The impact of Covid-19 and lockdown measures on self-reported life satisfaction and social relationships does not differ by ethnicity.

Mental health and wellbeing is reported to have declined due to the Covid-19 pandemic and lockdown measures,1,2,3 and some data suggests this may vary by ethnic group.1,2,3 There is however little information on Covid-19 and life satisfaction (e.g. physical, mental, spiritual health etc.) and social relationships by ethnicity. To address this we examined the impact of the Covid-19 pandemic and lockdown measures on self-rated life satisfaction and social relationships in a random sample of adults

Percentage uptake of a referral to a general practitioner.

<p>Percentage uptake of a referral to a general practitioner.</p

Percentage of screening population referred to their practitioner.

<p>Percentage of screening population referred to their practitioner.</p

Percentage of individuals exceeding cut offs by risk factor.

<p>i. Diabetes. ii. Hypercholesterolemia. iii. Hypertension.</p

Summary of Included Studies.

<p>NR = Not reported.</p><p>(a) & (b) refers to two study arms from the same two arm randomised study reporting differing rates for the two main included outcomes.</p><p><b>Cut-offs Used.</b></p><p><b>Diabetes.</b></p>§<p> = tick test scoring method (more than 1 recognized risk factor for diabetes) and fasting blood glucose ≥5.5 mmol/l or random blood glucose ≥11 mmol/l.</p>¶<p> = tick test scoring method (more than 1 recognised risk factor for diabetes).</p><p>** = Fasting blood glucose ≥8 mmol/l,</p>††<p> = random blood glucose ≥10 mmol/l,</p>‡‡<p> = random blood glucose or ≥11 mmol/l fasting blood glucose 6 mmol/l.</p><p><b>Blood Pressure.</b></p><p>* = ≥160/100 mmHg,</p>†<p> = ≥160 mmHg systolic only,</p>‡<p> = ≥140/100 mmHg.</p><p><b>Cholesterol.</b></p>§§<p> = total cholesterol ≥200 mg/dl,</p><p>*** = total cholesterol ≥232 mg/dl.</p

Reporting and representation of underserved groups in intervention studies for patients with multiple long-term conditions: a systematic review

Objectives Globally, there is a growing number of people who are living with multiple long-term conditions (MLTCs). Due to complex management needs, it is imperative that research consists of participants who may benefit most from interventions. It is well documented that ethnic minority groups and lower socioeconomic status (SES) groups are at an increased risk of developing MLTCs. Therefore, the aim of this systematic review was to determine the level of reporting and representation of underserved groups (ethnic minority and low SES) in intervention studies addressing MLTCs. Design Systematic review. Four databases including Cochrane Library, MEDLINE, CINAHL and Scopus were searched for intervention studies from North America or Europe published between January 1990 and July 2023. Setting Hospital and community-based interventions. We included interventional studies focusing on improving MLTC-related outcomes. Participants Patients with MLTCs. Main outcome measures Total number of studies reporting on ethnicity and SES. Number and proportion of studies reporting by ethnic/SES group. Results Thirteen studies met the inclusion criteria. Only 4 of 13 studies (31%) recorded and reported ethnicity information. Of these four studies that reported on ethnicity, three studies consisted of primarily White participants. Ethnic minority groups were underrepresented, but one study included a majority of African American participants. Moreover, 12 of 13 studies (92%) reported on SES with income and educational level being the primary measures used. SES representation of higher deprivation groups was varied due to limited data. Conclusions For ethnicity, there was a lack of reporting, and ethnic minority groups were underrepresented in intervention studies. For SES, there was a high level of reporting but the proportion of study samples from across the spectrum of SES varied due to the variety of SES measures used. Findings highlight a need to improve the reporting and representation of ethnic minority groups and provide more detailed information for SES through using consistent measures (e.g. education, income and employment) to accurately determine the distribution of SES groups in intervention studies of people with MLTCs

Developing a conceptually equivalent type 2 diabetes risk score for Indian Gujaratis in the UK

