Impact of social restrictions during the COVID-19 pandemic on the physical activity levels of older adults
Physical inactivity adversely affects older adults, with more than 60% of those aged over 75 years not sufficiently physically active for good health as defined by meeting the WHO and UK guidelines. From March until June 2020 in the UK, a national ‘lockdown’ was implemented to reduce exposure to, and transmission of, COVID-19. Although applied to the whole population, adults aged over 70 years and those with underlying health conditions at higher risk of severe COVID-19 disease were asked to follow more stringent social distancing measures. These included remaining at home where possible; avoiding social mixing in the community; avoiding physically interacting with friends and family; and avoiding public transport. In a paper published in the journal the introduction of lockdown were BMJ Open, we examined self- found in those who were over 85 reported physical activity before years old (640 (95% CI 246 to 1034) and after the introduction of MET min/week less); were divorced lockdown, as measured by or single (240 (95% CI 120 to 360) metabolic equivalent of task (MET) MET min/week less); living alone minutes. Associations of physical (277 (95% CI 152 to 402) MET activity with demographic, lifestyle min/week less); reported feeling and social factors, mood and frailty lonely often (306 (95% CI 60 to 552) were also examined. The study MET min/week less); and showed population comprised adults symptoms of depression (1007 (95% enrolled in the Cognitive Health in CI 612 to 1401) MET min/week less) Ageing Register for Investigational compared with those aged 50–64 and Observational Trials cohort years, married, cohabiting and not from general practitioner practices reporting loneliness or depression, in North West London from April to respectively. July 2020. 6219 cognitively healthy adults aged 50–92 years completed We concluded that markers of social the survey. isolation, loneliness and depression were associated with lower physical Mean physical activity was activity following the introduction significantly lower following the of lockdown in the UK. Targeted introduction of lockdown from 3519 interventions to increase physical to 3185 MET min/week (p<0.001). activity in these groups are needed After adjustment for confounders to limit adverse health outcomes and pre-lockdown physical activity, from lower levels of exercise. lower levels of physical activity after
Following on from last summer’s successful Global Creative Competition: Medical Student Responses to COVID-19, MEdIC has been running another competition for 2021. This year medical students from around the world were invited to submit their creative responses on the theme of Global Unity. We expanded the parameters of creative work to include not only painting, drawing, sculpture, comics and photography but also short film, animation, music and spoken word.
We also asked students to submit a short written reflection on why they had chosen to make the piece, what it means to them personally and how it reflects the theme of global unity. This year students could also submit entries or reflections in their preferred language. This enabled us to broaden the reach of the competition and increase the potential for students to participate from all corners of the world. We have now started the process of shortlisting the entries. This year we have enlisted a panel comprising of faculty members from both within Imperial and from other medical schools around the United Kingdom. All entries will be double marked by a medical student, with the student panel comprising of Imperial students, MEdIC masterclass alumni and entrants to the 2020 competition who did not enter this year. Two winners will receive the top prize of £300 and two runners-up will each receive £150. Winners and runners-up will be announced at an awards ceremony in November 2021.
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Three articles from DPCPH researchers to be featured in BMJ Innovations’ special issue on ‘Frugal innovations in healthcare’ The peer-reviewed journal BMJ Innovations published a special issue on frugal innovations in healthcare in October 2021. A flurry of articles on the topic from researchers in the Department of Primary Care and Public Health (DPCPH) were accepted for publication in the issue.
What is ‘frugal innovation’ exactly? In one resources – human ingenuity – is used to of the articles, Defining Frugal optimize limited resources to solve Innovations: A Critical Review, PhD problems. Yet, many of these frugal student Chandni Hindocha [1] aims to innovations are unlikely to have shed light on this question. With the undergone rigorous scientific testing, term’s growing popularity – as evidenced, patent filing or acceptance. Instead, they perhaps, by BMJ Innovations’ special issue tend to survive as medical folklore or by – multiple definitions have emerged, but word-of-mouth communications. For they lack a theoretical foundation which, frugal innovations to be critically Chandni argues, can hinder research and appraised, clear and transparent reporting adoption in practice. This review surveys in papers and journals is essential. To papers from many different disciplines, better enable this standardized reporting, including management, entrepreneurship, Matthew Harris (DPCPH) co-authored an business, and organization studies, to article led by Prof Dhananjaya Sharma compare and contrast the different from the Centre for Low Cost Solutions definitions that have emerged. She found and Global Surgical Innovation, Jabalpur, that although there are some common India [2]. In their paper, A plea for themes across disciplines – such as standardized reporting of Frugal affordability, adaptability, resource Innovation, they propose a new scarcity and sustainability – few can agree framework, STRONG-FI (Standardized on what a frugal innovation actually is. Reporting Of Novel Grassroots Frugal She argues, therefore, that the best way Innovation) to permit the communication to define a frugal innovation may be by of knowledge in a scientifically rigorous comparing it to an incumbent alternative, and objective way. What’s more, it could rather than a poorly-defined concept: If play an important role in leveling the the innovation does more with less, playing field in the exchange of knowledge retains the core functionalities of the and expertise between authors