December 2020 Department of Primary Care & Public Health NHS must fix its poor record on staff health, for the sake of patients as well as workers Image: Holding onto Hope by Helen Han University of New South Wales
December 2020 It’s now been nine months since Imperial College moved to remote working and teaching because of the Covid-19 pandemic. Although we will continue to largely work this way in the new year, there is hope that we can finally bring this pandemic that has blighted our personal and professional lives, and which has had a huge human cost, under control. In recent weeks, we have had positive news about progress in the development of new vaccines for Covid-19. Many of the staff in the department and our clinical teachers will be involved in the delivery of the new vaccines once they are available for use. Finally, congratulations to Professor Neena Modi on her appointment as President Elect of the British Medical Association and to Professor Azeem Majeed Professor Kosh Ray for having one of his papers selected as the ‘Paper of the Year’ by Head of Department of Primary Care and the Oligonucleotide Therapeutics Society. Public Health Imperial College London Follow Prof Majeed on Twitter We welcome feedback on the ARCHIVE PRIVACY NOTICE newsletter and are taking submissions for future issues. Email your news, events, achievements and stories to us. [email protected] PCPH eMagazine Team Subscribe Unsubscribe Javier Gallego Mehrosa Memood Copyright © 2020 Department of Primary Care & Public Health, Imperial College London
Our new paper published in the Journal of the Royal Society of Medicine discusses excess mortality during the Covid-19 pandemic. The scale of the COVID-19 pandemic has forced policymakers to operate with limited evidence for the relative success of different control measures. Excess mortality is one key outcome measure. The highest excess mortality per million population is seen in Spain, followed by England and Wales. The majority of these excess deaths are caused by COVID-19, but a significant proportion are not directly related to COVID-19. In measuring the impact of COVID-19, mortality is however only one of many important outcomes. Even in ‘mild’ cases not requiring hospitalisation, symptoms can be long-lasting, and heart and lung complications are common, affecting quality of life and ability to work. Beyond the effects on health, the pandemic has disrupted all aspects of society – many countries have experienced record economic recessions, while school closures affect children’s educational attainment.
DEPARTMENT NEWS Child Health Unit (CHU) Congratulations to Dr Richard Ma who has passed his Late Stage Review of his PhD. Richard’s PhD is on ‘Improving the effectiveness and equity of contraceptive provision in UK primary care’. This PhD was funded through an NIHR Doctoral Research Fellowship. He is due to complete this in August 2022. The first research from this PhD has been published recently (see page 40) on PLoS Medicine. Self-Care Academic Research Unit (SCARU) Researching attitudes to Self-Care Since the onset of the pandemic, self-care has become the mainstay of patient management outside the hospital setting. Drs Peter Smith & Austen El-Osta are leading a qualitative study to investigate prevailing attitudes and perceptions and changes in professional attitudes to self-care during the pandemic. The study will also unpack the prevailing attitudes into self-care generally. Imperial SCARU is also collaborating with Susan Barber & NWL ARC to investigate extant drivers, barriers and competencies that would enable healthcare professionals to promote self-care capability in patients with multimorbidity. Imperial Centre for Cardiovascular Disease Prevention Professor Kosh Ray has been selected as the paper of the year by the Oligonucleotide Therapeutics Society for the paper ‘Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. And for Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia’. Congratulations on this well-deserved honour. Image by pch.vector via freepik.com
Global Digital Health Unit analysing hospital inpatient movement (GDHU) patterns. Researchers have been awarded Strengthening the relationship over £800,000 to review the impact between Imperial and Tokyo Tech of a digital alert system to monitor patients with sepsis at NHS Dr Paul Expert has been appointed visiting hospitals Associate Professor with the newly created Risk Management in Complex Systems Lab for Sepsis, also known as blood poisoning, is life his expertise in the characterisation of spatio- threatening and accounts for an estimated temporal patterns in complex systems, with 48,000 deaths in the UK each year. If applications in Neuroscience and diagnosed early it can be treated effectively Computational Epidemiology. The Risk with antibiotics, but the difficulty lies in Management in Complex System Lab is part of spotting sepsis before it develops, as the World Research Hub Initiative at the symptoms are similar to other illnesses, such Tokyo Institute of Technology. as flu. The Tokyo Tech World Research Hub Initiative The study, funded by NIHR, builds on previous is part of the Institute for Innovative research which showed that the introduction Research, the driving force behind Tokyo Tech of the digital sepsis alert system at Imperial aspiration to achieve both interdisciplinary College Healthcare NHS Trust in 2016 was exchanges between the world’s top associated with lower odds of death, shorter researchers and act as a centre for ground- hospital stays and increased odds of receiving breaking research. timely antibiotics. Medical Research Foundation Dr Céire Costelloe, Director of the GDHU and National PhD Training Programme study lead, said: “Identifying sepsis at an early in Antimicrobial Resistance - stage in order to prevent death is a major Annual Conference focus for health systems across the world. This funding will build on our previous GDHU colleague and final year PhD student, research which showed that the introduction Shirin Aliabadi, presented one of her PhD of a digital alert system helped save lives and studies at the third annual Medical Research improve care at Imperial College Healthcare Foundation National PhD Training Programme NHS Trust hospitals. We look forward to in Antimicrobial Resistance Annual working closely with NHS clinicians to ensure Conference. The programme, which has that the introduction of alerts in UK NHS developed an active network of antimicrobial hospitals has the maximum impact’’. resistance doctoral researchers in the country, aims to encourage the exchange of research World Congress on Public Health ideas as well as shared learning. Shirin presented her work on the effect of the GDHU presented two abstracts at the World implementation of the Quality Premium, a Congress on Public Health 2020. Estera national financial reward to reduce Boncea exhibited her findings on the inappropriate antibiotic prescribing, on association between intrahospital transfers antimicrobial resistance in Escherichia coli and increased odds of developing a hospital- bloodstream infections. The conference, acquired infection among elderly patients, which was joined virtually by participants, was which is part of the unit’s broader work a unique opportunity to discuss research aimed at tackling antimicrobial resistance.
