Leicester General Hospital (LGH) is a National Health Service hospital located in the suburb of Evington, about three miles east of Leicester City Centre, and is a part of University Hospitals of Leicester NHS Trust. It has approximately 430 beds. The hospital is the largest employer in the area.
BACKGROUND:People exist at a combination of different individual and neighbourhood deprivations. Each of these combinations may have a unique impact on health. However, little is known about the intersectional inequality of these combinations on general and central obesity, including when considering their demographics. This study aims to answer these questions. METHODS:The sample comprised 452,339 participants from the UK Biobank study. Individuals were grouped into 320 intersectional strata according to their household income, neighbourhood deprivation, sex, ethnicity and age. Linear and logistic multilevel analysis of individual heterogeneity and discriminatory accuracy was used to establish the total, additive and interactive inequality of body mass index (BMI), fat mass index (FMI), and waist to height ratio (WHtR), as well as the associated obesity classifications. RESULTS:6.5%, 25.2% and 9.1% of the total variation in BMI, FMI and WHtR, respectively, was due to inequality between the strata. Of this, 26.5%, 3.5% and 22.0% is interactive. 79, 58 and 93 strata for BMI, FMI and WHtR demonstrate a significant interactive effect. We found some patterns; for example, affluent white women have an advantaged interactive effect, whilst deprived black women have a disadvantaged effect. Meanwhile men experience the inverse relationship. The relationship between individual and neighbourhood deprivation is not universally experienced by all strata. For example, black men living in areas of high deprivation have higher BMIs as their household income increases. CONCLUSIONS:A large proportion of variation in general and central obesity is due to intersectional inequality, with up to 26.5% being interactive. It is important that these intersectional effects are considered when designing policy interventions to avoid policy failure, such as by focussing on groups with high total and interactive risk.
Purpose Photography is used for triage, management and monitoring treatment in plastic surgery. However, in regards to soft tissue trauma, there are no current standards or guidelines, therefore the aims of this study were to: identify/establish key benchmark criteria for clinical photography in soft-tissue trauma, and investigate if recommendations improve the quality of images received. Methods Categories influencing photograph quality (certainty of imaged anatomy, clarity of background/foreground, image framing, orientation, correct angles, resolution, colour grading and lighting) were extracted from a Delphi questionnaire and used as the basis for recommendations. 60 sets of photographs before and after recommendations were assessed by blinded clinicians and scored 1(lowest)-to-5(highest) against the aforementioned categories, each clinician reviewed 20 sets of photographs, selected randomly. Average scores for each domain were compared using Student’s T-test and correlations with Spearman’s Rank correlation and regression modelling. Results ANOVA testing of the importance of each category of photography quality showed no significant difference (p>0.05) between seniority of clinicians. Significant increase in mean overall score of photograph quality was found following implementation of guidelines (3.58 to 4.17, mean increase= 0.583±0.144, p<0.001). Spearman’s rho assessing overall quality with individual quality categories was either significantly fairly (0.5>ρ≥0.2) or moderately (0.7>ρ≥0.5) positively correlative (p<0.05) across all domains both pre- and post-guidelines. Regression modelling identified overall photograph score correlated strongest when angles, resolution, and anatomy were combined, with R= 0.842 and R= 0.802 in pre- and post-recommendation cohorts respectively. Conclusions Recommendations lead to recordable improvement in photographs overall quality, future studies should assess impact of photograph quality on clinical decision making.
