NHS Health Check Programme: a qualitative study of prison experience.

BACKGROUND: NHS Health Checks began in England in 2009 and were subsequently introduced into English prisons. Uptake has been patchy and there is limited understanding about factors that may limit or enhance uptake in prison settings. Uptake of this programme is a key policy in reducing the risk of cardiovascular disease and death in these settings. METHOD: Semi-structured focus groups were conducted with groups of prisoners (attendees and non-attendees to the health check), prison healthcare staff, custodial staff and ex-prisoners (n = 50). Participants were asked about their awareness and experiences of the NHS Health Check Programme in prison. RESULTS: All groups highlighted barriers for not attending a health check appointment, such as poor accessibility to the healthcare department, stigma and fear. The majority of participants expressed a lack of awareness and discussed common misconceptions regarding the health check programme. Methods of increasing the uptake of health checks through group-based approaches and accessibility to healthcare were suggested. CONCLUSIONS: This study reports on prisoner, staff and ex-prisoner perspectives on the implementation of NHS Health Checks within a restrictive prison environment. These findings have potentially substantial implications for successful delivery of care within offender healthcare services.

Screening male prisoners for depression and anxiety with the PHQ-9 and GAD-7 at NHS Healthcheck: patterns of symptoms and caseness threshold.

BACKGROUND: Screening for depression and anxiety disorders has been proposed in prison populations but little is known about caseness thresholds on commonly used self-report measures in relation to core symptoms, risk factors and symptom patterns. METHOD: A cross-sectional prevalence survey measured depression and anxiety caseness (threshold scores > 10 and > 15 on PHQ-9 and GAD-7 and diagnostic algorithm on PHQ-9) in 1205 male prisoners aged 35-74 years eligible for an NHS Healthcheck from six English prisons. Caseness scores were compared with the presence or absence of daily core symptoms of depression and generalised anxiety disorder (GAD), demographic, prison and cardiovascular risk factors. Cluster analysis was applied to PHQ-9 and GAD-7 items in prisoners scoring > 10 on PHQ-9. RESULTS: 453(37.6%) and 249(20.7%) prisoners scored > 10 and > 15 respectively on PHQ-9; 216 (17.9%) had a depressive episode on the PHQ-9 algorithm; 378(31.4%) and 217(18.0%) scored > 10 and > 15 on GAD-7 respectively. Daily core items for depression were scored in 232(56.2%) and 139(74.3%) prisoners reaching > 10 and > 15 respectively on PHQ-9; daily core anxiety items in 282(74.9%) and 179(96.3%) reaching > 10 and > 15 on GAD-7. Young age, prison and previous high alcohol intake were associated with > 15 on the PHQ-9. Cluster analysis showed a cluster with core symptoms of depression, slowness, restlessness, suicidality, poor concentration, irritability or fear. Altered appetite, poor sleep, lack of energy, guilt or worthlessness belonged to other clusters and may not be indicative of depression. CONCLUSIONS: In male prisoners > 35 years, a score of > 10 on the PHQ-9 over diagnoses depressive episodes but a score of > 10 on the GAD-7 may detect cases of GAD more efficiently. Further research utilising standardised psychiatric interviews is required to determine whether the diagnostic algorithm, a higher cut-off on the PHQ-9 or the profile of symptoms on the PHQ-9 and GAD-7 used singly or in combination may be used to screen depressive episodes efficiently in prisoners.

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK.

Background: Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. Methods: 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. Results: 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. Conclusion: We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.

Health-Related Quality of Life and Disability Among Older New Zealanders With Kidney Failure: A Prospective Study.

