BACKGROUND:The protection provided by the inactivated influenza vaccine (IIV) in adults can wane during a single influenza season. We aimed to assess temporal changes in haemagglutinin inhibition assay (HAI) titres and vaccine effectiveness in healthy adults after IIV. METHODS:In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Cochrane CENTRAL and screened citations for studies published from database inception to July 6, 2022. We included studies that reported two or more vaccine effectiveness or HAI estimates in healthy adults (aged 18-65 years) after a single standard dose IIV with at least one effect estimate being 2 months after vaccination or longer. Unpublished studies, studies not published in English, cross-sectional studies, case reports, and modelling studies that did not report original data were excluded. We applied random-effects meta-analysis and metaregression to aggregate mean differences in log2 HAI geometric mean titres (GMT) and odds ratio (OR) for influenza infection over time with inverse-variance weighting. We completed quality assessments using Joanna Briggs Institute critical appraisal checklists, assessed between-study variation using τ2, and assessed publication bias using funnel plots. This study is registered with PROSPERO (CRD42021233774). FINDINGS:Of 1387 records identified, we included 35 studies in the systematic review, of which 23 studies reported vaccine-effectiveness estimates, 11 studies reported HAI titres, and one study reported both. HAI titres were significantly higher 5-7 months after IIV than before vaccination (influenza A/H1: log2 GMT 1·57 [95% CI 1·06-2·09], τ2=0·70; influenza A/H3: 1·16 [0·70-1·62], τ2=0·46; influenza B: 0·78 [0·08-1·49], τ2=0·41). Three studies reported titres 11-13 months after vaccination with no significant difference compared with pre-vaccination titres for influenza A/H1, A/H3, and B. For influenza A/H1, the odds of influenza infection favoured vaccination more than 5 months after IIV (aOR 0·66 [95% CI 0·51-0·87], τ2=not calculable), whereas vaccination made no significant difference on influenza A/H3 or influenza B infection more than 5 months after vaccination (influenza A/H3: 0·96 [0·78-1·18], τ2=not calculable; influenza B: 0·75 [0·49-1·16], τ2=0·10). An assessment of publication bias was restricted due to the small number of studies included in each analysis; when there were sufficient studies, no publication bias was observed through visual inspection of the funnel plots. INTERPRETATION:IIV-induced HAI titres in healthy adults aged 18-65 years persisted 5-7 months after vaccination, but might not be significantly sustained at 11-13 months. For influenza A/H3 and influenza B, there was a significant decline in vaccine effectiveness beyond 5 months after vaccination. Evaluating the temporal changes in vaccine effectiveness remains challenging due to methodological biases; a greater understanding is needed to optimise vaccine design and timing to maximise effectiveness throughout the influenza season. FUNDING:None.

BACKGROUND:Migrants' participation in health research is essential to give voice to their needs and inform evidence-based practice. We conducted a mixed-methods study with migrants living in Leicester, United Kingdom, to understand their perceptions of participation in health research and factors influencing participation. METHODS:Our study included a questionnaire and focus groups with migrants. Interviews and focus groups were also conducted with key informants. The study was carried out at two sites in Leicester. Questionnaire data were analysed descriptively in R. The COM-B framework was used to thematically analyse interview and focus group transcripts. Workshops with public members of migrant origin helped with data interpretation and analysis. RESULTS:119 questionnaires and 4 focus groups (n = 28) were completed with migrants. Seven interviews and one focus group (n = 7) were conducted with key informants. Questionnaire respondents originated from 34 different countries, with a significant proportion (25%) identifying themselves as asylum seekers/refugees. Migrants in the focus groups were from 16 different countries and were mainly asylum seekers/refugees (n = 18). The three components of the COM-B model (Capability, Opportunity and Motivation) were identified as the main themes, and descriptive statistics from the questionnaire data have been used to supplement the 16 sub-themes. Individual capabilities encompassing awareness and perception of research, language abilities and skills in the use of technology significantly influenced participation. Simultaneously, the presence or absence of opportunities such as costs, competing needs and priorities, healthcare access and experiences in the United Kingdom, language barriers, opportunities for learning and taking part, precarious living conditions and socio-cultural norms and perceptions about health were found to be important for research participation. Motivations to take part in research included trust, context of the research, need-based research, altruism, desire to be heard and receiving incentives. CONCLUSION:Our study contributes to the limited evidence base exploring migrants' participation in health research. Our findings, grounded in the COM-B model, exhibit how migrants' motivations, influenced by a host of individual capabilities and environmental and social opportunities, can influence motivation and impact research participation behaviour. These findings may support the design of accessible, inclusive, equitable and impactful health research involving underserved groups. PATIENT OR PUBLIC CONTRIBUTION:Patient and Public Involvement and Engagement (PPIE) in the project was obtained through the EMBRACE (East Midlands Migrant Research Advisory Collaborative) group, which was created as a migrant specific advisory group in 2019. We recruited new migrant members into the group and involved them in the interpretation of the study results. We organised two workshops with the group, and in the first workshop, held in February 2024, nine members took part to review the preliminary results and offer insights in contextualising and interpreting the data. The research team took into consideration the feedback received at the workshop and integrated it into the analysis. The final analysis was presented to the group again in September 2024, and the discussions held at that workshop were instrumental in shaping this manuscript.