National Diversity and Inclusion in Primary Care Educa Group WITHINImage by freepik.com PRIMARY CARE EDUCATION
cation Working Group At the end of August, the Medical Education Innovation and Research Centre (MEdIC) held a workshop bringing together leading undergraduate primary care educators across the UK to discuss diversity and inclusion within undergraduate primary care education. The workshop also included representation from the Imperial medical student body, to ensure that our focus remained firmly on those elements of diversity and inclusion which matter most from a student’s perspective.
All medical students should limited to) gender, class, and sexual feel they belong in their orientation. Discussion centred on learning environment and are three key areas of undergraduate able to be their authentic primary care: curriculum and selves. There is, however, a assessment, promoting diversity large literature which and inclusion in the student demonstrates that a significant community and institutional proportion of students from culture. Delegates were candid under-represented groups about experiences within their own continue to feel excluded, institutions, many of which had unsupported and have been shared themes. Following on from subject to racial harassment. the workshop, key priority areas These issues affect learning were identified to take forward, and contribute to the ethnic including exploring faculty attainment gap that emerges development needs, sharing through medical education. resources on curriculum This topic has perhaps been development and fostering never more pertinent belonging within the undergraduate considering the Black Lives student learning environment, Matter movement and including development of a diverse widening health inequities personal tutor system. including the disproportionate impact of COVID-19 on BAME The group will meet on a regular populations. basis to continue discussions and develop new research with the aim The lens of race and ethnicity was of leading change for used to examine diversity within undergraduate primary care primary care education. There was, education, creating an environment however, recognition of the where all students feel included and importance of approaching the are able to advocate for work with an intersectional marginalised groups. This workshop mindset, acknowledging that when is one of several initiatives that understanding experience of MEdIC is undertaking in their discrimination and oppression, all Diversity and Inclusion Theme. aspects of a person’s social and Further details can be found on the political identity must be MEdIC website. For those interested considered, including (though not in finding out more about this work, please email Dr Nina Dutta (Diversity and Inclusion Theme Lead for MEdIC).
Image by freepik.com
Image: Spectator's account by Jasmin Johnson, Cardiff University
By Jack Stewart Medical students from around the world have shared their creative responses to the COVID-19 pandemic in Imperial's first Global Creative Competition. The Competition was launched around the world to come in August by the Medical together to reflect and share Education Innovation and their personal and professional Research Centre (MEdIC). It experiences during this saw over 650 entries from 52 challenging time.” countries. The competition was inspired by a piece of art that The entries were assessed by Nour Houbby, a current an expert panel of judges medical student at Imperial, including Professor Dame shared with Dr Sonia Kumar. Parveen Kumar (Queen Mary University of London and “The pandemic has had an Author of Kumar and Clark), unprecedented impact on all of Rosamund Lupton (Sunday us our jobs our lives our Times Bestselling author), Nour families. It really has touched Houbby (Medical student, all of us in so many ways Imperial College London), around the world. At MEdIC we Professor Ashley Hall (Professor strive to bring together of Design Innovation, School of education and societal impact.” Design, Royal College of Art) Dr Sonia Kumar, Director of and Dan Simpson (Poet in Undergraduate Primary Care Residence, Imperial College Education and MEdIC in the London) with the winners School of Public Health revealed at an event on Wednesday 14 October. “We wanted to provide a platform for medical students FULL ARTICLE
The Ultimate Collaboration by Devika Nair, University of Birmingham
RUNNER UP Painting of a young woman on a mobile phone Missed calls Serena Ramjee Barts and the London, United Kingdom Serena's reflection: \"Like many others, I experienced a deterioration in my mental health during lockdown. Amongst my symptoms was unsociability which in normal circumstances is eased by face-to-face interactions. However, these interactions were not possible during lockdown, and technology was the predominant method of socialising. As a result, relationship maintenance required more energy than I possessed, so I unintentionally isolated myself. I felt guilty for not being on my phone, so I put pressure on myself to socialise despite my lack of energy. \"_missed calls\" aims to capture this pressure and the feeling of only having myself for company. Recovery began with prioritising my health before work and visiting my GP. Hence, I cherish \"_missed calls\" because it's proof of me dedicating time to my hobby and relaxing. Additionally, I had to confront my guilt associated with socialising and understand that I don't have to consistently use my phone as long as I communicate that to people. Overall, I now recognise I must continue putting my health first even after normalcy returns and throughout my medical career\"