Background: Disability is prevalent in individuals with kidney failure and can contribute to significantly reduced quality of life and survival. In older individuals with kidney failure, disability can be caused by a combination of factors, including issues directly related to their kidney disease and/or treatment, including weakness, low energy, and low activity. Few studies have investigated health-related quality of life (HRQoL) as a possible predictor of disability among older individuals experiencing kidney failure. Objective: This study aimed to determine if patient-reported HRQoL, and/or other factors at baseline, predicts disability in people with kidney failure, aged ≥65 years, after 12 months of follow-up. Design: The DOS65+ study was an accelerated longitudinal cohort design comprising of both cross-sectional and longitudinal components. Participants were eligible if they were aged ≥65 years, had chronic kidney disease stage 5G (CKD 5G) (estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2), and had: commenced kidney replacement education, or were on an active conservative pathway, or were newly incident dialysis patients commencing dialysis therapy or prevalent on dialysis. Setting: Three New Zealand District Health Board (DHB) nephrology units (Counties Manukau, Hawke's Bay, and Southern DHB) were involved in the study. Participants: Participants were eligible if they were aged ≥65 years, had CKD 5G (eGFR <15 ml/min/1.73 m2), and had: commenced kidney replacement education, or were on an active conservative pathway, or were newly incident dialysis patients commencing dialysis therapy or prevalent on dialysis. Measurements: Disability and HRQoL were measured by EQ-5D-3L, a WHO Disability Assessment Schedule (WHODAS) 2.0. Methods: Baseline and 12-month data from our longitudinal dialysis outcomes in older New Zealanders' study were analyzed to determine if HRQoL at baseline predicted disability outcomes 12 months later. Results: Of the 223 participants at baseline, 157 participants completed a follow-up interview 12 months later. Individuals with "considerable disability" at baseline had a significantly (86%) higher risk of experiencing "considerable disability" at 12 months compared with those with "lesser/no disability" at baseline. Two thirds of those with ≥3 comorbidities were experiencing "considerable disability." In addition, those with problems with EQ-5D-3L self-care, EQ-5D-3L usual activities, and EQ-5D-3L anxiety/depression reported higher rates of disability. Limitations: Selection bias is likely to have been an issue in this study as participants were excluded from the follow-up interview if they had an intercurrent illness requiring hospitalization within 2 weeks of the survey interview or if the treating nephrologist judged that the individual's ability to take part was significantly impaired. Sample size meant there were a limited number of explanatory/confounding variables that could be investigated in the multivariable model. Conclusions: EQ-5D-3L mobility and self-care may be useful in predicting subsequent disability for individuals with CKD 5G. Although individuals with kidney failure often experience disability, previous studies have not clearly identified HRQoL or disability as predictors of later disability for individuals with kidney failure. Therefore, we would recommend the assessment of mobility and self-care, in conjunction with existing disabilities in the clinical review and pre-dialysis education of individuals with kidney failure as they approach the need for kidney replacement therapy.Trial registration: the Australian and New Zealand clinical trials registry: ACTRN12611000024943.

Allometry of carbon and nitrogen content and growth rate in a diverse range of coccolithophores.

As both photoautotrophs and calcifiers, coccolithophores play important roles in ecosystems and biogeochemical cycles. Though some species form blooms in high-latitude waters, low-latitude communities exhibit high diversity and niche diversification. Despite such diversity, our understanding of the clade relies on knowledge of Emiliana huxleyi. To address this, we examine carbon (C) and nitrogen (N) content of strains (n = 9) from the main families of the calcifying Haptophyceae, as well as allometry and cell size frequency across extant species. Coccolithophore cell size is constrained, with ~71% of 159 species smaller than 10 µm in diameter. Growth rates scale with cell biovolume (µ = 1.83 × cell volume-0.19), with an exponent close to metabolic theory. Organic carbon (C) per cell is lower than for other phytoplankton, providing a coccolithophore-specific relationship between cell organic C content and biovolume (pg C cell-1 = 0.30 × cell volume0.70). Organic C to N ratios (~8.3 mol:mol) are similar to other phytoplankton, implying little additional N cost for calcification and efficient retention and recycling of cell N. Our results support observations that coccolithophores are efficient competitors in low-nutrient conditions, able to photosynthesize, calcify and run the routine metabolic machinery necessary without any additional need for N relative to noncalcifying algae.

Cardiovascular risk profiles and the uptake of the NHS Healthcheck programme in male prisoners in six UK prisons: an observational cross-sectional survey.

