Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018–2022

Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018–2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted

Ophyiulus in Victoria: results of millipede surveys from south-eastern Australia

The composition and ecology of the millipede fauna of Victoria remain poorly understood. We collected millipedes as part of a series of ecological arthropod surveys across south-eastern Australia, focusing mainly on Victoria. These samples almost exclusively contained millipedes from the introduced order Julida. We pursued species identification of the julids when it became apparent there were species other than the well-recorded Ommatoiulus moreleti (Lucas, 1860) (Portuguese millipede) in the samples. The majority of specimens were O. moreleti, but we also detected at least one species of Cylindroiulus Verhoeff, 1894, as well as an Ophyiulus Berlese, 1884, species, specimens of which have been identified as Ophyiulus cf. targionii. These are the first Ophyiulus records for Victoria to our knowledge. We present preliminary data on the abundance through the year of Ophyiulus. This is the first study to examine this species in Victoria and little is currently known about its likely impact on agriculture or on native species. Monitoring and research of the species in the future is therefore warranted

Assessing the impact of artistic and cultural activities on the health and well-being of forcibly displaced people using participatory action research

Objective Drawing on a growing body of research suggesting that taking part in artistic and cultural activities benefits health and well-being, the objective was to develop a participatory action research (PAR) method for assessing the impact of arts interventions on forcibly displaced people, and identify themes concerning perceived benefits of such programmes. Design A collaborative study following PAR principles of observation, focus groups and in-depth semistructured interviews. Setting London-based charity working with asylum seekers and refugees. Participants An opportunity sample (n=31; 6 males) participated in focus groups comprising refugees/asylum seekers (n=12; 2 males), volunteers (n=4; 1 males) and charity staff (n=15; 3 males). A subset of these (n=17; 3 males) participated in interviews comprising refugees/asylum seekers (n=7; 1 males), volunteers (n=7; 1 males) and charity staff (n=3; 1 males). Results Focus group findings showed that participants articulated the impact of creative activities around three main themes: skills, social engagement and personalemotions that were explored during in-depth interviews. Thematic analysis of interviews was conducted in NVivo 11 and findings showed that artistic and cultural activities impacted positively by helping participants find a voice, create support networks and learn practical skills useful in the labour market. Conclusions The study expanded on arts and well-being research by exploring effects of cultural and creative activities on the psychosocial well-being of refugees and asylum seekers. By focusing on the relationship between arts, well-being and forced displacement, the study was instrumental in actively trying to change the narrative surrounding refugees and asylum seekers, often depicted in negative terms in the public sphere

The Impact of Culture-, Health- and Nature-Based Engagement on Mitigating the Adverse Effects of Public Health Restrictions on Wellbeing, Social Connectedness and Loneliness during COVID-19: Quantitative Evidence from a Smaller- and Larger-Scale UK Survey

Numerous UK surveys conducted during COVID-19 examined the pandemic’s detrimental effects on health, and the consequences of lockdown and other public health restrictions on mental health. Some surveys considered specific populations and social inequities exacerbated during COVID-19. Fewer surveys examined the ways in which the adverse effects of public health restrictions, such as lockdown, shielding and social distancing, might be alleviated. Drawing upon self-determination theory, the purpose of the current study was to assess whether culture-, health- and nature-based engagement would mitigate the effects of these restrictions on psychological wellbeing, social connectedness and loneliness. Quantitative data from a smaller-scale survey (n = 312) and a subset of questions embedded in a larger-scale survey (n = 3647) were analyzed using univariate and multivariate methods. Frequency of engagement, whether participation was online or offline and with or without other people, and the extent to which type of participation was associated with psychological wellbeing, social connectedness and loneliness were examined. Sports and fitness, gardening and reading occurred frequently in both surveys. For the smaller-scale survey, increases in connectedness and frequency of participation and decreases in loneliness were significantly associated with improved wellbeing, whereas the type of participation and age range were not significant predictors. Outcomes from the smaller-scale survey approximated the larger-scale survey for measures of loneliness, type and frequency of participation and proportion of respondents in each age range. As the frequency of participation was a significant predictor of wellbeing, but the type of participation was not significant, the findings implied that any type of participation in a sufficient quantity would be likely to boost wellbeing

Effects of a museum-based social-prescription intervention on quantitative measures of psychological wellbeing in older adults

Aims: To assess psychological wellbeing in a novel social prescription intervention for older adults called Museums on Prescription, and to explore the extent of change over time in six self-rated emotions (‘absorbed, ‘active’, ‘cheerful’, ‘encouraged’, ‘enlightened’ and ‘inspired’). Methods: Participants (n=115) aged 65-94 were referred to museum-based programmes comprising 10, weekly sessions, by healthcare and third sector organisations using inclusion criteria (e.g. socially isolated; able to give informed consent; not in employment; not regularly attending social or cultural activities) and exclusion criteria (e.g. unable to travel to the museum; unable to function in a group situation; unlikely to be able to attend all sessions; unable to take part in interviews and complete questionnaires). In a within-participants design, the Museum Wellbeing Measure for Older Adults (MWM-OA) was administered pre-post session at start- mid- and end-programme. Twelve programmes, facilitated by museum staff and volunteers, were conducted in seven museums in central London and across Kent. In addition to the quantitative measures, participants, carers where present, museum staff and researchers kept weekly diaries following guideline questions, and took part in end programme in-depth interviews. Results: Multivariate analyses of variance showed significant participant improvements in all six MWM-OA emotions, pre-post session at start- mid- and end-programme. Two emotions, ‘absorbed’ and ‘enlightened’, increased pre-post session disproportionately to the others; ‘cheerful’ attained the highest pre-post session scores whereas ‘active’ was consistently lowest. Conclusions: Museums can be instrumental in offering museum-based programmes for older adults to improve psychological wellbeing over time. Participants in the study experienced a sense of privilege, valued the opportunity to liaise with curators, visit parts of the museum closed to the public, and handle objects normally behind glass. Participants appreciated opportunities afforded by creative and co-productive activities to acquire learning and skills, and get to know new people in a different context

