Exploring the link between self-management of migraine and emotional wellbeing: a cross-sectional study of community-dwelling migraine sufferers.

BACKGROUND: Globally, an estimated 14% of adults live with migraine disease which impacts their physical, emotional and social wellbeing. To target the disease comprehensively, research recommends a multidisciplinary approach to migraine management. Yet, at present, migraine management primarily centers around pharmaceutical treatments. The aim of this study was to investigate the extent to which emotional awareness could influence the uptake of self-care behaviours of community-dwelling adults with migraine. METHODS: A cross-sectional online survey explored personal experiences with migraine disease and strategies or behaviours to manage migraine attacks. Chi-squared tests were used to investigate differences in ratings of migraine prevention and management strategies between users and non-users of the strategies. Univariable logistic regressions were used to assess the effectiveness of self-care behaviours to manage or prevent migraine attacks. RESULTS: We surveyed 170 community-dwelling adults with migraine in the United Kingdom, Austria, Germany and the United States. Most (85%) respondents had experienced migraine for over five years, where 42% of attacks usually lasted several days. Whereas we did not differentiate between diagnosis by a neurologist or self-diagnosis, the most common diagnoses in the cohort were migraine without aura (38.9%) and migraine with aura (29%). Staying hydrated was the most popular preventative strategy (87%), 70.2% used prescription medication and 64.9% changed their diet and/or supplements. Almost all ( 92.4%) respondents stated that their mood or emotions could trigger their migraine attacks. Keeping a headache or mood diary was the lowest-rated prevention strategy and was rated as "probably ineffective" or causing "no change" in preventing migraine attacks. Over a third (39.7%) kept track of their physical wellbeing and symptoms. Reasons stated for tracking symptoms included to identify triggers (65.8%), show reports to a healthcare professional (59.6%), understand when they must take medication (48.1%), track improvements (67.3%) or deteriorations (67.3%). CONCLUSIONS: Migraine management is dominated by pharmaceutical management for acute pain attacks and lifestyle changes for managing migraine long-term. Perception of the effectiveness of those techniques is high, whereas perception of interventions that target the emotional or psychological components of chronic pain management (keeping a mood diary, and mental health support) is mixed. There exists a gap between the recommended biopsychosocial approach and the current state of migraine management.

Investigating self-reported efficacy of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study.

BACKGROUND: Erectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy. AIM: Investigate self-reported efficacy of lifestyle medicine approaches to tackle ED. METHODS: A cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition. OUTCOMES: Self-reported measure: perceived effectiveness of lifestyle medicine interventions to tackle ED. RESULTS: Most respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated. CLINICAL IMPLICATIONS: Structured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED. STRENGTHS AND LIMITATIONS: To our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal limitation was the lack of follow-up, and not recording other information including lifestyle factors such as nutrition, smoking, and the use of alcohol and recreational drugs, which may have enabled a fuller exploration of the factors that could influence the primary outcome measures examined. CONCLUSION: Despite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition.

Erectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED can be treated using lifestyle medicine approaches with or without the use of medicines. The aim of this study was to investigate self-reported efficacy of lifestyle medicine approaches to tackle ED. We conducted a cross-sectional online survey of 1177 community dwelling adults to explore the prevalence, methods and perceived effectiveness of lifestyle medicine approaches to tackle ED in the community setting. Most respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, high blood cholesterol and obesity. After medication stress management (43.5%) and weight loss (40.4%) were most frequently cited lifestyle medicine intervention. Cardiovascular training was identified as the best rated strategy by its users (37.8%). To our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. Despite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition.

The impact of the 2022 spring COVID-19 booster vaccination programme on hospital occupancy in England: An interrupted time series analysis.