Objectives To understand the opportunities and practices that can support responsive healthcare for forced migrant communities.Design A qualitative study of five transnational case examples of services actively working to improve access and experiences of care for forced migrant communities, which is one strand of the MORRA Study.Setting Five services (Australia, Belgium, UK) providing a range of care (primary care, health advocacy, education and support, holistic health screening, care planning/coordination, transcultural mental healthcare). Delivered through state and not-for-profit structures in initial and contingency accommodation sites, health clinics and community spaces. Data collection took place between July and October 2022.Participants 47 participants including forced migrants using or having used one of the five services, service leads, clinical and non-clinical workers (paid and volunteer), interpreters and service partners. Services supported recruitment of a crude representative sample of worker roles and service users/clients. Participants were required to speak one of nine languages for which we had translated study materials.Main outcome measures Experiences, practices, knowledges, skills and attributes of workers; experiences of forced migrants engaging in services.Results Services showed a willingness to innovate and work outside existing practice and organisational structures, including a ‘microflexibility’ in their interactions with patients, and through the creation of safe spaces that encouraged trust in providers. Other positive behaviours included engaging in intercultural exchange; facilitating the connection of people with their cultural sphere (eg, nationality, language) and a reflexive attitude to the individual and their broader circumstances. Social and political structures can diminish these efforts.Conclusions Environments that enable good health and support forced migrants to live lives of meaning are vital components of responsive care. This requires flexibility and reflexivity in practice, intercultural exchange, humility, and a commitment to communication. A broader range of caring practitioners can, and should, through intentional and interconnected communities of care, contribute to the healthcare of forced migrants. Opening up healthcare systems to include other state actors such as teachers and settlement workers and a range of non-state actors that should include community leaders and peers and private players is a key step in this process. Future work should focus on the health and health service implications of immigration practices; the inclusion of peers in a range of healthcare roles; alliance-building across unlikely collaborators and the embedding of intercultural exchange in practice.

[This corrects the article DOI: 10.1016/j.lanepe.2021.100299.].

INTRODUCTION:Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in the United Kingdom, placing significant pressure on the National Health Service (NHS). Despite the growing popularity of Ayurveda for managing NCDs, little is known about its use among people with these conditions in the United Kingdom. This study explored the experiences and perspectives of people with NCDs who use Ayurveda to manage their conditions in the United Kingdom. METHODS:Twenty qualitative semi-structured interviews were conducted with UK-based adults with NCDs. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. FINDINGS:Three key themes were identified. First, participants chose Ayurveda due to its alignment with personal values like natural, holistic healing and dissatisfaction with Western medicine, particularly side effects and impersonal care. Second, they reported positive experiences with Ayurvedic treatment, including personalised consultations, diverse treatment options and improved health outcomes. Third, participants highlighted challenges in sustaining Ayurvedic care, such as concerns over product safety, difficulty following complex regimens, limited medicine availability and financial barriers-especially since treatments are not covered by the NHS. CONCLUSION:People living with NCDs described Ayurveda as a more natural and philosophically congruent healing system, reflecting their cultural and personal perspectives. Despite structural and financial challenges, they considered it a relevant option for managing their conditions. These findings suggest that Ayurveda continues to hold significance as a complementary approach to NCD management in the United Kingdom.

