Greta Rait

University College London | UCL · Department of Primary Care and Population Health (PCPH)

Introduction: Care is often inadequate and poorly integrated after a dementia diagnosis. Research and policy highlight the unaffordability and unsustainability of specialist-led support, and instead suggest a task-shared model, led by primary care. This study is part of the PriDem primary care led postdiagnostic dementia care research programme an...

Introduction: There has been global investment of new ways of working to support workforce pressures, including investment in clinical pharmacists working in primary care by the NHS in the England. Clinical pharmacists are well suited to support older adults who have multiple long-term conditions and are on multiple medications. It is important to...

Introduction Trans and/or gender diverse (TGD) people in the UK are less likely to access sexual health services (SHS) than cisgender people and more likely to report negative service experiences. The BASHH Gender and Sexual Minorities Special Interest Group (GSM SIG) developed expert recommendations for TGD-inclusivity but lacked evidence from ser...

Objectives: The study aims to describe people with dementia and informal caregivers' respective experiences of support after diagnosis and compares these experiences. Additionally, we determine how people with dementia and informal caregivers who are satisfied with support differ from those dissatisfied. Methods: A cross-sectional survey study i...

Background: The need to improve support following a diagnosis of dementia is widely recognised, but it is unclear how this can best be achieved within UK health and social care systems. A task-shared and task-shifted approach has been recommended, but there is limited guidance on how to achieve this in practice. As part of a programme of research,...

Background Dementia leads to multiple issues including difficulty in communication and increased need for care and support. Discussions about the future often happen late or never, partly due to reluctance or fear. In a sample of people living with dementia and carers, we explored their views and perceptions of living with the condition and their f...

Decisions about end-of-life care are often left to family caregivers to make with professionals. Caregivers find these decisions difficult. A decision aid is one option to support family caregivers. We aimed to test the acceptability and feasibility of a co-produced decision aid for family carers of people with severe dementia or those towards the...

Background Advance care planning in dementia does not always happen. As dementia progresses, decisions are often left for family carers to make with professionals. Aim To test the feasibility and acceptability of the delivery and use of a decision aid for family carers of people with severe dementia or towards the end-of-life. Design Feasibility...

Introduction: We investigated the incidence of diagnosed dementia and whether age at diagnosis and survival afterward differs among the United Kingdom's three largest ethnic groups. Methods: We used primary care electronic health records, linked Hospital Episode Statistics and mortality data for adults aged ≥65 years. We compared recorded dement...

Introduction: COVID-19 has disproportionately affected people living with dementia and their carers. Its effects on health and social care systems necessitated a rapid-response approach to care planning and decision-making in this population, with reflexivity and responsiveness to changing individual and system needs at its core. Considering this,...

Aim The UK incidence of vitamin D prescribing in children has increased by 26-fold in recent years. ¹ Public Health England recommends that children over 1 year take a daily vitamin D supplement. ² But the availability of over 200 different vitamin D products can be confusing for parents and clinicians. Our study aimed to assess the usage of licens...

Background COGNISANCE is an international research programme (Australia, UK, Canada, Netherlands, and Poland). In partnership with people living with dementia, informal care partners, health and social care professionals and key national and international dementia organisations and researchers, we have co‐designed online toolkits aiming to improve...

Background Recent literature calls for a focus on providing quality post diagnostic dementia care (Wong & Knapp, 2020). There is dissatisfaction among people with dementia (PwD) and care partners (CP) with post diagnostic dementia support (Hagan, 2020). To improve experiences of post diagnostic support for PwD and CP, it is vital to understand what...

Background Over the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000–2018. Methods A repeated cross-sectional study using patient data from the IQVIA Medical...

Background How contraceptive formulation, dose, duration of therapy and mode of delivery affects the risk of inflammatory bowel disease (IBD) is poorly described. Aim To examine associations between types of hormonal contraception and development of IBD. Methods This was a nested case–control study using IQVIA Medical Research Data. Women aged 15...

Background: Eating and drinking problems can arise at any point in dementia progression, especially at the later stages and the end-of-life. However, we know little about the perspectives of people living with dementia on how they might wish for such problems to be managed. Aims: This study aimed to understand the experiences and needs of older peo...

Introduction: The prevalence of vitamin D deficiency is high in children with chronic kidney disease (CKD). However, current dosing recommendations are based on limited pharmacokinetic (PK) data. This study aimed to develop a population PK model of colecalciferol that can be used to optimise colecalciferol dosing in this population. Methods: Dat...

