Explore the vast range of titles available.

The global evidence on the risk of symptoms of Long Covid in general populations infected with SARS-CoV-2 compared to uninfected comparator/control populations remains unknown. We conducted a systematic literature search using multiple electronic databases from January 1, 2022, to August 1, 2024. Included studies had ≥100 people with confirmed or self-reported COVID-19 at ≥28 days following infection onset, and an uninfected comparator/control group. Results were summarised descriptively and meta-analyses were conducted to derive pooled risk ratio estimates. 50 studies totaling 14,661,595 people were included. In all populations combined, there was an increased risk of a wide range of 39 out of 40 symptoms in those infected with SARS‑CoV‑2 compared to uninfected controls. The symptoms with the highest pooled relative risks were loss of smell (RR 4.31; 95% CI 2.66, 6.99), loss of taste (RR 3.71; 95% CI 2.22, 7.26), poor concentration (RR 2.68; 95% CI 1.66, 4.33), impaired memory (RR 2.53; 95% CI 1.82, 3.52), and hair loss/alopecia (RR 2.38; 95% CI 1.69, 3.33). This evidence synthesis, of 50 controlled studies with a cumulative participant count exceeding 14 million people, highlights a significant risk of diverse long-term symptoms in individuals infected with SARS-CoV-2, especially among those who were hospitalised. Estimating the risk of long COVID is challenging because many of its symptoms are associated with other conditions. Here, the authors conduct a systematic review and meta-analysis of studies that estimate long COVID risk while accounting for background symptoms using comparator control populations.

This review systematically synthesised the evidence on quality of life measures and outcomes for people living with multiple long-term conditions in the Southeast Asia region. Results were analysed using a combination of methods, meta-analysis for studies where the same quality of life score was reported across three or more cohorts, and descriptive narrative synthesis. In total, 34 studies comprising 11,876 participants were included in the narrative synthesis and 14 of these were included in meta-analysis. The most common quality of life tools used included WHOQOL-BREF ( n  = 8) and EQ-5D-5L ( n  = 3) with pooled mean values of 70.47 (95% CI: 62.71 to 78.24) and 0.76 (95% CI: 0.67 to 0.84) respectively, indicating reduced but good quality of life. As healthcare systems adapt to the evolving challenges associated with multiple long-term conditions, understanding the tools and measures used to assess quality of life in different contexts becomes imperative to account for disease combinations and cultural nuances. People living with multiple long-term conditions often experience reduced quality of life, but evidence from Southeast Asia is fragmented. Here the authors show that commonly used tools indicate moderately reduced yet generally good quality of life, highlighting the need for context-sensitive measurement approaches.

IntroductionAmyotrophic lateral sclerosis (ALS) is a devastating illness that leads to muscle weakness and death usually within around 3 years of diagnosis. People with ALS (pwALS) often lose weight due to raised energy requirements and symptoms of the disease presenting significant challenges to taking adequate oral diet, with those who lose more weight being at a greater chance of earlier death. There is also some evidence to suggest that a higher calorie diet may benefit the disease course in pwALS, but further research is needed.Methods and analysisTwo armed, parallel group, superiority, open labelled, randomised controlled trial, with internal pilot, to assess the effectiveness of an early high calorie diet on functional outcomes in ALS, comprising two treatment arms: (1) standard care, (2) standard care with additional active management using the OptiCALS complex intervention to achieve a high calorie diet (initially randomised 1:1, then 1:2 following a protocol amendment). Using a food first approach, pwALS will be encouraged and supported to follow a diet that meets an individualised calorie target from food before prescribing oral nutritional supplements. 259 pwALS will be recruited from up to 20 ALS centres across the United Kingdom and Ireland and followed up for a period of 12 months. Primary outcome is functional change measured over 12 months, using the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale. Secondary end points include measures of functional health, quality of life, calorie intake and weight, as well as time to gastrostomy and survival. A health economic analysis and process evaluation will also be undertaken. Participant recruitment is expected to complete in September 2025, and participant follow-up is expected to complete in September 2026. The results of this study are expected in March 2027.Ethics and disseminationThe trial was approved by Greater Manchester—North West Research Ethics Committee, reference 20/NW/0334 on 8 September 2020. We will publish the study findings in peer-reviewed academic journals and present at local, national and international conferences where possible.Trial registration numberISRCTN30588041.