from the incumbent, and does this all in a cost- global south – where a lot of frugal efficient way, it may very well be a frugal innovations originate – and practitioners innovation. Chandni, and co-authors Prof in the global north, who have traditionally James Barlow (ICL Business School), Grazia been less receptive to ideas emerging Antonacci (DPCPH) and Matthew Harris from contexts other than their own. (DPCPH) indicate that creating a universal definition and a common understanding The final paper offers a prescient example of frugal innovation could support of a frugal innovation that could be of use strategies for its successful acceptance in the UK but, for a variety of reasons, has and diffusion globally. not been widely scaled there. Preterm birth is a leading cause of mortality Though frugal innovations have a long globally for children aged under 5. The history in many areas of global health, long-term effects of preterm birth can finding them is not straightforward. The place a significant burden not only on philosophy of frugal innovation originates parents, but on the wider healthcare from resource-constrained areas, where system, too. In low-resource settings, the most abundant of all-natural where access to expensive incubators may be limited, the need for a clinically proven
and effective alternative has given rise to student (2020-2021 cohort) Giulietta Kangaroo Mother Care (or KMC). KMC Stefani [3] aims to better understand the consists of early and continuous skin-to- reasons behind this. The study found that skin contact between a parent and the research into KMC in the UK is patchy and baby, exclusive breastfeeding or breast of poor quality, and that the term is often milk feeding, early discharge after – falsely – used interchangeably with less hospital-initiated KMC with continuation intensive techniques, such as regular skin- at home, and adequate support and on-skin contact. Though a wholesale follow-up for mothers and infants at replacement of incubators with KMC in home. Several high-income countries such the UK seems unlikely, Giulietta and her as Sweden and Norway have already co-authors Cheryl Battersby (Chelsea and optimally incorporated KMC into routine Westminster Hospital), Mark Skopec care. And although the UK has produced (DPCPH) and Matthew Harris (DPCPH) studies that show how some components advise that KMC uptake could still be of KMC – such as breastfeeding – could improved, particularly considering its well- lead to significant cost-savings in proven benefits in low-income and high- treatment of aftereffects of preterm income countries alike. Staff training and births, KMC is not widely used in the UK. parental support should be improved, and The paper, Why is Kangaroo Mother Care guidelines must be developed to not yet scaled in the UK? A systematic implement KMC to reduce the need for review and realist synthesis of a frugal incubator use in the UK. innovation for newborn care, by MPH References: [1] Hindocha C, Antonacci G, Barlow J, Harris M. ‘Defining Frugal Innovation: A Critical Review’ [2] Sharma D, Harris M, Agarwal V, Agrawal P. ‘A plea for standardized reporting of Frugal Innovations’ [3] Stefani G, Skopec M, Battersby C, Harris M. ‘Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care’ Image by Engin_Akyurt from Pixabay
The work environment is an important determinant of health and health inequalities, and workplaces play key roles in preventing ill health. International and national organisations like the World Health Organisation and Public Health England encourage implementing employer-led workplace health initiatives tailored to regional contexts, but rigorous evidence for their effectiveness is limited. Imperial SCARU & NIHR ARC Northwest London are collaborating with ARC West Midlands, ARC North East & North Cumbria on an applied research study to investigate how best to embed a culture of health and wellbeing in workplaces that promotes the sustained adoption of health-seeking self-care behaviours in ways that apply to diverse contexts, including COVID- 19. The 2-year research programme will generate and synthesise new knowledge about the effectiveness of workplace health initiatives across different England regions – the West Midlands, North East & North Cumbria & Northwest London. The consortium will work collaboratively to answer the following research questions: 1. What are the mechanisms through which workplace health initiatives prevent context- relevant ill health and wellbeing outcomes? Lead ARC-NENC 2. How do workplace health initiatives help employers support their staff in identifying and addressing barriers and facilitators to adopting healthier behaviours, such as individual competencies and self-care behaviours? Lead ARC-NWL & Imperial SCARU 3. What is the effectiveness of a mental contrasting intervention delivered through workplaces in motivating staff to change their health behaviour and wellbeing? Lead ARC-WM Using a mixed methods research approach, the programme intends to develop: 1. A theory of change to understand mechanisms through which multilevel (environmental, organisational, individual) strategies promote context-relevant health, business, and organisational-culture outcomes 2. A self-care competencies framework that could be used to inform the development of interventions that promote the sustained and routine adoption of health-seeking self- care behaviours within workplace health initiatives. 3. A mixed-methods evaluation of cross-regional workplace health initiatives including a cluster randomised controlled trial (cRCT) of a behaviour change intervention The project is the brainchild of Dr Laura Kudrna Communications Manager at ARC NENC. The study seeks to engage with a wide mix of public, private and charitable organizations (as employers) and their employees. It is being delivered as part of the National Priority Research Programmes - ARC (nihr.ac.uk)
GCHG COMMENTARY: MIGRATION AND HEALTH By Dr Lindsay Cooley The COVID19 pandemic has had devastating impacts on health, economies, and societies worldwide, however some populations are disproportionately affected. One such population is refugees. Following an unprecedented international effort, the first effective COVID19 vaccines have brought hope for an eventual end to the pandemic. How can we ensure access to such vaccines for refugees? Here we examine and propose different vaccine allocation strategies. Image by Hassan T from Pixabay