Abstract Background and aims The EPITOME study (NCT06055725) evaluates how many stroke survivors with paresis develop post-stroke spasticity (PSS) that may benefit from medication within one-year. The study uses the 13-item Post-Stroke Spasticity Monitoring Questionnaire (PSMQ) for remote monitoring. This prespecified interim analysis measured predictiveness of PSMQ for spasticity detection. Methods Participants (18-85y) were recruited ≤4 weeks after first-ever stroke with paresis ≤2 weeks and completed the PSMQ at defined intervals. Participants whose PSMQ indicates possible spasticity (score ≥2) undergo a confirmatory assessment but continue monitoring if PSS is not clinically confirmed. For this analysis of the first 151 participants to reach month 3, all attended a clinic visit regardless of PSMQ score. Receiver operating characteristic (ROC) curve analyses evaluated which PSMQ items were most predictive of spasticity. Results PSMQ total scores remained low [median 0-1] throughout the first three months of follow-up. Overall 65.6% (99/151) had a PSMQ score of ≥2, and 45.7% (69/151) had confirmed PSS. The sensitivity of the PSMQ was 81% but specificity was 48%. ROCAUCanalysis revealed item predictiveness: Q1(stiffness/tightness) and Q2(difficulty bending/flexing limb): 0.66; Q6(symptoms >1 month): 0.61. Other items had an ROCAUC of ≤0.60. Simplifying the PMSQ to Q1 and Q2 retained tool predictiveness (ROCAUC of 0.69 with items 1+2 vs 0.66 with PSMQ-total score) while reducing the burden of questionnaire completion. Conclusions 45.7% of stroke survivors with paresis developed PSS within 3 months. A simplified tool using PMSQ Q1+Q2 will be used in the study to improve monitoring while reducing patient burden. Conflict of interest Richard D. Zorowitz, Laura Serrano Barrenechea, Simon Butet, David Hernández Herrero, Rama Prasad, and Alessandro Picelli are investigators for the EPITOME study, sponsored by Ipsen. Pascal Lecomte and Sophie Vandenbremt act as patient and caregiver advisors for Ipsen. Mathieu Beneteau, Pascal Maisonobe, and Simon Page are employed by Ipsen. Figure 1 - belongs to Results
Introduction The global prevalence of type 2 diabetes (T2D) is rising and disproportionately affects South Asian adults, including those in the United Kingdom. South Asians develop T2D at a higher rate and at a younger age than their white British counterparts, at a lower body mass index. Active efforts to reduce adiposity can improve glycaemic control and in some cases achieve T2D remission. However, a substantial proportion of lean mass is lost while achieving weight loss, which may have physiological and metabolic consequences, affecting long-term health outcomes and quality of life for people living with T2D and obesity. We are examining the impact of a combined low energy diet and supervised exercise intervention versus a low energy diet alone for the preservation of lean mass in an understudied South Asian population living with T2D and excess adiposity.Methods and analysis This prospective, randomised, two-arm parallel-group, open-label, blinded-endpoint trial is being conducted in Leicester, UK. 36 South Asian adults aged 40–65 years within 10 years of T2D diagnosis and not on insulin therapy will be enrolled. Both intervention arms will receive an 800–900 kcal/day low energy diet for 12 weeks. Those randomised to the exercise group will additionally receive a mixture of supervised and home-based resistance and aerobic exercise training three times per week. The primary outcome is the difference in the change of lean mass between groups measured using dual-energy X-ray absorptiometry at baseline and 12 weeks and will be analysed using linear regression modelling.Ethics and dissemination The trial was approved by the NHS research ethics service (23/WM/0201). All participants will provide informed consent prior to enrolment, and the study will be conducted in accordance with the Declaration of Helsinki. Findings will be shared widely (publications, presentations, press releases, social media platforms) and will inform an effectiveness trial.Trial registration number ISRCTN11175684.
Background: Type 2 diabetes (T2D) increases cardiovascular disease (CVD) risk and predisposes individuals to heart failure with preserved ejection fraction. Metabolic dysfunction-associated steatotic liver disease (MASLD), prevalent in T2D, may worsen cardiac remodelling and haemodynamics. This secondary analysis of the DIASTOLIC trial examined the relationship of liver fat to cardiac remodelling in T2D at baseline and after a 12-week intervention or standard care. Methods: Adults with obesity and T2D and matched controls underwent hepatic MRI, cardiac MRI, echocardiography, and adipokine profiling as part of the DIASTOLIC study (NCT02590822). Participants with T2D were randomised to supervised exercise, a low-calorie meal-replacement plan (MRP), or routine care for 12 weeks. A baseline case–control and then pre- and post-analyses in those with T2D were performed. Associations between changes in liver fat and cardiovascular measures were assessed using correlation and adjusted generalised linear models. Results: At baseline, 81 T2D and 35 healthy controls were compared, and 76 subjects with T2D completed the trial. Participants with T2D had ~4× higher hepatic fat and adverse haemodynamics. The MRP arm achieved the greatest reductions in BMI, blood pressure, dysglycaemia, insulin resistance, and hepatic fat (−8.9%), with favourable adipokine changes. Overall, hepatic fat loss was associated with reductions in cardiac index and stroke volume and with additional reductions in end-diastolic volume in the MRP arm, independent of BMI. Conclusions: In T2D, hepatic fat is strongly linked to pathological haemodynamic profiles. Intensive caloric restriction achieves substantial hepatic fat loss and normalisation of hyperdynamic cardiovascular physiology independent of weight loss, identifying hepatic steatosis as a potential therapeutic target for early cardiovascular risk reduction.
