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BackgroundThe risk of incident gout in the United Kingdom (UK) appears to have declined since 2013.[1] However, whether this is temporary or likely to continue is unclear.ObjectivesTo examine the influence of age, calendar year, and year of birth on recent gout incidence in the UK.MethodsUsing data from IQVIA Medical Research Database in the UK, we identified incident gout by READ codes from 1999 to 2019. We grouped age, calendar year, and year of birth into 3-year categories. We assessed the effect of age, calendar year, and birth cohort categories on the incidence rate of gout using the age-period-cohort model among all participants and in men and women separately.ResultsOver the 21 years, there were 164,588 incident gout cases. The incidence rate of gout increased with age until age 80, then leveled off (P for trend <0.001) (Figure 1A). The gout incidence increased from 1999 to 2013, then declined (Figure 1B). The incidence rate of gout was higher in the late birth cohorts than in the early birth cohorts from the Year 1999 to the Year 2013 (Figure 1C);however, such a trend was reversed after the Year 2013, with the incidence rate of gout being higher in the early birth cohorts than that in the late birth cohorts (Figure 1D). Similar patterns were observed in men and women.ConclusionUsing the age-period-cohort model, we found that the risk of gout in the UK increased from 1999 to 2013 and then declined afterward. These findings suggest that some environmental factors occurring after 2013 may play role. Such a downward trend of the risk of gout may continue if these environmental factors are still present.Reference[1]Abhishek A, Tata LJ, Mamas M, et al. Has the gout epidemic peaked in the UK? A nationwide cohort study using data from the Clinical Practice Research Datalink, from 1997 to across the COVID-19 pandemic in 2021. Ann Rheum Dis 2022 Jan 27.Figure 1.(A) Age rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each age category compared with the reference age category (57-59) was adjusted for the calendar year and birth cohort. (B) Calendar year rate ratios and 95% confidence intervals of gout incidence. The relative risk of each calendar year compared with the reference calendar year (2008-2010) was adjusted for age and birth cohort. (C) Cohort rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each birth cohort (1911-1982) compared with the reference birth cohort (1950-1952) was adjusted for age and calendar year. (D) Cohort rate ratios and the corresponding 95% confidence intervals of gout incidence. The relative risk of each birth cohort (1923-1988) compared with the reference birth cohort (1950-1952) was adjusted for age and calendar year.[Figure omitted. See PDF]AcknowledgementsThis work was supported by the National Natural Science Foundation of China (81930071, 82072502, U21A20352), Project Program of National Clinical Research Center for Geriatric Disorders (2021LNJJ06, 2022LNJJ07), the Natural Science Foundation of Hunan Province (2022JJ20100), and the Science and Technology Innovation Program of Hunan Province (2022RC3075, 2022RC1009).Disclosure of InterestsNone Declared.
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Objectives: The COVID-19 pandemic dramatically highlighted health inequities and the differential impact that vaccination can have on health, depending on social advantage. In a non-pandemic setting, vaccination can improve equity, but this broader value of vaccination is not currently considered in health economic analysis despite equity being a policy priority in many countries. Method(s): A panel of health economists and policy experts convened to discuss how to capture the equity dimension of the value of vaccination. This was conceptualized using a distributional cost-effectiveness analysis framework with four steps leading to differential health impact: (i) differences in vaccine preventable disease incidence;(ii) differences in the vaccination uptake;(iii) differences in health effects;and (iv) differences in health opportunity costs. The concept was illustrated by a retrospective modelling exercise of 4-component meningococcal serogroup B (4CMenB) infant vaccination against serogroup B invasive meningococcal disease (MenB) in England, for which an existing model was adapted. Five social groups were analysed based on Index of Multiple Deprivation Quintiles (IMDQ). Result(s): 4CMenB infant vaccination disproportionately prevented MenB cases among more deprived groups: of all prevented cases, 40.3% were among the most deprived IMDQ (accounting for 25.9% of the target population <5 years of age) and 78.1% among the three most deprived IMDQs. Vaccination had a positive, though small, net equity benefit, and the direction of equity impact was robust to sensitivity analyses varying the distribution of uptake, MenB carriage prevalence, and assumptions related to life expectancy and utility stratified by IMDQ. Conclusion(s): Within a national immunisation programme, 4CMenB vaccination improves health equity by preventing disproportionately more cases in more socially disadvantaged groups. The health equity impacts of vaccination can be captured in health economic evaluation although there is a need to improve the evidence base and develop more user-friendly equity impact measures. Copyright © 2022