In 2020, 26 million refugees were registered with the UN Refugee Commission (UNHCR), of whom 4.2 million are asylum seekers, and 85% are hosted by lower- and middle-income countries (1) (LMIC). Given unregistered refugees, the true number of refugees is underestimated. Refugees are vulnerable to COVID19 for multiple reasons, including weakened health, restricted access to health services, overcrowded and unsanitary living conditions that make social distancing and hand washing challenging, food and employment insecurity, xenophobia and stigmatisation (2,3). These susceptibilities have been further exacerbated by the pandemic (2,3). Refugees are therefore a vulnerable population and should be considered a priority for vaccination against COVID19. VACCINE ALLOCATION STRATEGIES sufficient doses for 20% of their populations. These are intended to be A number of vaccines have now been used for the most high-risk groups approved for use(4). Stocks will be limited including health workers and those with while manufacturing and delivery are age and comorbidity risk factors. Only scaled up to the level necessary for global once all countries have received sufficient vaccination. To what extent will they be doses for 20% coverage will further doses accessible to refugee communities? be released. History shows that during the H151 (2004) This ensures that LMICs, who host the and H1N1 (2009) influenza pandemics, majority of refugees, will have access to higher income countries (HICs) used their vaccines. But will this translate into access manufacturing and financial capacity to for their refugee communities? acquire the majority of vaccine stocks, crowding out poorer countries and leaving The COVAX allocation system has been them with insufficient supplies (5). In the criticised for prioritising equality rather current pandemic, we see a similar than equity. One group recently proposed situation developing with a limited a “Fair Priority Model” in which vaccine number of HICs having pre-purchased a allocation would prioritise countries large portion of available and forthcoming where they would provide most benefit vaccine doses (4,6). Modelling studies (7) (9). Benefit is measured according to lives suggest that such “vaccine nationalism” saved, improved income, and reduced could prolong the pandemic and cause community virus transmission. Such a increased global deaths. It exacerbates framework would naturally favour at-risk inequalities between HIC and LMIC and groups such as refugees. However, while would severely limit access to vaccine for this proposal may be highly equitable, we most refugees. find it unlikely to be acceptable to richer countries who would be obliged to wait in The COVAX Facility is a WHO-led global line for access to vaccines they have scheme to provide fairer access to largely funded. COVID19 vaccines. Currently 190 countries (98 HIC and 92 LMIC) have An alternative proposal advocates that pooled resources to share the cost and countries receiving COVAX doses explicitly risk of vaccine acquisition (8). The Facility include refugees in the at-risk group for aims to purchase and distribute 2 billion vaccination (10). This approach is doses by the end of 2021. All countries, supported by UNHCR (11). While this regardless of financial input, will receive solution also prioritises refugee
vaccination, we believe that it would tend to be less able to purchase additional increase inequalities. doses for their native populations. Host countries may therefore be unwilling to The proportion of refugees to host vaccinate refugees at the expense of their populations varies widely between own citizens. countries (see Figure1). Host countries devoting a greater proportion of their PROPOSAL available vaccines to refugees have correspondingly less to offer their own We propose that the COVAX Facility citizens. For example, Lebanon has the should maintain a dedicated stock of highest per-capita refugee population in vaccine doses destined for the global the world (25%) (12). The entire stock of refugee population as though for an COVAX-allocated vaccines would be additional member state. A stock of 50 insufficient to vaccinate all refugees, even million doses would correspond to 2.5% of if no native Lebanese were vaccinated. the 2 billion doses which COVAX plans to This approach thus penalises countries acquire (8). This stock would then be used having accepted greater proportionate to supplement the doses allocated to host numbers of refugees, over those who countries according to the size of their have accepted less. These countries also refugee populations (see Figure1), with
oversight by relevant institutions such as a threat to us all (14). It is thus imperative UNHCR. to adopt mechanisms allowing refugees equitable access to COVID19 vaccination. Such an approach also has flaws. Allocation of extra doses to rich countries REFERENCES with substantial refugee populations (e.g., Germany) can be considered inefficient. 1. UNHCR - Figures at a Glance [Internet]. [cited 2021 Jan 22]. Adding an additional group to COVAX Available from: https://www.unhcr.org/figures-at-a- necessarily slows down receipt of vaccines glance.html to all groups somewhat and adds 2. UNSDG | Policy Brief: COVID-19 and People on the Move bureaucratic and administrative [Internet]. [cited 2021 Jan 24]. Available from: complexity to vaccine allocation, https://unsdg.un.org/resources/policy-brief-covid-19-and- particularly given the inaccuracies in people-move refugee-related data. Furthermore, one 3. Kluge HHP, Jakab Z, Bartovic J, D’Anna V, Severoni S. Refugee could legitimately question special and migrant health in the COVID-19 response [Internet]. Vol. inclusion for refugees but no other 395, The Lancet. Lancet vulnerable groups. Publishing Group; 2020 [cited 2021 Jan 2]. p. 1237–9. Available from: https://www.feantsa.org/ Nevertheless, we feel this approach 4. So AD, Woo J. Reserving coronavirus disease 2019 vaccines represents an improvement on the for global access: Cross sectional analysis. BMJ [Internet]. 2020 currently suggested strategies. It is Dec 15 [cited 2021 Jan 20];371. Available from: equitable, with extra doses allocated https://www.bmj.com/content/371/bmj.m4750 according to the needs of the population. 5. Fidler DP. Negotiating Equitable Access to Influenza Vaccines: It does not penalise countries for hosting Global Health Diplomacy and the Controversies Surrounding refugees and transfers the obligation of Avian Influenza H5N1 and Pandemic Influenza H1N1. Lee K, providing vaccine doses to the editor. PLoS Med [Internet]. 