WATCCH – a student mentor perspective By Nida Hafiz WATCCH (Widening Access To Community Careers in Healthcare), run by the Undergraduate Primary Care Education Team at PCPH is now in its fourth year of running. The programme aims to support Year 13 students from widening participation backgrounds to pursue a career in healthcare, providing information on a range of careers and guiding them through admissions processes. Mentors, recruited by Vision Society, facilitate the small group sessions within workshops and were first introduced to the scheme last year. I was delighted to be accepted as a mentor last year, and this year am honoured to be student lead. I decided to apply to become a WATCCH mentor for many reasons. Knowing how difficult and stressful the university application process can be even with support around, I wanted to help provide guidance for those students who do not have access support elsewhere. As someone who would once shy away from mentoring, I really wanted to work on my interpersonal skills and confidence and felt that WATCCH was a great opportunity to do that whilst making a difference. In the past I have volunteered at one-day university application workshops but what drew me to WATCCH was its longitudinal approach, meeting with the same students at each workshop, allowing rapport to be built and maintained, creating a familiar environment for students to seek the guidance they would like. The workshops are typically held monthly, this year online, covering different aspects of the application process. Following the central delivery of the main content, mentors work with students in breakout rooms on the topic pertaining to the workshop. For example, in the opening workshop in August, mentors and students discussed different healthcare professions’ roles and learnt about each student, their career goals and challenges they anticipated facing this year. September’s workshop was on personal statement writing, and students were able to have their personal statements reviewed in small groups. There is also now the online Brightside platform, new to WATCCH, meaning that mentoring can continue safely outside of the workshops. Image by prostooleh at freepik.com
Being a WATCCH mentor provides constant opportunities to build on mentoring and communication skills alike. During the training session, Dr Arti Maini ran through key skills for mentoring and coaching, including the GROW model, a personal favourite which involves asking a series of questions to help one think about a difficult situation more objectively. I have learnt what it is to mentor and guide someone rather than handing them the answer, something I have mistakenly done in the past but have been able to work on during the mentoring sessions. I have also learnt to become more adaptable and comfortable not knowing the answer to every question and to take on that mentoring approach and find ways to enable students to reach a solution themselves. These skills, whilst useful as part of WATCCH, could also provide a good foundation to build on later as doctors teaching medical students or doctors mentoring junior colleagues. Mentoring with WATCCH has made me more appreciative of inequities that exist in accessing places at university and obstacles students can face when applying. To help better support students applying for non- medicine courses we have built up information resources for a range of different healthcare courses for mentors and students to access and we hope this can be carried forwards for years to come. It is incredibly rewarding to be able to help provide the WATCCH students with support to help them achieve their potential and get into their desired healthcare course.
Life on the COVID front line: Checking the wellbeing of health and social care workers Image © Pete McKee
In April this year, the BBC pictorially remembered more than 100 NHS staff and other healthcare workers who had died from COVID-19. The deaths testified to their professional commitment to help others in extraordinary times. It was a sacrifice that heralded a period of fervent street clapping and heroic fundraising in support of frontline care providers, the nation publicly acknowledging the central value of doctors, nurses, social workers, and allied staff in our lives.
As well as the risk of catching the virus, frontline care work in circumstances where there is potential for significant mental health harm. The COVID-19 pandemic provides the exact circumstances where long-term emotional distress in staff will be experienced, such as complex post-traumatic stress disorder, depression, anxiety and substance misuse. These impacts are likely to be greatest among those people who, by virtue of pre-existing social inequalities, were previously at greater risk of mental health problems and most vulnerable to COVID-19; this is a pandemic that leaves an unequal legacy of bereavement, trauma and economic repercussions. People from Black, Asian and minority ethnic (BAME) groups are highly represented among the health and social care workforce, especially in urban areas, comprising 52% of the adult social care workforce and approximately half the doctors in London. Ensuring mental health and wellbeing challenges are identified and addressed effectively is premised on a full understanding of the lived experience of frontline work, helping to determine the long-term mental health support that will enable NHS and social care workers to continue to provide invaluable care. As Dr Dasha Nicholls, Reader in Child anxiety, depression, self-harm, suicide, Psychiatry at Imperial College London and other mental health issues among (IC), the principal investigator of a 24- vulnerable groups of front-line month study aimed at Assessing need workers, to understand mechanisms for mental health interventions among and inform interventions”. NHS and social care front line staff secondary to the COVID-19 pandemic, The study is project managed by commented on the multi-dimensional Richard A. Powell, working with Dr impact of the virus: Victoria Burmester, PDRA in Brain Sciences, in close collaboration with “Front-line workers might be colleagues at King’s College London. It particularly affected by fears of focusses on the short- and medium- contamination, disruption of normal term psychosocial impact of the supportive structures, work stress, and pandemic on North-West London retention issues. Many will have to (NWL) NHS and social care-affiliated make difficult choices to deliver care staff performance and wellbeing, that they know is suboptimal, explain identifying psychosocial indicators of difficult decisions to relatives or make resilience and vulnerability and decisions that jar with their personal evaluating the effectiveness of staff values. An immediate research priority support programmes offered through is to monitor and report rates of employer organisations.