Background: The balance of benefits and harms associated with enteral tube feeding for people with severe dementia is not clear. An increasing number of guidelines highlight the lack of evidenced benefit and potential risks of enteral tube feeding. In some areas of the world, the use of enteral tube feeding is decreasing, and in other areas it is...

Background Family carers of people living with dementia often need support with making decisions about care. Many find end-of-life care decisions particularly difficult. The aim of this article is to present an evidence- and theoretical-based process for developing a decision aid to support family carers of people with dementia towards the end-of-l...

People living with dementia can develop eating and drinking problems; however, their perspectives on such problems have not been widely canvassed. This study explored the perspectives of older people living with mild dementia about possible eating and drinking problems in the future. Semi-structured interviews were conducted with 19 people with mil...

Background Equitable implementation of HIV Pre-Exposure Prophylaxis (PrEP) is not well defined, particularly for populations already experiencing high levels of health inequity (e.g. people experiencing poverty or other social disadvantages). The five stages of the PrEP care-continuum (PCC) (awareness, acceptability, uptake, adherence, retention) c...

Background Eating and drinking problems are common among people living with later-stage dementia, yet few studies have explored their perspectives. Objective This study aimed to explore how people living with mild dementia understand possible future eating and drinking problems and their perspectives on assistance. Design Qualitative study using...

Background Many people with dementia reach the end-of-life without an advance care plan. Many are not ready to have conversations about end-of-life, and decision-making is left to their families and professionals when they no longer have capacity. Carers may benefit from further support with decision-making. To develop this support, it is important...

Background The impact of COVID-19 restrictions on people living with dementia and their carers is an emerging focus of recent research determining how we can best support this population. People living with dementia have faced service curtailment, increased risk for COVID-19, as well as potential heightened deterioration. This study reports the exp...

The aim of this paper was to understand the needs of family caregivers and professionals supporting people living with dementia with eating and drinking difficulties towards the end of life and the strategies they use to overcome them. A total of 41 semi-structured interviews with family caregivers (n = 21) and professionals (n = 20) were conducted...

Primary care coronavirus disease 2019 (COVID-19) clinics were rapidly introduced across the UK to review potentially infectious patients. Evaluation of these services is needed to guide future implementation. This mixed-methods study evaluates patient demographics, clinical presentation, co-morbidities, service usage, and outcomes for the Islington...

Primary care coronavirus disease 2019 (COVID-19) clinics were rapidly introduced across the UK to review potentially infectious patients. Evaluation of these services is needed to guide future implementation. This mixed-methods study evaluates patient demographics, clinical presentation, co-morbidities, service usage, and outcomes for the Islington...

Background: Epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic. Methods: Cohort study of 179 UK care homes with 9,339 residents and 11,604 staff. We used manager-reported daily tall...

Background: Poor retention of participants in randomised trials can lead to missing outcome data which can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to improve retention but few have been formally evaluated. Objectives: To quantify the effect of strategies...

Background People living with dementia may experience difficulties with eating and drinking, affecting their nutrition and hydration throughout the dementia trajectory. Such difficulties increase towards the end-of-life causing a strain on family carers. The aim of this study was to understand the needs of family carers and professionals supporting...

Background Family carers often struggle to support relatives living with dementia with nutrition and hydration towards the end-of-life. The aim of this study was to co-design with family carers and professionals an information resource to support family carers with this task. Methods This study consisted of four phases: 1) qualitative systematic r...

Background An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable h...

Background Syndemic theory highlights the potential for health problems to interact synergistically, compounding impact. Young adults not in education, employment or training (NEET) are more likely to experience disadvantage and poorer general health outcomes. However, there is little research on their sexual health, or the extent to which this clu...

Background: COVID-19 has accelerated remote healthcare provision in primary care, with changes potentially permanent. The implementation of remote provision of healthcare needs to hear from vulnerable populations, such as people living with dementia. Aim: To understand the remote healthcare experiences of patients living with dementia and their...

Introduction HIV pre-exposure prophylaxis (PrEP) is an effective intervention to reduce acquisition of HIV. PrEP provision has increased in recent years, however, it is not known whether PrEP implementation has been equitably implemented across all risk groups, particularly groups experiencing high levels of health inequity. A PrEP care continuum (...

Introduction Studies describing the epidemiology of inflammatory bowel disease (IBD) in the UK have been limited by small sample size and low generalisability. We describe temporal trends in the recorded incidence of IBD in UK primary care patients between 2000 and 2018. Methods Cohort study of all individuals contributing to the IQVIA Medical Res...