Inappropriate antibiotic use is one of the main reasons for antibiotic resistance (AMR) worldwide. Rates of AMR are steadily rising, including in the United Kingdom (UK), although figures show differences in the burden of AMR experienced by different racial and ethnic groups. We aimed to 1) ascertain what factors contribute to behaviours around antibiotic use among ethnic minority groups in the UK and 2) propose areas for future research and intervention to reduce AMR-related health inequalities in different ethnic groups. This qualitative study comprised four focus groups with people living in Leicester, UK. Participants were aged ≥18 years, belonged to an ethnic minority group (i.e. any group except White British) with no restrictions on migration status. We followed a thematic framework analysis, guided by the Modified Health Belief model (HBM) for public antibiotic use to analyse the transcripts. We recruited 28 participants (females=24), aged 19-75 years (median, 41), from 13 different countries. Most identified as Asian/Asian British (n = 12) and White-European (n = 9). Antibiotic use in different ethnic minority groups results from the complex interplay of factors, such as age (younger generations less likely to rely on antibiotics), education and income, knowledge of antibiotic use and AMR, perceived severity of the illness, perceptions around benefits of antibiotics, risk appraisal, access to antibiotics, prescription behaviour of doctors, influence of social norms and policies, access to health services and awareness campaigns. Our study highlights the complexity of factors at play, at an individual, interpersonal and societal level around antibiotic (mis)use. While this presents a picture of antibiotic use from a patient/consumer perspective, more work is needed to understand the possible influence of ethnicity (and other demographic variables) in prescribing behaviour of professionals. Future interventions may include culturally-sensitive, co-produced campaigns to raise awareness of AMR and disseminate these through various media.

Objectives To assess the prevalence of UK healthcare workers (HCWs) who reported symptoms of COVID-19 lasting for longer than 5 weeks and examine associated factors with experiencing long COVID in an ethnically diverse cohort.Design A cross-sectional study using data from the UK Research study into Ethnicity And COVID-19 Outcomes in HCWs cohort study.Setting Data were collected electronically between December 2020 and March 2021.Participants Individuals aged 16 years or older, residing in the UK, and working as HCWs or ancillary workers in a healthcare setting and/or registered with one of the seven major UK healthcare professional regulators.Primary and secondary outcome measures The main outcome was long COVID (symptoms>5 weeks). The primary exposure of interest was self-reported ethnicity. We employed univariable and multivariable logistic regression to identify associations. We adjusted for demographic information, health status and existing long-term conditions in our multivariate analysis.Results In our analysis of 11 513 HCWs, we found that 2331 (20.25%) reported COVID-19, of whom 525 (22.52%) experienced long COVID. There were no significant differences in risk of long COVID by ethnic group. In terms of other demographic characteristics, the majority of those experiencing long COVID were female (80.0%) and were slightly older than those who did not experience long COVID (median age 46 (IQR 36–54)). In multivariable analyses of those who reported having had COVID-19, HCWs in nursing/midwifery roles (adjusted OR (aOR) 1.76, 95% CI 1.26 to 2.46; p=0.001) and allied health professions (aOR 1.42, 95% CI 1.05 to 1.93; p=0.023) had higher odds of experiencing long COVID compared with those in medical roles. Other factors significantly associated with long COVID included self-reported psychological conditions (eg, depression and anxiety) and respiratory conditions (eg, asthma).Conclusions In this large ethnically diverse cohort study, more than one in five UK HCWs reported experiencing long COVID after acute COVID-19 during the first year of the pandemic. We found that specific demographic (older age and female gender) and occupational factors (nursing/midwifery and allied health professions) were associated with higher odds of long COVID. Notably, there were no significant differences in the risk of long COVID by ethnic group. Further research and collaborative efforts are urgently needed to address these factors effectively, develop targeted interventions and understand the temporal and longitudinal dynamics of the condition.

Little is known about multiple long-term conditions (MLTCs) patterns in migrants. To aimed to synthesise evidence on the burden of MLTCs among migrant populations in high-income countries. We searched five databases for studies reporting the prevalence of two or more health conditions among migrants in high-income countries between 2012 and 2024. The identified conditions were grouped into three categories: communicable, non-communicable-physical, and mental health. We explored the most commonly reported combined patterns of MLTCs (clusters) and summarised the findings using narrative synthesis and forest plots. We included 165 studies reporting co-prevalence of two or more conditions in 3,491,883 migrants. The migrants were from a wide range of countries, but most studies were conducted in 22 countries mostly in Europe (97/165, 58.8%) and North America (53/165, 32.1%). 61.2% (101/165) reported on communicable-related clusters, 44.8% (74/165) on non-communicable-physical conditions clusters, and 33.3% (55/165) on mental health clusters. The most common clusters were communicable conditions: HIV-tuberculosis (TB) (32/101, 32%) and HIV-viral hepatitis (29/101, 29%). Highest in the non-communicable-physical cluster were diabetes-TB (10/74, 14%) and diabetes-hypertension (8/74, 11%). Mental health conditions were not often reported alongside non-communicable or communicable conditions, and common clusters were depression-PTSD (18/55, 32%) and depression-anxiety (17/55, 31%). Narrative review showed that migrant status, poor living conditions, time to diagnosis, and length of stay in the resident country were significant risk factors for developing and managing several conditions. Migrants experience a significant burden of MLTCs, particularly a high burden of long-term communicable diseases. Mental health disorders appeared to be under-investigated in the context of other health needs. Interventions to address MLTCs in migrants must consider communicable diseases and mental health needs in addition to non-communicable diseases and integrate a holistic approach acknowledging the structural, systemic, and social determinants of health driving comorbid health needs.