Background Full-time employees often exhibit unhealthy 24-hour movement behaviours (i.e., prolonged sedentary behaviour, insufficient physical activity, and inadequate sleep). The workplace provides a unique setting for implementing interventions aimed at changing movement behaviours, but there is limited understanding of the design, implementation and effectiveness of these interventions conducted during paid working time. This review aimed to describe the characteristics and outcomes of movement behaviour interventions conducted as a break from work during paid working time. Methods Five databases (MEDLINE, Web of Science, Scopus, APA PsycInfo, Cochrane Library) were searched from inception to June 2024. Inclusion criteria consisted of: (1) adults in full-time employment, (2) interventions that included a break from work allocated to changing movement behaviour(s), and (3) breaks that occurred during paid working time, not during pre-existing breaks. Results Of 168 articles included, 134 (79.8%) were physical activity, 28 (16.7%) were sedentary behaviour, and 6 (3.6%) were sleep interventions. Studies were predominantly randomised controlled trials ( n  = 101, 60.1%), conducted in high-income countries ( n  = 136, 81.0%), and involved white-collar employees ( n  = 139, 82.7%) from office/administrative ( n  = 79, 47.0%) and healthcare ( n  = 27, 16.1%) professions. Positive effects on primary outcomes were reported in 85.1% of physical activity and 85.7% of sedentary behaviour interventions. Conclusion Despite heterogeneity in designs and outcomes, interventions targeting physical activity and sedentary behaviour largely showed promising results. However, the predominance of studies conducted in high-income countries and among white-collar employees may limit generalisability. Future interventions should focus on scalability and allow employees greater autonomy to choose movement behaviour(s) based on individual preferences/needs. Further research is needed to determine the effectiveness of sleep interventions, particularly in identifying implementation barriers. Protocol registration Open Science Framework ( https://osf.io/m9w5t ).

BackgroundDelayed discharge from hospital is a global problem with negative consequences for patients and the healthcare system. Common causes of delayed discharge for patients medically ready for discharge are issues such as a lack of appropriate social care or housing for their needs. However, whilst there is now a plethora of non-medical interventions which have been developed to facilitate timely discharge there remains a lack of evidence on their impact. To bridge this gap in evidence we aimed to explore the impact of a housing support coordinator (HSC) on hospital discharge processes, service user outcomes and hospital costs. The aim of the HSC service was to work with patients on their housing related issues whilst in hospital to improve hospital discharge outcomes and reduce chances of readmission.MethodsWe conducted a mixed methods process evaluation in two UK hospital trusts employing semi structured interviews with service users, hospital and housing staff (=16), secondary analysis of routine patient data (N=488) and an economic evaluation to assess costs. Framework analysis was undertaken on the qualitative data using an initial framework developed from discussions with housing and NHS partners. Descriptive analysis was undertaken for routinely collected data. We used the ‘following the thread’ technique to integrate the different methods. A sense checking workshop was conducted to ensure the findings reflected stakeholder experiences.Results488 people were supported by the service. Almost two thirds were male (n=321). Service-users faced different housing barriers. Over 25% experienced homelessness (n=136) and a further 52 faced challenges with their accommodation no longer meeting their physical needs. Service users were appreciative of the service and received support for a variety of issues such as assistance with medical priority, assisted bidding on properties and referral to other support services. Hospital staff at all levels felt the service facilitated discharge and significantly reduced stress on clinical staff. Having experienced housing officers embedded within the patient’s care team with access to medical systems was key. The service was constrained by the unavailability of appropriate housing stock and wider support systems for service-users post discharge.ConclusionThe evaluation has demonstrated the benefits of housing services to support hospital discharge. The findings were used to develop several recommendations for the service which will be of use to other organisations wishing to develop similar integrated services. It is recommended other hospitals experiencing housing related barriers to discharge may want to adopt a similar model.

In healthy individuals, coronary arteries dilate in response to sympathetic nervous system (SNS) stimulation, whereas in patients with increased cardiovascular disease (CVD) risk this produces a truncated dilation. Conversely, in patients with significant disease, these arteries constrict. Previous research has demonstrated a correlation between carotid and coronary artery function. In addition, a non-invasive measure of carotid artery response (CAR%) has been shown to predict adverse events in patients with peripheral arterial disease. In this thesis, these findings were extended to investigate the effect of blood pressure (BP) increase caused by the Cold Pressor Test (CPT) as a driver of CAR%. CAR% was then also investigated as a means to predict risk in patients with central arterial disease undergoing Coronary Artery Bypass Graft (CABG) surgery. Methods. The (CPT), a sympathetic nervous system stimulus (SNS) using cold water, was used to investigate carotid artery response to an SNS stimulus in two studies. The first investigated CPT alongside continuous blood pressure measurement. The second examined CAR% in patients with CVD undergoing CABG, with a 30-day follow-up period.Results. Study one: The timing of peak CAR% was significantly later than peak MAP. There was no significant difference in CAR% when participants are separated by MAP response. There was no significant difference in MAP in “dilation” vs “constriction” groups. Study two: There was a weak inverse correlation between CAR% and EuroSCORE II. Neither EuroSCORE II nor CAR% alone predicted risk. There may be a trend towards a marginal improvement in predictive capacity when CAR% is combined with EuroSCORE II. Although this did not predict risk.Discussion. Study one: This study provided evidence that CAR% is not significantly driven by increase in MAP throughout the CPT. In addition, it further supports the validity of CAR% as a surrogate of endothelial function. Study two: Alone, neither EuroSCORE II nor CAR% were predictors of risk. Combined, the two measures demonstrated marginal increased predictive capacity. This study suggests that CAR% may improve the predictive capacity of established prediction tools. This cannot be tested conclusively due to the low number of adverse events. Future Work: This thesis highlighted future areas for research including regulation of CAR%, areas for further technological and practical development and areas of potential clinical integration, namely in the identification and monitoring of endothelial function alongside interventions to improve function and reduce perioperative risk.