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Prevalence, awareness, treatment and control of hypertension among ethnoracial minorities in France: results from the CONSTANCES cohort

Por: Silberzan · L. · Wiernik · E. · Bajos · N. · Kelly-Irving · M.
Objectives

Race/ethnicity, combined with sex, is an important determinant of hypertension prevalence and management in high-income countries, but data for France are lacking. This study aims to explore hypertension prevalence and each stage of the cascade of care (i.e., awareness, treatment, and control), at the intersection of sex and race/ethnicity in a French cohort.

Design

We used data from the population-based CONSTANCES cohort, linked with the French National Health Data System.

Participants

180 459 individuals were included, aged 18–69 (mean age 47, SD: 13), among which 53% (n=95 395) women and 81% (n=145 983) of the majority group, and 4.9% (n=8 775) of North African, 1.2% (n=2 220) of sub-Saharan African (SSA), 1.2% (n=2 204) of Asian, 1.4% (n=4 462) of Overseas France départements and regions (DROMs) and 10% of European and other descents. Among these 180 459 individuals, 54 009 (29.9%) had hypertension.

Primary and secondary outcome measures

Migration status was used as a proxy for race/ethnicity. Age-standardized hypertension rates were estimated by sex and race/ethnicity. Multinomial logistic regressions, adjusted for age, were used to compare ethnoracial differences in the cascade of care.

Results

Individuals from SSA or DROMs had higher prevalence rates than the majority group, especially among women (37.6% and 26.8% vs 20.8%, respectively). These groups also had higher odds of entering a hypertension care path, although women from SSA tended to remain treated, instead of achieving control (OR 1.39 (0.99 to 1.96)). Women of Europe and others (OR 1.46 (1.14 to 1.87)) and men originating from Asia (OR 1.85 (1.03 to 3.33)) were more likely to remain at the awareness step.

Conclusion

Race/ethnicity impacts hypertension prevalence and management in France, with variations by sex. Our findings underscore the necessity to consider these results when designing intervention strategies to reduce the burden of uncontrolled hypertension.

VR READY: a protocol for a non-randomised, single-arm, mixed methods, feasibility trial of a coproduced ViRtual REality intervention to AiD recoverY in people recently admitted to intensive care

Por: Drew · C. J. G. · Smallman · K. · Gill · S. · Greenstock · C. · Cullen · K. · Irving · A. · Twose · P. · Battle · C. · White · D. · Smalley · M. · Lynch · C.
Introduction

Post-intensive care syndrome (PICS) describes a cluster of ongoing symptoms experienced by a large proportion of patients previously admitted to critical care. Despite a large rise in survival following critical care, interventions to support recovery and combat PICS are lacking. It has been suggested that the use of digital tools such as virtual reality (VR) may play a useful role in the development of recovery-supporting interventions. We engaged with people with lived experience of critical care admission to coproduce a VR intervention (ViRtual REality to AiD recoverY post ICU (VR READY)). Here, we present a protocol for the initial feasibility and acceptability testing of this intervention.

Methods and analysis

This is a single-arm, single-site, non-randomised feasibility trial of VR READY. Up to 25 participants recently admitted to critical care will be recruited to use the VR READY intervention for at least 5 min per day for a period of 14 days. Participants must have capacity to consent and be free from ongoing delirium in order to participate. Outcomes relating to sleep and well-being will be measured at baseline and at day 14 after intervention delivery. The primary outcome is feasibility, which will be assessed according to prespecified criteria. Participants will complete a qualitative interview to assess acceptability of the intervention, trial design and outcomes approximately 1 month after completing the intervention period. No formal statistical analysis of outcomes will be conducted, but these will be summarised descriptively. Interviews will be subjected to reflexive thematic analysis.

Ethics and dissemination

This study received a favourable ethical opinion by North-East York Research Ethics Committee (Ref 23/NE/0113) in June 2024. Study results will be disseminated through the peer review literature, ISRCTN registry and directly to participants, which will be facilitated by the study public and patient involvement steering group.

Trial registration number

ISRCTN88854487.

