Health and Care Research Wales

BackgroundOlder adults make up the largest proportion of nonusers of the internet. With the increasing digitalization of services, it is important to identify what interventions are effective at reducing digital exclusion in older adults.ObjectiveWe aimed to identify what evidence exists on the effectiveness of interventions to address digital exclusion in older adults.MethodsThis rapid review assessed the effectiveness of interventions to address digital exclusion in older adults aged 60 years or older. Searches were conducted in November 2023 across a range of databases and used supplementary search methods. Searches were limited to comparative studies published from 2018 onward in English. Data were analyzed using a narrative synthesis approach.ResultsA total of 21 studies were included that aimed to increase a range of digital literacy skills. Sample sizes ranged from 5 to 381. Intervention approaches varied considerably and were often multicomponent and undertaken in a variety of settings. There is evidence to suggest that a range of interventions can reduce physical, personal, and perceptual barriers and improve older adults’ skills, knowledge, digital literacy, and perceived self-efficacy, reduce technophobia, and increase use of technology. Importantly, findings indicated improvements among a range of subpopulations, including those living in rural areas, at risk of social isolation, who are homebound, of lower socioeconomic groups, and individuals with visual impairment. To achieve improved and sustained digital inclusion in older adults, evidence suggests it may be important to ensure structural barriers, such as access to the internet and affordability of devices, are removed. However, all studies contained methodological limitations and may not be adequately powered to determine effectiveness.ConclusionsThe evidence shows the potential benefits of interventions aimed at improving a range of digital skills and increasing technology use in older adults, which could help to address digital exclusion. The findings of this rapid review can inform the development and delivery of future interventions. However, it is important to consider the context in which the included interventions were used and the lack of certainty of the findings. This review also identified a lack of high-quality evidence, as all studies identified contained methodological limitations and may not have been adequately powered to determine effectiveness. In addition, consideration should also be given to those who do not wish to engage with the online world to ensure they are not left behind.

ObjectivesUnderstanding compliance with the national heart failure (HF) clinical pathway can help drive improvement in early diagnosis. In Wales, this is limited by the lack of nationally reported echocardiograms (ECHOs). Through collaboration between clinicians and analysts, various proxy measures were tested to assess performance against the intended interventions. MethodsThe NICE guideline for HF diagnosis from primary care referrals requires a simple B-type natriuretic peptide (BNP) blood test to assess the need and urgency for an ECHO as the gold standard diagnostic test. Clinicians and analysts collaborated to test compliance with the national standard using existing nationally held datasets. Due to the lack of nationally reported ECHOs and the Outpatients Appointments Dataset (OPA) only available at specialty level, innovative approaches were employed. Using the Welsh Results Reporting dataset (WRRS), patients with raised BNP identified in primary care were linked to the OPA, to trace them in a Cardiac specialty. ResultsPatients were traced to determine if they had received a cardiology appointment within 6 weeks of a raised BNP (>= 400ng/L) over the past 5 years. Recognising that not all raised results necessitate a referral, we explored three denominator approaches: all patients with raised results, those referred following a raised result, and those with an appointment post-referral. Each approach yielded different outcomes: Included all patients with raised BNP, providing a broad overview but potentially overestimating compliance. Focused on those referred, offering a more targeted measure but excluding patients not referred despite raised results. Patients with appointments post-referral, provided the most specific measure but was limited by incomplete data. These variations highlight the challenge in accurately measuring compliance to guidelines using existing data. ConclusionImproving data quality and standardisation through PACS (Picture Archiving and Communication System) investment, collaboration across NHS organisations, and acquisition of National Institute for Cardiovascular Outcomes Research (NICOR) data is crucial. Standardising coding, data submission, and reporting, along with mandating regular audits, will enhance national data consistency and accuracy.

This study shows overall ground water fluoride contamination scenario of entire Bankura district of West Bengal. Ten out of twenty two district are recorded to have ground water fluoride concentration above WHO permissible limit 1.5 mg/L. People living in these ten districts are found to have dental fluorosis problem due to regular consumption of fluoride contaminated drinking water in addition to fluoride-contaminated rice, pulses, and vegetables. Body weakness, muscle-nervous fluorosis in addition to skeletal, non-skeletal and dental fluorosis is recorded in Simlapal block due to consumption of highly fluoride contaminated drinking water. Weathering of fluorine rich minerals, lateritic soil character in these regions, unscientific use of fluorine rich phosphatic fertilizers are mainly responsible for the elevated level of fluoride contamination in ground water and soil of Bankura district. Alternative sources of water like rain water harvesting, continuous monitoring of ground water for pollutants, household supply of safe drinking water could be the probable long-term solution for the study area.

