London Borough Of Lewisham

Social deprivation and cardiovascular disease occur in overlapping cohorts of patients. Ameliorating the burden of social deprivation may improve both adherence to treatment for cardiovascular disorders and outcomes, but this hypothesis has yet to be proven. The aim of this work is to develop a screening pathway to identify and then provide targeted intervention for patients with concurrent social deprivation and cardiovascular disease at a specialist care public hospital in London, United Kingdom. The primary outcome of this work is to create a social prescribing pathway. A 3- phase approach was taken. The first phase assessed the level of deprivation in a cohort of patients using a digital screening tool. The second phase assessed the feasibility of introducing a digital screening tool with limited support, while also assessing the validity of the tool itself. The third phase built on learning from phase I and II to co-produce a pathway to accurately screen patients and address common needs, and evaluate the effectiveness and impact of social intervention in this group. In phase I, we screened 360 patients on a digital pathway using a screening tool. The questionnaire was circulated to 360 patients of whom 168 (46%) responded. We found that 61/168 (36%) “always”, “often” or “sometimes” had difficulty making ends meet. We used this phase to evaluate the baseline level of deprivation in a population of cardiovascular patients in our area. In phase II, screening was deployed in the setting of a cardiology clinic where adoption of the digital tool was not supported with face-to-face onboarding, the level of digital exclusion became more relevant. Evaluation of the process revealed only 69/150 (46%) patients were able to register for the digital service, but fewer 38/150 (25%) responded to the screening questionnaire. Amongst that group, 16/38 (42%) flagged for a self-reported level of deprivation, the majority of which related to financial instability. No attempt was made to improve uptake of the digital tool in the first and second phases, as the goal of the early work was to determine its effectiveness as a non-supported tool. The final phase of this work, where a patient focus group was provided with this data and asked for feedback, provided a process evaluation of the methods used in the first few phases. We present learning from phased introduction of a screening questionnaire for deprivation in a specialist care hospital. Digital tools exclude some patients so future pathways must employ a multimodality approach to improve engagement. Patients with lived experience reinforced the value of identifying these issues and encouraged sensitivity to barriers to access. Management of expectations is important when providing a new service.

This study considers the rating of the airborne sound insulation of oors which separate dwellings in terms of sound reduction index R and level difference D.

To develop a position statement which identifies research priorities to address health inequalities in diabetes and provides recommendations to researchers and research funders on how best to conduct research in these areas. A two-day research workshop was conducted bringing together research experts in diabetes, research experts in health inequalities, healthcare professionals and people living with diabetes. The following key areas were identified as needing increased focus: How can we improve patient and public involvement and engagement to make diabetes research more inclusive of and relevant to diverse communities? How can we improve research design so that the people who could benefit most are represented? How can we use theories from implementation science to facilitate the uptake of research findings into routine practice to reach the populations with highest need? How can we collate and evaluate local innovation projects and disseminate best practice around tackling health inequalities in diabetes? How can we best collect and use data to address health inequalities in diabetes, including the harnessing of real-world and routinely collected data? How could research funders allocate funds to best address health inequalities in diabetes? How do we ensure the research community is representative of the general population? This position statement outlines recommendations to address the urgent need to tackle health inequalities in diabetes through research and calls on the diabetes research community to act upon these recommendations to ensure future research works to eliminate unfair and avoidable disparities in health.

With the advent of technology, Artificial Intelligence is emerging exponentially. Using this advancement, chatbots are widely used in various sectors to accommodate users with their queries without waiting. In this study, work in the development, training, improvement, and chat sentiment analysis of Skillbot Chatbot is performed. First, the data was scrapped using tools like the GPT2 model from the Gov. UK website, and that data was used to train intents for the Skill bot model. After successful training, testing, and evaluation of Skillbot for better performance, conversations of users were analyzed deeply. Sentiment analysis was also performed as it is important to train the Skillbot to efficiently respond to users. Then, this project was deployed on Streamlit named Conversation Analyzer. Analysis was performed using different technologies like Natural Languages processing, Vader model for sentiment analysis, TextBlob for topic modeling of conversations, Streamlit for visualization, Rasa, Artificial Intelligence, and machine learning. Chatbot training with cleaned data and conversation analysis would be very beneficial for Skillbot to give users better services. The findings with massive data wrangling, model training for Skillbot, and chat analysis would provide results' evaluations with successful and unsuccessful dialogues with insights to help warrant future research and Skillbot improvement.