2010 May 4 [cited 2021 Jan international community. This is in line 19];7(5): e1000247. Available from: with the UN’s Comprehensive Refugee https://dx.plos.org/10.1371/journal.pmed.1000247 Response Framework (13) key objective to 6. With First Dibs on Vaccines, Rich Countries Have ‘Cleared the reduce pressure on countries that host Shelves’ - The New York Times [Internet]. [cited 2021 Jan 10]. refugees. Available from: https://www.nytimes.com/2020/12/15/us/coronavirus- CONCLUSION vaccine-doses-reserved.html 7. Chinazzi M, Davis JT, Dean NE, Mu K, Pastore Y Piontti A, Ensuring access of refugee communities Xiong X, et al. Estimating the effect of cooperative versus to COVID19 vaccine is critical for moral, uncooperative strategies of COVID-19 vaccine allocation: a legal, and practical reasons. Refugees are modeling study. a fragile population whose vulnerability 8. COVAX explained | Gavi, the Vaccine Alliance [Internet]. gives us a moral obligation to intercede on [cited 2021 Jan 20]. Available from: their behalf, and whose protection is https://www.gavi.org/vaccineswork/covax-explained enshrined in international law and 9. Emanuel EJ, Persad G, Kern A, Buchanan A, Fabre C, Halliday recognised by multiple international D, et al. An ethical framework for global vaccine allocation. governance agreements. On a practical Science (80- ). 2020 Sep 1;369(6509):1309–12. level, it is in the interests of the global 10. Mukumbang FC. Are asylum seekers, refugees and foreign community to participate in the control of migrants considered in the COVID-19 vaccine discourse? the virus among all populations. Allowing [Internet]. Vol. 5, BMJ Global Health. BMJ Publishing Group; it to persist unchecked among refugees is 2020 [cited 2021 Jan 16]. p. 4085. Available from: http://gh.bmj.com/ 11. UNHCR - Q&A: “Including refugees in the vaccine rollout is key to ending the pandemic” [Internet]. [cited 2021 Jan 21]. Available from: https://www.unhcr.org/news/latest/2021/1/5fff1afe4/qa- including-refugees-vaccine-rollout-key-ending-pandemic.html 12. Lebanon | Global Focus [Internet]. [cited 2021 Jan 22]. Available from: https://reporting.unhcr.org/lebanon 13. UNHCR - Comprehensive Refugee Response Framework [Internet]. [cited 2021 Jan 23]. Available from: https://www.unhcr.org/comprehensive-refugee-response- framework-crrf.html 14. If Refugees Cannot Get Coronavirus Treatment, Host Countries Will Suffer [Internet]. [cited 2021 Jan 22]. Available from: https://foreignpolicy.com/2020/03/27/coronavirus- refugee-health-pandemic-unhcr/ 15. Migration IO for. Migration Data Portal [Internet]. International Organisation for Migration; Available from: https://migrationdataportal.org/about
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COLLABORATION BETWEEN IMPERIAL COLLEGE LONDON AND NNEDPRO GLOBAL CENTRE FOR NUTRITION AND HEALTH Photo by Oladimeji Odunsi on Unsplash
Following on from several years of collaboration, NNEdPro Global Centre for Nutrition and Health have signed a Memorandum of Understanding with Imperial College London to harness strategic partnership opportunities in research and education. The collaboration will be taken forward through the Department of Primary Care and Public Health as well as the WHO Collaborating Centre linked with the department. Areas of joint interest include training and research around nutrition and food security in the Middle East and North Africa Region as well as other conflict prone countries. NNEdPro Global Centre for Nutrition and Health is an independent, interdisciplinary, international and research- intensive think tank that believes everyone has the right to good nutrition. They bring together a diverse range of professionals and a multitude of stakeholder organisations from across the globe who contribute to nutrition-related innovation for better health outcomes. They provide direct support to vulnerable populations, as well as education programmes to train frontline professionals. The NNEdPro Global Centre is anchored in Cambridge (UK) and operates through 12 Regional Networks. The organisation is currently active in nearly 40 countries, and their online platforms enable professionals all around the world to learn together and to share resources and best practice that help solve complex malnutrition related issues. With the emergence of the COVID-19 pandemic, NNEdPro has created a Nutrition & COVID-19 Taskforce with the aim to influence actions and policy in the nutrition domain to mitigate the impact of COVID-19 on food and healthcare systems as well nutrition and health outcomes. For more information on NNEdPro, please visit www.nnedpro.org.uk
PATIENT-INITIATED SECOND MEDICAL OPINIONS IN HEALTHCARE Image by Vecteezy.com
A second medical opinion is a medical decision-making tool for patients, physicians, hospitals and insurers. For patients, it is a way to gain an additional opinion on a diagnosis, treatment or prognosis from another physician. Physicians seeking another colleague’s opinion may refer a patient to another consultant to gain further advice. Many health insurers mandate second opinion programmes to reduce medical costs and eliminate ineffective or suboptimal treatments. Hospitals may also require second reviews as part of routine pathology, radiology reviews or for legal purposes. consultant to consultant referrals. Patients in primary care may also request an opinion from a second specialist when unhappy with the opinion from the first specialist. We carried out a systematic review to summarise evidence on (1) the characteristics and motivating factors of patients who initiate second opinions; (2) the impact of patient-initiated second opinions on diagnosis, treatment, prognosis and patient satisfaction; and (3) their cost effectiveness. The review was published in BMJ Opinion. Thirty-three articles were included in the review. 29 studies considered patient characteristics, 19 patient motivating factors, 10 patient satisfaction and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle-age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions. The review identified several demographic factors associated with seeking a second opinion, including age, gender, health status, and socioeconomic status. Differences in opinion received, and in the impact of change in opinion, varies significantly between medical specialties. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions.
