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Our knowledge of the incidence and prevalence of inflammatory bowel disease (IBD) is uncertain. Recent studies reported an increase in prevalence. However, they excluded a high proportion of ambiguous cases from general practice. Estimates are needed to inform health care providers who plan the provision of services for IBD patients. We aimed to estimate the IBD incidence and prevalence in UK general practice. We undertook a retrospective cohort study of routine electronic health records from the IQVIA Medical Research Database covering 14 million patients. Adult patients from 2006 to 2016 were included. IBD was defined as an IBD related Read code or record of IBD specific medication. Annual incidence and 12-month period prevalence were calculated. The prevalence of IBD increased between 2006 and 2016 from 106.2 (95% CI 105.2-107.3) to 142.1 (95% CI 140.7-143.5) IBD cases per 10,000 patients which is a 33.8% increase. Incidence varied across the years. The incidence across the full study period was 69.5 (95% CI 68.6-70.4) per 100,000 person years. In this large study we found higher estimates of IBD incidence and prevalence than previously reported. Estimates are highly dependent on definitions of disease and previously may have been underestimated.

Background Local-level analysis of ethnic inequalities in health is lacking, prohibiting a comprehensive understanding of the health needs of local populations and the design of effective health services. Knowledge of ethnic disparities in child weight status is particularly limited by overlooking both the heterogeneity within ethnic groupings; and the complex ecological contexts in which obesity arises. This study aimed to establish whether there was variation in childhood BMI across ethnic groups in Coventry, and the influence of individual, school and neighbourhood contexts, using routinely collected local data. Methods National Child Measurement Programme data were compiled for the period 2007/8–2014/15 and combined with routinely collected local data reflecting school performance and demographics, and school and neighbourhood physical environments. Multi-level modelling using Monte Carlo Markov Chain methods was used to account for the clustering of children within schools and neighbourhoods. Ethnic group differences in BMI z-score (zBMI) were explored at 4–5 years and 10–11 years for girls and boys alongside individual, school and neighbourhood covariates. Results At age 4–5 years ( n  = 28,407), ethnic group differences were similar for boys and girls, with children from South Asian, White other, Chinese and ‘any other’ ethnic groups having a significantly lower zBMI, and Black African children having a higher zBMI, versus White British (WB) children. Patterns differed considerably at age 10–11 years ( n  = 25,763) with marked sex differences. Boys from White other, Bangladeshi and Black African groups had a significantly higher zBMI than WB boys. For girls, only children from Black ethnic groups showed a significantly higher zBMI. Area-level deprivation was the only important school or neighbourhood covariate, but its inclusion did not explain ethnic group differences in child zBMI. Conclusion This analysis contributes to the existing literature by identifying nuanced patterns of ethnic disparities in childhood adiposity in Coventry, supporting the targeting of early obesity prevention for children from Black African groups, as well as girls from Black Caribbean and Black other ethnic backgrounds; and boys from Bangladeshi and White other ethnic backgrounds. It also demonstrates the utility of exploring routinely collected local data sets in building a comprehensive understanding of local population needs.

•We introduce a novel multimodal MRI graph metric termed “SC-FC Bandwidth”.•Most FC nodes are mediated by indirect SC.•Nodes with higher SC-FC Bandwidth tend to be closer, and highly synchronous.•High bandwidth SC-FC triangles predominate the somatomotor network.•High-bandwidth SC-FC quads predominate the default mode network. The human brain is a complex network that seamlessly manifests behaviour and cognition. This network comprises neurons that directly, or indirectly mediate communication between brain regions. Here, we show how multilayer/multiplex network analysis provides a suitable framework to uncover the throughput of structural connectivity (SC) to mediate information transfer—giving rise to functional connectivity (FC). We implemented a novel method to reconcile SC and FC using diffusion and resting-state functional MRI connectivity data from 484 subjects (272 females, 212 males; age = 29.15 ± 3.47) from the Human Connectome Project. First, we counted the number of direct and indirect structural paths that mediate FC. FC nodes with indirect SC paths were then weighted according to their least restrictive SC path. We refer to this as SC-FC Bandwidth. We then mapped paths with the highest SC-FC Bandwidth across 7 canonical resting-state networks. We found that most pairs of FC nodes were connected by SC paths of length two and three (SC paths of length >5 were virtually non-existent). Direct SC-FC connections accounted for only 10% of all SC-FC connections. The majority of FC nodes without a direct SC path were mediated by a proportion of two (44%) or three SC path lengths (39%). Only a small proportion of FC nodes were mediated by SC path lengths of four (5%). We found high-bandwidth direct SC-FC connections show dense intra- and sparse inter-network connectivity, with a bilateral, anteroposterior distribution. High bandwidth SC-FC triangles have a right superomedial distribution within the somatomotor network. High-bandwidth SC-FC quads have a superoposterior distribution within the default mode network. Our method allows the measurement of indirect SC-FC using undirected, weighted graphs derived from multimodal MRI data in order to map the location and throughput of SC to mediate FC. An extension of this work may be to explore how SC-FC Bandwidth changes over time, relates to cognition/behavior, and if this measure reflects a marker of neurological injury or psychiatric disorders.