Aims. To apply and assess the suitability of a model consisting of commonly used cross-cultural translation methods to achieve a conceptually equivalent Gujarati language version of the Leicester self-assessment type 2 diabetes risk score. Methods. Implementation of the model involved multiple stages, including pretesting of the translated risk score by conducting semistructured interviews with a purposive sample of volunteers. Interviews were conducted on an iterative basis to enable findings to inform translation revisions and to elicit volunteers’ ability to self-complete and understand the risk score. Results. The pretest stage was an essential component involving recruitment of a diverse sample of 18 Gujarati volunteers, many of whom gave detailed suggestions for improving the instructions for the calculation of the risk score and BMI table. Volunteers found the standard and level of Gujarati accessible and helpful in understanding the concept of risk, although many of the volunteers struggled to calculate their BMI. Conclusions. This is the first time that a multicomponent translation model has been applied to the translation of a type 2 diabetes risk score into another language. This project provides an invaluable opportunity to share learning about the transferability of this model for translation of self-completed risk scores in other health conditions

Effects of an Electronic Software "Prompt" With Health Care Professional Training on Cardiovascular and Renal Complications in a Multiethnic Population With Type 2 Diabetes and Microalbuminuria (the GP-Prompt Study): Results of a Pragmatic Cluster-Randomized Trial.

OBJECTIVE:Tight, targeted control of modifiable cardiovascular risk factors can reduce cardiovascular complications and mortality in individuals with type 2 diabetes (T2DM) and microalbuminuria. The effects of using an electronic "Prompt" with a treatment algorithm to support a treat-to-target approach has not been tested in primary care. RESEARCH DESIGN AND METHODS:A multicenter, cluster-randomized trial was conducted among primary care practices across Leicestershire, U.K. The primary outcome was the proportion of individuals achieving systolic and diastolic blood pressure (<130 and <80 mmHg, respectively) and total cholesterol (<3.5 mmol/L) targets at 24 months. Secondary outcomes included proportion of individuals with HbA1c <58 mmol/mol (<7.5%), changes in prescribing, change in the albumin-to-creatinine ratio, major adverse cardiovascular events, cardiovascular mortality, and coding accuracy. RESULTS:A total of 2,721 individuals from 22 practices, mean age 63 years, 41% female, and 62% from black and minority ethnic groups completed 2 years of follow-up. There were no significant differences in the proportion of individuals achieving the composite primary outcome, although the proportion of individuals achieving the prespecified outcome of total cholesterol <4.0 mmol (odds ratio 1.24; 95% CI 1.05-1.47; P = 0.01) increased with intensive intervention compared with control. Coding for microalbuminuria increased relative to control (odds ratio 2.05; 95% CI 1.29-3.25; P < 0.01). CONCLUSIONS:Greater improvements in composite cardiovascular risk factor control with this intervention compared with standard care were not achieved in this cohort of high-risk individuals with T2DM. However, improvements in lipid profile and coding can benefit patients with diabetes to alter the high risk of atherosclerotic cardiovascular events. Future studies should consider comprehensive strategies, including patient education and health care professional engagement, in the management of T2DM

Randomised controlled trial of an innovative hypoglycaemia pathway for self-care at home and admission avoidance: a partnership approach with a regional ambulance trust.

BackgroundHypoglycaemia is a common and potentially life-threatening condition in people with diabetes, commonly caused by medications such as insulin. Hypoglycaemic events often require in-patient treatment and/or follow-up with a diabetes specialist nurse (DSN) or GP to make adjustments to medication. This referral pathway commonly relies on patient self-referral to primary care, and as a result many patients are not actively followed up and go on to experience repeat hypoglycaemic events.MethodsRandomised controlled trial in partnership with East Midlands Ambulance Service NHS Trust. People with diabetes calling out an ambulance for a severe hypoglycaemic episode and meeting the eligibility criteria were randomised to either a novel DSN-led pathway or to their general practice for routine follow-up. Primary outcome was proportion of participants with a documented consultation with a healthcare professional to discuss the management of their diabetes within 28 days of call-out.Results162 people were randomised to one of the pathways (73 DSN arm, 89 GP arm) with 81 (50%, 35 DSN, 46 GP) providing full consent to be followed up. Due to lower than anticipated randomisation and consent rates, the recruitment target was not met. In the 81 participants who provided full consent, there were higher rates of consultation following the call-out when referred to a DSN compared to primary care (90% vs. 65%). Of the 81 participants, 26 (32%) had a second call-out within 12 months.ConclusionsConsultation rates following the call-out were high in the DSN-led arm, but there was insufficient power to complete the planned comparative analysis. The study highlighted the difficulty in recruitment and delivery of research in pre-hospital emergency care. Further work is needed to provide more feasible study designs and consent procedures balancing demands on ambulance staff time with the need for robust well-designed evaluation of referral pathways

Additional file 2 of Widening participation – recruitment methods in mental health randomised controlled trials: a qualitative study

Supplementary Material