Background The functioning of a dementia healthcare triad, namely a person living with dementia, their (family) carer and their healthcare professional, is a recent focus of improving the understanding of relationships that are important in person‐centred care. Evidence was reviewed to synthesise qualitative research that included members of the tr...

Background International policy emphasises the importance of gaining a diagnosis and access to better support to for people living with dementia and those providing support. The COGNISANCE programme aligns with key policy objectives to advance dementia diagnosis and post‐diagnostic support across three continents. COGNISANCE comprises an internatio...

Objectives To pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents. Design Pilot cluster randomised controlled trial. Setting 14 NHs (7 intervention, 7 control) in London and West Yorkshire. Participants NH residents, their family care...

Topic Visual impairment (VI) and cognitive impairment (CIM) are prevalent age-related conditions that impose substantial burden on the society. While the bidirectional association of VI and CIM has been hypothesized, findings have been equivocal. Hence, we conduct a systematic review and meta-analysis to examine the bidirectional relationship betwe...

Aims To synthesize the qualitative evidence of the views and experiences of people living with dementia, family carers, and practitioners on practice related to nutrition and hydration of people living with dementia who are nearing end of life. Design Systematic review and narrative synthesis of qualitative studies. Data sources MEDLINE, Embase,...

Background Effective use of contraception can reduce numbers of unintended pregnancies, but misunderstandings and concerns about contraception abound. Increasingly, women seek health-care information online. Objectives To develop an interactive website to aid informed choice of contraceptive method, including long-acting reversible contraception (...

Aims The UK incidence of vitamin D prescribing in children has increased by 26-fold in recent years. Public Health England recommends that children over 1 year take a daily vitamin D supplement. But the availability of over 200 different vitamin D products can be confusing for parents and clinicians. Our study aimed to assess the usage of licensed...

Objectives: To explore the views of commissioners, service development leads, service managers and senior staff in selected dementia services on increasing the role of primary care in postdiagnostic support for people with dementia. Design: Qualitative semi-structured telephone interviews and a focus group. Setting: Participants were drawn fro...

Objectives: Concentrating post-diagnostic dementia care in primary care may lead to better and more cost-effective care closer to home. We aimed to assess which intervention components and contextual factors may contribute to the successful delivery and implementation of primary care-led post-diagnostic dementia care. Methods: Mixed-methods syst...

Background There have been reports that lung cancer in non-smokers (LCINS) is increasing in the UK but it is unclear whether this simply reflects fewer people smoking cigarettes or changing environmental risk factors such as increased emissions from domestic combustion. We examined UK-wide sociodemographic trends in the incidence of LCINS. Methods...

Aim: To evaluate the type (licensed vs unlicensed) and cost of preparations used to fulfil vitamin D prescriptions in England over time, and to compare measured vitamin D content of selected vitamin D preparations against labelled claim. Methods: Retrospective analysis of vitamin D prescription data in primary care in England (2008-2018). Labora...

Background Epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic. Methods Cohort study of 179 UK care homes with 9,339 residents and 11,604 staff.We used manager-reported daily tallie...

The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn...

Introduction: There are reports that lung cancer in non-smokers (LCINS) is increasing in the United Kingdom (UK) and other high-income countries but evidence from large-scale cohort studies to support this claim is limited. Material and methods: Using The Health Improvement Network (THIN) IQVIA™ Medical Research Data, we identified a cohort of 3...

Objectives We describe temporal trends in the recorded incidence of inflammatory bowel disease (IBD) in UK primary care patients between 2000 and 2018. Design A cohort study. Setting The IQVIA Medical Research data (IMRD) primary care database. Participants All individuals registered with general practices contributing to IMRD during the period...

Background: Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV. Methods: We conducted a systematic search for randomised controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive'...

Purpose Post-diagnostic dementia care is often fragmented in the United Kingdom, with great variation in provision. Recent policies suggest moving towards better community-based care for dementia; however, little is known on how this care is delivered. This study aimed to map the post-diagnostic dementia support provided in England a decade after t...

Objective Improving use of effective contraception to prevent unintended pregnancy is a global priority, but misperceptions and concerns about contraception are common. Our objective was to evaluate an interactive website to aid informed choice of contraception. Methods The Contraception Choices website is an interactive digital intervention which...