Chronic health consequences of the COVID-19 pandemic on school workers: a cross-sectional post-pandemic analysis

Por: Watts · A. W. · Pitblado · M. · Li · S. · Irvine · M. A. · Golding · L. · Coombs · D. · OReilly · C. · OBrien · S. F. · Goldfarb · D. M. · Masse · L. C. · Lavoie · P.
Importance

The COVID-19 pandemic dramatically affected schools. However, there are insufficient data on the chronic physical and mental health consequences of the pandemic in school workers.

Objectives

To determine the prevalence and the functional and mental health impact of pandemic-related chronic health symptoms among school workers towards the end of the COVID-19 pandemic.

Design

Cross-sectional analysis of health questionnaires and serology testing data (nucleocapsid, N antibodies) collected between January and April 2023, within a cohort of school workers.

Setting

Three large school districts (Vancouver, Richmond, Delta) in the Vancouver metropolitan area, Canada (representing 186 elementary and secondary schools in total).

Participants

Active school staff employed in these three school districts.

Exposure

COVID-19 infection history by self-reported viral and/or nucleocapsid antibody testing.

Main outcomes

Self-reported, new-onset pandemic-related chronic health symptoms that started within the past year, lasting at least 3 months, after a positive viral test among those with a known infection.

Results

Of 1128 school staff enrolled from 185/186 (99.5%) schools, 1086 (96.3%) and 998 (88.5%) staff completed health questionnaires and serology testing, respectively. The N-seroprevalence adjusted for clustering by school and test sensitivity and specificity was 84.7% (95% Credible Interval (95% CrI): 79.2% to 91.8%) compared with 85.4% (95% CrI: 81.6% to 90.3%) in a community-matched sample of blood donors. Overall, 31.1% (95% CI: 28.4% to 34.0%) staff reported new-onset chronic symptoms. These symptoms were more frequently reported in staff with viral test-confirmed infections (38.0% (95% CI: 34.3% to 41.9%)) compared with those with positive serology who were unaware that they had COVID-19 (14.3% (95% CI: 7.6% to 23.6%); p

Conclusions

The pandemic had major health impacts on school workers. To our knowledge, this study is among the first to concurrently quantify a broad range of chronic physical and mental health impacts, highlighting the need for further research and targeted health programmes to address this significant burden.

Participants perspectives of the advanced ovarian cancer biomarker study VALTIVE1: a qualitative study

Por: Holland-Hart · D. · Carucci · M. · Slusarczyk · M. · Longo · M. · Campbell · S. · Irving · A. · Noble · S. · Jayson · G. · Hopewell-Kelly · N.
Objectives

VALTIVE1 is a multi-centre, single-arm, non-interventional biomarker study for patients with advanced ovarian cancer. Plasma samples (Tie2 concentration) are collected to detect vascular control in tumours during standard treatment with chemotherapy and bevacizumab. This qualitative study embedded in VALTIVE1 aimed to assess the acceptability and feasibility of a potential VALTIVE2 trial. It explored the participants’ perceptions of the study and treatments and how they might feel if bevacizumab were discontinued based on the results from the biomarker test.

Design

This qualitative study used semi-structured telephone interviews, which were analysed using deductive and inductive thematic analysis.

Settings

Cancer treatment sites in the UK.

Participants

Participants recruited to VALTIVE1 were invited to take part in qualitative interviews. 11 female participants took part from four clinical sites.

Results

Participants reported that they experienced side effects attributed to bevacizumab, including stiffness, pain, fatigue, nose bleeds and muscle aches. Participants felt that combining chemotherapy and bevacizumab may have increased the severity of the side effects they experienced. Most participants felt that it was acceptable, if not preferable, to be allocated to a group in a future VALTIVE2 study where bevacizumab may be discontinued according to the results from the biomarker test. A clear preference of participants was to be informed of the biomarker test results, health status and treatment side effects.

Conclusion

A future trial should consider ensuring all participants have access to test results, as participants indicated a preference to know whether bevacizumab was working and to discontinue bevacizumab if it had not prevented tumour growth based on the biomarker results. Comprehensive and ongoing information and support regarding treatment side effects should be provided to all participants throughout their cancer pathways and trials.