The NWL branch of the study will be unilaterally and comparatively among the first to include social care, primary the wider collaboration. care and mental health staff as well as NHS staff in acute Trusts. A short “The study findings promise to provide online survey will collect socio- us with very rich data on vulnerable demographic and basic clinical staffing groups by socio-economic information, supplemented by more status and ethnicity. Data arising from detailed psychosocial outcome the BAME questions module is measurements for those wishing to particularly novel, hopefully addressing participate. Data collection will be the needs and wellbeing of a repeated at 3, 12 and 18 months. significant group of the NHS and social Dissemination events will take place care workforce that has been among NWL London colleagues disproportionately affected by the through ARC networks, as well as pandemic”, said Mr Powell. For further information on the study, please contact Dr Victoria Burmester. Image by Tim Dennell - Creative Commons
Syrian women and war (detail) by Little Shiva – Creative Commons
An innovative Global Health curriculum on the armed conflict in Syria By James Romero and Murray McKay \"UK medical graduates need to appreciate the local and global factors that affect people’s health,” says Dr Mariam Sbaiti, Deputy Director of the Global Health BSc course within Imperial’s School of Public Health. However, disparities in global health education and research funding mean that curricula often involve teaching about people unrepresented in the classroom. In July, then-Vice Provost for Education Simone Buitendijk and Professor of Public Health Helen Ward highlighted the vital importance of South-North cooperation in medical education. It’s a cause Dr Sbaiti is committed to, having invited people with lived experience of inequality, such as indigenous colleagues and sex workers to teach in her classrooms.
Dr Mariam Sbaiti, Deputy Director of the Global Health BSc course In 2018, she scaled this up, developing a “Our partners worked collaboratively to model called Virtual Roundtables for make the curriculum truer to reality. Collaborative Education Design (ViRCoED). Whilst the ViRCoED model is not going to This was used to reshape the Global solve asymmetries in global health Health BSc to deliver innovative teaching research and education, it prompted us to and a key assessment around the Syrian consider social accountability more conflict. In 2019 this included a film explicitly when designing our teaching. It’s screening, a refugee policy-making a fundamental ethical requirement that simulation, and data visualisation and our students go on to appreciate the communication training. importance of the rich social and political context of data before analysing it”. A range of partners took part in the ViRCoED exercise including educators, In this article we talk to some of those students and colleagues with lived and behind the project to discuss how a new professional experience of public health at approach to education design can help the frontlines of the conflict. The project develop responsible global health leaders. also gained a StudentShaper award to bring an alumna on board. Aula Abbara, consultant in infectious diseases and researcher at Imperial NHS Healthcare Trust Aula is a British-Syrian expert in health policy and the Syrian conflict. She co-chairs the Syria Public Health Network and has volunteered as a clinician, researcher and educator in the Syrian context since 2012. She helped Mariam set up the project before sourcing real-time epidemiological data for the assessment and introducing partners with lived and humanitarian experience. ”It was important to focus on Syria because the scale of destruction and population movement highlights the intersecting factors that can impact public health. Hopefully this novel approach to education will allow those from conflict affected countries to lead future discussions about their own health systems, rather than the narrative being led by those without lived experience or knowledge of the wider context”.