YOUR PATH IN RESEARCH The NIHR Applied Research Collaboration Northwest London support people from all backgrounds to take an interest and engage with our applied health research and we enable researchers to take the next step in their research career. They do this because research is richer and more meaningful for having more people involved.
As part of the NIHR Your Path in Research campaign we hear from Kanika Dharmayat, who is starting the second year of an NIHR ARC Northwest London supported PhD on familial hypercholesterolemia (FH), to see how she has benefitted from the opportunity. FH is one of the most common genetic conditions that causes individuals to have elevated levels of cholesterol from birth and are therefore at increased risk of premature atherosclerotic cardiovascular events. Kanika is using her PhD to investigate this further and look at how to improve detection, it’s thought that fewer than 5% of the potential 25-35 million with FH have been detected. EVIDENCE-BASED PRACTICE Kanika describes what it was about the PhD that appealed to her: “The NIHR ARCs specifically focus on applied research which is an area I wanted to develop my skills and experience in. There was the opportunity to do a lot of applied research within the FH community which was really appealing.” Kanika doesn’t see her research career pathway as conventional because her studies have been interspersed with experiences working within hospital trusts. She has also completed internships abroad with UNICEF and others in countries such as Ghana and India. While carrying out this ‘hands on’ practical work she realised the value and importance of evidence-based practice and how research informs this. She describes her motivation to get further involved: “In order to drive evidence-based work, you need to conduct research and that’s where my interest and skillset are, that’s what I enjoy. What motivates me is being part of research that can inform guidelines and policies at the local, national and international levels to address public health challenges.” 'A NEW PERSPECTIVE' Despite the impact of the COVID pandemic, Kanika and her fellow PhD students have valued the support and opportunities the ARC supported PhD offers. She has carried out training in Health Economics, an area she wouldn’t have previously considered, engaged with collaborative learning events and taken the opportunity to interact with patients and members of the public through Patient and Public Involvement (PPI). “We get an insight from that perspective, of how our research is going to shape the front line and impact communities and individuals. Previously with my other research activities I didn’t get to do that so much, I was sitting at a desk and analysing numbers. We were never able to see the impact and have that direct conversation.” FOLLOW YOUR INTERESTS Kanika’s advice to anyone considering getting involved in research is to explore what’s out there and follow what interests them. She found the NIHR website a great resource for finding opportunities and experts to speak to about taking the next step. As she says: “There are endless opportunities for researchers at all stages.”
