the role alongside existing workload. This peer-led buddy scheme appears feasible and valued by participants and may help support racially minoritised applicants navigating public health specialty recruitment. However, the small sample size and comparison with overall national offer rates, rather than ethnicity-specific comparator data, limit interpretation of recruitment outcomes. Addressing differential attainment is likely to require interventions beyond peer support alone and should be embedded within broader structural equity initiatives.
Waiting times for planned health care treatments have been increasing in England and other OECD countries. One policy to reduce the impact of waiting times on patients' health is for doctors to prioritise patients according to their health status. This study tests the extent to which publicly-funded patients in poorer health are prioritised on the list, and whether prioritisation differs between public and private providers. We use hospital administrative data in 2015-2021 on hip replacements in England. Our results provide evidence of inpatient waiting-time prioritisation (from specialist addition to list to admission for surgery) based on pre-operative health with a difference of at least 15 days between patients with lowest and highest pre-operative health. The gradient becomes steeper as waiting times increase, and much steeper during COVID-19. While outpatient waiting times (from referral to specialist visit) comprise a substantial proportion of total time waited (inpatient plus outpatient), we find limited evidence of outpatient waiting time prioritisation. Differences in inpatient waiting-time prioritisation between public and private providers are mostly due to different casemix and shorter average waiting times by private providers. We also simulate the effect of prioritisation policies that reduce inpatient waiting times for patients with low pre-operative health by 20% while simultaneously increasing it for those with high pre-operative health. We find that these policies could generate health gains of 183 QALYs in a given year. We conclude that there is scope for improving prioritisation of patients on the waiting list.
There is no consensus for the use of adjuvant chemotherapy (ACT) after radical resection in rectal cancer. We use real-world data from the Netherlands (NL), England and Scotland, from patients who underwent surgery without neoadjuvant chemotherapy, to explore the potential benefit of ACT. Routine administrative healthcare data from the NL (2012-2017), England (2014-2019) and Scotland (2013-2017) were used to identify patients with a clinical or pathological T3, T4, or N+ rectal cancer; managed with radical resection ± neoadjuvant (chemo)radiotherapy. Data on patient, tumour, treatment demographics and survival were collected. Kaplan-Meier curves and Cox regression models were used to understand the association between ACT and 5-year survival. Models were estimated for the total population and different pre-defined subgroups within each cohort, unadjusted and adjusted for relevant confounding factors. 33,211 patients were included, 12,649, 18,729 and 1833 patients from NL, English and Scottish cohorts, respectively. ACT use differed with administration rates of 3.6%, 34.4% and 33.1%, respectively. The use of neo-adjuvant (chemo)radiotherapy was higher in NL (75·7%, 36.2% and 42.3%, respectively). The Hazard Ratio for death at 5 years was in favour of ACT in all three cohorts, reaching statistical significance in the English and Scottish cohorts (adjusted HR 0.66, 95% CI 0.61-0.71) and (adjusted HR 0.50, 95% CI 0.37-0.68), respectively. Whilst this survival benefit must be interpreted with caution due to the limitations of real-world data, in the absence of high-level evidence, it offers further weight to contemporary rectal cancer literature that multimodality treatment including systemic therapy offers an OS in rectal cancer.
Little is known about hepatitis B virus (HBV) and Hepatitis D virus (HDV) coinfection in the UK. HDV screening is recommended among all individuals with HBV, with coinfection associated with increased disease progression. Using data on HDV testing, shared by 11 laboratories in the UK who reported undertaking HDV testing, and national testing data for HBV we established a cohort of individuals tested for HDV, investigating testing pathways, describing characteristics and outcomes of those HDV-RNA positive to inform targeted interventions for testing, diagnosis and linkage to care. Demographic information, clinical assessments, treatment and recent laboratory results from NHS trusts, and through linkage to national healthcare datasets was collected for HDV-RNA positive individuals. Between 2011 and 2021, 42% of individuals newly diagnosed with HBV in England were linked to an HDV test. Anti-HDV positivity was 5.0%, 55.8% were HDV-RNA tested and 45.7% were ever HDV-RNA positive. HDV-RNA positivity in the absence of an anti-HDV result was 6.4%. Among individuals who were HDV-RNA positive, 94.3% were non-UK born, with 24 different primary languages reported, 49% had evidence of treatment, and 48% had evidence of cirrhosis. 10% had died of which 58.4% died of liver disease. In conclusion, our findings indicate that HDV testing in HBV positive individuals in the UK is sub-optimal against testing guidelines, including RNA testing among those who are anti-HDV positive. Considerable work is needed to improve the patient care pathway, to ensure patients are appropriately diagnosed, linked and retained in care, with adequate access to treatment.