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In an effort to limit physical contact during the COVID-19 pandemic, there has been rapid implementation of virtual cancer care clinics using messaging, audio, and video communication. This model has advantages, particularly in convenience for patients who do not have to travel to a distant centre for specialist care, but has the potential to limit communication and also omits physical examination. The aim of this survey study was to assess whether patients attending the oncology unit at a tertiary care academic cancer centre were satisfied with the virtual clinic model and explore challenges in the delivery of virtual care. We also surveyed medical oncology trainees and consultant oncologists in the centre on the use of virtual care. Methods: All patients attending St Vincent's University Hospital Oncology, Dublin, Ireland, who had received a virtual oncology clinic appointment were invited by text message to participate in a survey study analysing attitudes towards virtual oncology clinics. Medical oncology trainees and consultants working were also invited to give their opinions. Results: Between April and October 2020, 207 patients (of 600 invited) who had at least one virtual clinic consultation responded to the survey. 95% had their consultation via telephone, and 5% by email. 80% reported satisfaction with the experience. 85% received timely notice of their appointment, but 50% of patients did not receive a telephone call at the scheduled time. 80% of patients thought they had enough time with the doctor. Some patients who were travelling from outside Dublin found virtual clinics more convenient. 50% of patients want to continue virtual consultations post Covid-19;the main criticism was that patients want to receive the call at the appointed time. 14 medical oncology trainees (of 18 invited)and 6 consultants (of 8 invited) responded to the survey. 92% of trainees and 100% of consultants believed virtual care is inferior to face to face care. 85% of junior doctors and 100% of consultants surveyed found clinical assessment more difficult via virtual consultation, but 76% of trainees and 100% of consultants found virtual clinics more time efficient. 62% of trainees reported face to face clinics as better for education from consultants. 80% of consultants believed the education of trainees was inferior in virtual clinics. 62% of trainees and 100% of consultants would like to continue virtual care in some form post Covid -19. Conclusions: Irish patients attending a tertiary academic cancer centre were mostly satisfied with the telephone consultations they had with their oncology team. Satisfaction rates were lower among the doctors than patients, reflecting doctors' difficulties in clinical assessment and teaching opportunities using virtual care. This survey highlights the need for more advanced technical platforms (including video calling and real time messaging) to provide excellent virtual care, as well as the development of new strategies for medical education through virtual clinics.
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Objectives: To ensure the provision of appropriate travel healthcare guidance, this service improvement study examined travel-related difficultiesand concerns which adult people with cystic fibrosis (PWCF)experience and if there are potential situations detrimental to patienthealth.Methods: A voluntary, anonymous questionnaire was distributed topatients (n = 68;17–71y) attending routine clinic and a virtual focusgroup with PWCFs and healthcare team discussed issues and experiencesto enable the co-production of appropriate healthcare-related guidance.The availability of published online guidance, from other UKCF centres andCF charities, were examined.Results: On vacation, 38% (25/66) took a break from nebulised therapiesand 9% (9/67) were not aware of travel adapter requirements. Cleaning ofnebuliser responses (n = 59) varied, involving tap water with/without soap(57.6%), heat/chemical disinfection (30.5%), cloth/wipes (5.1%), rinsing incooled boiled water (3.4%), dishwasher (1.7%) and nothing (1.7%). PWCFconcerns included travel insurance costs, medication (having enough;maintaining cold chain during travelling and accommodation), airportsecurity (searching of bags, swabbing of nebulisers, scrutiny of medicinelist and issues if incomplete, concern with presence of a PEG) and flights(acquiring infections, travelling with other potential passengers with CF,concern that medicines will get lost or damaged hence necessity to carry ascabin baggage with restrictions;passengers complaints about coughing).Information available from online resources was varied in content anddepth. Patients indicated the value of comprehensive advice from theirhealthcare team.Conclusions: Healthcare teams should prepare travel guidance and stressthe importance of continued nebulised therapies during vacations andproper nebuliser cleaning and disinfection methods to minimise the risk ofcontaminating nebulisers with environmental/water organisms
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Like most other universities in the United States, classes and labs at University of the Pacific went fully virtual in March 2020 as a result of the Coronavirus (COVID-19) pandemic. Prior to this event, all classes were taught in face-to-face synchronous mode. At the end of the semester, we administered a survey to students in the School of Engineering and Computer Science asking for feedback on their remote learning experience. In addition to numerical ratings, specific feedback was sought using the following questions: • What elements of remote delivery were effective/not effective? • Do you have any specific suggestions for improving delivery of course or lab content in remote environments? • What elements of the remote environment made it easy to learn/difficult to learn? • Do you have any specific suggestions that could improve students' ability to learn in remote environments? • What elements of the remote environment made it easy/difficult to complete your