BACKGROUND:Healthcare workers (HCWs) have been particularly impacted by long COVID, with negative effects on their work patterns and wellbeing. The aim of this study was to explore the intersection between work and long COVID for HCWs, to understand the impact of long COVID on their professional identify, their orientation to work, their wellbeing as professionals, and support needs and strategies for them as well as their managers to continue to work. METHODS:This qualitative study was conducted through semi-structured online interviews with three groups: HCWs with long COVID, their support network members, and healthcare managers between March 2023 and May 2024. To maintain confidentiality and address concerns about workplace stigma, healthcare managers were not matched with specific HCWs. Participants were recruited through purposive and snowball sampling, until data saturation was reached, defined as the point at which no new insights or themes were identified. Data were analysed using reflexive thematic analysis. RESULTS:A total of 42 participants were interviewed from three groups, comprising 24 HCWs, five support network members, and 13 healthcare managers. Four key themes were identified describing experiences of long COVID for HCWs: (1) Living and coping with long COVID as a HCW, (2) Workplace impact and adjustments, (3) The uncertain nature of long COVID and challenges of the definition, and (4) Feelings of guilt, stigma and blame. CONCLUSION:In conclusion, long COVID has created significant challenges not only for HCWs but also for their managers, who struggled with staffing shortages and lack of clear guidance, and support network members who experienced emotional strain while providing care. The combination of these challenges threatens NHS workforce stability and service delivery. Developing and embedding flexible, standardised workplace interventions-such as phased return-to-work policies and tailored occupational health support-could mitigate these impacts and inform scalable solutions across diverse healthcare systems. Enhanced training for healthcare managers and further research into culturally diverse coping mechanisms could improve support for affected HCWs, reduce stigma, and contribute to a more stable and resilient healthcare workforce. While based in the UK, these findings offer important insights for health systems globally that are grappling with the long-term workforce implications of long COVID.

Background:Bacterial antimicrobial resistance (AMR) is a leading cause of death globally. However, there has been no data synthesis on whether it influences mortality within hospital settings. We conducted a systematic review and meta-analysis to quantify the prevalence and risk of mortality associated in hospitalised patients with AMR, compared to patients with infections not classified as AMR. Methods:Databases (MEDLINE, EMBASE, and Cochrane library) were searched from inception up to 14th April 2025 for studies that reported the prevalence of AMR in patients who acquired infections in hospitals and mortality (PROSPERO CRD42023420609). We calculated pooled prevalence estimates of AMR as well as unadjusted and adjusted estimates of the effect of AMR on mortality using a random-effects model. Study quality was assessed using the Joanna Briggs Quality Appraisal Tool, risk of bias using DOI plots and LFK index and certainty of evidence of mortality using GRADE criteria. Findings:We identified 34 studies (20,658 patients with resistant organisms) from 18 countries-namely the USA, China, the UK, Canada, Israel, Japan, Malaysia, Korea, Brazil, and Singapore. Of these, 33 were observational studies whilst two studies (one observational study and one purely modelling study) mechanistically modelled risk of mortality in relation to transmission. No studies were conducted in the African subcontinent, the Middle-East, Russia, and India. The prevalence of AMR was high in patients in hospital (pooled prevalence: 36.5%, 95% CI: 29%-44%, I 2 = 99%) and associated with higher mortality (unadjusted pooled risk ratio [RR]: 1.64, 95% CI: 1.37-1.97, I 2 = 96.22%, τ2 = 0.20; adjusted pooled RR: 1.58, 95% CI: 1.33-1.87, I 2 = 85.9%, τ2 = 0.13) compared to non-AMR organisms.Sensitivity analyses showed particularly elevated risks for in-hospital mortality and for AMR-associated bacteraemia. Study quality was generally rated to be high, but there was evidence of publication bias in estimates of both prevalence and mortality. Overall certainty of evidence of mortality was graded to be low. Interpretation:AMR is highly prevalent within hospital settings globally and associated with increased in-hospital mortality. Crucially, no data was identified from the India subcontinent, African subcontinent, the Middle East, and Russia, and only two studies used mechanistic modelling to explore how transmission of AMR affects mortality. Further research is required, particularly in underrepresented regions to inform interventions aimed at reducing both AMR transmission and its related mortality within hospital settings. Funding:Pacific Life.

