COVID-19 led to significant economic and psychosocial impacts on individuals and their local communities. This research aimed to investigate the psychosocial impacts of the COVID-19 pandemic on a diverse range of individuals living in coastal areas in East Sussex, UK, including adverse, unexpected and positive outcomes.

This cross-sectional qualitative study used semistructured interviews conducted remotely between December 2020 and March 2021, referred to as the third lockdown. Interviews were recorded and transcribed. Thematic analysis was used to identify, describe, and analyse themes and patterns within the data.

Purposive sampling was used to recruit 25 participants living in East Sussex, to include a range of ages (above 18 years), genders, race/ethnicities, identities (eg, lesbian, gay, bisexual, trans or intersex) and social backgrounds.

The pandemic was described as a significant life-changing event, with people saying their plans had changed ‘overnight’ and that their life was ‘on hold’ or it had lost its ‘infrastructure’ during the pandemic. Immediate changes to social lives, education, future plans, work, and housing were evident. These changes were felt particularly by those shielding (due to underlying health conditions) and people placed in emergency accommodation. Significant areas of impact were around family, friends, leisure, mental health, health-related behaviours, and employment. Some participants reflected on positive impacts around an increased sense of well-being or the restrictions affording time and flexibility to re-engage with their families. Adverse impacts around reduced friendship groups and the disruption to family life were often mitigated by developing strategies that helped adapt to new situations.

Residents of coastal areas in East Sussex were impacted widely and differentially. Both positive and challenging impacts related to the COVID-19 pandemic were experienced unequally, potentially exacerbating health inequalities in coastal communities who were already at risk. Long-term strategies should consider the vulnerabilities of people living in coastal areas in planning for future health crises.

Gambling is of public health importance due to the potential impacts of gambling on individuals and their communities.

This review draws on evidence to address: ‘What is known about gambling in lesbian, gay, bisexual, trans and queer+ (LGBTQ+) communities?’ including (i) the prevalence of gambling harm; (ii) the lived experience of gambling harms; (iii) the interventions and service barriers and (iv) the risk and protective factors against gambling harms.

The identified peer-reviewed and grey literature papers were screened against inclusion and exclusion criteria by two reviewers prior to extracting data. Eligibility for inclusion was assessed via the Critical Appraisal Skills Programme (CASP) framework and a Weight of Evidence approach.

PubMed, Web of Science, ProQuest, Google Scholar and Cochrane were searched for peer reviewed and grey literature published from June 2000 to June 2023.

Data extraction tables were developed to include the characteristics, methods, sample and key findings for each study.

19 papers were included, which showed mixed prevalence of problems with gambling among lesbian, gay and bisexual populations. There is more consistent evidence that trans and gender diverse people experience higher levels of problems with gambling compared with cisgender (not trans) people. Limited research focused on the lived experience or the wider impact of gambling harm among LGBTQ+communities. Risk factors for gambling harm included minority stress, societal stigma, discrimination and isolation. Protective factors against gambling harm included higher levels of support, positive social interaction and mainstream community connectedness. No studies were identified with gambling interventions specific to LGBTQ+people. General health service barriers included professionals’ use of pathologising language or a lack of cultural competency and education around LGBTQ+issues.

Research on LGBTQ+ gambling harm remains distinctly limited. Further, population-based surveys as well as in-depth qualitative research are needed to develop a comprehensive understanding of gambling in LGBTQ+communities. Research should be undertaken in collaboration with LGBTQ+peers. A better understanding of gambling could inform a whole systems approach with targeted interventions to protect against gambling harm and to promote greater health equity. Open Science Framework registration number (http://osf.io/jf85y/).

Rare diseases (RD) are collectively common and often genetic. Families value and can benefit from precise molecular diagnoses. Prolonged diagnostic odysseys exacerbate the burden of RD on patients, families and the healthcare system. Genome sequencing (GS) is a near-comprehensive test for genetic RD, but existing care models—where consultation with a medical geneticist is a prerequisite for testing—predate GS and may limit access or delay diagnosis. Evidence is needed to guide the optimal positioning of GS in care pathways. While initiating GS prior to geneticist consultation has been trialled in acute care settings, there are no data to inform the utility of this approach in outpatient care, where most patients with RD seek genetics services. We aim to evaluate the diagnostic yield, time to diagnosis, clinical and personal utility and incremental cost-effectiveness of GS initiated at the time of referral triage (pre-geneticist evaluation) compared with standard of care.

200 paediatric patients referred to one of two large genetics centres in Ontario, Canada, for suspected genetic RD will be randomised into a 1:1 ratio to the intervention (GS first) or standard of care (geneticist first) arm. An unblinded, permuted block randomisation design will be used, stratified within each recruitment site by phenotype and prior genetic testing. The primary outcome measure is time to genetic diagnosis or to cessation of active follow-up. Survival analysis will be used to analyse time-to-event data. Additional measures will include patient-reported and family-reported measures of satisfaction, understanding and perceived test utility, clinician-reported measures of perceived test utility and management impact, and healthcare system utilisation and costs.

This study was approved by Clinical Trials Ontario. Results will be disseminated, at minimum, via peer-reviewed journals, professional conferences and internal reports to funding bodies. Efforts will be made to share aggregated study results with participants and their families.

NCT06935019.