work? • Do you have any specific suggestions for things that could make it easier for students to complete their work in remote environments? • Top three factors that affected your learning negatively/positively. We received 48 responses that included over 400 individual comments. Student demographic data indicated that responses were received from students in all years, although most respondents were seniors. Responses were analyzed using the ASCE ExCEEd Teaching Model. Comments were coded manually using a spreadsheet and also categorized using MAXQDA qualitative data analysis software and were checked for consistency between the two methods used. Students' comments predominantly addressed appropriate use of technology, student engagement in the class or lab, and structured organization of the material and activities presented synchronously and asynchronously. Findings of the survey were shared with faculty in the School to inform preparation for, and teaching in, Fall 2020. Survey results, the analysis approach used, and observations are presented in this paper. The ASCE ExCEEd Teaching Model proved to be a valuable framework for cataloging and analyzing over 400 comments provided by students. Analysis of the comments showed that students prefer live classes with recorded lectures for later use together with ample opportunity for office hours and contact and communication with faculty and their peers. © American Society for Engineering Education, 2021
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Law Teacher Policy and Educational Developments Editor Kat Langley sat down with the creators of the hugely popular "Connecting Legal Education" Community of Practice (CLE CoP), to find out what inspired them, how the sessions have evolved, and what's next. The first CLE online hangout happened in response to the Covid-19 pandemic, and continues to run via a hosted Teams site. The CLE CoP offers presentation, conversation, and networking opportunities for all members of the legal education community. The conversation with Professor Michael Doherty (Lancaster University), Associate Professor Lydia Bleasdale (University of Leeds) and Birmingham Fellow Emma Flint (University of Birmingham) follows below.
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Background: The guide to Deathbed Etiquette was created in 2019 by The Centre for the Art of Dying Well (@artofdyingwell) to support those at the bedside of a loved one who is dying. Updated guidance was developed in 2020 in response to the COVID-19 pandemic. During the COVID19 pandemic, many people (healthcare professionals and lay) have discussed the guide online;however, the nature of these discussions has not been examined. Aims: To evaluate the online response to the Deathbed Etiquette guide. Methods: We conducted a retrospective 2-year analysis of social media and newspaper comments, which referenced the Deathbed Etiquette guide. We conducted a sentiment analysis of three UK online newspaper comments about the guide. On Twitter, we analysed sentiment and frequency of tweets using the #deathbedetiquette hashtag;we also explored the relationship of this data with tweets from the @Artofdying Twitter account. Results: 104 Tweets included the #deathbedetiquette hashtag (with 272 retweets and 432 likes). Three peaks in tweet intensity corresponded with promotional activity from the @Artofdyingwell account. These dates were July 2019 (Deathbed etiquette launch), August 2019 (attention from Catholic Church and media) and April 2020 (relaunch of COVID19 guide). Sentiment on Twitter was positive with no negative tweets. The newspaper sentiment analysis demonstrated how the public voiced both supportive, but more negative comments about the guide. For example, some people did not like the term etiquette or the directive structure of the guide. They also disliked what they considered to be the depressing subject matter. Conclusion: Online discussion about the Deathbed Etiquette was varied. Our data demonstrates the potential to use social media and online comments to gain understanding about palliative care interventions. Future work can examine the content of these discussions in greater depth and include other social networks, newspapers and digital formats.
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This paper describes the epidemiology of coronavirus disease 2019 (COVID-19) in Northern Ireland (NI) between 26 February 2020 and 26 April 2020, and analyses enhanced surveillance and contact tracing data collected between 26 February 2020 and 13 March 2020 to estimate secondary attack rates (SAR) and relative risk of infection among different categories of contacts of individuals with laboratory confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Our results show that during the study period COVID-19 cumulative incidence and mortality was lower in NI than the rest of the UK. Incidence and mortality were also lower than in the Republic of Ireland (ROI), although these observed differences are difficult to interpret given considerable differences in testing and surveillance between the two nations. SAR among household contacts was 15.9% (95% CI 6.6%-30.1%), over 6 times higher than the SAR among 'high-risk' contacts at 2.5% (95% CI 0.9%-5.4%). The results from logistic regression analysis of testing data on contacts of laboratory-confirmed cases show that household contacts had 11.0 times higher odds (aOR: 11.0, 95% CI 1.7-70.03, P-value: 0.011) of testing positive for SARS-CoV-2 compared to other categories of contacts. These results demonstrate the importance of the household as a locus of SARS-CoV-2 transmission, and the urgency of identifying effective interventions to reduce household transmission.