BackgroundSelf-reported health (SRH) is widely used as a proxy for health status; it is a simple, holistic measure of health and has been associated with other health outcomes. However, variation in these associations has been found by subgroup, leaving open the possibility of systematic reporting differences, including by socioeconomic status.MethodsUsing data from the 2017 and 2018 waves of the Health Survey for England, we assessed the relationship between deprivation quintile and SRH using multiple linear regression models for EQ-5D score, a health-related quality of life measure. Reporting heterogeneity between deprivation quintiles was assessed by the significance of model interaction terms. Analyses were stratified by sex and accounted for age group, ethnicity, marital status and religion (females only).ResultsSignificant interactions were found between deprivation quintile and SRH in the models for EQ-5D score for participants reporting poor health in the two most deprived quintiles, with coefficients ranging from –0.041 to –0.098. The largest differences were in the second most deprived quintile for men (–0.075, 95% CI: –0.110 to –0.040, p<0.001) and the most deprived quintile for women (–0.098, 95% CI: –0.128 to –0.067, p<0.001). Secondary analyses using body mass index as the response variable, for models structured in a similar way to those for EQ-5D, found no significant interaction terms between deprivation quintile and SRH.ConclusionsThis analysis suggests that people from more deprived areas who report themselves to be in poor health may have worse health, as measured by EQ-5D, than those from less deprived areas. This could lead to an underestimation of health inequalities, including in measures, such as healthy life expectancy in England, that incorporate SRH data.

Background Employment within social firms in the UK is under-developed and under-researched, but a potentially beneficial route to vocational rehabilitation for people with mental health problems. This study explores the views and experiences of employees with mental ill-health, managers of social firms and mental health clinicians, in order to understand the potential value of social firms for the vocational rehabilitation, employment and well-being of people with mental health problems. Methods Semi-structured interviews were conducted with 23 employees with mental health problems in 11 social firms in England. A focus group and individual interviews were conducted with 12 managers of social firms. Two focus groups were held with 16 mental health clinicians. Data were analysed using thematic analysis. Results Most employees expressed very positive views about working in a social firm. In responses from both employees and social firm managers, an overarching theme regarding the supportive ethos of social firms encompassed several related features: openness about mental health issues; peer, team and management support; flexibility; and support to progress and develop skills over time. Managers identified benefits of employing people with mental health problems who were sufficiently recovered. Knowledge of social firms within clinician focus groups was very limited, although clinicians thought they could be a welcome additional vocational resource. Conclusions High levels of job satisfaction among social firm employees may be explained by the supportive ethos of these working environments. Social firms have potential to be a helpful addition to the range of vocational pathways available for people with mental ill-health. Further mixed methods investigations of experiences and outcomes in order to understand who engages with and benefits from this form of vocational rehabilitation would be valuable in informing decisions about scaling up the model.