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Regimen is a German based company that has built a CE marked, digital multimodal programme for individuals struggling with erectile dysfunction (ED). The Regimen platform hosts a programme which combines patient education, targeted exercise, nutrition plans, lifestyle advice, stress management and optional tracking functionalities to empower users to improve their intimate and overall health. Prior to starting the Regimen programme, reviewed journal. Regimen are also individuals are invited to complete the working on improving the functionality of gold standard ED questionnaire consisting the platform to streamline collection of of the International Index of Erectile key data points to support evaluation and Function (IIEF-5). This tool classifies ED evidence generation. In time, this would into one of five categories ranging from enable Regimen to demonstrate the severe (5-7 points) to none at all (22-25 impact of their product for patient benefit points). End-users are then invited to and to support evidence-based complete the questionnaire every 4 weeks commissioning decision. Further to track improvements to their erection as development is expected to allow the they continue with the programme. clinical team and service users to monitor the ongoing delivery of the pathway and Regimen joined Cohort 5 of the Digital to demonstrate local improvements to Health London Accelerator programme in patient outcomes and possible cost 2020 and their key goal was to understand savings. “how to demonstrate that their innovation is safe and effective to payers, With oversight from Dr Mummery, practitioners, regulators and the patient”. Imperial SCARU is supporting Regimen in Regimen’s internal data showed that 75 developing a mixed methods research percent of individuals using the platform study to investigate extant barriers and improved their erection by 5 points or drivers for the widespread adoption and more on the IIEF scale during the first 12 diffusion of the Regimen lifestyle weeks of the programme. The platform medicine tool in the contemporary also achieved a 40 percent retention rate setting. Another aspect of the study will 6 months after initial activation. investigate the effectiveness of Lifestyle Medicine approaches (such as the Regimen are collaborating with Dr David Regimen app) to tackle erection Mummery (NIHR CRN NWL Primary Care dysfunction and to explore the role of Theme Lead) & Imperial SCARU to develop healthcare professionals and pharmacies a thought leadership think-piece as key enablers of self-care. earmarked for publication in a peer
MEdIC Medical Education Masterclasses During the summer, the Medical Education Research and Innovation Centre (MEdIC) delivered a series of free, virtual medical education masterclasses aimed particularly at UK medical students from under-represented backgrounds. Sessions covered topical areas in medical education including coaching, preparation for practice, diversity & inclusion, digital health and professional identity. The sessions were attended by 250 students from several UK universities including Imperial, Cardiff, Dundee, Leeds and Nottingham. The feedback was overwhelmingly positive; students commented on how inspiring the sessions were and the enjoyment of meeting other medical students. “Overall, the masterclasses provided a broad and insightful overview of medical education. I particularly enjoyed the opportunity to meet other like-minded students from different medical schools and the chance to listen to presentations and panel discussions by experts who shared their experience and passion for medical education” Students felt the masterclasses had helped to increase their interests in pursuing future careers in medical education: “This experience has definitely made me consider medical education as a career choice” “Prior to attending the masterclasses, I was uncertain about what medical education truly entails. However, now I have a deeper understanding of not only what it's really about but also how to take the first steps to be involved” “Overall, the masterclasses have encouraged me to look at medical education with an inquisitive eye, always asking the questions: how well does current medical education translate into well-prepared doctors, and what changes are still needed? So, by giving me an insight into where the gaps may still lie, my interest in a career in medical education, as a means of being an instrument of change, has increased” As part of the masterclasses, MEdIC ran a competition for students to submit medical education research project proposals. The shortlisted entries were presented to a panel in November and the winning submission provided with supervision and funding by MEdIC to complete the project.
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In In 2020 NHS staff saw UK citizens applaud their efforts including hospital doctors and general practitioners in a Clap for Carers campaign. While the pandemic was peaking in the first phase, GPs managed sick populations to stave off surge pressures in NHS hospitals. From the winter lockdowns of late 2020 and into the release of restrictions in 2021 the doors of general practices never closed. Primary care was responsible for implementing much of the vaccination programme that has successfully protected the highest risk UK adult populations and is now mass vaccinating the younger population. The general practice workforce is already battling years of underinvestment as more work shifts from hospital to community. The Coronavirus pandemic has added to the workload because of additional pressures to protect staff and patients by prior triage, combining remote consultations with face to face and addressing population needs with health service provision in community and hospitals. Against these changes, is a slowly growing backlog of work as patients who have delayed presenting less urgent problems to their GP. By September 2021, already stretched GP resources were reaching saturation and staff morale had fallen as the workforce felt the strain of workload pressures. The lack of representation of GPs among the UK political leadership may have contributed to misinformation about what happens on the ground in practices. To ‘showcase the humans behind general practice’ @YourGP2021 is asking for general practitioners to join a #yourGP campaign. • TAKE A PHOTO • GIVE YOUR NAME • SAY WHY YOU LOVE GENERAL PRACTICE And help raise the visibility of our valuable work!
SELF-CARE HEALTH STORYLINES The International Self-Care Foundation (ISF) with support from Self-Care Catalysts & Imperial SCARU launched an application-based platform designed to help those who may find practicing self-care difficult. The Self-Care Health Storylines App is based on the Seven Pillars of Self-Care developed by the ISF. The informational content is designed to help individuals take practical steps to improve their health & wellbeing through self-care, behaviour change & lifestyle modification. The app includes a unique toolkit that works alongside curated information developed in conjunction with the ISF. Amongst the tools there are trackers and information on nutrition, exercise, risk avoidance (like quitting smoking) and the opportunity for app users to integrate their health care provider and track their self-care potential on several levels. The app also acts as a single consolidated hub for current self-care news. Daily content is generated that provides updates on new evidence for self-care interventions as well as links to additional sources. Regular use of the app could help people to stay informed & feel supported in their self-care journey. The platform also includes an opportunity to access the user base for research and targeted messaging for disease-related groups (e.g., diabetes). The app is available to download on Android & Apple devices
RISK OF COVID-19 IN SHIELDED AND CARE HOME PATIENTS Early in the Covid-19 pandemic, the elderly and people who were clinically extremely vulnerable were asked to shield to reduce their risks of Covid-19 infection and its complications. We evaluated the effectiveness of shielding in a study published recently in the journal BJGP Open. We found that Covid-19 rates were much Our results suggest that shielding alone is higher in the shielded group compared not enough to protect clinically vulnerable with non-shielded group (6.5% vs 1.8%). people and that vaccination, along with The increase in risk of infection in the suppressing community infection rates, shielded group persisted after adjustment remains the best way to protect these for a wide range of factors in a Cox patients from the risk of serious illness proportional hazards regression model. and death from Covid-19. We also found that Covid-19 rates were Our results also refute suggestions that the seven times higher in people living in care UK could have avoided lockdowns by shielding homes; and were also higher among vulnerable groups, whilst allowing society to people from ethnic minorities, those living otherwise function normally. This policy in poorer areas, and in people with long- would probably have led to even higher term medical conditions such as infection, hospitalisation, and death rates in respiratory disease. vulnerable people.