IntroductionChildren and young people (CYP) with long-term physical health conditions (LTCs) are at increased risk of emotional and behavioural difficulties, yet barriers to psychological support remain, particularly for families from ethnic minority backgrounds. Mental health drop-in services were set up and evaluated at 6 paediatric healthcare settings, aiming to provide a more accessible route to care.MethodsThis study conducted a secondary analysis of quantitative and qualitative data collected as part of the multi-site roll-out of mental health drop-in services in paediatric healthcare settings to explore their accessibility and acceptability. The services provided short-term psychological interventions delivered by child wellbeing practitioners or equivalent, under supervision of a clinical psychologist 120 families provided quantitative data, and 104 families shared qualitative feedback. Differences in access routes and mental health symptoms were compared across White British families and those from different ethnicities. Inductive, latent content analysis of the open text feedback was conducted to understand families' experiences of the drop-in services.ResultsCYP from ethnic minority backgrounds were over-represented in the present study (32%), when compared with nationwide CAMHs users that identify as non-white British (21%). Families from ethnic minority backgrounds reported comparable mental health outcomes and satisfaction levels to White British families. There was a significant difference in mental health change scores, with ethnic minority families showing greater improvements after accessing the service, t (46) = -3.05, p < .01, d = -1.08. Qualitative analysis found that the services were highly acceptable across ethnicities, highlighting themes of life-changing support, therapeutic relationships, and improved parent and family wellbeing.DiscussionDrop-in services embedded in paediatric healthcare settings are both accessible and acceptable, demonstrating positive clinical outcomes, and positive family feedback across different ethnic groups. This model may help reduce inequalities by improving access to psychological support for ethnic minority families with CYP living with LTCs. Why was the study done? Children and young people with long term illnesses are more likely than others to have poor mental health. However, these children and their families usually struggle to access mental health support. Receiving support can be even harder for families from non-White backgrounds. A drop-in service providing short-term mental health support for these children was set up at six children’s hospitals across England. This study looked at how families from non-White backgrounds accessed these services, and whether it helped their mental health. It also explored what all families, across ethnicities, thought of the service. What did the researchers do? Researchers looked at the mental health of 120 families before and after using the service. They explored if families from non-White backgrounds had the same experience as White British families who used the service. Families gave feedback about the service. This was used to understand what families thought of the service, what they liked about it and what they thought could be improved. What did the researchers find? Researchers found that many families who were not White used the service. Non-White families’ mental health symptoms improved more than White families’ after using the service. Families from all backgrounds shared very positive experiences with the service, mainly focusing on how it changed children's lives, improved parents' mental health, and how it was an easy way to get support. What do the findings mean? Families from all backgrounds shared positive experiences reaching and using the service. Providing mental healthcare this way at children's hospitals may make it easier for children with long term illnesses and families from all ethnicities to receive mental health support.
To examine the association between personality domains and concurrent and incident pain to identify psychological risk and protective factors. Participants were middle-aged and older adults (N > 40,000; Age-range: 23-104, Mean Age = 65.52) from seven cohort studies from the US, England, and Japan. In each sample, personality, demographic factors, disease burden, depressive symptoms, and pain were assessed at baseline. Pain was assessed again 5 to 15 years later. Random-effects meta-analyses indicated that neuroticism was associated with higher likelihood of concurrent (Odds Ratio [OR] = 1.33, 95%CI: 1.26-1.40, p < .001) and incident (OR = 1.16, 95%CI: 1.11-1.21, p < .001) pain. In contrast, higher extraversion and conscientiousness were related to a lower likelihood of concurrent (extraversion OR = 0.86, 95% CI = 0.81-0.93, p < .001; conscientiousness OR = 0.85, 95% CI = 0.83-0.87, p < .001) and incident (extraversion OR = 0.93, 95% CI = 0.90-0.97, p < .001; conscientiousness OR = 0.93, 95% CI = 0.90-0.97, p < .001) pain. Openness and agreeableness were unrelated to both concurrent and incident pain. Disease burden and depressive symptoms partially accounted for the association between personality and pain. Age and sex did not systematically moderate these associations. The present study found replicable associations between personality and concurrent and incident pain. Neuroticism may be a risk factor of pain, whereas extraversion and conscientiousness may be protective factors, suggesting that personality assessment could inform personalized pain interventions.