In recent years, migration to and within Europe has increased. Human mobility has been hypothesised as a contributing factor towards antimicrobial resistance (AMR). However, there is limited evidence to explain how migration contributes towards antibiotic resistance. More qualitative research regarding migrants’ perspectives of antibiotic use is needed to understand this complex interaction. The aim of this study was to explore experiences of antibiotic use and healthcare access among migrants in the UK, and how this might influence the risk of AMR. Adult migrants were purposively recruited through community organisations, collaborators, online platforms and snowball sampling representing different migrant statuses, countries of origin and ethnicities. Semi-structured interviews were conducted online, by phone or face-to-face, in participants’ preferred languages, between March and July 2022 exploring antibiotic use and healthcare access. Data were analysed thematically and the study was informed by a Project Advisory Committee, with members from Doctors of the World and professionals who were previously refugees or asylum seekers. Twenty-seven migrants (17 males and 10 females), aged 21–60, from 17 different countries were interviewed. Four main themes were generated: 1) Uncharted territory: navigating a new healthcare system (sub-themes (a) access to care during journey, (b) difficult access to healthcare in the UK and (c) comparison between different healthcare systems); 2) Preserving the sense of agency and decision-making around antibiotic use, 3) Self-perpetuating cycle (sub-themes - (a) co-infections; (b) using alarming symptoms or “red-flags” and (c) taking antibiotics due to previous similar symptoms or persisting symptoms), and 4) The fragile state of the patient-doctor relationship. These findings give useful insight into barriers faced by migrants when trying to access healthcare services both en route and after arriving in the UK, as well as their attitudes and behaviours in relation to antibiotics. Results also shed light on the complexity of factors contributing to health-seeking behaviour and antibiotic use, and how these may vary depending on previous experiences. We discuss implications for future research and practice, and how current policies may need to evolve to better support and reduce possible risk factors for AMR in migrant communities.

Background:Ayurveda, a traditional system of medicine, has gained recognition in the Organisation for Economic Cooperation and Development (OECD) countries as a complementary and alternative medicine for managing noncommunicable diseases (NCDs). Qualitative studies have been conducted in various OECD countries regarding the use of Ayurveda for NCD management. However, no qualitative systematic review has been conducted on this topic. Aim:This review aimed to synthesize the experiences, perceptions, and perspectives of patients with NCDs and Ayurvedic practitioners on the use of Ayurveda for NCD management in OECD countries. Methods:The JBI qualitative systematic review guidelines were followed. Several databases were searched to identify published and unpublished qualitative studies. Results:Of the 18,541 records identified, 9 studies met the eligibility criteria and were included in the review. Using the JBI checklist for qualitative research (10 criteria), the critical appraisal scores of the studies ranged from moderate to high quality. Patients turned to Ayurveda because of concerns about side effects and dissatisfaction with conventional Western treatments and were driven by the perceived gentleness and holistic qualities of Ayurveda. Complementing these patient insights, Ayurvedic practitioners emphasized that Ayurveda identifies and addresses the root causes of diseases rather than treating symptoms alone. Integration challenges, limited medication access, and regulatory constraints were identified as factors affecting Ayurveda's service delivery. Conclusions:Patients preferred Ayurveda because of its natural approach and fewer side effects, whereas Ayurvedic practitioners valued its holistic approach. However, its wider acceptance has been hampered by hurdles such as regulatory barriers and limited access to medicines. Strategies to overcome some of the barriers identified in this review as well as to promote the strengths discussed in this review may facilitate the effective use of Ayurveda to manage NCDs in OECD countries. Trial Registration: PROSPERO, Registration No. CRD42023397952.