Mervat Haffar, pharmacist and humanitarian activist Refuge policy-making simulation Mervat was a pharmacist in Damascus and “I wanted to ensure that the students she came to London to study an MSc. She understand conflict situations are often now runs a human library session more complicated than what the media (pictured above) for students to hear how presents. In Syria, each city has its own alternative health systems are built and experience of the conflict and you can’t managed during conflicts. She also co- generalise. With the simulation exercise, developed a refugee policy-making we wanted to remove any naivety around simulation, where student’s role-play as how things really function, including how humanitarian representatives of the health can be politicised or used as a World Health Organisation or Red Cross, weapon in conflict”. negotiating improved sanitation within Syrian refugee camps. Melanie Leis, Head of Big Data Unit Melanie oversees the learning and public and policymakers. Healthcare assessment of data visualisation in the consultants can now use machine learning curriculum, teaching students how to to identify key drivers of patient safety to communicate data effectively to the advocate for change or answer politician’s
questions. But that is only useful if you “The BSc students gain experience can identify the key insights that aid working with real life data in an ongoing decision-making. These critical skills are conflict. As a result, they will be better developed through authentic assignments prepared for that first messy dataset they where students write briefing documents are asked to summarise in the with data visualisations for policymakers. professional world”. Vicki Pilkington, Student Shaper Former global health student Vicki was brought onto the team early on to influence the design of the assessment. “I genuinely felt that my thoughts were given a lot of weight by the team. My student perspective on everything from working hours and attendance, to ability levels, assessment content and structure seemed genuinely valued and helped steer the new assessment towards what I would have wanted during my BSc. The experience has also been helpful
personally for job applications, future research groups”. clinical practice and working within Maryam Omar, former Masters of Public Health student Maryam, a Master of Public Health Douedari, a colleague who provided student was invited to bring her healthcare in Aleppo. humanitarian sector experience to the course. She was involved in the film “We wanted to contextualise the socio- screening of the Oscar nominated political background of the country and documentary, For Sama, which tells the convey the reality of healthcare in a story of a family providing healthcare conflict setting. By humanising those facilities during the siege of Aleppo. The involved and affected, I hope students screening was followed by a Q&A panel develop greater empathy and with Maryam, Mervat Alhaffar and Yazan understanding”. Future Plans Recent qualitative research with the latest BSc cohort showed the Syrian curriculum cited by students as a more inclusive approach to global health education. However, Dr Sbaiti sees the course transformation as an ongoing project. For example, she is set to partner with a human rights charity working in UK Immigration Removal Centres to create new learning opportunities for future students. “Our aim is to develop responsible global health practitioners, who can enter into mutually beneficial collaborations based on an understanding of each other’s’ position in the world”. Photo by rawpixel.com – freepik.com
Introducing the ‘Longitudinal Integrated Apprenticeship’ Planning is underway for a new longitudinal GP course for our fifth-year medical students, the Longitudinal Integrated Apprenticeship (LIA). This will be overseen by Dr Vanessa Sivam, who has now started in her lead role, as recruitment for the first cohort of students and GPs begins. The course will initially have fifty self-selected students in July 2021, rolling out to the whole year group by July 2023. What is it? LIA will run over the entire course of fifth year: students will be based in General Practice for one day a week and continue to attend their speciality placements on the other days. Why do we need it? LIA is about fostering longitudinal relationships between students, tutors and their patients, enabling learning in an authentic way. Students will have ownership of managing a patient caseload with supervision, preparing them for professional practice. Through this, they will deepen their understanding of integrated working between specialties, as the patient journey weaves between primary and secondary care. We intend on creating refreshing ways of teaching in small and large group settings, supported by new interactive digital platforms. Students will also engage in a rewarding community collaboration project, which aligns to their curriculum whilst cultivating a socially accountable mindset. We very much look forward to working with our enthusiastic students and GP tutors to make this new course a success.
Image by Anh Nguyễn Duy from Pixabay
Launch of the iMprOVE study: evaluating children’s physical activity, health and wellbeing
Dr Bina Ram and Professor Sonia Saxena launched the iMprOVE study in September 2020 across all Greater London primary schools to coincide with the re-opening of schools and a major television campaign to get children more active by taking part in The Daily Mile™. The iMprOVE study is a quasi-experimental cohort study comparing physical and mental health, and educational attainment of primary school children that do The Daily Mile with those that do not. It encourages children to run or jog, for 15 minutes, at their own pace, every day. An estimated 10,000 schools and nurseries take part in 77 countries worldwide. Evidence of the health benefits from doing The Daily Mile One million primary school children in registration to The Daily Mile by signed up to run The Daily Mile. As local authority, which is in keeping part of her PhD studies, Ms Tishya with other research that has found Venkatraman, a National Institute that some local authorities to be for Health Research (NIHR) School actively promoting The Daily Mile. of Public Health Research (SPHR) PhD student, and who is part of the Currently less than half of children iMprOVE research team, has shown and young people in the UK meet that schools in socio-economically the recommendation of an average disadvantaged areas of England, of 60 minutes of physical activity where poorer health outcomes are daily. These results are encouraging more common, are more likely to as they suggest one in five schools be registered to do The Daily Mile. have registered for the Daily Mile initiative, which builds activity into The findings from the research the school day. The Daily Mile can suggest that one in five primary be carried out at safe social schools in England have registered distances, which makes it suitable for The Daily Mile. She also found for our current times. It is that The Daily Mile has been reassuring that previously hard to particularly popular in urban and reach groups, like those schools in deprived areas and could be deprived urban postcodes and reaching over one million children in those with large pupil numbers are 3,502 primary schools across just as likely to sign up to The Daily England. The findings also indicate Mile as other schools. This is that there was significant variation important because so often wide
