Impact of the social deprivation on the psychosocial difficulties of pediatric cancer survivors: a prospective multicentric study

Background The posttreatment period is a key part of the management of pediatric cancer care. At this period, psychosocial effects (scholarly and psychological difficulties) have been described in pediatric cancer patients and can be prognostic for the success of social reintegration. Psychosocial effects and their impact may be related to the household’s socioeconomic background. The aim of this study was to estimate psychosocial difficulties during the posttreatment period based on a social deprivation score. Design This study is based on a prospective multicentric study database, and focused on the children who had received psychosocial evaluation during their follow-up after cancer treatment since 01/01/2013. We retrieved data on their learning and psychological difficulties. Socioeconomic status of the household was estimated by a social deprivation score. Results 1003 patients were analyzed. Learning difficulties at school were noted in 22% of patients. A greater social deprivation was significantly associated with learning difficulty (OR=1.09 per unit of the deprivation score). Tumor relapse, treatment with hematopoietic stem cell transplantation, and diagnosis of a CNS tumor remained significant risk factors. In the subgroup analysis of children with CNS tumors, learning difficulties were increased and associated with greater social deprivation. By contrast, psychological difficulties were not associated with the deprivation score. Conclusion There is a link between SE status and learning difficulties in survivors of childhood cancer. Further investigations should be carried out to confirm these results for children with CNS tumors, which is the population of the greatest concern.

493 An Examination into The Impact of Sleep Deprivation on Surgeons

Background Lack of sleep amongst surgeons is significant and worrying. It poses short- and long-term risks to surgeons’ health and negatively impacts patient outcomes. Previous studies have examined sleep deprivation amongst health care professionals. The aim of the present study was to examine impact in a specific population of surgical doctors. Method A questionnaire-based study completed in the anatomy department of King’s College London University. Surgical subjects spanned the United Kingdom. Subjects completed 14 questions regarding sleep habits. Data was compiled, calculating a sleep deprivation score. Results Valid responses were obtained from 66 surgical subjects of varying seniority. Mean age of subjects was 33.7 years old. 59.1% of subjects had rota commitments changing on a weekly basis. Average sleep amongst subjects amounted to 6.15 (± 1.26) hours per night. Daily sleep did not present differences dependent on seniority level (p = 0.186). 25.8% of subjects took >30 minutes to fall asleep. Our subjects woke 1.67 (± 1.21) times a night. Mean sleep deprivation score amongst our surgical population was 16.5 (± 4.26) demonstrating moderate negative impact on daily activities. 28.9% accumulated ≧20 sleep deprivation score demonstrating severe impact of sleep deprivation on life. Conclusions Our study has demonstrated reduced quantity and quality of sleep amongst our subject population. With protecting the health of both patients and surgeons in mind, we must place higher importance on improving sleep amongst surgical professionals.

Role of community pharmacies in a population-based colorectal cancer screening program: opportunities for quality improvement

Background In Catalonia (Spain), most CRC screening hubs use the pharmacy-based model to distribute and collect the fecal immunochemical test (FIT) kits. The comprehensive evaluation of CRC screening programs, which include the role and implications of pharmacy involvement, is essential to ensure program quality and identify areas for further improvement. The present study aimed to analyze pharmacy collaboration with the screening program and pharmacy-based FIT kit distribution. Methods A descriptive study to describe the role of community pharmacies as well as the FIT distribution and collection data during 2018 was conducted. Time to FIT completion was assessed by Kaplan-Meier estimation, and with the log-rank test. A Cox regression model was used to adjust for other variables associated with the completion of FIT such as sex, age, deprivation score and previous screening behavior. Results Overall, 82.4% of pharmacies collaborated with CRC screening program. Out of 82,902 FIT kits distributed to screening invitees 77,524 completed FIT kits were returned to pharmacies (93.5%) with a participation of 39.8% among the 193,766 invitees. From those who completed a FIT, the median time to return the kit was 3 days. FIT completion time was significantly lower among women, older age, high deprivation score and previous CRC screening (p < 0.005). Conclusions In our cancer screening setting the engagement of community pharmacies is high. Our findings suggest that community pharmacists as part of an integrated screening program team and by providing key screening process data can enable a better understanding of CRC screening behavior.

Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank

Background We examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors. Methods We studied 4510 UK Biobank participants tested for COVID-19 (positive, n = 1326). Multivariate logistic regression models including age, sex and ethnicity were used to test whether addition of (1) cardiometabolic factors [diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking and body mass index (BMI)]; (2) 25(OH)-vitamin D; (3) poor diet; (4) Townsend deprivation score; (5) housing (home type, overcrowding) or (6) behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status. Results There was over-representation of men and BAME ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations. Conclusions In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors. Factors which underlie ethnic differences in COVID-19 may not be easily captured, and so investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised.

Greater risk of severe COVID-19 in non-White ethnicities is not explained by cardiometabolic, socioeconomic, or behavioural factors, or by 25(OH)-vitamin D status: study of 1,326 cases from the UK Biobank

BackgroundWe examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and non-White ethnicities is explained by cardiometabolic, socio-economic, or behavioural factors.MethodsWe studied 4,510 UK Biobank participants tested for COVID-19 (positive, n = 1,326). Multivariate logistic regression models including age, sex, and ethnicity were used to test whether addition of: 1)cardiometabolic factors (diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking, BMI); 2)25(OH)-vitamin D; 3)poor diet; 4)Townsend deprivation score; 5)housing (home type, overcrowding); or 6)behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status.ResultsThere was over-representation of men and non-White ethnicities in the COVID-19 positive group. Non-Whites had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and flats/apartments. Male sex, non-White ethnicity, higher BMI, Townsend deprivation score, and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations.ConclusionsSex and ethnicity differential pattern of COVID-19 is not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels, or socio-economic factors. Investigation of alternative biological pathways and different genetic susceptibilities is warranted.