Background:For those displaced across borders, significant adversity before, during and after displacement journeys, including attitudes and structures in countries of transit and arrival, contributes to considerable risk of poor physical and mental health, and poor and exclusionary experiences of health care. Objectives:We aimed to understand the opportunities and practices that can support better healthcare responses for forced migrants. Design:We integrated (1) local stakeholder perspectives, from workshops and dialogue; (2) evidence and knowledge from a mixed-methods systematic review; and (3) learning from five case examples from current international practice. Review methods and data sources:We ran database searches (American Psychological Association PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, National Institute for Health and Care Research Journals Library) in February 2022, searched relevant agency websites and conducted backward and forward citation searches, extracted data, assessed methodological quality and integrated qualitative and quantitative findings. Case examples:We studied three services in the UK, one in Belgium and one in Australia, conducting semistructured interviews with providers, collaborators and service users, and making site visits and observations if possible. Results:The review identified 108 studies. We identified six domains of impact: (1) benefit from and creation of community, including linkages with formal (health) services; (2) the formation of networks of care that included traditional and non-traditional providers; (3) proactive engagement, including conducting care in familiar spaces; (4) considered communication; (5) informed providers and enhanced attitudes; and (6) a right to knowledge (respecting the need of new arrivals for information, knowledge and confidence in local systems). The case examples drew attention to the benefits of a willingness to innovate and work outside existing structures, 'micro-flexibility' in interactions with patients, and the creation of safe spaces to encourage trust in providers. Other positive behaviours included engaging in intercultural exchange, facilitating the connection of people with their cultural sphere (e.g. nationality, language) and a reflexive attitude to the individual and their broader circumstances. Social and political structures can diminish these efforts. Limitations:Review: wide heterogeneity in study characteristics presented challenges in drawing clear associations from the data. Case examples: we engaged only a small numbers of service users and only with service users from some services. Conclusions:We found that environments that enable good health and enable people to live lives of meaning are vital. We found that these environments require flexibility and reflexivity in practice, intercultural exchange, humility and a commitment to communication. We suggest that a broader range of caring practitioners can, and should, through intentional and interconnected practice, contribute to the health care of forced migrants. Opening up healthcare systems to include other state actors (e.g. teachers and settlement workers) and a range of non-state actors, who should include community leaders and peers and private players, is a key step in this process. Future work:Future work should focus on the health and health service implications of immigration practices, the inclusion of peers in a range of healthcare roles, alliance-building across unlikely collaborators and the embedding of intercultural exchange in practice. Study registration:This study is registered as PROSPERO (CRD42021271464). Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132961) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 13. See the NIHR Funding and Awards website for further award information.

Background Redeployment was critical in addressing the increased demands of COVID-19 on the healthcare system. Previous research indicates that ethnic minority healthcare workers (HCWs), those on visas, and in junior roles, were more likely to be redeployed to COVID-19 duties compared to White UK-born HCWs. There is limited evidence on how redeployment was practically organized, preparedness of HCWs and the NHS for rapid changes, and the decision-making processes involved. This paper discusses HCWs’ redeployment experiences, their alignment with NHS policy for deploying staff safely, and potential links to staff attrition. Methods As part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes among Healthcare workers, we conducted a qualitative sub-study, between December 2020 and July 2021, consisting of interviews and focus groups with 164 HCWs from different ethnicities, genders, job roles, migration statuses, and UK regions. Sessions were conducted online or by telephone, recorded, transcribed and analysed with participants’ consent. We utilised the breadth-and-depth approach, initially identifying transcripts mentioning redeployment or changes in work patterns, followed by an in-depth thematic analysis. Results Of the 164 HCWs, 22 (13.4%) reported redeployment to a new role, while 42 (26.8%) reported changes in their working patterns. Redeployment experiences varied based on HCWs’ workplaces, skillsets, input into decisions, and perceived risks. Four themes were identified: 1. redeployment and the changing nature of work, 2. pandemic (un)preparedness, 3. redeployment decision-making, and 4. risk assessments in the context of redeployment. Our data revealed the practical realities of redeployment, including discrepancies between the NHS policy and actual practices, particularly early deployment without adequate training and supervision. The lack of planning and preparedness had an operational and emotional impact on HCWs, affecting their morale. Lastly, some HCWs felt disempowered and undervalued due to a lack of agency in redeployment decisions Conclusion This study highlights HCWs’ redeployment experiences during COVID-19, the conditions under which it occurred, and its impacts. The findings, although rooted in the pandemic, remain relevant for addressing staffing challenges in the healthcare workforce. We recommend future redeployment strategies prioritise HCWs' training and supervision, ensure strategic planning with clear communication and support for all staff, foster a sense of value among HCWs, and integrate an intersectional equity lens into workforce planning to improve staff retention and morale.

