A Study of Universal Severe Acute Respiratory Syndrome Coronavirus 2 RNA Testing Among Residents and Staff in a Large Group of Care Homes in South London.

BACKGROUND: Care homes have experienced a high number of coronavirus disease 2019 (COVID-19)-related deaths among residents since the onset of the pandemic. However, up to May 2020, there has been a lack of information about the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents and staff in care homes and limited testing in this setting. METHODS: Combined nose and throat swab testing for SARS-CoV-2 RNA was carried out in 2455 residents and staff across 37 care homes in the London Borough of Bromley across a 3-week period. Results were reported within 24 hours of sample delivery, and data were collected on the presence or absence of symptoms. RESULTS: Overall, the point prevalence of SARS-CoV-2 infection was 6.5%, with a higher rate in residents (9.0%) than in staff (4.7%). A key finding was the high proportion of asymptomatic infection detected in staff (69%) and residents (51%), with evidence of underdetection of symptoms by care home staff. CONCLUSIONS: The high proportion of asymptomatic infection combined with underdetection of symptoms by care home staff indicates that offering a test to all residents and staff in care homes with rapid reporting of results would assist accurate identification of infected individuals, facilitating prompt infection prevention and control action.

A building concern? The health needs of families in temporary accommodation.

BACKGROUND: The number of families living in temporary accommodation in the UK is increasing. International evidence suggests that family homelessness contributes to poor mental health outcomes for both child and parent/carer, yet there is no routine way of understanding these health impacts at a local area level. METHODS: A homeless health needs audit was adapted to include questions about family health and completed in survey form by 33 people living in temporary accommodation in the London Borough of Bromley. Data were supplemented through an engagement event with 23 health and community care practitioners. RESULTS: The small population sample surveyed showed high levels of poor mental health in addition to behaviours that increase the risk of physical ill health (such as smoking) and a high use of secondary healthcare services. Engagement with practitioners showed awareness of poor health amongst this population group and challenges with regard to providing appropriate support. CONCLUSIONS: There needs to be a sustainable and representative way of understanding the health needs of this population group including a comparison of the health needs of people placed in temporary accommodation in and out of their resident area.

Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for non-diabetic hyperglycemic patients referred by primary care in the UK.

OBJECTIVES: To determine if a diabetes prevention program (DPP) delivered by a commercial weight management provider using a UK primary care referral pathway could reduce the progression to type 2 diabetes (T2D) in those diagnosed with non-diabetic hyperglycemia (NDH-being at high risk of developing T2D). RESEARCH DESIGN: This is a quasi-experimental translational research study. METHODS: 14 primary care practices identified, recruited and referred patients with NDH (fasting plasma glucose ≥5.5 to ≤6.9 mmol/L and/or glycated hemoglobin (HbA1c) ≥42 to 47 mmol/mol (6.0%-6.4%)) and a body mass index (BMI) ≥30 kg/m2 to a DPP. Eligible patients were asked to contact Weight Watchers to book onto their DPP, an intensive lifestyle intervention which included a 90 min activation session followed by the offer of 48 weekly Weight Watchers community group meetings. Patients' blood tests were repeated by primary care, weight change plus self-reported data was recorded by Weight Watchers. RESULTS: 166 patients were referred to the program and 149 were eligible. 79% of eligible patients attended an activation session (117 eligible patients) and 77% started the weekly sessions. The study sample was primarily female (75%), white (90%), with 5% living in the most deprived quintile in the UK. Using intention-to-treat analysis, the DPP resulted in a mean reduction in HbA1c of 2.84 mmol/mol at 12 months (from 43.42±1.28 to 40.58±3.41, p<0.01). 38% of patients returned to normoglycemia and 3% developed T2D at 12 months. There was a mean weight reduction in BMI of 3.2 kg/m2 at 12 months (35.5 kg/m2±5.4 to 32.3 kg/m2±5.2, p<0.01). CONCLUSION: A UK primary care referral route partnered with this commercial weight management provider can deliver an effective DPP. The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact.

Childhood chest illness and the rate of decline of adult lung function between ages 35 and 45 years.

RATIONALE: There is an association between childhood chest illness and impairment of adult ventilatory function. It has not yet been established whether respiratory illness in childhood predisposes to chronic obstructive pulmonary disease by accelerating the decline in adult lung function. OBJECTIVES: To determine the effects of childhood chest illness and smoking on the rate of decline of adult ventilatory function from the age of 35 to 45 yr in a large, nationally representative sample of British adults. METHODS: Spirometry measurements were compared at 35 and 45 yr of age in 1,158 adults participating in the British 1958 Birth Cohort. Multiple regression analysis was used to measure the association between childhood chest illness and within-person change in spirometric volumes between age 35 and 45 yr, adjusting for potential confounding factors. MEASUREMENTS AND MAIN RESULTS: The mean reduction in FEV(1) between ages 35 and 45 yr was 35 ml/yr. Compared with subjects without the relevant respiratory history, the rate of decline was not significantly associated with pneumonia (mean difference, -0.2; 95% confidence interval, -6.1 to +5.8 ml/yr), whooping cough (0.7, -5.1 to +6.5 ml/yr), wheeze by age 7 yr (0.4, -5 to +5.9 ml/yr), or wheeze onset by age 8 to 16 yr (-3.4, -10.5 to +3.6 ml/yr). A similar pattern emerged for forced vital capacity. CONCLUSIONS: Childhood chest illness does not adversely affect the rate of decline of lung function in mid-adult life.