rollout of health policies and Tishya is supervised by Prof Sonia interventions can in some cases act Saxena and Dr Ceire Costelloe and is to widen health disparities – split between the Child Health Unit especially interventions that depend and the Global Digital Health Unit. on individuals voluntarily changing Tishya also successfully passed her their behaviour. Health behaviour is Late Stage Review in September and not always a choice, especially is now officially a year away from for children who do not always have submitting her PhD thesis! control over when they are allowed to be active. Although evidence to date is promising, there are no longer-term This work was done in collaboration evaluations of The Daily Mile to with colleagues at University understand whether any impacts College London (Prof. Russell Viner) are sustainable throughout primary and the University of Cambridge (Dr school life. Esther van Sluijs) and was funded by the NIHR School for Public Health @tishyavenk Research. will identify how many implement The iMprOVE study The Daily Mile. In Phase two we will begin assessments of children in Funded by the NIHR School of Public Year 1 (aged 5-6 years) measuring Health Research and The Daily Mile their physical activity, mental health Foundation, iMprOVE is the largest and educational attainment. Phase evaluation of an active mile III will follow-up the children yearly initiative to date. Phase one of the throughout primary school. study has begun; distribution of a school survey to 1,721 state funded primary schools in Greater London
Professor Sonia Saxena: “It’s important to ensure children get regular classroom breaks to reduce the spread of COVID 19, as well as benefit from getting the chance to be physically active after these long months of lockdown. Physical activity is crucial for children’s physical and mental health, and The Daily Mile could be a much-needed scheme for helping children to stay well throughout the pandemic” Dr Bina Ram: “It has been really exciting to lead, develop and launch the iMprOVE study and the research that has informed the work. Developing a core outcomes set through a systematic review, Patient and Public Involvement (PPI), and modified-Delphi methods with health professionals, teachers, parents, children and researchers has identified important outcomes to measure in school-based physical activity interventions which we have been able to incorporate into the study”
In September, the MEdIC team (Medical Education Innovation & Research Centre) based within PCPH, attended the AMEE (International Association of Medical Education) 2020 conference. Due to COVID restrictions, the conference was held entirely on a virtual 3D platform. On registration, attendees created their own avatar, who could wander through a hall of virtual posters, attend presentations in virtual conference rooms, and network with nearby avatar attendees. There were no difficult choices on which sessions to attend, as all presentations were streamed live and then available on demand. Although there were a few technical hiccups, and people occasionally lost control of their avatars, the whole experience was both unique and rather fun. The quality of the work presented at the outside the formal curriculum’, and conference was high. Predictably there MEdIC’s Dr Nina Dutta, shared her work was a strong focus on the educational on ‘widening access to community careers response to COVID, and the use of in healthcare’ (WATCCH) within the technology to support digital learning and Diversity and Inclusion stream. remote teaching. However, there was an impressive range of other topics featured, Whilst not quite like being there, the including innovative presentations on the change of format brought its own arts in medical teaching, diversity and advantages. With continued access to inclusion, serious games and clinical recorded conference material over the reasoning. Dr Noreen Ryan (PCPH) coming year, AMEE 2020 will continue to presented work on ‘what influences early stimulate discussion and inspire future years patient safety teaching and learning teaching innovations within MEdIC.
Self-care practices & lifestyle behaviours to tackle social isolation & loneliness during the COVID-19 lockdown The COVID-19 pandemic has shaken up educational systems leading to near-total closures of educational institutions in the UK. This has led to growing concerns over the impact of school closures on the mental health and wellbeing of parents and school-aged children, and in particular about feelings of social isolation and loneliness. Immy Webber & Aos Alaa, both Research lockdown were identified as key factors in Assistants at SCARU (Self-Care Academic reducing feelings of social isolation and Research Unit), set out to investigate the loneliness. Recent modelling studies impact of school closures and predict that school closures alone would disseminated a survey to 1,214 adult only prevent 2–4% of deaths. parents and legal guardians of children who were attending primary or secondary Furthermore, physical activity education in the UK. They revealed a interventions in particular have been number of characteristics that were shown to reduce loneliness and improve associated with greater feelings of social psychological well-being. School closures isolation & loneliness including: (1) being have thus shed a light on the subsequent female; (2) parenting a child with special social and economic consequences of the needs; (3) lower levels of education; (4) pandemic, including a rise in inequalities unemployment; (5) reduced access to such as digital exclusion, reduced access technology, (6) no dedicated space where to tablets and smartphones or a dedicated the child can study; (7) lower levels of space where the child can study. Policy physical activity and (8) observed prescriptions and public health messaging disruption in the sleep patterns of should look to promote the adoption of members of their household during the good health-seeking self-care behaviours lockdown. such as increased levels of physical activity and the maintenance of good sleep Two modifiable health seeking lifestyle hygiene practices to help prevent or behaviours (higher levels of physical reduce the risk social isolation and activity and the maintenance of good loneliness. sleep hygiene practices) during the
Image by wirestock via freepik.com
MEDIA MENTIONS GP cash incentives associated with falling abortion rate in Britain, study finds GIPmacgae sbyhRoinbicneMnarttiyv-eCsreaatisvseoCocmiamtoends –wadiatphtedfatollrienpgeataabs poarttteironn rate in Britain, study finds
Dr Richard Ma published his first research paper from his NIHR Doctoral Research Fellowship titled, ‘Impact of a pay-for- performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study’. This is one of the four projects for his PhD and research programme. The co- authors include Dr Elizabeth Cecil, Dr Rebecca French, Professor Alex Bottle and Professor Sonia Saxena. Published in PLoS Medicine, it examined health records of over 3 million women aged 13 to 54 years old, from over 600 primary care practices across Britain from financial years 2004/2005 to 2013/2014. It compared yearly LARC prescriptions and abortions in the years before and after the LARC advice scheme was introduced in 2009/2010. There was 13% more LARC prescriptions and 38% fewer abortions than expected since the scheme was introduced, particularly in younger women aged 20–24 and those from poorer backgrounds. Financial incentives for GPs to give LARC advice to women were associated with more LARC prescriptions and reductions in abortions. The greater impact in younger women and those from more disadvantaged backgrounds suggests potential to reduce health inequalities by improved awareness of options for effective fertility control. The study gained some media attention, featuring in The Guardian among other news outlets. Professor Sonia Saxena, supervisor and co-author of the study was invited to talk about the findings on BBC Radio 4’s Women’s Hour. Richard is a part-time GP in London and was awarded the NIHR Doctoral Research Fellowship in 2017, due to complete in summer 2022.