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SPOTLIGHT ON CHILD HEALTH UNIT: FOCUS ON TACKLING HEALTH INEQUALITIES In September 2021, The Child Health Unit team led by Professor Sonia Saxena came together for their first in person and hybrid meeting since the Covid 19 pandemic hit
The theme was focused on one of the main priorities -tackling health inequalities in children and young people. Dr Kim Foley presented her ARC funded work to examine the impact of Covid 19 on trends in children and young people’s primary care use, Dr Nishani Jayasuriya spoke about adolescent transitions in medication adherence in inflammatory bowel disease, Dr Rizwana Lala gave a talk on decolonising sugar; understanding health inequalities in dental health services and Dr Francesca Neale presented her plans to understand local disparities in children’s health service use. Our strategy meeting that followed in the afternoon allowed us to reflect together on the past year; what went well and challenges to set goals for the years ahead. Our group is now entering its ninth year and we look forward to resetting our goals to meet emerging need for information to inform primary care and public health efforts to improve child health and tackle health inequalities. We rounded the day off with an enjoyable networking stroll along the Thames for an early supper and social evening.
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Widening Access to Careers in Community Healthcare (WATCCH) is a widening participation initiative aimed at Year 12 students from state schools interested in a career in healthcare. WATCCH provides work experience, near-peer mentoring, and a programme of workshops on a range of healthcare careers and admissions help. The work experience and first two workshops have now been completed. The first Imperial student-led workshop was on ‘Reflection and Coaching’ in which students engaged with mentors to reflect on their recent GP-based work experience as well as discuss their thoughts on matters such as the importance of reflection within the general/healthcare setting. Students then delved into the world of coaching. They were introduced to reflection and coaching frameworks and went on to apply their learning and skills in smaller groups. The workshop was really interactive and enjoyable and received really positive feedback from the students. The second workshop was on ‘Personal Statements and Where should I apply’ where current medical students gave advice and tips on personal statement writing followed by a collaborative session reviewing personal statement drafts. The second workshop built on the first workshop where students used the reflection frameworks from the first workshop to probe further thinking regarding their personal statements in this conducive learning environment. Once again, the workshop received very positive feedback. Preparation is already underway for the next useful workshop – ‘Interview Skills’.
The WHO Collaborating Centre for Education and Training Team Delivered an Acute Events Management Course to create a new Academy for Public Health for Saudi Arabia The Public Health Authority, previously known as the Saudi Centre for Disease Prevention and Control (SCDC), is leading the work to transform the public health workforce across the Kingdom. The public health workforce encompasses a broad background in education and training, representing the functions they take on at work across many ministries, institutions, community organizations, and the private sector. Consequently, training needs to improve public health core knowledge and skills that are variable and require a wide variety of different learning models. The development of The Academy for Public Health is part of the Authority’s pioneering initiative across the Arab world. The Academy aims to provide a well-defined, structured, and sustainable professional development programme in public and population health for all staff with health and well-being responsibilities achieved by delivering Public Health training courses and workshops. This Public Health Practice Course is the second of many courses delivered by the now established Saudi Academy for Public Health in collaboration with the WHOCC at Imperial College London.