Objectives: Antimicrobial resistance (AMR) is a major global public health concern. Although low-income countries are disproportionately affected by AMR, certain underserved groups in high-income countries (HICs), such as migrants and ethnic minorities, disproportionately bear the burden of AMR. This may be driven by socio-cultural factors including differences in health literacy. This review aimed to investigate the level of antibiotic knowledge amongst different ethnic minority groups in HICs. Study design: This was a mixed-methods systematic literature review. Methods: We searched four databases (MEDLINE, EMBASE, the Cochrane library, CINAHL) to May 5, 2023, for primary studies on knowledge of antibiotics in different ethnic groups in HICs. We included studies in English using qualitative, quantitative and/or mixed-methods approaches and reporting on antibiotic knowledge by ethnicity. We used the convergent integrated approach for data synthesis and the Mixed-Methods Appraisal tool for quality assessment. Results: 3935 articles were screened and 24 studies (17 quantitative, 5 qualitative, and 2 mixed-methods) were included, comprising 52778 participants from 8 countries (USA, UK, Australia, New Zealand, Netherlands, Greece, Sweden, Germany). Overall, participants from ethnic minority groups were able to identify common names of antibiotics and were aware of risks of antibiotics and side effects. However, participants thought antibiotics would treat viral-type illnesses. Ethnic minority groups generally had lower levels of knowledge compared to ethnic majority groups. Conclusions: Although ethnic minority communities possessed good levels of knowledge on certain aspects of antibiotics (e.g. being able to identify names of antibiotics), there were gaps in other areas (e.g. misperception that antibiotics are used for viral infections). The lower level of knowledge in ethnic minority groups compared to majority groups may be a contributing factor to health inequalities, which calls for co-designed, culturally competent, educational interventions.

Objective: The burden of tuberculosis (TB) in migrant children and young people (CYP) is commonly overlooked, despite the increasing incidence of TB in migrant populations in the European region. This study aimed to examine the distribution and disease characteristics of TB among migrant and native-born CYP through analysis of data from the European Centre for Disease Prevention and Control (ECDC) surveillance system (TESSy). Study design: Retrospective database analysis. Methods: A retrospective database analysis was conducted on all CYP TB cases (0-17 years) reported to TESSy (1995-2017), exploring distribution, site of TB, and presence of MDR-TB using multivariate analysis in R statistical software. Results: Of the 73,176 CYP TB cases reported in the EU/EFTA (1995-2017), 24.4% (n = 17,879) occurred in migrant CYP and 75.6% (n = 55,297) occurred in native-born CYP. Migrant CYP were more likely (P < 0.001) to have pulmonary TB (OR: 1.90; 95% CI: 1.74-2.09) and unsuccessful treatment outcomes (OR: 2.05; 95% CI: 1.74-2.40) compared to native-born CYP. The proportion of extrapulmonary TB, compared to pulmonary TB across total CYP cases was higher than the existing evidence base. Conclusions: Overall, there were significant differences in the site of TB and treatment outcomes between migrant and native-born CYP. To improve outcomes, TB screening and detection practices should focus on facilitating care in migrant CYP. However, to better understand the implications of these findings on broader TB control, TB among CYP should be addressed more frequently in reports and research. (c) 2024 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

Background: The incidence of mental illness has risen since the coronavirus disease 2019 (COVID-19) pandemic. The number of healthcare workers (HCWs) needing mental health support has increased significantly.Objective: This secondary analysis of qualitative data explored the coping strategies of migrant HCWs living in the UK during the COVID-19 pandemic. Our aim was to identify the coping strategies used by migrant HCWs, and how they could be explored post-pandemic as support mechanisms of an increasingly diverse workforce.Method: As part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes among Healthcare workers (UK-REACH), we conducted in-depth semi-structured interviews and focus groups with clinical and non-clinical HCWs across the UK, on Microsoft Teams, from December 2020 to July 2021. We conducted a thematic analysis using Braun and Clarke’s framework to explore the lived experiences of HCWs born overseas and living in the UK during the COVID-19 pandemic. The key themes that emerged were described using Lazarus and Folkman’s transactional model of stress and coping.Results: The emerging themes include stressors (situation triggering stress), appraisal (situation acknowledged as a source of stress), emotion-focused coping (family and social support and religious beliefs), problem-focused coping (engaging in self-care, seeking and receiving professional support), and coping strategy outcomes. The participants described the short-term benefit of the coping strategies as a shift in focus from COVID-19, which reduced their anxiety and stress levels. However, the long-term impact is unknown.Conclusion: We found that some migrant HCWs struggled with their mental health and used various coping strategies during the pandemic. With an increasingly diverse healthcare workforce, it will be beneficial to explore how coping strategies (family and social support networks, religion, self-care, and professional support) could be used in the future and how occupational policies and infrastructure can be adapted to support these communities.