Background:Childhood obesity is a growing global health concern, with far-reaching implications on health in childhood and in later life. Early intervention strategies are key to reducing childhood obesity. This study aims to evaluate the implementation of an Early Years Nutrition programme in the London Borough of Newham’s children’s centres.Methods:A service evaluation of the Early Years Nutrition programme was conducted at children’s centres within the borough. Information was collected on the sessions provided to parents by staff, breastfeeding promotion and nutritional topics the centres were displaying. Nutritional activities in each centre were assessed for compliance with the National Institute for Health and Care Excellence (NICE) guidelines.Results: Eight out of eleven (72.7%) centres participated. Parent sessions focused mostly on oral health (n=4/8, 50.0%). Display board topics most commonly related to generic health and wellbeing (n=4/8, 50.0%). All centres displayed the UNICEF breastfeeding logo and complied with the NICE guidelines for nutritional activities.Conclusions:The programme is consistent with NICE guidelines in the centres evaluated; however, further acquisition of data on obesity-associated factors specific to communities and preventive measures for reducing childhood obesity, such as increased parental and community engagement, promotion of breastfeeding and improved staff training, will help tailor similar programmes elsewhere with higher social and cultural acceptance.

BackgroundHigh rates of preterm births remain a UK public health concern. Preterm birth is a major determinant of adverse infant and longer-term outcomes, including survival, quality of life, psychosocial effects on the family and health care costs. We aim to test whether a model of care combining continuity of midwife care with rapid referral to a specialist obstetric clinic throughout pregnancy, intrapartum and the postpartum period is feasible and improves experience and outcomes for women at increased risk of preterm birth.MethodsThis pilot, hybrid, type 2 randomised controlled implementation trial will recruit 350 pregnant women at increased risk of preterm birth to a midwifery continuity of care intervention or standard care. The intervention will be provided from recruitment (antenatal), labour, birth and the postnatal period, in hospital and community settings and in collaboration with specialist obstetric clinic care, when required. Standard care will be the current maternity care provision by NHS midwives and obstetricians at the study site. Participants will be followed up until 6–8 weeks postpartum. The composite primary outcome is the appropriate initiation of any specified interventions related to the prevention and/or management of preterm labour and birth. Secondary outcomes are related to: recruitment and attrition rates; implementation; acceptability to women, health care professionals and stakeholders; health in pregnancy and other complications; intrapartum outcomes; maternal and neonatal postnatal outcomes; psycho-social health; quality of care; women’s experiences and health economic analysis. The trial has 80% power to detect a 15% increase in the rate of appropriate interventions (40 to 55%). The analysis will be by ‘intention to treat’ analysis.DiscussionLittle is known about the underlying reasons why and how models of midwifery continuity of care are associated with fewer preterm births, better maternal and infant outcomes and more positive experiences; nor how these models of care can be implemented successfully in the health services. This will be the first study to provide direct evidence regarding the effectiveness, implementation and evaluation of a midwifery continuity of care model and rapid access to specialist obstetric services for women at increased risk of preterm birth.Trial registrationISRCTN37733900. Retrospectively registered on 21 August 2017.

older women are at high risk of presenting with breast cancer when it has reached a late stage, which may be partly because of poor breast cancer awareness. the aim of this project was to implement and evaluate a new way of delivering the Promoting Early Presentation (PEP) Intervention during flu vaccination appointments in primary care. The PEP Intervention is a 1-minute intervention, accompanied by a booklet and delivered by primary care health professionals to provide older women with the knowledge, confidence and skills to present promptly on discovering symptoms of breast cancer. health professionals delivered the PEP Intervention to older women at six general practices in south London. The authors measured changes in breast cancer awareness after the intervention and interviewed practice staff about their experiences of using it. knowledge of breast symptoms and breast checking was greater in women aged 70 years and above after the implementation than before. Health professionals' found it acceptable and feasible to implement. this intervention is a novel way of increasing breast cancer awareness in older women, which could contribute to earlier presentation and diagnosis of breast cancer in the UK.