Trial registration number

NCT04523116.

Insights and interventions for improving cultural humility towards Asian American, Native Hawaiian and Pacific Islander populations in medical curricula: a qualitative case study

Por: Cai · C. · Kong · S. · Im · C. · Mondell · E. · Le · T. K. · Irvin · N. · Lawson · S. M.
Objectives

The Asian American, Native Hawaiian and Pacific Islander (AANHPI) community is the fastest-growing racial/ethnic population in the USA. Previous research identified that medical students perceived a lack of exposure to AANHPI patients and topics in medical school curricula; however, there remains a lack of potential interventions to address this need. The goal of our study is to present a case study for identifying interventions in medical school curricula that improve cultural humility-based training for providing medical care for AANHPI populations.

Design

In this qualitative study, authors conducted four virtual focus groups with 15 medical students at a single institution to identify curricular interventions. The authors then conducted virtual semistructured interviews with eight medical educators one-on-one to explore the feasibility of the proposed interventions. Data were analysed using qualitative thematic analysis, and analysis was performed with ATLAS.ti.

Setting

Medical students and medical educators based at medical institutions in the USA.

Participants

15 medical students and eight medical educators participated in the study.

Results

All medical students (n=15) and educators (n=8) noted that there is limited engagement of AANHPI communities in current medical curricula and limited curricular components that address the diversity within the AANHPI umbrella. Medical student focus groups identified three interventions to improve cultural humility-based training for treating AANHPI patients: reflection spaces, community engagement and clinical training on documenting cultural needs. Educators supported the feasibility and importance of these interventions to prepare students to work with not only AANHPI patients but also with patients of other diverse backgrounds.

Conclusion

AANHPIs represent a heterogeneous population consisting of unique cultural heritages. Our research demonstrates the importance of highlighting this community in cultural humility curricula to provide an example of how to consider and appreciate diversity in patient populations. In this paper, we present student and medical educator-supported curricular interventions that not only increase awareness of issues impacting AANHPI communities, but also emphasise building skills of self-reflection, lifelong learning and empathy that are applicable to patients of all backgrounds.

Are client and provider preferences for HIV care coordination programme features concordant? Discrete choice experiments in Ryan White part A-funded New York City care coordination programmes

Por: Zimba · R. · Fong · C. · Conte · M. · Guarino · H. · Avoundjian · T. · Carmona · J. · Herndon · G. · Gambone · G. · Irvine · M. K. · Nash · D.
Objectives

The New York City (NYC) HIV Care Coordination Programme (CCP) is designed to help people with HIV (PWH) overcome barriers to care and treatment engagement. We assessed preferences for CCP components among programme enrollees (’clients’) and providers. Our objective is to compare client and provider preferences, which were previously analysed separately.

Design

We used a discrete choice experiment to assess preferences for four CCP features (‘attributes’): Help with Adherence to Antiretroviral Therapy (ART), Help with Primary Care Appointments, Help with Issues other than Primary Care and Where Programme Visits Happen. Each of these attributes had 3–4 variants (‘levels’). In the original surveys, levels within Where Programme Visits Happen varied by participant type (client vs provider). We recoded the levels by visit location (VL) or by travel time (TT) to make them comparable and report results from both approaches.

Setting

25 Ryan White Part A-funded NYC CCPs participated.

Participants

152 providers and 181 clients completed the survey.

Primary and secondary outcome measures

Preferences were quantified using the relative importance of the attributes and utility of the levels.

Results

From January 2020 to March 2021, 152 providers and 181 clients completed the survey. Most of the providers (52%) were

Conclusions

Client and provider preferences clearly diverged regarding CCP service intensity: in the aggregate, clients tended to prefer lower-intensity services, whereas providers endorsed higher-intensity services. These results highlight the importance of engaging clients as partners in decisions about programme services to facilitate alignment with client values.

A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE‐AIM framework

Abstract

Background

Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations.

Aim

The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations.

Methods

A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction.

Results

Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample.

Linking Evidence to Action

Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.

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