Women let down by patchy access to contraception during Covid- 19 lockdown in the United Kingdom The UK government introduced measures to reduce community spread of Covid-19 on 23 March 2020. Health services had to adapt to the lockdown measures; general practices were advised to use total triaging and remote consultation models and this included provision of contraception. However, fitting and changing expiring long acting reversible contraception (LARC) were deemed “low priority” by the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA). To evaluate women’s experiences of consultations, self-check for repeat contraceptive provision during Covid- prescriptions and sending prescriptions 19 lockdown, Dr Richard Ma, Dr Kim directly to their preferred pharmacist Foley and Professor Sonia Saxena before the lockdown. conducted a survey of women’s experiences of access to contraception More options such as remote from across the UK. consultations and electronic prescription service (EPS - not available This internet survey ran between 27 across all of UK) need to be explored May 2020 and 9 June 2020. There were and offered more widely, while over 200 responses from all 12 UK maintaining face-to-face access which regions with age range from under 18 might be beneficial for some. Services (33%) to 45-54 years (4%). need to consider timely provision for women during postnatal period and While most women were able to those who use contraception for other obtain contraception after lockdown, it indications. highlighted the need for better information and signposting to obtain The findings from this survey was free contraception through the NHS. It submitted as evidence to the All-Party also found variation in availability and Parliamentary Group on Sexual access to contraceptive services across Health’s (APPG SRH) inquiry into access the 4 UK countries. Some of the to contraception during Covid-19. The problems were already present before full report, Women's Lives, Women's lockdown. Rights: Strengthening Access to Contraception Beyond the Covid-19 While many GPs had already been Pandemic, was published by the APPG offering innovative ways for women to on Sexual and Reproductive Health on have check-ups and prescriptions for 10 September 2020. their contraceptives such as telephone
Image by freepik.com
Section of Die Blutgefasse Des Menschen lithograph (1898) – Creative Commons
More patients could benefit from combinations of cholesterol-lowering drugs to reduce their risk of stroke and heart attacks. New findings from a large European study of patients in 18 countries, including the UK, show that while many patients can reduce their risk through taking statins, those at the highest risk of cardiovascular events may benefit from combinations of lipid- lowering therapies. According to the authors, the study recommended goals and to improve this highlights a gap between current clinical will require use of combination therapy of guidelines and clinical practice for more than one drug. Currently less than cholesterol management across Europe. 10% of very-high risk patients in Europe They explain that even among patients receive some form of combination who are already receiving optimal doses therapy, 9% with ezetimibe and 1% with of statins, greater use of other, non-statin PCSK9 inhibitors”. cholesterol-lowering drugs could help to further reduce cholesterol levels and High levels of low-density lipoprotein potentially improve health outcomes for (LDL) cholesterol, or so-called ‘bad’ those most at risk. cholesterol, in the blood are a known risk factor for cardiovascular disease. While The findings, which will be presented at diet and lifestyle are important factors in the virtual meeting of the European reducing LDL cholesterol, many patients Society of Cardiology 2020, are published are at increased risk - such as those with in the European Journal of Preventive diabetes, inherited conditions or who Cardiology. have previously had heart attack or stroke - and are prescribed cholesterol-lowering Professor Kausik Ray, from Imperial’s drugs, like statins, to reduce their School of Public Health, who led the DA cholesterol. VINCI study, said: “In order to tackle the burden of cardiovascular disease, a global But several other classes of cholesterol- approach is needed. After diet and lowering drugs are available, which act on lifestyle, cholesterol lowering with different elements of the body’s medications is a key approach to lowering cholesterol-metabolism. These risk of heart disease and strokes. Based on treatments, such as ezetimibe, bempedoic trial data we have compelling evidence acid, or PCSK9 inhibitors, can be used in that lower cholesterol levels benefit those combination with statins to further reduce at highest risk particularly. LDL-cholesterol levels. Though statins are first line treatment, it In the DA VINCI study, a consortium of is clear from our contemporary study that researchers led by the Imperial Clinical statins alone even when optimally used Trials Unit at Imperial College London will not help most patients achieve looked at patients across Europe who European Society of Cardiology were prescribed lipid-lowering therapies. cholesterol goals. Only one in five very- high risk patients achieve 2019