ObjectivesThere is a paucity of qualitative research exploring the patient experience of living with a meniscal tear, vital to effective patient management. The aim of this study was to explore the experiences and expectations of treatment of patients aged 18–55 years with a meniscal tear of the knee.DesignQualitative study involving semistructured interviews.SettingParticipants were selected from nine secondary care centres in England.Participants10 participants diagnosed with a meniscal tear were recruited from the Meniscal Tear Outcome cohort study using a purposive sampling strategy until data saturation was achieved. Semistructured interviews were conducted between April and May 2021 and thematic analysis was used to identify key patient experiences.ResultsThemes identified relate to the broad areas of symptoms, clinical consultation and experience of treatment. Meniscal tears have a profound impact on pain and many patients experience effects on their family and financial life in addition to physical symptoms. Participants expected most of their management to occur in secondary care and most thought surgery would be a definitive treatment, while they believed the effectiveness of physiotherapy could not be guaranteed as it would not fix the physical tear.ConclusionThis study is one of the first to explore patient experiences of a meniscal tear and their perceptions of treatment options. Patient experiences and perceptions are important for clinicians to understand in order to provide the best possible care. It is important to elicit these experiences, listen to the patient, discuss their perspectives and build these experiences and expectations into clinical care.Trial registration numberISRCTN11534691.

Background Colon capsule endoscopy (CCE) has become an alternative to traditional colonoscopy for low-risk patients. However, CCE's low completion rate and inability to take biopsies or remove polyps often result in a CCE-to-conventional colonoscopy conversion (CCC). Objective(s) The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC. Methods This prospective study analysed data from patients who underwent CCE as part of the CESCAIL study from Nov 2021 till June 2024. Predictive factors were examined for their association with CCC, including patient demographics, comorbidities, medications, and laboratory results from symptomatic and surveillance groups. Statistical methods such as LASSO, linear, and logistic regression were applied. Results Six hundred and three participants were analysed. Elevated f-Hb levels (OR = 1.48, 95% CI:1.18–1.86, p  = 0.0002) and smoking (OR = 1.44, 95% CI: 1.01–2.11, p  = 0.047) were significantly associated with CCC. The area under the curve (AUC) of elevated f-Hb for predicting CCC was 0.62 after adjusting for confounders. Diabetes was linked to poor bowel preparation (OR = 0.40, 95%CI:0.18–0.87, p  = 0.022). Alcohol ( p  = 0.004), smoking ( p  = 0.003), psychological conditions ( p  = 0.001), and haemoglobin levels ( p  = 0.046) were significantly associated with the number of polyps, whilst antidepressants ( p  = 0.003) and beta-blockers ( p  = 0.001) were linked to the size of polyps. Conclusion Non-smokers with lower f-Hb levels are less likely to need conventional colonoscopy (CCC). Patient selection criteria are key to minimising the colonoscopy conversion rate. Our findings would benefit from validation in different populations to develop a robust CCE Conversion Scoring System (CECS) and ultimately improve the cost-effectiveness.

