Family caregiver’s loneliness and related health factors: what can be changed?

Background Loneliness is a public health issue which may affect the entire population. Loneliness is associated with depression, sleep disorders, fatigue and increase the risk of obesity and diabetes. Risk factors for loneliness include poor social network and poor physical and mental health. The main objective was to study factors related to loneliness of family caregivers caring for independent older people. Methods We performed a non-interventional observational cross-sectional study in south-eastern France. Family Caregivers caring for people aged 70 and over living at home were included. These older people were independent, without long-term conditions and who applied for professional social assistance for daily living. Data were collected through a questionnaire, administered face-to-face or by telephone. Loneliness and perceived health status were measured through a single-question. Burden was assessed through the Mini-Zarit Scale, frailty was measured through the Gerontopole Frailty Screening Tool. Results Of the 876 caregivers included, 10% felt lonely often or always. They reported more physical and mental health issues than those who did not feel loneliness (p<0.001). Family caregivers with loneliness were more likely to be looking after a parent and were twice as likely to have a moderate to severe burden (OR=2.6). They were more likely to feel anxious (OR=5.6), to have sleep disorders (OR=2.4), to be frail (OR=2) and to feel their health as poor or bad (OR=2). Conclusions Loneliness has a negative impact on health, frailty and burden of family caregivers. Means must be implemented to anticipate the consequences of the loneliness felt by family caregivers, notably by orienting them towards the relevant services.

Associations between multiple long-term conditions and mortality in diverse ethnic groups

Background Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. Methods and Findings A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Cox regression models were used to estimate mortality by number of long-term conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional long-term condition at baseline was associated with increased mortality. This association differed across ethnic groups. Compared with 50-year-olds of white ethnicity with no conditions, the mortality rate was higher for white 50-year-olds with two conditions (HR 1.77) or four conditions (HR 3.13). Corresponding figures were higher for 50-year-olds of Black Caribbean ethnicity with two conditions (HR=2.22) or four conditions (HR 4.54). The direction of the interaction of number of conditions with ethnicity showed higher mortality associated with long-term conditions in nine out of ten minoritised ethnic groups, attaining statistical significance in four (Pakistani, Black African, Black Caribbean and Black other ethnic groups). Conclusions The raised mortality rate associated with having multiple conditions is greater in minoritised ethnic groups compared with white people. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.

The use of social network analysis in social support and care: a systematic scoping review protocol

Background In recent decades, the literature on Social Network Analysis and health has experienced a significant increase. Disease transmission, health behavior, organizational networks, social capital, and social support are among the different health areas where Social Network Analysis has been applied. The current epidemiological trend is characterized by a progressive increase in the population’s ageing and the incidence of long-term conditions. Thus, it seems relevant to highlight the importance of social support and care systems to guarantee the coverage of health and social needs within the context of acute illness, chronic disease, and disability for patients and their carers. Thus, the main aim is to identify, categorize, summarize, synthesize, and map existing knowledge, literature, and evidence about the use of Social Network Analysis to study social support and care in the context of illness and disability. Methods This scoping review will be conducted following Arksey and O'Malley's framework with adaptations from Levac et al. and Joanna Briggs Institute’s methodological guidance for conducting scoping reviews. We will search the following databases (from January 2000 onwards): PubMed, MEDLINE, Web of Science Core Collection, SCOPUS, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, PROSPERO, and DARE. Complementary searches will be conducted in selected relevant journals. Only articles related to social support or care in patients or caregivers in the context of acute illnesses, disabilities or long-term conditions will be considered eligible for inclusion. Two reviewers will screen all the citations, full-text articles, and abstract the data independently. A narrative synthesis will be provided with information presented in the main text and tables. Discussion The knowledge about the scientific evidence available in the literature, the methodological characteristics of the studies identified based on Social Network Analysis, and its main contributions will highlight the importance of health-related research's social and relational dimensions. These results will shed light on the importance of the structure and composition of social networks to provide social support and care and their impact on other health outcomes. It is anticipated that results may guide future research on network-based interventions that might be considered drivers to provide further knowledge in social support and care from a relational approach at the individual and community levels. Trial registration Open Science Framework https://osf.io/dqkb5.

