ObjectivesTo identify: (i) risk of cardiovascular disease (CVD) in homeless versus housed individuals and (ii) interventions for CVD in homeless populations.MethodsWe conducted a systematic literature review in EMBASE until December 2018 using a search strategy for observational and interventional studies without restriction regarding languages or countries. Meta-analyses were conducted, where appropriate and possible. Outcome measures were all-cause and CVD mortality, and morbidity.ResultsOur search identified 17 articles (6 case-control, 11 cohort) concerning risk of CVD and none regarding specific interventions. Nine were included to perform a meta-analysis. The majority (13/17, 76.4%) were high quality and all were based in Europe or North America, including 765 459 individuals, of whom 32 721 were homeless. 12/17 studies were pre-2011. Homeless individuals were more likely to have CVD than non-homeless individuals (pooled OR 2.96; 95% CI 2.80 to 3.13; p<0.0001; heterogeneity p<0.0001; I2=99.1%) and had increased CVD mortality (age-standardised mortality ratio range: 2.6–6.4). Compared with non-homeless individuals, hypertension was more likely in homeless people (pooled OR 1.38–1.75, p=0.0070; heterogeneity p=0.935; I2=0.0%).ConclusionsHomeless people have an approximately three times greater risk of CVD and an increased CVD mortality. However, there are no studies of specific pathways/interventions for CVD in this population. Future research should consider design and evaluation of tailored interventions or integrating CVD into existing interventions.

ObjectiveTo assess global health (GH) training in all postgraduate medical education in the UK.DesignMixed methodology: scoping review and curricular content analysis using two GH competency frameworks.Setting and participantsA scoping review (until December 2017) was used to develop a framework of GH competencies for doctors. National postgraduate medical training curricula were analysed against this and a prior framework for GH competencies. The number of core competencies addressed and/or appearing in each programme was recorded.OutcomesThe scoping review identified eight relevant publications. A 16-competency framework was developed and, with a prior 5-competency framework, used to analyse each of 71 postgraduate medical curricula. Curricula were examined by a team of researchers and relevant learning outcomes were coded as one of the 5 or 16 core competencies. The number of core competencies in each programme was recorded.ResultsUsing the 5-competency and 16-competency frameworks, 23 and 20, respectively, out of 71 programmes contained no global health competencies, most notably the Foundation Programme (equivalent to internship), a compulsory programme for UK medical graduates. Of a possible 16 competencies, the mean number across all 71 programmes was 1.73 (95% CI 1.42 to 2.04) and the highest number were in paediatrics and infectious diseases, each with five competencies. Of the 16 core competencies, global burden of disease and socioeconomic determinants of health were the two most cited with 47 and 35 citations, respectively. 8/16 competencies were not cited in any curriculum.ConclusionsEquity of care and the challenges of practising in an increasingly globalised world necessitate GH competencies for all doctors. Across the whole of postgraduate training, the majority of UK doctors are receiving minimal or no training in GH. Our GH competency framework can be used to map and plan integration across postgraduate programmes.

Background Cardiovascular disease causes excess mortality and morbidity in socially excluded (inclusion health) populations. However, no specific guidelines exist for the treatment of cardiovascular disease in these individuals, including homeless populations. We aimed to better understand the disease burden and to identify evidence-based interventions in this setting by reviewing studies examining targeted interventions and prevalence of cardiovascular disease in homeless individuals.Methods In this systematic review, we searched Embase for observational and interventional studies of cardiovascular disease in homeless populations published on or before Dec 19, 2018, using the keywords "heart diseases", "adrenergic beta-antagonists", "cardiotonic agents", "cardiovascular diseases", "cardio-renal syndrome", "hypertension" and "homeless [population]". Two independent reviewers selected eligible articles and extracted relevant data, and used the Newcastle-Ottawa Scale to grade the quality of studies. The main outcome, assessed by a random-effects metaanalysis, was prevalence of cardiovascular disease (International Classification of Diseases-10 definition).

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Background: Prior studies report that most published medical education research is unfunded. We sought to determine the extent and sources of funding for medical education research articles published in leading journals, and how these have changed in the last two decades.Methods: All research articles published in Academic Medicine, Advances in Health Sciences