INTRODUCTION: Half of all deaths in custody are due to natural causes, the most common being cardiovascular disease (CVD). National Health Service Healthchecks should be available to all eligible prisoners; it is not clear who receives them. Mental health issues are common in prisoners and may affect how healthcare interventions should be delivered. Current policy is to offer Healthchecks to those serving over 2 years in prison. OBJECTIVES, METHODS, SETTING AND DESIGN: An observational cross-sectional survey in six male prisons in England between September 2017 and January 2019 in prisoners aged 35-74 to identify who was eligible for a Healthcheck and compare CVD risk data with those that were not, and factors associated with uptake. OUTCOME MEASURES: Characteristics of those accepting a Healthcheck were compared with those declining. Assessments of anxiety and depression were compared with CVD risk factors. RESULTS: 1207 prisoners completed a Healthcheck. 21.8% of prisoners were ineligible due to existing comorbidities. 76.4% of those invited took up a Healthcheck, and of those, 12.1% were found to have new significant CVD comorbidity. CVD risk was similar to community levels but this population was 10 years younger. Definite case-level depression or anxiety was present in 20.7% and 18.0%, respectively, of participants. An association was found between ethnicity and those invited (p=0.023, φ=0.1) and accepting (p=0.008, φ=0.1) a Healthcheck. 9.7% of prisoners serving less than 2 years had CVD risk scores of 10% or more, and had similar CVD risk profiles but much higher levels of anxiety (p<0.001, φ=0.2) or depression (p=0.009, φ=0.2) than those serving 2 years or more. CONCLUSION: Cardiovascular risk was comparable with community rates and in some prisons, much higher. Rates of anxiety and depression were high. The national policy for selecting prisoners for Healthchecks may leave many high-risk prisoners without appropriate cardiovascular preventative assessments.

A review of mentoring deaf and hard-of-hearing scholars.

Diversification of the scientific workforce usually focuses on recruitment and retention of women and underrepresented racial and ethnic minorities but often overlooks deaf and hard-of hearing (D/HH) persons. Usually classified as a disability group, such persons are often members of their own sociocultural linguistic minority and deserve unique support. For them, access to technical and social information is often hindered by communication- and/or language-centered barriers, but securing and using communication access services is just a start. Critical aspects of training D/HH scientists as part of a diversified workforce necessitates: (a) educating hearing persons in cross-cultural dynamics pertaining to deafness, sign language, and Deaf culture; (b) ensuring access to formal and incidental information to support development of professional soft skills; and (c) understanding that institutional infrastructure change may be necessary to ensure success. Mentorship and training programs that implement these criteria are now creating a new generation of D/HH scientists.

Comparison of 24-hour urine and 24-hour diet recall for estimating dietary sodium intake in populations: A systematic review and meta-analysis.

This systematic literature review and meta-analysis examined whether 24-hour diet recall is a valid way to measure mean population sodium intake compared with the gold standard 24-hour urinary assessment. The authors searched electronic databases MEDLINE, Embase, and Scopus using pre-defined terms. Studies were eligible for inclusion if they assessed adult humans in free-living settings, and if they included group means for 24-hour diet recall and 24-hour urinary collection of sodium intake in the same participants. Studies that included populations with an active disease state that might interfere with normal sodium metabolism were excluded. Results of 28 studies are included in the meta-analysis. Overall, 24-hour diet recall underestimated population mean sodium intake by an average of 607 mg per day compared to the 24-hour urine collection. The difference between measures from 24-hour urine and 24-hour diet recall was smaller in studies conducted in high-income countries, in studies where multiple-pass methods of 24-hour diet recall were reported and where urine was validated for completeness. Higher quality studies also reported smaller differences between measures than lower quality studies. Monitoring of population sodium intake with 24-hour urinary excretion remains the most accurate method of assessment. Twenty-four-hour diet recall tends to underestimate intake, although high-quality 24-hour diet recall improves accuracy, and may be used if 24-hour urine is not feasible.

Dependence on place: A source of autonomy in later life for older Maori.

Attachment to place is an important component of ageing. Although the importance of place for older people's well-being is known, the ways in which different conceptions of place and expectations for what later life may hold depend upon cultural beliefs, values, and expectations is underexplored. This study examined the ways that place influences experiences of ageing for older Maori in New Zealand. Eight interviews with older Maori were analysed thematically alongside field notes from a research visit. Attachment to place provided the foundation for experiences of ageing for older Maori. Through their connection to place, the participants drew on a comforting and comfortable dependence on land and family to enable autonomy in later life. Rather than seeking to maintain independence in terms of avoiding reliance on others, older Maori conceptualised older age through autonomy and freedom to live in accordance with Maori values encapsulated by whakawhanaungatanga. A good old age depended on balancing competing demands of living in wider society with attachment to place and Maori identity in later life.