Same storm, different boats: can the UK recapture improving life expectancy trends?

The COVID-19 pandemic has led to devastating loss of life and livelihood across the world. It has resulted in falls in life expectancy, a widely used summary measure of contemporary age-specific mortality rates, in most European countries.1 In England and Wales, life expectancy has fallen by 0.9 and 1.2 years for women and men, respectively, when compared to 2019.2 These falls are, however, part of a longer-term trend that began long before the COVID-19 pandemic. For the past decade, life expectancy in the UK has been stalling, and falling in some regions and social groups, and inequality in age at death has been rising.3 In this piece, we consider the health of the UK population before the pandemic, compare this to the health of the populations in the USA and Japan, as investigated in a recent paper,3 and ask if it is possible to recapture previous improving life expectancy trajectories

Access to healthcare for people seeking and refused asylum in Great Britain: a review of evidence

This research report is a review of evidence looking at the barriers people seeking or refused asylum face in trying to access healthcare services in the UK, and what may help them to do so more easily. This report, and the partner report on lived experiences (https://www.equalityhumanrights.com/en/publication-download/lived-experiences-access-healthcare-people-seeking-and-refused-asylum), will be of interest to people who play an important role in delivering healthcare and related support services to people seeking or refused asylum. We have also made recommendations for what changes are needed (https://www.equalityhumanrights.com/en/publication-download/making-sure-people-seeking-and-refused-asylum-can-access-healthcare-what-needs) to make sure that people seeking and refused asylum have full enjoyment of their right to health. This review was carried out by Imperial College London, with primary data provided by Doctors of the World UK

The lived experiences of access to healthcare for people seeking and refused asylum

This research aims to explore the lived experiences of accessing healthcare among people currently seeking asylum and those who have had their claim for asylum refused, as well as the experiences of health service providers working with these communities. It examines the extent to which people are able to exercise their rights to access healthcare. It looks at the differences between those currently in the asylum system and those who have had their claim refused in England, Scotland and Wales. This report, and the partner report providing a review of evidence (https://www.equalityhumanrights.com/en/publication-download/access-healthcare-people-seeking-and-refused-asylum-great-britain-review), will be of interest to people who play an important role in delivering healthcare and related support services to people seeking or refused asylum. We have also made recommendations for what changes are needed (https://www.equalityhumanrights.com/en/publication-download/making-sure-people-seeking-and-refused-asylum-can-access-healthcare-what-needs) to make sure that people seeking and refused asylum have full enjoyment of their right to health. This report was produced in collaboration with Imperial College London and Doctors of the World UK

Re: Rise in mortality in England and Wales in first seven weeks of 2018

Within the first seven weeks of 2018, some 93 990 people died in England and Wales. Over the same weeks in the previous five years, an average of 83 615 people died. This rise of 12.4%, or 10 375 additional deaths, was not due to the ageing of the population. Ageing is a slow process and leads to slow, not sudden, rises in mortality. An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why

Does infection with Chlamydia trachomatis induce long-lasting partial immunity? Insights from mathematical modelling.

OBJECTIVES: To explore whether existence of long-lasting partial immunity against reinfection with Chlamydia trachomatis is necessary to explain C. trachomatis prevalence patterns by age and sexual risk, and to provide a plausible estimate for the effect size, defined here as a reduction in susceptibility to reinfection. METHODS: A population-based mathematical model was constructed to describe C. trachomatis natural history and transmission dynamics by age and sexual risk. The model was parameterised using natural history, and epidemiological and sexual behaviour data, and applied for UK and US data. Sensitivity analyses were conducted to assess the robustness of predictions to variations in model structure and to examine the impact of alternative assumptions for the mechanism underlying partial immunity. RESULTS: Partial immunity against reinfection was found necessary to explain observed C. trachomatis prevalence patterns by age and sexual risk. The reduction in susceptibility to reinfection was estimated at 93% using UK data (95% uncertainty interval (UI)=88%-97%) and at 67% using US data (95% UI=24%-88%). The model-structure sensitivity analyses affirmed model predictions. The immunity-mechanism sensitivity analyses suggested a mechanism of susceptibility reduction against reinfection or a mechanism of infectious-period duration reduction upon reinfection. CONCLUSIONS: A strong long-lasting partial immunity against C. trachomatis reinfection should be present to explain observed prevalence patterns. The mechanism of immunity could be either a reduction in susceptibility to reinfection or a reduction in duration of infection on reinfection. C. trachomatis infection appears to naturally elicit a strong long-lasting immune response, supporting the concept of vaccine development

Body image, body dissatisfaction and weight status in south asian children: a cross-sectional study