BACKGROUND Sufficient sample size and minimal sample bias are core requirements in empirical data analyses. Combining opportunistic recruitment with an online survey and data collection platform yields new benefits compared to traditional recruitment approaches. OBJECTIVE The objective of this paper is to report on the success of different recruitment methods to obtain participants’ characteristics, participation behavior, recruitment rates, and representativeness of the sample. METHODS A longitudinal online survey was implemented as part of the European PASTA project, which was online between November 2014 and December 2016. During this period participants in seven European cities were recruited on a rolling basis. For all cities to reach a sufficient number of adult participants a standardized guide on recruitment strategy was developed. In order to make use of the strengths and to minimize weakness a combination of different opportunistic recruitment methods was applied. In addition, the city of Oerebro applied random sampling approach. In order to reduce attrition rate and improve real-time monitoring the online platform featured a participant and a researchers` user interface and dashboard. RESULTS A total of 10,691 participants were recruited. Most people found out about the survey through their workplace or employer (21.5 %), outreach promotion (20.8 %), and social media (17.4 %). The average number of questionnaires filled-in per participant varied between the cities, with the highest number in Zurich (11.0 ± 0.33) and the lowest in Oerebro (4.8 ± 0.17). Collaboration with local organizations, the use of Facebook and mailing lists, and direct street recruitment were the most effective approaches in reaching a high share of participants (p = <.001). Under consideration of invested working hours Facebook (p = <.001) was one of the most time-efficient methods. Compared to the cities census data, the composition of study participants was broadly representative in terms of gender distribution, however included younger and better educated participants. CONCLUSIONS We observed that offering a mixed recruitment approach was very effective in achieving a high participation rate. The highest attrition rate and the lowest average number of questionnaires filled-in per participant were observed in Oerebro, who also recruited participants through random sampling. The findings suggest that people that are more interested in the topic are more willing to participate and to stay in a survey than those who are selected randomly and may not have a strong connection to the research topic. Whereas direct face-to-face contacts were very effective with respect to the number of recruited participants; recruiting people through social media was not only effective, but also very time-efficient. The collected data is based on one of the largest recruited longitudinal samples with a common recruitment strategy in different European cities.

BackgroundUptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake.PurposeThe present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks.MethodsWe conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance.Results12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval −0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (−0.03 to 3.07%, p = .054).ConclusionsUptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.

A national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake. To evaluate the effectiveness of an enhanced invitation method using the question-behaviour effect (QBE), with or without the offer of a financial incentive to return the QBE questionnaire, at increasing the uptake of health checks. The research went on to evaluate the reasons for the low uptake of invitations and compare the case mix for invited and opportunistic health checks. Three-arm randomised trial and cohort study. All participants invited for a health check from 18 general practices. Individual participants were randomised. (1) Standard health check invitation only; (2) QBE questionnaire followed by a standard invitation; and (3) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by a standard invitation. The primary outcome was completion of the health check within 6 months of invitation. A p-value of 0.0167 was used for significance. In the cohort study of all health checks completed during the study period, the case mix was compared for participants responding to invitations and those receiving 'opportunistic' health checks. Participants were not aware that several types of invitation were in use. The research team were blind to trial arm allocation at outcome data extraction. In total, 12,459 participants were included in the trial and health check uptake was evaluated for 12,052 participants for whom outcome data were collected. Health check uptake was as follows: standard invitation, 590 out of 4095 (14.41%); QBE questionnaire, 630 out of 3988 (15.80%); QBE questionnaire and financial incentive, 629 out of 3969 (15.85%). The increase in uptake associated with the QBE questionnaire was 1.43% [95% confidence interval (CI) -0.12% to 2.97%; p = 0.070] and the increase in uptake associated with the QBE questionnaire and offer of financial incentive was 1.52% (95% CI -0.03% to 3.07%; p = 0.054). The difference in uptake associated with the offer of an incentive to return the QBE questionnaire was -0.01% (95% CI -1.59% to 1.58%; p = 0.995). During the study period, 58% of health check cardiovascular risk assessments did not follow a trial invitation. People who received an 'opportunistic' health check had greater odds of a ≥ 10% CVD risk than those who received an invited health check (adjusted odds ratio 1.70, 95% CI 1.45 to 1.99; p < 0.001). Uptake of a health check following an invitation letter is low and is not increased through an enhanced invitation method using the QBE. The offer of a £5 incentive did not increase the rate of return of the QBE questionnaire. A high proportion of all health checks are performed opportunistically and not in response to a standard invitation letter. Participants receiving opportunistic checks are at higher risk of CVD than those responding to standard invitations. Future research should aim to increase the accessibility of preventative medical interventions to increase uptake. Research should also explore the wider use of electronic health records in delivering efficient trials. Current Controlled Trials ISRCTN42856343. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 84. See the NIHR Journals Library website for further project information.