NIHR open research最新文献

Background: Despite global efforts to improve on vaccine impact, many African countries have failed to achieve equitable vaccine benefits. Reduced vaccine impact may result from interplay between structural, social, and biological factors, that limit communities from fully benefiting from vaccination programs. However, the combined influence of these factors to reduced vaccine impact and the spatial distribution of vulnerable communities remains poorly understood. We developed a Community Vaccine Impact Vulnerability Index (CVIVI) that integrates data on multiple risk factors associated with reduced vaccine impact, to identify communities at risk, and key drivers of vulnerability.

Methods: The index was constructed using 17 indicators selected through literature review and categorised into structural, social, and biological domains. Secondary data was obtained from national Demographic and Health surveys from Uganda (2016) and Kenya (2022), covering 123 districts and 47 counties, respectively. Percentile rank methodology was used to construct domain-specific and overall vulnerability indices.. Geo-spatial techniques were used to classify and map districts/counties from least to most vulnerable.

Results: We observed distinct geographical patterns in vulnerability.. In Kenya, the most vulnerable counties were clustered in the northeast and eastern counties such as Turkana, Mandera, and West Polot. In Uganda, vulnerability was more dispersed, with the most vulnerable districts in the northeast (e.g. Amudat, Lamwo) and southwest e.g. Buliisa,Kyenjojo). Key drivers of vulnerability included long distance to health facilities, low maternal education, poverty, malnutrition, limited access to postnatal care, and limited access to mass media. Some areas with high vaccine coverage also showed high vulnerability, suggesting coverage data may not reliably reflect vaccine impact. Each community showed a unique vulnerability profile, shaped by different combinations of social, structural and biological factors, highlighting the need for context specific interventions.

Conclusions: The CVIVI is a useful tool for identifying vulnerable communities and underlying factors. It can guide the design of tailored strategies to improve vaccine impact in vulnerable settings.

Background: In adults, treatment of growth hormone deficiency with daily recombinant human growth hormone injections has shown to improve many clinical features associated with GHD. Currently, many adults with GHD receive GH treatment indefinitely. However, to date, no study has consistently demonstrated that GH treatment has a sustained beneficial effect in adults with GHD. A randomised controlled trial is needed to understand the impacts of discontinuation of long-term GH therapy in adults. However, prior to embarking on an RCT, the feasibility of a discontinuation study and the acceptability of randomisation to patients and clinicians need to be assessed.

Research aims: (a) to explore the current practice of offering discontinuation of long-term GH treatment in adults in the UK and(b) to assess the feasibility of conducting an RCT looking at the effects of discontinuing long-term GH treatment in adults with GHD.

Methods: This mixed-method study which will be conducted in three phases.Phase 1: An online survey of endocrine clinicians' practice of offering discontinuation of long-term GH therapy in adult patients with GHD.Phase 2: Feasibility cohort study which involves recruiting two groups of adult patients with GHD (aged more than 25 years), who have been on GH treatment for at least 5 years.: (a) an intervention group consisting of 20-25 patients who will be discontinuing their long-term GH treatment for two years and (b) a control group consisting of 20-25 patients who will continue with their GH treatment.Phase 3: Qualitative study. 10-16 participants will be recruited to explore their experiences of participation in the feasibility study using semi-structured interviews.

Potential benefits: This study will provide evidence of current GH treatment discontinuation practice in the UK and determine the feasibility of any future RCT. Long-term, this could promote and underpin the development of the much-needed relevant clinical guidance.

Background: Hospital-acquired pneumonia (HAP) is an important complication of hospital admission, with both high incidence and consequences for patients. However, our understanding of causative organisms and prognostic factors is limited. Although ventilator-associated pneumonia (VAP,) an important subset of HAP,has been extensively investigated, less is known about non-ventilated cases, leading to calls for focused research in this group. This retrospective observational cohort study aims to define a population of patients treated as HAP by comparing ventilated and non-ventilated cases. It aims to clarify how often a microbiological diagnosis is reached, what organisms are frequently identified, and whether this has a relevant impact on the outcomes. The relative impact of positive radiographic changes among patients treated for HAP will also be assessed.

Methods: Data will be obtained from the Health Data Research UK acute care hub, 'PIONEER' Cases meeting coding criteria or a clinical surveillance definition of HAP over a 5-year period will be extracted. Demographic, clinical, and microbiological variables will be analysed initially descriptively, and subsequently, with multiple logistic regression analysis to investigate factors affecting microbiological diagnosis. Key outcome variables are in-hospital, 30-day and 1 year mortality, as well as all-cause readmissions within 1 year. Secondary outcomes include nosocomial infections, such as C. difficile. Kaplan-Meier curves and a Cox proportional hazards regression model will be used to investigate outcomes and compare subgroups. A key comparison is between those in whom a putative pathogen is identified and those treated entirely empirically. For this purpose, we will also compare outcomes using an inverse probability of treatment weighting analysis. Additionally, we will explore identifying consolidation on chest imaging reports using natural language processing to allow consideration of the relative impact this may have on mortality and readmission rates.