Regular booster vaccination programmes help protect the most vulnerable from COVID-19 and limit pressure on health systems. Existing studies find booster doses to be effective in preventing hospital admissions and deaths but focus on individual effects, failing to consider the population impact of incomplete vaccination coverage and seasonal patterns in disease transmission. We estimated the effectiveness of the 2022 spring booster vaccination programme, available for those aged 75 years and older, residents in care homes, and adults with weakened immune systems, on COVID-19 hospital bed occupancy in England. Booster vaccine coverage in the eligible population increased rapidly in the months after rollout (from 21st March 2022), flattening out just below 80% by July 2022. We used interrupted time series analysis to estimate a 23.7% overall reduction in the rate of hospital occupancy for COVID-19 following the programme, with a statistically significant benefit in the 6-12 weeks following rollout. In the absence of the programme, we calculate that a total of 380,104 additional hospital bed-days would have been occupied by patients with COVID-19 from 4th April to 31st August 2022 (95% CI: -122,842 to 1,034,590). The programme delayed and shortened the duration of the peak while not reducing its magnitude. In sensitivity analyses adjusting the start of the post-intervention period or removing the rate of COVID-19 infection in the over 60s from the model, the effect of the spring booster programme on hospital bed occupancy remained similar. Our findings suggest that timing is a critical consideration in the implementation of COVID-19 booster programmes and that policymakers cannot rely on intermittent booster vaccination of high-risk groups alone to mitigate anticipated peaks in hospital pressure due to COVID-19 epidemics.

Investigating barriers & facilitators for the successful implementation of the BP@home initiative in London: Primary care perspectives.

BACKGROUND: The COVID-19 pandemic led to the implementation of a national policy of shielding to safeguard clinically vulnerable patients. To ensure consistent care for high-risk patients with hypertension, NHS England introduced the BP@home initiative to enable patients to self-monitor their blood pressure by providing them with blood pressure monitors. This study aimed to identify barriers and facilitators to the implementation of the initiative based on the experience and perspectives of programme managers and healthcare professionals (HCPs) involved in its implementation in London. METHODS AND FINDINGS: We conducted five semi-structured focus groups and one individual interview with a total of 20 healthcare professionals involved at different levels and stages in the BP@home initiative across four of the five London Integrated Care Systems (ICSs). All focus groups and interviews were audio-recorded, transcribed and analysed thematically following the Framework Method. Respondents reported being challenged by the lack of adequate IT, human and financial resources to support the substantial additional workload associated with the programme. These issues resulted in and reinforced the differential engagement capacities of PCNs, practices and patients, thus raising equity concerns among respondents. However respondents also identified several facilitators, including the integration of the eligibility criteria into the electronic health record (EHR), especially when combined with the adoption of practice-specific, pragmatic and opportunistic approaches to the onboarding of patients. Respondents also recommended the provision of blood pressure monitors (BPMs) on prescription, additional funding and training based on needs assessment, the incorporation of BP@home into daily practice and simplification of IT tools, and finally the adoption of a person-centred care approach. Contextualised using the second iteration of the Consolidated Framework for Implementation Research (CFIR), these findings support key evidence-based recommendations to help streamline the implementation of the BP@home initiative in London's primary care setting. CONCLUSIONS: Programs such as BP@Home are likely to become more common in primary care. To successfully support HCPs' aim to care for their hypertensive patients, their implementation must be accompanied by additional financial, human and training resources, as well as supported task-shifting for capacity building. Future studies should explore the perspectives of HCPs based in other parts of the UK as well as patients' experiences with remote monitoring of blood pressure.

Impact of COVID-19 vaccination on COVID-19 hospital admissions in England during 2021: an observational study.

