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Background: Type 2 diabetes is a public health priority for the UK. A growing body of evidence has indicated ethnic and socioeconomic disparities in rates of diabetes prevalence and complications. Attendance at diabetes follow-up checks is key to ensuring complications are identified and managed at an early stage. The aim of this rapid review was to identify and summarise evidence of ways to improve diabetes management in ethnic minority groups., Methods: In this rapid review, we searched PubMed, PsycInfo, and CINAHL for studies published in English between Jan 1, 2000, and Jan 31, 2023. Studies were included if the population was from ethnic minority groups and if the intervention was community-based and aimed to improve diabetes self-care. The comparisons were persuasion and behaviour change, and the outcomes were improved diabetes self-management including, glycaemic control, attending eye tests, kidney, and foot screening follow-up checks. This study is registered with PROSPERO 2023, CRD42023399283., Findings: Nine studies were included, from Mexico (n=1), USA (n=7), and UK (n=1). Most studies reported on community engagement (n=8), and one focussed on peer support and diabetes self-management. Peer support and diabetes self-management education were found to significantly improve diabetes control in a Mayan community (n=29) in Mexico (p<0·0001) and in the Korean American (n=105), African American (n=107), and Latino American (n=56) communities in the USA. Another study showed that women from the Pakistani community in England also benefitted from a culturally appropriate and socially supportive environment when learning about diabetes self-management. Diabetic eye screening rates could be increased through education but not through incentive payments., Interpretation: Culturally competent health-care policies and programmes have been shown to increase diabetes self-management including uptake of diabetes screening for people with diabetes from ethnic minority communities to avoid potential harmful and life limiting conditions. A strength of this review is that robust, recent, and relevant papers regarding self-management of diabetes were included. The main limitations were that none of the nine studies included any cost analyses, and only one UK-based study was included, indicating that further research is required to fill the evidence gap., Funding: Research for Patient and Public Benefit (RfPPB), Health and Care Research Wales., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The percentage of people in Wales experiencing severe mental health issues more than doubled during the COVID-19 pandemic. Additionally, hundreds of people in Wales wait more than a year for help with their mental health. The EmotionMind Dynamic (EMD) programme is a six-session programme over 3 months involving self-reflective introspection, self-analysis, problem solving, goal setting, and action taking. Furthermore, this programme challenges negative self-perception and increases self-awareness, self-confidence, and self-esteem. We aimed to estimate the social return on investment of EMD lifestyle coaching, both face-to-face and online formats, by comparing the costs of running the programme with the social value generated from clients as measured by improvement in self-confidence and mental wellbeing., Methods: We included 15 clients from previous face-to-face EMD coaching and 17 clients from a new online version of EMD. For face-to-face clients, quantitative data were collected retrospectively with a one-time only questionnaire. For new online clients, quantitative data were collected from baseline and follow-up questionnaires. Qualitative data were collected after intervention from interviews with both groups. Outcomes from questionnaires for both groups included changes in mental wellbeing measured with the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS) and self-efficacy assessed with the General Self-Efficacy Scale (GSES)., Findings: For every £1 invested, lifestyle coaching generated social values ranging from £4·12 to £7·08 for face-to-face clients compared with £2·37 to £3·35 for online participants. Quantitative and qualitative data from questionnaires and interviews indicated that many clients had improved mental wellbeing and self-efficacy. All 15 face-to-face clients and 11 (65%) of 17 online clients reported an increase of 5 points or more on the SWEMWBS questionnaire. Similarly, all 15 face-to-face clients and ten (59%) of 17 online clients reported an increase of 5 points or more on the GSES questionnaire., Interpretation: The results showed that both face-to-face and online formats of the EMD lifestyle coaching generated a positive social return on investment ratios. With continued long waiting lists for people with mental health challenges, face-to-face and online lifestyle coaching might become more essential across statutory, private, and third sectors to meet the growing demand for mental health support., Funding: Accelerate: the Welsh Health Innovation and Technology Accelerator., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Context: Although pain is frequent in people with dementia (PwD), evidence on the prevalence and factors influencing ratings of pain in dementia is limited. Carer variables are often associated with bias in proxy ratings of pain, but few studies have examined the role of caregiver pain in influencing these ratings., Objectives: This study explored the prevalence of pain in PwD in a large U.K., Sample: A secondary aim was to identify factors influencing ratings of pain in people with mild to moderate dementia and whether carer pain systematically influences proxy ratings., Methods: This was a cross-sectional study of 488 caregiving dyads living in the community. Self- and carer-rated pain was assessed as part of the EuroQoL-5D (EQ-5D). Depression and anxiety for the PwD were measured by the Cornell Scale for Depression in Dementia and the Rating of Anxiety in Dementia Scale. The Hospital Anxiety and Depression Scale was used to measure anxiety and depressive symptoms in carers. Using logistic regression modeling, we examined the relationship between self- and carer-rated (proxy) pain in PwD and psychological distress, functional ability, and health status. Carer variables included self-rated health, strain, anxiety, depression, and caregiver pain., Results: A total of 45% of PwD reported pain, whereas carer-rated pain was higher (59%). Self-rated pain was more frequent in those with lower self-rated health (adjusted odds ratio [AOR] 0.97; 95% CI 0.96-0.99, P ≤ 0.001) and higher anxiety (AOR 1.07; 95% CI 1.01-1.12, P = 0.013). Carer-rated (proxy) pain was additionally predicted by poor proxy-rated health in