The dynamics of frailty development and progression in older adults in primary care in England (2006–2017): a retrospective cohort profile

Background Frailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to describe the epidemiology of frailty and understand the dynamics of frailty within individuals and across the population. This article describes the structure of the dataset, cohort characteristics and planned analyses. Methods Retrospective cohort study using electronic health records. Participants were aged ≥50 years registered in practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre between 2006 to 2017. Data include GP practice details, patient sociodemographic and clinical characteristics, twice-yearly electronic Frailty Index (eFI), deaths, medication use and primary and secondary care health service use. Participants in each cohort year by age group, GP and patient characteristics at cohort entry are described. Results The cohort includes 2,177,656 patients, contributing 15,552,946 person-years, registered at 419 primary care practices in England. The mean age was 61 years, 52.1% of the cohort was female, and 77.6% lived in urban environments. Frailty increased with age, affecting 10% of adults aged 50–64 and 43.7% of adults aged ≥65. The prevalence of long-term conditions and specific frailty deficits increased with age, as did the eFI and the severity of frailty categories. Conclusion A comprehensive understanding of frailty dynamics will inform predictions of current and future care needs to facilitate timely planning of appropriate interventions, service configurations and workforce requirements. Analysis of this large, nationally representative cohort including participants aged ≥50 will capture earlier transitions to frailty and enable a detailed understanding of progression and impact. These results will inform novel simulation models which predict future health and service needs of older people living with frailty. Study registration Registered on www.clinicaltrials.gov October 25th 2019, NCT04139278.

Danish validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and findings from a population health survey: a mixed-methods study

ObjectiveTo validate the Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) and obtain a population-based evaluation of treatment burden.DesignMixed-methods.SettingDanish population-based survey.ParticipantsTranslation by professional translators and an expert group. The scale was tested by 13 407 participants (aged ≥25 years) in treatment.MeasuresThe 10-item MTBQ was translated into Danish using forward-backward translation and used in a large population health survey. A global MTBQ score was calculated and factor analysis and Cronbach’s alpha assessed dimensional structure and internal consistency reliability, respectively. Spearman’s rank correlations between global MTBQ scores and scores of self-rated health, health-related quality of life and the number of long-term conditions, respectively, assessed construct validity. MTBQ scores were grouped into four categories (no, low, medium, high burden) to assess interpretability and population-based evaluation of treatment burden.ResultsThe scale showed high internal consistency (α=0.87), positive skewness and large floor effects. Factor analysis supported a one-dimensional structure of the scale with a three-dimensional structure as a less parsimonious alternative. The MTBQ score was negatively associated with self-rated health (rS−0.45, p<0.0001) and health-related quality of life (rS−0.46/−0.51, p<0.0001), and positively associated with the number of long-term conditions (rS 0.26, p<0.0001) and perceived stress (rS 0.44, p<0.0001). Higher treatment burden was associated with young age, male sex, high educational level, unemployment, being permanently out of work, not living with a spouse/cohabitant, living with child(ren) and long-term conditions (eg, heart attack, stroke, diabetes and mental illness).ConclusionThe Danish MTBQ is a valid measure of treatment burden with good construct validity and high internal reliability. This is the first study to explore treatment burden at a population level and provides important evidence to policy makers and clinicians about sociodemographic groups at risk of higher treatment burden.

Pharmacological aspects & medicinal uses of Trigonella foenum-graecum: A Current Review

Globally a large number of people are affected by acute and chronic diseases resulting in high morbidity and mortality rate. A huge amount of pharmaceutical drugs are being manufactured on a daily basis to combat these diseases. But due to their high cost and deleterious effects, it becomes critically important to state emphasis on finding an alternative way to manage these long term conditions. Medicinal herbs could provide a good source of dietary supplement combined with existing therapies. Many scientific studies have demonstrated that medicinal plants and herbs have the potential for the treatment of many serious infections and many disorders. Out of these herbs, Fenugreek is recognized as an oldest herb with great medicinal potential. Fenugreek harbors many essential macronutrients and micronutrients along with trace elements. Numerous chemical constituents present in fenugreek highlights a variety of pharmacological activity such as anti-glycemic activity, anti-oxidant capacity, anti-inflammatory effects, hypocholesterolemic activity and many more. This article explores the diverse active compounds and potential pharmacological applications of Trigonella foenum-graecum also known as fenugreek. It also focuses on the medicinal significance and health impact of taking fenugreek in our day to day nutrition.

Creativity, health and wellbeing: challenges of research and evidence

Creativity, health and wellbeing (CHW) has emerged as a multidisciplinary field of research, policy and practice over the last 20 years. Its beginnings can be traced from the establishment of art therapies in the post war period and from the growth of community arts in the 1960s, which fostered connections between arts professionals, researchers, educators and policy advocates seeking to respond to local challenges (White, 2009). Subsequently the CHW field has grown through evidence building, advocacy and sector development and there is now a wider recognition of the contribution of arts and cultural engagement to a wide range of policy objectives. For example, policies such as social prescribing view arts spaces, activities and resources as community assets that can be used to improve health, to support people living with long-term conditions and to reduce pressure on health services. Nevertheless, the successful integration of arts and creativity into policy and practice is some way off, partly because of ongoing theoretical, methodological and political challenges (Daykin, 2020).

Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review

People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality compared to people with physical conditions alone. South Asians (SAs) are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. SAs are less likely to recognise symptoms which may represent mental health problems. To explore how people of SA origin with LTCs understand, experience and seek help for emotional distress, depression and anxiety. Systematic review of qualitative studies exploring emotional distress in SAs with diabetes or coronary heart disease, within primary and community care settings worldwide. Comprehensive searches of eight electronic databases from inception to 1st September 2021. Data extracted included study characteristics, and understanding, experience and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The CASP checklist for qualitative studies was used to assess quality of papers, and GRADE-CERQual used to determine the overall strength of evidence. Twenty one studies from 3,165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension,’ and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and gender differences. Help-seeking behaviour: self-management, seeking help from family, friends, and faith, and inadequate clinical support. This review provides a greater understanding of SAs’ conceptualisation of emotional distress in the context of LTCs, to support improvement in its recognition and management.

Simulation of long-term spatiotemporal variations in regional-scale groundwater recharge: contributions of a water budget approach in cold and humid climates

Groundwater recharge (GWR) is a strategic hydrologic variable, and its estimate is necessary to implement sustainable groundwater management. This is especially true in a global warming context that highly impacts key winter conditions in cold and humid climates. For this reason, long-term simulations are particularly useful for understanding past changes in GWR associated with changing climatic conditions. However, GWR simulation at the regional scale and for long-term conditions is challenging, especially due to the limited availability of spatially distributed calibration data and due to generally short observed time series. The objective of this study is to demonstrate the relevance of using a water budget model to understand long-term transient and regional-scale GWR in cold and humid climates where groundwater observations are scarce. The HydroBudget model was specifically developed for regional-scale simulations in cold and humid climate conditions. The model uses commonly available data such as runoff curve numbers to describe the study area, precipitation and temperature time series to run the model, and river flow rates and baseflow estimates for its automatic calibration. A typical case study is presented for the southern portion of the Province of Quebec (Canada, 36 000 km2). With the model simultaneously calibrated on 51 gauging stations, the first GWR estimate for the region was simulated between 1961 and 2017 with very little uncertainty (≤ 10 mm/yr). The simulated water budget was divided into 41 % runoff (444 mm/yr), 47 % evapotranspiration (501 mm/yr), and 12 % GWR (139 mm/yr), with preferential GWR periods during spring and winter (44 % and 32 % of the annual GWR, respectively), values that are typical of other cold and humid climates. Snowpack evolution and soil frost were shown to be a key feature for GWR simulation in these environments. One of the contributions of the study was to show that the model sensitivity to its parameters was correlated with the average air temperature, with colder watersheds more sensitive to snow-related parameters than warmer watersheds. Interestingly, the results showed that the significant increase in precipitation and temperature since the early 1960s did not lead to significant changes in the annual GWR but resulted in increased runoff and evapotranspiration. In contrast to previous studies of past GWR trends in cold and humid climates, this work has shown that changes in past climatic conditions have not yet produced significant changes in annual GWR. Because of their relative ease of use, water budget models are a useful approach for scientists, modelers, and stakeholders alike to understand regional-scale groundwater renewal rates in cold and humid climates, especially if they can be easily adapted to specific study needs and environments.

A comprehensive high cost drugs dataset from the NHS in England - An OpenSAFELY-TPP Short Data Report

Background: At the outset of the COVID-19 pandemic, there was no routine comprehensive hospital medicines data from the UK available to researchers. These records can be important for many analyses including the effect of certain medicines on the risk of severe COVID-19 outcomes. With the approval of NHS England, we set out to obtain data on one specific group of medicines, “high-cost drugs” (HCD) which are typically specialist medicines for the management of long-term conditions, prescribed by hospitals to patients. Additionally, we aimed to make these data available to all approved researchers in OpenSAFELY-TPP. This report is intended to support all studies carried out in OpenSAFELY-TPP, and those elsewhere, working with this dataset or similar data. Methods: Working with the North East Commissioning Support Unit and NHS Digital, we arranged for collation of a single national HCD dataset to help inform responses to the COVID-19 pandemic. The dataset was developed from payment submissions from hospitals to commissioners. Results: In the financial year (FY) 2018/19 there were 2.8 million submissions for 1.1 million unique patient IDs recorded in the HCD. The average number of submissions per patient over the year was 2.6. In FY 2019/20 there were 4.0 million submissions for 1.3 million unique patient IDs. The average number of submissions per patient over the year was 3.1. Of the 21 variables in the dataset, three are now available for analysis in OpenSafely-TPP: Financial year and month of drug being dispensed; drug name; and a description of the drug dispensed. Conclusions: We have described the process for sourcing a national HCD dataset, making these data available for COVID-19-related analysis through OpenSAFELY-TPP and provided information on the variables included in the dataset, data coverage and an initial descriptive analysis.