Colon capsule endoscopy (CCE) is an established non-invasive alternative to colonoscopy for selected low-risk patients. However, its diagnostic limitations, including incomplete transit, and an inability to biopsy or perform polypectomy, often lead to conversion to conventional colonoscopy (CCC). Understanding the factors contributing to CCC is critical to optimise patient selection, procedural efficiency and cost-effectiveness. This study aimed to identify and characterise the pre- and intra-procedural factors predicting CCC, including issues with bowel preparation, capsule excretion, pathology detection (polyp number and size) and other clinical or technical variables that influence the need for follow-up investigations. This prospective analysis is nested within the CESCAIL study, involving patients who underwent CCE between November 2021 and June 2024. Data were analysed from both symptomatic and post-polypectomy surveillance cohorts. Variables included demographics, comorbidities, medications and laboratory values. Statistical modelling employed LASSO selection, followed by multivariate logistic and linear regression. Sensitivity analyses were conducted using both complete case analysis (CCA) and multiple imputation by chained equations (MICE). A total of 603 participants were included. The CCC rate was 54.1% (326/603), with colonoscopy accounting for 32.9% and flexible sigmoidoscopy for 21.2% of follow-up procedures. Among intra-procedural contributors, pathology detection during CCE alone led to 145 CCC cases (24%), making it the leading cause. Inadequate bowel preparation and capsule battery depletion also contributed to CCC. Pre-procedural predictors of CCC included elevated log-transformed faecal haemoglobin (f-Hb) levels (OR=1.48, 95% CI: 1.18–1.86, p<0.001) and current smoking status (OR=1.44, 95% CI: 1.01–2.11, p=0.047). The adjusted predictive accuracy of f-Hb for CCC was modest (AuROC=0.62), reflecting the low-risk nature of this cohort, selected using an f-Hb threshold of ≤100 µg/g. Men had significantly higher capsule excretion rates (OR=2.22, 95% CI: 1.10–4.58, p=0.024), but this did not translate to lower CCC, likely because of their higher rate of advanced polyp detection. While male sex was associated with better bowel cleansing on univariate analysis (OR=1.46, p=0.023), this was not significant in multivariable analysis (p=0.084). Bowel preparation quality was significantly poorer in patients with type 2 diabetes mellitus (OR=0.40, 95% CI: 0.18–0.87, p=0.022), consistent with previous colonoscopy literature. Factors associated with pathology detection included alcohol consumption (p=0.023), smoking (p=0.025), psychological conditions (p=0.013) and haemoglobin level (p=0.046) for polyp number; and antidepressant (p=0.028) and beta-blocker use (p=0.008) for polyp size. Larger polyps were more commonly observed in antidepressant users, although the underlying mechanism remains unclear. Conversely, beta-blocker use was associated with smaller polyps and lower CCC rates, aligning with some prior findings suggesting a potential tumour-suppressive role. Non-smokers with lower f-Hb levels are less likely to need CCC. Patient selection criteria are key to minimising the colonoscopy conversion rate. Our findings would benefit from validation in different populations to develop a robust CCE Conversion Scoring System (CECS) and ultimately improve the cost-effectiveness of treatment.

Colon capsule endoscopy (CCE) has regained popularity for lower gastrointestinal investigations since the COVID-19 pandemic. While there have been systematic reviews and meta-analyses on colonic polyp detection using CCE, there is a lack of comprehensive evidence concerning colonic inflammation. Therefore, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of CCE for colonic inflammation, predominantly ulcerative colitis (UC) and Crohn’s disease (CD). Methods: We systematically searched electronic databases (EMBASE, MEDLINE, PubMed Central, and Cochrane Library) for studies comparing the diagnostic accuracy between CCE and optical endoscopy as the standard reference. A bivariate random effect model was used for the meta-analysis. Results: From 3797 publications, 23 studies involving 1353 patients were included. Nine studies focused on UC, and ten focused on CD. For UC, CCE showed a pooled sensitivity of 92% (95% CI, 88–95%), a specificity of 71% (95% CI, 35–92%), and an AUC of 0.93 (95% CI, 0.89–0.97). For CD, the pooled sensitivity was 92% (95% CI, 89–95%), and the specificity was 88% (95% CI, 84–92%), with an AUC of 0.87 (95% CI, 0.76–0.98). Overall, for inflammatory bowel disease, the pooled sensitivity, specificity, and AUC were 90% (95% CI, 85–93%), 76% (95% CI, 56–90%), and 0.92 (95% CI, 0.94–0.97), respectively. Conclusions: Despite the challenges around standardised disease scoring and the lack of histological confirmation, CCE performs well in diagnosing inflammatory bowel disease. It demonstrates high sensitivity in both UC and Crohn’s terminal ileitis and colitis and high specificity in Crohn’s disease. Further studies are needed to evaluate the diagnostic accuracy of other colonic inflammatory conditions.

This article examines the history of the Baseball Hall of Fame as a cultural consecration project. It argues that the legitimacy of any consecration project depends on the cultural authority of the organization initiating the project, the rigorous selection procedures used by this organization, the relative selectivity of its outcomes, and the existence of objective differences in merit between the consecrated and the unconsecrated. However, prior research suggests that the relationship between merit and consecration is mediated by a series of social characteristics and contextual factors. This study proposes a theory of cumulative recognition, which asserts that the likelihood of consecration is affected by the cumulative effects of social characteristics and circumstances, prior social recognition, and media discourse, as well as by objective differences in achievement. The results of discrete-time event-history analyses of the outcomes of the Hall of Fame elections over the past four decades provide substantial confirmation of this theory. Overall, it is concluded that the procedural and substantive rationality exhibited by the Hall of Fame contributes greatly to its cultural legitimacy as a consecration project.