People with neuroendocrine neoplasms (NENs) face a multitude of challenges, including delayed diagnosis, low awareness of the cancer among healthcare professionals and limited access to multidisciplinary care and expert centres. We have developed the first patient care pathway for people living with NENs in England to guide disease management and help overcome these barriers. The pathway was developed in two phases. First, a pragmatic review of the literature was conducted, which was used to develop a draft patient care pathway. Second, the draft pathway was then updated following semi-structured interviews with carefully selected expert stakeholders. After each phase, the pathway was discussed among a multidisciplinary, expert advisory group (which comprised the authors and the Deputy Chief Operating Officer, West Suffolk NHS Foundation Trust), who reached a consensus on the ideal care pathway. This article presents the outputs of this research. The pathway identified key barriers to care and highlighted how these may be addressed, with many of the findings relevant to the rest of the UK and international audiences. NENs are increasing in incidence and prevalence in England, compounding pre-existing inequities in diagnosis and disease management. Effective integration of this pathway within NHS England will help achieve optimal, equitable care provision for all people with NENs, and should be feasible within the existing expert multidisciplinary teams across the country.

暂无摘要。

This study investigated the five-year (2016−2020) trend in physical activity adherence rate (PAR)—before and after the onset of the COVID-19 pandemic—and its association with socioeconomic status and community environment among Korean adults. Data were analyzed from the Korea Community Health Survey 2016−2020 concerning adults (19−65 years old) living in seven metropolitan municipalities of South Korea (N = 190,761). The independent variables were socioeconomic status (household income and educational attainment) and community environment (density of physical activity facilities and social cohesion), and the dependent variable was the PAR, as measured by the International Physical Activity Questionnaire-Short Form, a recall-based subjective survey. Multilevel logistic regression models with age, sex, and body mass index as covariates were applied. The results showed that the PAR increased from 37.26% (2016) to 40.84% (2019), during the pre-COVID-19 pandemic, but it sharply decreased to 31.59% (2020) during the COVID-19 confinement (trend p < 0.001); PAR disparities were observed following socioeconomic status, as indicated by household income (trend p < 0.001) and educational attainment (trend p < 0.001). Furthermore, significant moderation effects were observed from socioeconomic status and community environment, but the direction of the effects varied by indicator and COVID-19-related confinement period. Lower educational attainment and higher income were associated with a greater decrease in PAR during the pandemic. This study shows that PAR substantively decreased in South Korea during the COVID-19 pandemic, although it had shown a steady increase through 2019. In addition, PAR disparities by socioeconomic status were found, and socioeconomic status and community environment had distinct influences on PAR trends, depending on their indicators and pre- and post-pandemic periods. Lower educational attainment is associated with greater decreases in PAR during the pandemic, suggesting the necessity for a public campaign to maintain a physically active lifestyle during such social disaster.