Background: Bullying increases during primary school and causes multiple mental/physical health harms. Whole-school interventions offer a feasible means of reducing bullying but few have been evaluated in primary schools. We previously trialled the Learning Together intervention in secondary schools comprising local needs assessment, student and staff participation in decision-making through 'action groups', restorative practice, and a social and emotional skills curriculum. This intervention was effective in preventing bullying and improving mental wellbeing. We aimed to adapt Learning Together for primary schools (Learning Together Primary Schools (LTPS)). This paper reports on how we adapted intervention materials to produce the LTPS intervention through a review of research evidence, online survey, and patient and public involvement and engagement (PPIE).

Methods: We conducted a rapid review of existing systematic reviews, online survey of primary schools in south-east England, and multiple PPIE workshops. PPIE was conducted with two primary schools (10 staff members and 20 pupils), with a group of 10 pupils from five primary schools, and with a group of six parents with primary-school-aged children.

Conclusions: We refined our initial plans for LTPS, developing an intervention appropriate for primary schools and supported by full materials, training and external facilitation. We retained key components including restorative practice and action groups and made several refinements, including guidance for action group implementation to accommodate for primary schools' smaller capacities. No refinements were made to the intervention theory of change. We found that it is possible to refine and elaborate interventions to provide full materials and support via processes drawing on evidence review, a survey and PPIE. Although not all PPIE suggestions could be acted upon, PPIE proved valuable in ensuring the feasibility and acceptability of the intervention in primary schools. Future work will include a pilot trial to assess whether progression to a full trial is justified.

Study registration: ISRCTN10215449 https://doi.org/10.1186/ISRCTN10215449.

Introduction: Motor Neurone Disease (MND) is a neurodegenerative condition affecting motor neurons in spinal cord and brainstem, leading to a reduced life expectancy. This study describes demographic trends in MND-associated mortality in the United States over a 20-year period.

Methods: Data was extracted from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research underlying cause of death database. All death certificates from 1999-2020 with MND (G12.2) recorded as the cause of mortality were extracted. Annual MND-associated crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 persons with 95% confidence intervals (CI) were calculated. Joinpont regression was used to calculate the annual trends in MND-associated mortality by calculating the annual percentage change.

Results: Between 1999 to 2020, there were a total 140,945 MND-associated deaths. Overall AAMR was 1.9 per 100,000 persons (95% CI 1.9-1.9). Male sex had a consistently higher AAMR (2.3 per 100,000 95% CI 2.3-2.3) than female sex (1.6 per 100,000 95% CI 1.5-1.6) across the study period. White patients had higher AAMR (2.1 per 100,000 95% CI 2.0-2.1) than Black/African Americans (1.1 per 100,000 95% CI 1.0-1.1), American Indians/Alaska Natives (0.8 per 100,000 95% CI 0.7-0.9), Asians/Pacific Islanders (0.8 per 100,000 95% CI 0.7-0.9). The 3 US States with the highest AAMR were Vermont, followed by Minnesota and Maine.

Conclusions: There are a significant number of MND-associated deaths annually in the United States. The knowledge of these trends facilitates the design of appropriate services in areas of higher need, allowing for the introduction of pathways that support more suitable care and enhanced quality of life.

Background: The consequences of critical illness can be substantial and multifactorial, encompassing physical deconditioning, mental health impairments, fatigue, and declines in health-related quality of life. We hypothesise that for people discharged after intensive care unit (ICU) for a critical illness, a six-week remote multicomponent rehabilitation intervention improves health-related quality of life, physical function, fatigue, mood, and other health-related outcomes after eight weeks, compared to standard care.

Methods: This is a pragmatic, randomised controlled, open-label, assessor blind, multicentre, clinical and cost effectiveness trial with internal pilot and embedded process evaluation. Recruitment will take place in NHS hospitals across the UK. Adults (n=428: control n= 197; intervention: n=231) within 12 weeks of discharge from hospital following an ICU admission for critical illness, requiring mechanical ventilation ≥48hours will be recruited.The intervention is a six week multicomponent, structured, rehabilitation programme, delivered remotely by a trained intervention team. The intervention includes four components: weekly symptom management; targeted exercise; psychological support, and peer support and information. The control group will receive standard NHS care.The primary outcome is Health-related quality of life (HRQoL) at eight weeks post-randomisation measured using the EQ-5D-5L. Secondary outcomes are: HRQoL (six months), physical function, fatigue, illness perceptions anxiety and depression, healthcare resource use at eight weeks and six months and intervention acceptability.

Conclusions: This trial will test a centrally delivered mulitcomponent rehabilitation intervention for survivors of critical illness, irrespective of geographic location or critical illness diagnosis.