Abstract Integrated care can be defined as the joining up of different health and/or social services to deliver care that meets individuals’ needs in an efficient way. There is limited clarity about the effectiveness of integrated care interventions in improving the timeliness of health and social care delivery. To address this gap, a rapid review was conducted, incorporating both quantitative and qualitative perspectives that evaluate the impact of integrated care interventions on waiting times and waiting lists.The review included studies published between 2015 and 2024. Sixty-one studies were identified out of which 30 reported integrated care interventions operating across two or more services. Studies were conducted in a number of different countries. Study population included older people (over the age of 65) with various injuries and diseases, and aged care or palliative care needs. The interventions involved integration across different services, with most covering both health and social care. All interventions were multifaceted.Weak quantitative evidence from multiple studies suggests that integrated care interventions including multidisciplinary team (MDT) working, pathways/ protocols and/or care coordination as their main element may help reduce various waiting times, for example time to admission and/or time to surgery in older people with hip fracture. Strong quantitative evidence from two studies shows that a multidisciplinary assessment for older people presenting at an emergency department (ED) for various reasons, is effective in reducing time spent in the ED.Qualitative studies mainly investigated waiting times from healthcare professionals’ perspectives. The findings suggest that integrated care interventions could support early assessment and diagnosis of dementia and complex chronic geriatric conditions; enable more timely symptom management and care planning in nursing homes; reduce processing time of aged care referrals in primary and community care; help streamline inpatient care for ageing associated diseases; and reduce delays for hip fracture care. One study explored older people’s and their relatives’ experiences and findings suggest that an ED avoidance service for older adults with urgent but non-emergency needs may help reduce emergency waiting times.There is a need for high quality research including studies i) investigating the effect of integrated care on waiting times, ii) evaluating the effectiveness of organisational integration on waiting times, iii) exploring older people’s experiences with waiting times in relation to integrated care.Policy and Practice Implications: There is some evidence that MDTs, integrated care pathways, and care coordination may improve inpatient waiting times to surgery, and emergency waiting times in an ED. Thus, initiatives supporting the development and implementation of these integrated care interventions is crucial.Funding statementThe authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government]

BackgroundThe moral panic surrounding trans, non-binary, and gender diverse (TGD) lives in the United Kingdom (UK) has been incited by high-level political and government actors and exacerbated by pervasive misinformation in social and press media. This hostile environment contributes to increasing interpersonal violence and social exclusion experienced by TGD people. Structural and interpersonal discrimination—conceptualised as minority stress—is understood to elicit physiological and psychological stress responses that predispose TGD individuals to a range of adverse health outcomes, including cardiovascular disease, and risk behaviours such as alcohol use.Main bodyHealth disparities among TGD people in the UK are driven by a combination of minority stress, barriers to general healthcare, and disadvantage across multiple social determinants of health. Limited access to gender-affirming healthcare compounds these disparities, contributing to stark differences in morbidity and mortality relative to cisgender populations. Preventive healthcare engagement is also disproportionately low among TGD individuals, further exacerbating long-term health risks. The intersection of social exclusion, policy-driven discrimination, and systemic healthcare inequities places TGD people at significant and potentially increasing risk of poor health outcomes.ConclusionsThe health disparities faced by TGD people in the UK constitute a real-time public health crisis that demands urgent and sustained intervention. TGD people must be central to shaping the strategic direction of a coordinated and adequately resourced response to these harms.

Abstract Outward medical tourism is when people seek medical treatment in a different country to the one they live in. There are concerns that people travelling abroad for surgery may be at risk of complications when they return home. This review aimed to identify all the studies that describe the impact on the UK NHS of patients who require follow-up care due to outward medical tourism for elective surgery and report on complications, costs and benefits.The review included evidence available until December 2024. 37 studies were included that described patients who were treated in the NHS for complications arising from elective surgery conducted abroad. 35 were case series or case reports, 19 relating to bariatric surgery, 15 to cosmetic surgery and 1 to ophthalmic surgery. 2 were surveys of plastic surgeons practicing in the NHS. 14 studies included a cost analysis.The case series and case reports included a total of 655 patients treated by the NHS between 2006 to 2024 for post-operative complications in specific hospitals. Not all studies reported all outcomes of interest. For the studies that reported demographic data, most patients were female (90%). The most common destination for surgery was Turkey (61%). For bariatric surgery tourism, abdominal pain, vomiting, inability to swallow and malnutrition were cited as presenting symptoms, with gastric leak being the most common diagnosis.Over a third of patients had to have a reversal or revision of the bariatric procedure. For cosmetic surgery tourism, the most common complications were infection and reopening of the surgical wound, with 57% of patients receiving antibiotics. No deaths were reported by any of the studies, although there was evidence that some patients needed complex treatment involving long hospital stays and multiple surgical interventions. Just over a half of patients required at least one investigation or intervention under local or general anaesthetic. Very low certainty of evidence indicates that costs to the NHS from outward medical tourism for elective surgery ranges from £1,058 to £19,549 per patient in 2024 prices. We found no studies that reported on benefits of outward medical tourism.Awareness-raising campaigns and interventions are warranted to inform members of the public considering going abroad for surgery about the potential for complications. There is a need for a systematic approach to collecting information on the impact on the UK NHS of treating complications arising from outward medical tourism for elective surgery and the associated costs. We still do not know how many people resident in the UK go abroad for elective surgery or how many people subsequently have complications. Without this data we cannot fully understand the amount of risk that people seeking surgery abroad are taking.Funding statementThe authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.