Background Childhood obesity is a continuing problem in the UK and South Asian children represent a group that are particularly vulnerable to its health consequences. The relationship between body dissatisfaction and obesity is well documented in older children and adults, but is less clear in young children, particularly South Asians. A better understanding of this relationship in young South Asian children will inform the design and delivery of obesity intervention programmes. The aim of this study is to describe body image size perception and dissatisfaction, and their relationship to weight status in primary school aged UK South Asian children. Methods Objective measures of height and weight were undertaken on 574 predominantly South Asian children aged 5-7 (296 boys and 278 girls). BMI z-scores, and weight status (underweight, healthy weight, overweight or obese) were calculated based on the UK 1990 BMI reference charts. Figure rating scales were used to assess perceived body image size (asking children to identify their perceived body size) and dissatisfaction (difference between perceived current and ideal body size). The relationship between these and weight status were examined using multivariate analyses. Results Perceived body image size was positively associated with weight status (partial regression coefficient for overweight/obese vs. non-overweight/obese was 0.63 (95% CI 0.26-0.99) and for BMI z-score was 0.21 (95% CI 0.10-0.31), adjusted for sex, age and ethnicity). Body dissatisfaction was also associated with weight status, with overweight and obese children more likely to select thinner ideal body size than healthy weight children (adjusted partial regression coefficient for overweight/obese vs. non-overweight/obese was 1.47 (95% CI 0.99-1.96) and for BMI z-score was 0.54 (95% CI 0.40-0.67)). Conclusions Awareness of body image size and increasing body dissatisfaction with higher weight status is established at a young age in this population. This needs to be considered when designing interventions to reduce obesity in young children, in terms of both benefits and harms

Microencapsulated herbal components in the diet of Lacaune ewes: impacts on physiology and milk production and quality

Abstract This study aimed to determine whether the addition of a microencapsulated herbal blend (MHB) based on thymol, carvacrol, and cinnamaldehyde in dairy sheep feed would improve production efficiency, milk quality, and animal health. Thirty lactating Lacaune ewes were divided into three groups: Control (T0), 150 mg blend/kg of feed (T150), and 250 mg blend/kg of feed (T250). Milk was measured before the beginning of the experiment (d 0), at the end of the adaptation period (d 15), and during the experiment (d 20). In milk samples, was measured the composition, somatic cell count (SCC), reactive oxygen species (ROS), lipoperoxidation (LPO), and total antioxidant capacity. The MHB improved the milk production (only T150 vs. T0 sheep on d 20), productive efficiency and feed efficiency, and reduced the milk SCC (only T250 vs. T0 sheep, on d 20), ROS and tended to reduce the milk levels of LPO (only T250 vs. T0 sheep on d 20). Also, MHB reduced the blood levels of neutrophils and ROS (only T250 vs. T0 sheep on d 20) and increased total protein and globulin levels. Thus, a microencapsulated blend of thymol, carvacrol, and cinnamaldehyde improved the productive performance and milk quality of sheep

Diagnosing type 2 diabetes using Haemoglobin A1c: A systematic review and meta-analysis of the diagnostic cut point based on microvascular complications

Aims: Diabetic microvascular complications of retinopathy, nephropathy and neuropathy may occur at hemoglobin A1c levels (HbA1c) below the 6.5% (48 mmol/mol) diagnostic threshold. Our objective was to assess the validity of the HbA1c diagnostic cutpoint of 6.5% based upon published evidence of the prevalence of retinopathy, nephropathy and neuropathy as markers of diabetes. Methods: Data Sources PubMed, Embase, Cochrane, Scopus and CINAHL from 1990-March 2019, grey literature sources. Study Selection All studies reported after 1990 (to ensure standardized HbA1c values) where HbA1c levels were presented in relation to prevalence of retinopathy, nephropathy or neuropathy in subjects not known to have diabetes. Data Extraction Studies were screened independently, data abstracted, and risk of bias appraised. Data Synthesis Data were synthesized using HbA1c categories of  55 (OR: 3.23; 95% CI 1.81–5.77), and African-American race (OR: 10.73; 95% CI: 4.34–26.55), to be associated with higher retinopathy prevalence. Marked heterogeneity in prevalence estimates was found across all meta-analyses (Cochran’s Q-statistic p  55 years and, most strikingly, in African-Americans, suggesting there may be excess microvascular complication prevalence (particularly nephropathy) in individuals below the diabetes diagnostic threshold

Regional employment and individual worklessness during the Great Recession and the health of the working-age population: cross-national analysis of 16 European countries

Studies from single countries suggest that local labour market conditions, including rates of employment, tend to be associated with the health of the populations residing in those areas, even after adjustment for individual characteristics including employment status. The aim of this study is to strengthen the cross-national evidence base on the influence of regional employment levels and individual worklessness on health during the period of the Great Recession. We investigate whether higher regional employment levels are associated with better health over and above individual level employment. Individual level data (N = 23,078 aged 15–64 years) were taken from 16 countries (Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Hungary, Ireland, Netherlands, Norway, Poland, Portugal, Spain, Sweden and United Kingdom) participating in the 2014 European Social Survey. Regional employment rates were extracted from Eurostat, corresponding with the start (2008) and end (2013) of the Great Recession. Health outcomes included self-reported heart or circulation problems, high blood pressure, diabetes, self-rated health, depression, obesity and allergies (as a falsification test). We calculated multilevel Poisson regression models, which included individuals nested within regions, controlling for potential confounding variables and country fixed effects. After adjustment for individual level socio-demographic factors, higher average regional employment rates (from 2008 to 2013) were associated with better health outcomes. Individual level worklessness was associated with worsened health outcomes, most strongly with poor self-rated health. In models including both individual worklessness and the average regional employment rate, regional employment remained associated with heart and circulation problems, depression and obesity. There was evidence of an interaction between individual worklessness and regional employment for poor self-rated health and depression. The findings suggest that across 16 European countries, for some key outcomes, higher levels of employment in the regional labour market may be beneficial for the health of the local population