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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.
We used data from the population-based CONSTANCES cohort, linked with the French National Health Data System.
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.
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.
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.
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.
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.
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.
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.
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.
This qualitative study used semi-structured telephone interviews, which were analysed using deductive and inductive thematic analysis.
Cancer treatment sites in the UK.
Participants recruited to VALTIVE1 were invited to take part in qualitative interviews. 11 female participants took part from four clinical sites.
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.
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.
Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations.
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.
A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction.
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.
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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