ObjectivesTo determine the association of housing items and amenities with psychological wellbeing (PWB) and their relationship with all-cause and cardiovascular disease (CVD) mortality.MethodsThis study was based on the framework of the HAPIEE study. Data from the Lithuanian Mortality Register were used to evaluate CVD and all-cause mortality from baseline survey (2006–2008) till 2023. The logistic regression model and multivariate Cox regression model were applied for data analysis.ResultsThe multivariable regression models showed that the material aspects of people’s lives influenced their PWB status: increasing the number of housing items per 1 unit significantly increased the odds ratio (OR) of higher PWB status for males [OR = 1.14 (95% CI 1.11–1.18)] and females [OR = 1.13 (95% CI 1.11–1.17)] and decreased the risk of all-cause and CVD mortality in females [respectively HR = 0.93 (95% CI 0.91–0.96) and HR = 0.91 (95% CI 0.87–0.95)] and in males [respectively HR = 0.92 (95% CI 0.90–0.94) and HR = 0.90 (95% CI 0.87–0.93)].ConclusionThese data suggest that the household items and amenities influenced PWB and may be used as risk factors in assessing the risk of all-cause and CVD mortality.

Abstract Currently, there is a significant demand for tier 3 weight management services, with individuals waiting between three and five years to access these services in parts of Wales. This rapid review aimed to identify and synthesise the evidence for the effectiveness of strategies for supporting the health and well-being of individuals with obesity on such waiting lists, with a focus on practical and resource-efficient interventions that can be implemented within current healthcare constraints.Seven studies were included, and these were published between 2017 and 2024. Studies were conducted in a range of countries, and no relevant UK based study was identified. Studies investigated exercise, physical activity counselling, education and text message-based prehabilitation interventions in people awaiting surgery.This review did not identify any studies assessing the effectiveness of interventions that could be feasibly implemented or scaled up within the resource limitations of typical tier 3 weight management services in Wales. Most studies required significant resource and input from healthcare professionals, and were delivered in-person at healthcare settings or remotely via teleconferencing. All studies assessed patients with obesity on a waiting list for surgery, but none included a patient population that matched those on waiting lists for tier 3 weight management services in Wales. None of the studies evaluated the cost-effectiveness of interventions.Overall, we are not confident in the evidence. Most studies were of low quality, with significant methodological and reporting limitations affecting the reliability of their findings. Although we have little confidence in the evidence, there is some evidence from four studies, that suggest exercise interventions may support the quality of life and anthropometric measures of people with obesity waiting for surgery. This evidence could be cautiously considered to inform interventions in practice, but those designing interventions should be mindful of the population and setting in which they are applied. Other interventions, including text message-based prehabilitation interventions, preoperative educational interventions and physical activity counselling interventions were reliant on findings from single low-quality studies. Some of these interventions showed improvements for participant’s quality of life, mental well-being and anthropometric measures.In relation to obesity weight management services, allocation of resources should allow for conducting and evaluating robust studies and economic evaluations investigating interventions for those awaiting obesity weight management services. Given the current healthcare resource constraints, it may be beneficial to consider the feasibility and scalability of interventions during their design.

Aims and ObjectivesThis study aimed to explore the impact of respiratory viral testing on the prevalence of invasive bacterial infections (IBI) in febrile infants up to ninety days of age. Infants in this age group are at high risk for bacteraemia and meningitis, collectively termed IBI, and tend to present with non-specific symptoms making risk assessment challenging. The study is novel in its focus on SARS-CoV-2, Influenza, and Respiratory Syncytial Virus (RSV) due to their availability as point-of-care tests (POC) and therefore their potential influence on the diagnostic pathway within the emergency care setting.Method and DesignThis secondary analysis used data from the Febrile Infant Diagnostic assessment and Outcome (FIDO) study, a prospective observational cohort study conducted across 35 sites in the UK and Ireland under the PERUKI network. Infants aged ≤90 days with a fever ≥38°C were included. The results of commercially available tests for SARS-CoV-2, Influenza, and RSV were compared against the presence of IBI, defined as a pathogen identified in blood or CSF by culture or molecular testing. Analysis was conducted with descriptive statistics (SPSS version 23).Results and ConclusionOf 1821 infants recruited to FIDO, 1395 underwent respiratory viral testing; 339 (24.3%) tested positive. Infants with a positive viral test had significantly lower IBI rates compared to those with a negative test (1.5% v 3.8%, p=0.034). In infants aged 29-90 days, those with a positive viral test had an IBI rate of 0.7% versus 3.2% for negative tests (p=0.015).These findings indicate that young febrile infants with a positive respiratory viral test for SARS-CoV-2, RSV or Influenza are at lower risk of IBI. Infants over 28 days of age with a positive test represent the lowest-risk cohort. Respiratory viral POC tests may therefore hold potential to streamline management by reducing painful procedures, decreasing admission rates or length of stay and enhancing antimicrobial stewardship.