BACKGROUND:Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic.METHODS:We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts.RESULTS:Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'.DISCUSSION:Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.

Background Antimicrobial resistance (AMR) is a critical global health concern. A previous systematic review showed that migrants in Europe are at increased risk of AMR. Since the COVID-19 pandemic there have been rapid changes in patterns of antibiotic use, AMR, and migration. We aimed to present an updated evidence synthesis on the current distribution of AMR among migrants in Europe. Methods We carried out a systematic review and meta-analysis in accordance with PRISMA guidelines (PROSPERO ID: CRD42022343263). We searched databases (MEDLINE, Embase, PubMed and Scopus) from 18 January 2017 until 18 January 2023 to identify primary data from observational studies reporting any laboratory-confirmed AMR among migrants in the European Economic Area (EEA) and European Union-15 (EU-15) countries using over 7 key search terms for migrants and over 70 terms for AMR and countries in Europe. Outcomes were infection with, or colonisation of AMR bacteria. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Observational Studies. We meta-analysed the pooled-prevalence of infection and/or colonisation of AMR organisms. Findings Among 630 articles, 21 observational studies met the inclusion criteria and were included in this review. The pooled prevalence for any detected AMR was 28.0% (95% CI 18.0%–41.0%, I2 = 100%) compared to a 25.4% seen in the previous review; gram-negative bacteria 31.0% (95% CI 20.0%–44.0%, I2 = 100%), and methicillin-resistant staphylococcus aureus 10.0% (95% CI 5.0%–16.0%, I2 = 99%). Drug-resistant bacteria were more prevalent in community settings in large migrant populations (pooled prevalence: 41.0%, 95% CI 24.0%–60.0%, I2 = 99%) than in hospitals (21.0%, 95% CI 12.0%–32.0%, I2 = 99%). AMR estimates in ‘other’ migrants were 32.0%, (95% CI 12.0%–57.0%, I2 = 100%) and 28.0% (95% CI 18.0%–38.0%, I2 = 100%) in forced migrants. No firm evidence of AMR acquisition with arrival time or length of stay in the host country was found. Interpretation Studies investigating AMR in migrants are highly heterogenous. However, since the COVID-19 pandemic, migrants may be at higher risk of acquiring resistant bacteria, particularly gram-negative bacteria, within community settings such as refugee camps and detention centres in Europe. Our study highlights the importance of infrastructure and hygiene measures within these settings, to mitigate transmission of resistant pathogens. Policy-makers should screen for AMR in migrants prior to departure from countries of origin, where feasible, and upon arrival to a new country to ensure optimal health screening, infection control and effective treatment. Funding There was no funding source for this study.

Objectives To assess how ethnicity, migration status and occupation are associated with healthcare workers (HCW) redeployment experiences during COVID-19 in a nationwide ethnically diverse sample. Design A cross-sectional analysis using data from the nationwide United Kingdom Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) cohort study. Setting Healthcare settings. Participants Healthcare workers (HCW). Main Outcome Measures Outcome measures included redeployment, provision of training and supervision during redeployment, change in patient contact and interaction with COVID-19 patients. Methods We used logistic regression to examine associations of ethnicity, migration status, and occupation with redeployment experiences of HCWs. Results Of the 10,889 HCWs included, 20.4% reported being redeployed during the first UK national lockdown in March 2020. Those in nursing roles (Odds Ratio (OR) 1.22, 95% Confidence Interval (CI) 1.04–1.42, p = 0.009) (compared to medical roles) had higher likelihood of being redeployed as did migrants compared to those born in the UK (OR 1.26, 95% CI 1.06–1.49, p = 0.01) (in a subcohort of HCWs on the agenda for change (AfC) pay scales). Asian HCWs were less likely to report receiving training (OR 0.66, 95% CI 0.50–0.88, p = 0.005) and Black HCWs (OR 2.02, 95% CI 1.14–3.57, p = 0.02) were more likely to report receiving supervision, compared to White colleagues. Finally, redeployed Black (OR 1.33, 95% CI 1.07–1.66, p = 0.009) and Asian HCWs (OR 1.30, 95% CI 1.14–1.48, p < 0.001) were more likely to report face-to-face interaction with COVID-19 patients than White HCWs. Conclusions Our findings highlight disparities in HCWs’ redeployment experiences by ethnicity, migration, and job role which are potentially related to structural inequalities in healthcare.