Trial registration: The trial is registered (04.07.2022) with the International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN11266403 https://doi.org/10.1186/ISRCTN11266403.

Background: The incidence and severity of liver disease in the United Kingdom have increased over the last 20 years. Many patients present with advanced disease with limited treatment options and subsequently high morbidity and mortality. There was also a significant correlation with deprivation. Strategies that support the earlier detection of liver disease are paramount to reverse this trend. Despite significant progress in terms of novel pathways, the optimal strategy for early detection of liver disease remains unknown. Novel ways to tackle the deprivation gradient and reduce health inequalities are urgently required.

Methods: Clinical research has an enormous role to play both in terms of identifying the true scale of this challenge, where current gaps exist, and to identify the optimal early detection strategies and their implementation. We therefore established Liver Research Cymru (LRC) a multi-disciplinary collaboration that seeks to maximise the benefits from our existing data sources and clinical networks and increase the output of hepatology research in Wales.

Results: LRC has developed the first Wales wide research collaborative. We have successfully collaborated with the Secure Anonymised Information Linkage (SAIL) data resource to develop a greater understanding of liver disease burdens through comprehensive analysis of primary and secondary care data. We are now using this information to evaluate the effectiveness of local early detection pathways and to identify the scale of delays in diagnosis with a view to addressing this important care gap.

Conclusion: LRC has successfully brought together patients. Hepatologists and population/primary care academics to better understand current discrepancies in the early diagnosis of liver disease in Wales. In addition, it has laid a foundation for future research work based both on our preliminary findings and allowed us to collaborate with other more established liver disease research groups.

Background: This study aimed to collect and summarise information on e-bike and e-scooter use in areas with and without e-bike (EB) and e-bike plus e-scooter (EB+ES) combined share-hire schemes.

Methods: This study employed a repeated cross-sectional design. An online survey asking questions about demographics, travel, and health was completed by people in August and September 2023 before the schemes were launched in Bristol (EB+ES) and Leeds (EB), with Bradford and Sheffield as control sites. A resurvey was conducted at the same sites one year later, but also in Bath (EB+ES) and Plymouth (EB). We also interviewed eight e-bike and e-scooter users and non-users in Bristol (n=4) and Leeds (n=4).

Results: Following data cleaning, 3771 remained in the baseline sample and 5370 remained in the resurvey sample. The majority of participants reported having never used an e-bike (baseline: 61%; resurvey: 69%) or e-scooter (baseline: 77%; resurvey: 84%). At baseline, the most common e-bike access route was the use of their own e-bike (45%), with access via a share-hire scheme lower at 25%. In the resurvey sample, access levels were similar via a share-hire scheme (38%) and personal e-bikes (36%). The most common e-scooter access route was a share-hire scheme (baseline: 60%; resurvey: 74%). The most common weekly e-bike and e-scooter destinations were leisure/leisure venues, followed by work/education and shopping/errands.Half said they would not use an e-bike scheme and 63% indicated they would not use an e-scooter scheme. Potential users were willing to walk ~500 m to access an e-bike/e-scooter.Interviewees generally supported share-hire schemes, seeing them as a good addition to the wider transport offer, but with more support for e-bikes and reservations around e-scooters.

Conclusions: These data will be important for a later evaluation of EB and EB+ES share-hire schemes on public health, social, economic, and environmental factors.

Introduction: Globally, childhood immunization is one of the most important public health interventions contributing to a significant reduction in childhood mortality and morbidity. This achievement has been made possible by several concerted efforts at the international and national levels. However, challenges persist, including disparities in vaccine coverage, consequently increasing vaccine vulnerability. This review aimed to examine how vulnerability issues are framed and addressed in Kenya's health sector and immunization policy documents.

Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines guided the review process. Policy documents were retrieved from online searches, searching through the reference list of retrieved documents and requesting relevant documents from stakeholders. To select documents, we screened the titles and executive summaries of documents guided by the exclusion and inclusion criteria. Data was extracted using a data extraction template prepared in Excel, capturing the general information about the documents and the specific information about vulnerability. The extracted data was then organized thematically to address the review objectives.

Results: Twenty-one documents were included for final review. Of these, four were immunization programme documents, 15 were documents that cut across the entire health sector and two were legislative documents. Across the documents, different vulnerable groups were outlined. We developed four typologies of vulnerability from the groups listed in the documents, namely: vulnerability as socio-economic condition; vulnerability as biological and health condition; and vulnerability as a physical location. Some of the strategies proposed in the documents to address vulnerability issues included, adopting a rights-based approach to service provision, removing financial barriers and conducting immunization outreach activities.

Conclusion: Future policy development should recognize the overlapping and intersecting nature of vulnerability factors and develop comprehensive and flexible approaches to address various forms of vulnerability.