the PwD (AOR 0.98; 95% CI 0.96-0.99, P = 0.006) and carers' own experience of pain (AOR 0.36; 95% CI 0.21-0.63, P ≤ 0.001)., Conclusion: Our results indicate that pain is very frequently reported in PwD and that the presence of pain is associated with high levels of anxiety. Caregiver pain affects carers' perceptions of pain in PwD., (Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: EQ-5D is widely used in studies with adults as a source of generic health-related quality of life information and utility weights to inform resource allocation decisions. This methodological systematic review describes the extent to which EQ-5D has been used in the evaluation of children's health care, assesses psychometric properties, and makes recommendations for future good practice., Methods: Systematic searches of databases and the Internet to identify studies published during 2000-2010 that either used EQ-5D with children younger than age 19 years as an outcome measure or reported psychometric data. Study characteristics, including measures and psychometric data, were extracted into tables for analysis., Results: We identified 29 studies that used four versions of the EQ-5D: adult EQ-5D, EQ-5D-Y, Dutch EQ-5D child, and extended with cognitive dimension, EQ-5D+C. Twelve of 29 studies did not specify the EQ-5D version used. Existing literature lacks detail on the specific use of EQ-5D and its potential effects on findings. Version use and psychometric properties were inadequately reported. There are large gaps in current knowledge of psychometric properties across all versions when used with children., Conclusions: For reasons of comparability with resource use across adult and children's services, there are arguments for continued use of EQ-5D in studies with children. We recommend use of EQ-5D alongside children-specific quality of life measures and disease-specific measures. Researchers are encouraged to undertake methodological and philosophical analyses to better understand and improve evidence as to how adults who make decisions about resource allocation can best take account of children in decision making., (Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Objectives: This article analyzes published studies on the application of the EQ-5D for the assessment of quality of life in patients with dementia and their carers. The EQ-5D, a generic instrument for measuring health-related quality of life, is widely used for economic evaluation in many areas of health research. However, there is considerable debate about the appropriateness of the EQ-5D for people with impaired cognition., Methods: We conducted a systematic review of research studies published in the past 10 years that either used the EQ-5D as an outcome measure or investigated different aspects of the performance of the EQ-5D in studies of dementia., Results: This study demonstrates that despite good feasibility and reliability of the EQ-5D instrument, there are problems with the validity of self-rated data because of a lack of association between patient and proxy ratings. There is a substantial ceiling effect for patient ratings. The visual analogue scale has poor reliability, even in patients with mild and moderate dementia. Different proxies (e.g., family carers, institutional carers, and health-care professionals) provide different ratings for patients' health., Conclusion: Careful selection of assessment mode and appropriate proxies is important to ensure the EQ-5D validity in studies of patients with dementia. Because the cost of informal patient care represents a significant proportion of total costs of dementia treatment, the impact of dementia on carer's quality of life should be included in economic evaluation., (Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

This study describes the self-reported health and well-being status of field and packhouse workers in UK vegetable horticulture, and tests the null hypothesis that there is no difference in the self-reported health of workers on organic and conventional horticultural farms. The majority of those sampled were migrant workers (93%) from Bulgaria, Latvia, Lithuania, Poland, Russia and the Ukraine. More than 95% of the respondents were aged 18-34 and recruited through university agricultural faculties in East European or employed via UK agencies. The health of 605 farm workers (395 males and 210 females) was measured through the use of four standard health instruments. Farm workers' health was significantly poorer than published national norms for three different health instruments (Short Form 36, EuroQol EQ-5D and the Visual Analogue Scale). There were no significant differences in the health status of farm workers between conventional and organic farms for any of these three instruments. However, organic farm workers scored higher on a fourth health instrument the Short Depression Happiness Scale (SDHS) indicating that workers on organic farms were happier than their counterparts working on conventional farms. Multiple regression analysis suggested that the difference in the SDHS score for organic and conventional farms is closely related to the range and number of tasks the workers performed each day. These findings suggest that a great deal of improvement in the self-reported health of farmers will need to occur before organic farms meet the requirements of the 'Principle of Health' as described by IFOAM. Ensuring that farm workers have a varied range of tasks could be a cost effective means of improving self-reported health status in both organic and conventional farming systems.

This study aimed to examine housing-related difficulties, the relationship with housing tenure and the subsequent influences on health status in a population sample of older people in Wales. Comparisons with health status normative data were undertaken to determine any geographical differences. A random sample of respondents were interviewed in their own homes (N=423). Data included demographic information, self-reported health status, housing problems, tenure and factors relating to energy efficiency. Univariate analysis found that owner occupiers reported the least housing difficulties and the best health status. Those in public rented properties experienced the most difficulties and the poorest health. The health status of the sample was generally poorer than the norms. Multivariate analysis found that housing difficulties, being cold with current heating and hours spent at home predicted poorer health status. This suggests that characteristics of the home environment may help to explain the differences between tenure and health. Considerable financial outlay may be required to meet policy initiatives that support older people remaining independent, autonomous and able to 'age in place'.