Objective The objective of this study was to explore young people’s perspectives barriers to chlamydia testing in general practice and potential intervention functions and implementation strategies to overcome identified barriers, using a meta-theoretical framework (the Behaviour Change Wheel (BCW)). Methods Twenty-eight semistructured individual...

Background Global policy recommendations suggest a task-shifted model of post-diagnostic dementia care, moving towards primary and community-based care. It is unclear how this may best be delivered. Aim To assess the effectiveness and cost-effectiveness of primary care-based models of post-diagnostic dementia care. Design and setting A systematic...

Overcoming barriers to a diagnosis of dementia: can we do it? - Volume 32 Issue 5 - Marie Poole, Jane Wilcock, Greta Rait, Henry Brodaty, Louise Robinson

Objective: We examined the association between frailty and disability in rural community-dwelling older adults in Kegalle district of Sri Lanka. Design: A population-based cross-sectional study. Participants: A total of 746 community-dwelling adults aged ≥60 years. Primary and secondary outcome measures: Frailty was assessed using the Fried phen...

Background: Many qualitative studies report the post-diagnostic care experiences of carers and people living with dementia; however, this is not often accompanied by opportunities to hear the corresponding views of their health care professionals and how this triadic relationship functions. The aim of this review was to identify and thematically s...

Background: Nursing home residents are often frail and most have complex healthcare needs. Hospitalisation is distressing to the person, their family and nursing home staff and costly for health services. Early detection of changes in residents’ health may reduce admissions. Our aim was to pilot a complex intervention with implementation support to...

Objective To examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016. Design Population-based cohort study. Setting UK general practice health records from The Health Improvement Network. Participants Children aged 0 to 17 years who were registered with...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the outcome of enteral tube feeding for people with severe dementia who develop problems with eating and swallowing or whose intake of food and fluid is reduced due to progression of the dementia.

Background People living with dementia often face eating and drinking difficulties as life is ending. Family and friends find this emotionally challenging and professionals also struggle to provide information and support. The aim of this systematic review was to 1) explore the views of people with dementia and those involved in supporting eating a...

Background: Caring for someone with dementia can be physically and emotionally difficult. Acting as a caregiver can make it difficult to access sources of support, particularly in the later stages of dementia. This paper reports the development and presents the targets (subject areas) and components of a prototype website to support family caregiv...

Purpose The objective of this study was to estimate the cross-sectional association of frailty status with overall and domain-specific quality of life (QoL) in rural community-dwelling older adults in Kegalle district of Sri Lanka. Methods A population-based cross-sectional study was conducted with 746 community-dwelling older adults aged ≥ 60 yea...

Objectives: Family carers towards the end of life face a range of difficult challenges and have high levels of support needs. The aim of this study was to explore the challenges carers of people with dementia face towards the end of life and the support needs which could be addressed by online support. Methods: Qualitative study using semi-structur...

Objectives We aimed to critically evaluate decision aids developed for practitioners and caregivers when providing care for someone with dementia or for use by people with dementia themselves. Decision aids may be videos, booklets, or web-based tools that explicitly state the decision, provide information about the decision, and summarize options a...

Through record linkage, we describe the causes of death among persons with diagnosis of hepatitis C virus (HCV) in England. Persons ≥1 year with anti‐HCV/HCV‐PCR tests reported to PHE sentinel surveillance during 2002‐2016 were linked to death registrations from the Office for National Statistics during 2008‐2016. We found that 8.6% of the 204 265...

Background HIV and other sexually transmitted infections (STIs) do not operate in isolation, particularly as people with risk-taking sexual behaviour may be co-infected. In this complex landscape, policy makers are limited by resource constraints while trying to find optimal coverage solutions. Disease modelling could help in this context. We aim t...

Background Young gay, lesbian, bisexual, transgender, and other sexuality/gender minority identities (LGBT+) exhibit poor sexual health outcomes (e.g., higher STI/HIV rates). In the UK, there is currently an effort to shift high-volume, low-cost testing (i.e., asymptomatic STI testing) away from expensive specialist settings and into primary care....

Background: There are a range of symptoms and challenges at the end of life which someone with dementia and their family may face. Despite attempts to increase advance care planning, many people with dementia reach the end of life without a plan. This means decisions are often left to family caregivers. Aim: The aims of this study were 1) Explore w...

Background: Many people with dementia do not have an advance care plan, decisions regarding their care and treatment are often left to their families. There is limited work exploring the views of people with dementia about end of life and what factors they would like their family to consider when making decisions. Aim: The aim of this study was to...