Enrichment analysis is a cornerstone of "omics" data interpretation, enabling researchers to connect analysis results to biological processes and generate testable hypotheses. Enrichment analysis in metabolomics poses distinct challenges for interpretation and multi-omics integration due to the lack of well-defined and consistent connections to well-curated gene-centered biological knowledge repositories. To address these challenges, we developed hypeR-GEM, a methodology and associated R package that adapts gene set enrichment analysis to metabolomics. hypeR-GEM leverages genome-scale metabolic models (GEMs) to infer reaction-based links between metabolites and enzyme-coding genes, enabling the mapping of metabolite signatures to gene signatures and their subsequent annotation via gene set enrichment analysis. We validated hypeR-GEM using paired metabolomics-proteomics and metabolomics-transcriptomics datasets by assessing whether genes mapped from metabolites significantly overlapped with differentially expressed proteins or transcripts. We further evaluated whether pathways enriched via hypeR-GEM-mapped genes corresponded to those derived from paired proteomic or transcriptomic data. In most datasets analyzed, both the predicted enzyme-coding genes and the associated enriched pathways showed significant concordance with independently derived omics signatures, supporting the utility and robustness of hypeR-GEM. Finally, we applied hypeR-GEM to the analysis of age-associated metabolic signatures from the New England Centenarian Study. The results revealed consistent enrichment of lipid-related pathways, aligning with the well-established role of lipid metabolism in aging, and highlighted additional pathways not captured in the metabolites' annotation, demonstrating hypeR-GEM's practical utility in a real-world use case. The hypeR-GEM R package, documentation, and workflow examples are freely available at https://github.com/montilab/hypeR-GEM and archived at https://doi.org/10.5281/zenodo.20586748. Supplementary data are available at Bioinformatics online.
To investigate the associations of the Short Physical Performance Battery (SPPB) and the Chair Stand Test (CST) with all-cause mortality risk among high-functioning older adults over a 15-year follow-up. Longitudinal cohort study using data from the English Longitudinal Study of Ageing (ELSA) with a 15-year follow-up. General community in England. A population-based sample of 2747 individuals with baseline high physical function (gait speed > 0.8 m/s or > 1.0 m/s). Poor lower extremity function was defined as SPPB ≤ 10 points and CST > 15 s. All-cause mortality during the follow-up. Cox proportional hazards models, adjusted for sociodemographic, behavioural, and clinical factors were used to estimate hazard ratios (HRs). Mortality rates were 19.6 and 39.7 per 1000 person-years for SPPB > 10 and ≤ 10 points, and 21.9 and 41.4 per 1000 person-years for CST ≤ 15 and > 15 s, respectively. The risk of mortality was 31% higher for SPPB ≤ 10 points (HR 1.31; 95% CI 1.12-1.54) and 36% higher for CST > 15 s (HR 1.36; 95% CI 1.13-1.62). In a sensitivity analysis (gait speed > 1.0 m/s), the risk of mortality was 43% higher for SPPB ≤ 10 (HR 1.43; 95% CI 1.11-1.83) and 75% higher for CST > 15 s (HR 1.75; 95% CI 1.30-2.36). Both the SPPB and the CST were associated with mortality risk among high-functioning older adults. However, given its quick, easy application, CST may be preferable in clinical settings.
To describe the clinical characteristics and dental treatment for patients treated at a dental hospital in the United Kingdom. This descriptive study utilized anonymized routinely collected electronic health record data from dental patients who attended Leeds Dental Institute, collected from 2014 to 2023. Patient characteristics, comorbidities and completion of dental treatment were reported through descriptive statistics (mean and standard deviation [SD]; percentage) and by clinic attended. A total of 109,718 patients were included in this study, of whom 58,964 (54%) were female, and 43,828 (40%) lived in the most deprived areas in England. The most frequently recorded comorbidities were joint or bone problems (n = 4913, 5%), chest or breathing problems (n = 4619, 4%), and heart problems (n = 4455, 4%). Across clinic groups, the proportion of patients with at least one recorded comorbidity was highest among those attending periodontal/restorative clinics (24%) and acute dental care clinics (19%). Less than half of all patients (n = 52,655, 48%) completed their dental treatment. Oral surgery had the highest percentage of patients who completed their treatment (n = 10,459, 71%). The sociodemographic and clinical characteristics reported in this study reflect a large population of dental patients from Leeds and the surrounding region. The findings of this study are consistent with literature showing sociodemographic trends in dental attendance. Future linkage of dental electronic health records with hospital records could improve understanding of the complexities of oral-systemic associations further.