Human Vascular Tissue Models Formed from Human Induced Pluripotent Stem Cell Derived Endothelial Cells

Here we describe a strategy to model blood vessel development using a well-defined induced pluripotent stem cell-derived endothelial cell type (iPSC-EC) cultured within engineered platforms that mimic the 3D microenvironment. The iPSC-ECs used here were first characterized by expression of endothelial markers and functional properties that included VEGF responsiveness, TNF-α-induced upregulation of cell adhesion molecules (MCAM/CD146; ICAM1/CD54), thrombin-dependent barrier function, shear stress-induced alignment, and 2D and 3D capillary-like network formation in Matrigel. The iPSC-ECs also formed 3D vascular networks in a variety of engineering contexts, yielded perfusable, interconnected lumen when co-cultured with primary human fibroblasts, and aligned with flow in microfluidics devices. iPSC-EC function during tubule network formation, barrier formation, and sprouting was consistent with that of primary ECs, and the results suggest a VEGF-independent mechanism for sprouting, which is relevant to therapeutic anti-angiogenesis strategies. Our combined results demonstrate the feasibility of using a well-defined, stable source of iPSC-ECs to model blood vessel formation within a variety of contexts using standard in vitro formats.National Institutes of Health (U.S.) (NIH 1UH2 TR000506-01)National Institutes of Health (U.S.) (3UH2 TR000506-02S1)National Institutes of Health (U.S.) (T32 HL007936-12)National Institutes of Health (U.S.) (RO1 HL093282)National Institutes of Health (U.S.) (R21 EB016381-01

Individual common variants exert weak effects on the risk for autism spectrum disorders.

While it is apparent that rare variation can play an important role in the genetic architecture of autism spectrum disorders (ASDs), the contribution of common variation to the risk of developing ASD is less clear. To produce a more comprehensive picture, we report Stage 2 of the Autism Genome Project genome-wide association study, adding 1301 ASD families and bringing the total to 2705 families analysed (Stages 1 and 2). In addition to evaluating the association of individual single nucleotide polymorphisms (SNPs), we also sought evidence that common variants, en masse, might affect the risk. Despite genotyping over a million SNPs covering the genome, no single SNP shows significant association with ASD or selected phenotypes at a genome-wide level. The SNP that achieves the smallest P-value from secondary analyses is rs1718101. It falls in CNTNAP2, a gene previously implicated in susceptibility for ASD. This SNP also shows modest association with age of word/phrase acquisition in ASD subjects, of interest because features of language development are also associated with other variation in CNTNAP2. In contrast, allele scores derived from the transmission of common alleles to Stage 1 cases significantly predict case status in the independent Stage 2 sample. Despite being significant, the variance explained by these allele scores was small (Vm< 1%). Based on results from individual SNPs and their en masse effect on risk, as inferred from the allele score results, it is reasonable to conclude that common variants affect the risk for ASD but their individual effects are modest

Efficient Gene Targeting by Homologous Recombination in Rat Embryonic Stem Cells

The rat is the preferred experimental animal in many biological studies. With the recent derivation of authentic rat embryonic stem (ES) cells it is now feasible to apply state-of-the art genetic engineering in this species using homologous recombination. To establish whether rat ES cells are amenable to in vivo recombination, we tested targeted disruption of the hypoxanthine phosphoribosyltransferase (hprt) locus in ES cells derived from both inbred and outbred strains of rats. Targeting vectors that replace exons 7 and 8 of the hprt gene with neomycinR/thymidine kinase selection cassettes were electroporated into male Fisher F344 and Sprague Dawley rat ES cells. Approximately 2% of the G418 resistant colonies also tolerated selection with 6-thioguanine, indicating inactivation of the hprt gene. PCR and Southern blot analysis confirmed correct site-specific targeting of the hprt locus in these clones. Embryoid body and monolayer differentiation of targeted cell lines established that they retained differentiation potential following targeting and selection. This report demonstrates that gene modification via homologous recombination in rat ES cells is efficient, and should facilitate implementation of targeted, genetic manipulation in the rat

A blended knowledge translation initiative to improve colorectal cancer staging [ISRCTN56824239]

BACKGROUND: A significant gap has been documented between best practice and the actual practice of surgery. Our group identified that colorectal cancer staging in Ontario was suboptimal and subsequently developed a knowledge translation strategy using the principles of social marketing and the influence of expert and local opinion leaders for colorectal cancer. METHODS/DESIGN: Opinion leaders were identified using the Hiss methodology. Hospitals in Ontario were cluster-randomized to one of two intervention arms. Both groups were exposed to a formal continuing medical education session given by the expert opinion leader for colorectal cancer. In the treatment group the local Opinion Leader for colorectal cancer was detailed by the expert opinion leader for colorectal cancer and received a toolkit. Forty-two centres agreed to have the expert opinion leader for colorectal cancer come and give a formal continuing medical education session that lasted between 50 minutes and 4 hours. No centres refused the intervention. These sessions were generally well attended by most surgeons, pathologists and other health care professionals at each centre. In addition all but one of the local opinion leaders for colorectal cancer met with the expert opinion leader for colorectal cancer for the academic detailing session that lasted between 15 and 30 minutes. DISCUSSION: We have enacted a unique study that has attempted to induce practice change among surgeons and pathologists using an adapted social marketing model that utilized the influence of both expert and local opinion leaders for colorectal cancer in a large geographic area with diverse practice settings