This training equipped the participants with the essential technical awareness and skill set to work with different acute events. Throughout this three-day course, the focus has been on acute events management, how to lead health organisations effectively across a range of dimensions including policy, service delivery, advocacy, resource mobilization in the event of public health acute event, and performance appraisals. Since the course had a specific target audience, around 25 participants were nominated to attend this course based on their qualifications and background. An online blackboard platform was set up on the WHO Collaborating Centre (WHO CC) Imperial College London website. All the materials, presentations, exercises, and recordings were uploaded and kept for the participants to use and review whenever they need with their login information. PUBLIC HEALTH COMPETENCIES ADDRESSED: The course was designed to equip public health professionals with the following competencies: 1. Develop and implement strategies based on relevant evidence, legislation, emergency planning procedures, regulations, and policies. 2. Understand the local implications of the One Health* approach, its global interconnectivity and how it affects health conditions in the population. 3. Critically analyse the changing nature, key factors and resources that shape One Health to influence actions (emergency preparedness planning and response) at the local and international levels. 4. Know and apply, where needed, the International Health Regulations to coordinate and develop strategic partnerships and resources in key sectors and disciplines for health security purposes. 5. Contribute to or lead communities based on health needs assessments, ensuring that assessments consider biological, social, economic, cultural, political, and physical determinants of health and broader determinants of health such as deprivation. * ONE HEALTH: ONE HEALTH IS AN APPROACH THAT RECOGNIZES THAT THE HEALTH OF PEOPLE IS CLOSELY CONNECTED TO THE HEALTH OF ANIMALS AND OUR SHARED ENVIRONMENT. Participants are now able to: 1. Demonstrate a universal understanding of health leadership during epidemic and pandemic setting. 2. Recognise best practice of resources management in the event of an acute outbreak. 3. Determine an ability to effectively tackle real problems from situational interpretation to high-level decision-making with a clear sense of accountability and responsibility during an acute event setting. 4. Effectively lead during acute events including pandemics whilst maintaining regular services. 5. Effectively manoeuvre political responses during an acute event and pandemic settings. 6. Meet the competencies required for acute level management. Photo by Felicia Buitenwerf on Unsplash
Five minutes with… Toqir Mukhtar Advanced Research Fellow
What is your role within the department and how long have you been here? Deputy Director of the Research Design Service (RDS) at ICL, and Advanced Research Fellow. This is my third year in the department. What does your role involve? I lead the RDS team at ICL. RDS is funded by the NIHR, and there are ten regional services in England. RDS London is hosted by four universities: University College London; Kings College London; Queen Mary University of London, and ICL. I am responsible for the day-to-day supervision of the team, and the coordination of RDS activities at ICL. An example of the services we offer is a ‘drop-in clinic’ in which advisors can advise clients on applications for funding, and the funding process. What do you enjoy most about your role? Learning about new, and potentially path-breaking, research studies that may have policy implications that make a positive difference to the lives of many. Meeting people who work within different fields of research (different to mine). What were you doing prior to this/what is your background? I’m a chronic disease epidemiologist. I have spent several years at Oxford working on a number of studies; for example, a study of breast cancer mortality trends and mammography screening. I have also spent a year as a Visiting Scientist at Harvard, working on a study of circulating vitamin D and breast cancer. In addition, I have spent some years directing studies in the areas of arts participation and intellectual property at Princeton. What are your goals for the next few years? To become Professor of Epidemiology. Outside of work, I would like to spend more time with immediate family, because these people mean a lot to me, and are irreplaceable. Why PCPH? A welcoming and friendly department; I am happy to be part of it. In my experience of working at universities on both sides of the pond, I have found that Department
Chairs are integral to setting the culture and ethos of a department; Professor Majeed has clearly contributed to making PCPH a great place to work. Tell us about your outside interests In addition to my role at Imperial, I am also examining the pleiotropic effects of rare genetic variants on risk of cancer, at Cambridge. (I am in the latter stages of completing a PhD.) I would like to travel more, and lately, and as for most people, my travel has been curtailed by the restrictions imposed during the pandemic. But I would like to spend some time in the coastal areas of the UK. When I have time, I like to read newspapers, magazines and books. As an undergraduate, I read quite a lot of English literature of the 1920s, and still will dip into this, occasionally. However, there is no one genre that interests me to the exclusion of others. A book that I would recommend is former Observer travel writer Alexander Frater’s ‘Chasing the Monsoon’. In this book, Frater traces the progression of the monsoon on the Indian Subcontinent, and describes places where rain ‘is tropical, the kind that seems to possess metallic weight and mass’. It is well worth a read. Here’s our PCPH version of Desert Island discs: What three tunes would you take with you on our desert island and what is your luxury item. To be perfectly candid, if I knew I were to be stranded on a desert island, the last thing I would think about taking with me would be three tunes. How useful would these be in a tropical rainstorm when really what I would most needed was shelter to keep dry? How about a really good tent, something to start a fire with; and a supply of sustenance/clean water? My luxury item would be good coffee. Because I like it. Who would be at your dream dinner party and why? Family whom I have lost over the years, and whom I would like to see again.
Photo of Bedruthan Steps in Cornwall by George Hiles on Unsplash
The Imperial Centre for Cardiovascular Disease Prevention (ICCP) team has developed a global, freely accessible, patient-focused directory of lipid clinics and patient advocacy groups named ‘FindMyLipidClinic.com’. This initiative stems from the wider European Atherosclerosis Society (EAS) Familial Hypercholesterolemia Studies Collaboration (FHSC), a consortium of investigators interested in dyslipidaemia, led by the ICCP and present in 66 countries. FindMyLipidClinic.com, which is available in 29 languages, is expected to help dyslipidemia patients and their relatives, who often struggle to find help with their condition, to find an adequate level of care and support close to their homes. In addition to allowing its users to find specialists and support organisations around a given location, FindMyLipidClinic.com also allows its users to filter specialist clinics according to the services provided (e.g., treating adults or children, genetic testing, Lp(a) testing, imaging). This non-commercial initiative is GDPR compliant, does not store users' personal information, and is accessible to visually impaired people. FindMyLipidClinic.com is expanding rapidly and currently contains 105 specialist lipid clinics across 37 countries most of which are part of the EAS FHSC, and 26 patient advocacy groups across 25 countries mostly contributed by The European FH Patient Network (FH Europe). Over the last 18 months, visitors of this Directory have searched for lipid clinics and/or patient advocacy groups ~10K times across 700 locations.
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