Risk factors for surgery due to rotator cuff disease in a population-based cohort

Aims Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort. Methods A population-based cohort of people aged between 40 and 69 years in the UK (the UK Biobank) was studied. People who underwent surgery for RCD were identified through a link with NHS inpatient records covering a mean of eight years after enrolment. Multivariate Cox proportional hazards regression was used to calculate hazard ratios (HRs) as estimates of associations with surgery for RCD accounting for confounders. The risk factors which were considered included age, sex, race, education, Townsend deprivation index, body mass index (BMI), occupational demands, and exposure to smoking. Results Of the 421,894 people who were included, 47% were male. The mean age at the time of enrolment was 56 years (40 to 69). A total of 2,156 people were identified who underwent surgery for RCD. Each decade increase in age was associated with a 55% increase in the incidence of RCD surgery (95% confidence interval (CI) 46% to 64%). Male sex, non-white race, lower deprivation score, and higher BMI were significantly associated with a higher risk of surgery for RCD (all p < 0.050). Greater occupational physical demands were significantly associated with higher rates of RCD surgery (HR = 2.1, 1.8, and 1.4 for ‘always’, ‘usually’, and ‘sometimes’ doing heavy manual labour vs ‘never’, all p < 0.001). Former smokers had significantly higher rates of RCD surgery than those who had never smoked (HR 1.23 (95% CI 1.12 to 1.35), p < 0.001), while current smokers had similar rates to those who had never smoked (HR 0.94 (95% CI 0.80 to 1.11)). Among those who had never smoked, the risk of surgery was higher among those with more than one household member who smoked (HR 1.78 (95% CI 1.08 to 2.92)). The risk of RCD surgery was not significantly related to other measurements of secondhand smoking. Conclusion Many factors were independently associated with surgery for RCD, including older age, male sex, higher BMI, lower deprivation score, and higher occupational physical demands. Several of the risk factors which were identified are modifiable, suggesting that the healthcare burden of RCD might be reduced through the pursuit of public health goals, such as reducing obesity and modifying occupational demands. Cite this article: Bone Joint J 2020;102-B(3):352–359

Is there an association between socioeconomic status of General Practice population and postgraduate training practice accreditation? A cross-sectional analysis of Scottish General Practices

Background Practice population socioeconomic status is associated with practice postgraduate training accreditation. General Practitioner recruitment to socioeconomically deprived areas is challenging, exposure during training may encourage recruitment. Objectives To determine the association of practice population socioeconomic deprivation score and training status, and if this has changed over time. Methods Cross-sectional study looking at socioeconomic deprivation and training status for all General Practices in Scotland (n = 982). Data from Information Services Division, from 2015, were combined with the Scottish Index of Multiple Deprivation to calculate weighted socioeconomic deprivation scores for every practice in Scotland. Scottish training body database identified training practices (n = 330). Mean deprivation score for training and non-training practices was calculated. Logistic regression was used to quantify the odds ratio of training status based on deprivation score, adjusted for practice list size, and compared with a similar 2009 analysis. Results Socioeconomic deprivation score is associated with training status, but is not significant when adjusted for practice list size [OR (adjusted) 0.87, 95% CI: 0.74–1.04]. In contrast, in 2009, adjusted deprivation score remained significant. Mean deprivation score in training and non-training practices remained similar at both time points [2015: 2.98 (SD 0.88) versus 3.17 (SD 0.81); 2009: 2.95 versus 3.19), with a more deprived mean score in non-training practices. Conclusions General practices in affluent areas remain more likely to train, although this association appears to be related to larger practice list sizes rather than socioeconomic factors. To ensure a variety of training environments training bodies should target, and support, smaller practices working in more socioeconomically deprived areas.

Tuberculosis patients with higher levels of poverty face equal or greater costs of illness

SETTING: Fifty-six public clinics in Limpopo Province, South Africa.OBJECTIVE: To evaluate the association between tuberculosis (TB) patient costs and poverty as measured by a multidimensional poverty index.DESIGN: We performed cross-sectional interviews of consecutive patients with TB. TB episode costs were estimated from self-reported income, travel costs, and care-seeking time. Poverty was assessed using the South African Multidimensional Poverty Index (SAMPI) deprivation score (a 12-item household-level index), with higher scores indicating greater poverty. We used multivariable linear regression to adjust for age, sex, human immunodeficiency virus status and travel time.RESULTS: Among 323 participants, 108 (33%) were ‘deprived' (deprivation score >0.33). For each 0.1-unit increase in deprivation score, absolute TB episode costs were 1.11 times greater (95%CI 0.97–1.26). TB episode costs were 1.19 times greater with each quintile of higher deprivation score (95%CI 1.00–1.40), but lower by a factor of 0.54 with each quintile of lower self-reported income (higher poverty, 95%CI 0.46–0.62).CONCLUSION: Individuals experiencing multidimensional poverty and the cost of tuberculosis illness in Limpopo, South Africa faced equal or higher costs of TB than non-impoverished patients. Individuals with lower self-reported income experienced higher costs as a proportion of household income but lower absolute costs. Targeted interventions are needed to reduce the economic burden of TB on patients with multidimensional poverty.