OBJECTIVES: To examine the impact of COVID-19 vaccination on hospital admissions in England in 2021. DESIGN: Observational study of emergency admissions for COVID-19 by vaccination status in people 16 years and over in England. SETTING: Hospitals in England. PARTICIPANTS: A total of 48.1 million people registered with an English GP, aged ≥16 years with a recent NHS contact. MAIN OUTCOME MEASURES: Emergency hospital admissions with a primary diagnosis of COVID-19 between 1 January and 31 December 2021. Monthly admission rates were directly standardised for age, sex, risk category and vaccination dose to estimate vaccine effectiveness (VE) over time, between vaccine doses, age groups and risk groups. RESULTS: A total of 192,047 hospital admissions were included. The unvaccinated admission rate was higher in December 2021 (6.1 admissions per 100,000 person-days; 95% CI: 5.9 to 6.3) than January 2021 (4.9; 95% CI: 4.9 to 5.0). Vaccinated admission rates were ≤1 per 100,000 from February to December. Doses 1 and 2 VE waned over time, particularly in older and clinically vulnerable groups (although this may reflect that they were vaccinated earlier). Dose 3 VE remained above 93%. CONCLUSIONS: COVID-19 hospitalisations were consistently highest in the unvaccinated. Despite high case rates at the end of 2021, overall admission rates remained stable, driven by low admission rates among vaccinated people. There is population-level waning in VE, recovering after subsequent doses, potentially more marked in older and at-risk groups. The findings support JCVI (Joint Committee on Vaccination and Immunisation) guidance for an ongoing booster programme, especially in older people and higher clinical risk groups.

Attendance at remote versus in-person outpatient appointments in an NHS Trust.

INTRODUCTION: With the growing use of remote appointments within the National Health Service, there is a need to understand potential barriers of access to care for some patients. In this observational study, we examined missed appointments rates, comparing remote and in-person appointments among different patient groups. METHODS: We analysed adult outpatient appointments at Imperial College Healthcare NHS Trust in Northwest London in 2021. Rates of missed appointments per patient were compared between remote versus in-person appointments using negative binomial regression models. Models were stratified by appointment type (first or a follow-up). RESULTS: There were 874,659 outpatient appointments for 189,882 patients, 29.5% of whom missed at least one appointment. Missed rates were 12.5% for remote first appointments and 9.2% for in-person first appointments. Remote and in-person follow-up appointments were missed at similar rates (10.4% and 10.7%, respectively). For remote and in-person appointments, younger patients, residents of more deprived areas, and patients of Black, Mixed and 'other' ethnicities missed more appointments. Male patients missed more in-person appointments, particularly at younger ages, but gender differences were minimal for remote appointments. Patients with long-term conditions (LTCs) missed more first appointments, whether in-person or remote. In follow-up appointments, patients with LTCs missed more in-person appointments but fewer remote appointments. DISCUSSION: Remote first appointments were missed more often than in-person first appointments, follow-up appointments had similar attendance rates for both modalities. Sociodemographic differences in outpatient appointment attendance were largely similar between in-person and remote appointments, indicating no widening of inequalities in attendance due to appointment modality.

Comparing registered and resident populations in Primary Care Networks in England: an observational study.

BACKGROUND: Primary Care Networks (PCNs) were established in England in 2019 and will play a key role in providing care at a neighbourhood level within integrated care systems (ICSs). AIM: To identify PCN 'catchment' areas and compare the overlap between registered and resident populations of PCNs. DESIGN & SETTING: Observational study using publicly available data on the number of people within each Lower layer Super Output Area (LSOA) registered to each general practice in England in April 2021. METHOD: LSOAs were assigned to the PCN to which the majority of residents were registered. The PCN catchment population was defined as the total number of people resident in all LSOAs assigned to that PCN. The PCN catchment populations were compared with the population of people registered to a GP practice in each PCN. RESULTS: In April 2021, 6506 GP practices were part of 1251 PCNs, with 56.1% of PCNs having 30 000-50 000 registered patients. There was a strong correlation (0.91) between the total registered population size and catchment population size. Significant variation was found in the percentage of residents in each LSOA registered to a GP practice within the same PCN catchment, and strong associations were found with both urban and rural status, and socioeconomic deprivation. CONCLUSION: There exists significant variation across England in the overlap between registered and resident (catchment) populations in PCNs, which may impact on integration of care in some areas. There was less overlap in urban and more deprived areas, which could exacerbate existing health inequalities.