In total 5888 patients, enrolled across 18 established cardiovascular disease. countries, provided information at However, among the patients receiving doctor’s appointment or in hospital to statins with a PCSK9 inhibitor about two manage cardiovascular conditions. thirds attained the new lower ESC Information included lifestyle factors, recommended cholesterol goals previous cardiovascular events (such as heart attack or stroke) as well as According to the authors, the findings measures of their current LDL cholesterol highlight the potential for combinations of levels and any current lipid-lowering lipid lowering drugs to help close the gap medications. and reduce the risk for millions of patients across Europe. They explain that reducing Current guidelines from the European LDL cholesterol levels in very-high risk Society of Cardiology (ESC)/European patients (from the observed levels of Atherosclerosis Society (EAS) recommend above 2mmol/L to below 1.4 mmol/L) statins as first-line treatment for lowering could offer an 11% relative reduction in LDL cholesterol. The guidance also cardiovascular events and 5% relative recommends goals based on risk reduction in mortality. groupings, such as a target of 50% reduction in LDL-C levels in very-high risk The authors add that untreated lipid levels patients and achieving LDL-C levels below were not available and so they were 1.4mmol/L, in order to reduce the risk of unable to quantify to what extent the additional cardiovascular events. ≥50% LDL-C reduction from baseline was achieved but used high-intensity statin In the DA VINCI study the team reviewed use as proxy. They add that physician how lipid-lowering therapies were used in choice of LLT, pre-treatment LDL primary and secondary care and the cholesterol levels and local prescribing attainment of cholesterol reduction goals restrictions could have influenced our set out by the guidelines. observations. Analysis revealed that 84% of patients “Over the last 15 years we have received statins as their primary lipid- seen improvements in guideline lowering therapy only, with high intensity implementation and control of statins used in approximately one-quarter cardiovascular risk factors. These (28%) of patients. Just 9% of patients were were based on better first line prescribed ezetimibe with moderate treatment such as statins. Now, intensity statins and just 1% of patients with lowering of cholesterol used PCSK9 inhibitors in combination with goals, our data suggest this will statins and/or ezetimibe. not be enough and we need to think about cholesterol in the They found that overall, less than half of same way as we look at blood patients were achieving the most recent pressure where often cholesterol-lowering goals set out by combinations of treatments are guidelines. Among patients receiving high- needed to optimise targets” intensity statins, 2019 LDL-C goals were achieved in 22% of patients with Professor Ray
Section of Die Blutgefasse Des Menschen lithograph (1898) – Creative Commons
The ‘lockdown’ of the United Kingdom on 23 March had pronounced impacts on travel patterns as we discussed in our recent JRSM paper. As many millions of people moved to either working at home or were furloughed from their jobs, there were large decreases in trips to workplaces alongside even steeper decreases in recreational journeys. Transport is an often-overlooked influence on the health of populations and health inequalities, affecting physical activity, road traffic incidents and air pollution, in addition to being a major contributor to climate change. There is ongoing uncertainty around the longer-term trajectory of COVID-19, meaning that the medium-term changes to transport and society are hard to predict. Nevertheless, the easing of the lockdown in England presented both opportunities and threats to the health impacts of transport.
A key factor is reduced capacity on public transport networks due to social distancing rules, meaning that many people will have to rethink their travel choices. This group faces three broad options: changing to walking or cycling (active travel); staying at home; or using a car or motorcycle. The availability of and ability to use these choices is socio economically patterned, with many low-income workers having fewer options than their higher-income counterparts. Low-income workers are less likely to be able to work at home, as are younger people. Physically active travel modes allow people to incorporate physical activity into their daily routines, and systematic review evidence points to health benefits. For example, people cycling to work are at reduced risks of death from any cause, people walking to work are at reduced risk of incident cancer, and people who change from driving to work to active modes have a reduced body mass index (BMI). In addition to these individual impacts on disease, increased walking and cycling reduce air pollution and greenhouse gases. Seventy-seven per cent of distance travelled in 2018 and 61% of trips in England and Wales were by car, meaning that there is considerable scope to increase walking and cycling. The potential impacts of changing these patterns are substantial; modelled estimates from a scenario with a quarter of the English population cycling regularly suggest an 11% decrease in all-cause mortality. Transport is a fundamental part of the modern world and has profound impacts on health. Prolonged limits to public transport capacity are likely, presenting individuals and governments with an opportunity to change previously detrimental travel patterns which were overly reliant on polluting and dangerous travel modes. Support in the next few weeks and months can ensure that beneficial shifts are made and maintained, which will be crucial to reducing pollutants and addressing the climate emergency. Image: Angry Gorilla by dgim-studio - freepik.com
NEW TO PCPH
Search
