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Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients’ data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts. [ABSTRACT FROM AUTHOR]

Background and Method: There is an absence of research on the prevalence of bereavement during early childhood and the relationship between childhood bereavement and socioeconomic status (SES) and this poses a challenge in both understanding and supporting children's bereavement experiences. Using longitudinal data from the Growing Up in Scotland study, which tracks the lives of three nationally representative cohorts of children, this paper aimed to address these gaps in research. It specifically drew on data from Birth Cohort 1 to document the recorded bereavements of 2,815 children who completed all 8 sweeps of data collection, from age 10 months to 10 years. Findings: The study found that 50.8% of all children are bereaved of a parent, sibling, grandparent or other close family member by age 8 and this rises to 62% by age 10. The most common death experienced was that of a grandparent or other close relative. The study also found that children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households. Discussion and Conclusion: Given the prevalence of childhood bereavement and its relationship with disadvantage, this paper argues that there is an important need to understand bereavement as a universal issue that is affected by the social conditions in which a child becomes bereaved, as well as an individual experience potentially requiring specialist support. This paper thus seeks to position childhood bereavement more firmly within the public health approach to palliative and bereavement care discourse and contends that doing so provides a unique and comprehensive opportunity to better understand and holistically respond to the experience of bereavement during childhood. [ABSTRACT FROM AUTHOR]

Childhood animal cruelty (CAC) is a risk for later interpersonal violence and a red flag for other forms of violence in the household, yet very few studies have spoken to children directly about their cruelty to animals. Animal Guardians (AG) is a humane education program run by the Scottish SPCA for children of age 5 to 12 years who have been cruel to animals or deemed at-risk. This research investigated how children referred to AG spoke about their experiences of animal cruelty and factors surrounding it. Research consent was obtained for 10 children (average age = 8.8 years, n = 9 males), referred concerning cruel/at-risk behavior toward their pets. The interview schedule combined techniques such as crafts, vignettes, open questions, and standardized measures. Interviews were qualitatively analyzed using content analysis and interpretative phenomenological analysis (IPA). Content analysis suggested that referred children (a) tended to have small attachment networks which often included pets, (b) tended to interpret ambiguous situations predominately negatively, (c) tended to like animals and see them as sentient, and (d) struggled admitting to cruelty. Three main superordinate themes emerged from the IPA: (a) Bonding to animals, (b) Exposure to/normalization of violence, and (c) Signs of emotional issues/trauma. Children who were referred for animal cruelty toward their pets were from vulnerable backgrounds, often had complex backdrops to their at-risk or cruel behavior, and sometimes had trouble regulating their emotions and behaviors. Programs hoping to address CAC should be aware of these complex emotional, psychological, and behavioral factors, tailoring interventions accordingly. [ABSTRACT FROM AUTHOR]

Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive care units were collected to understand healthcare staff experiences relating to early mobilisation in mechanical ventilation. Data included observations of mobilisation activities, individual staff interviews and two focus groups with multidisciplinary staff. Managing Risks emerged as the core category and was theorised using the concept of risk. The middle-range theory developed in this study suggests that the process of early mobilisation starts by staff defining patient status and includes a process of negotiating patient safety, which in turn enables performing accountable mobilisation within the dynamic context of an intensive care unit setting. [ABSTRACT FROM AUTHOR]

Background: The UK 5-year antimicrobial resistance (AMR) National Action Plan highlights the need to prevent community infections through education of children. Activities around infection prevention (IP) and antibiotics were piloted by UK youth groups in 2016–2018, prompting Public Health England (PHE) to develop a standardised programme. The aim of the study was to develop and pilot an educational programme on IP and antibiotics for use by community youth groups in the UK. Methods: A working group, including youth group volunteers interested in IP and AMR, agreed on the programme content through consensus, informed by the Capability, Opportunity, Motivation, Behaviour model (COM-B). The Antibiotic Guardian Youth Badge (AGYB) included learning through interactive e-Bug activities on IP and prudent antibiotic use, action setting through Antibiotic Guardian pledges and consolidation through poster development. The programme was piloted and evaluated with conveniently recruited youth groups in 2019, including quantitative and qualitative questionnaire feedback from community leaders and children. Results: Fourteen youth group leaders and 232 children from uniformed Girlguiding/Scout groups in England and Scotland participated in the pilot evaluation, as well as two primary schools. Leaders reported alignment to the themes of their youth organisation, but struggled to teach antibiotics and antibiotic resistance. Children reported enjoyment and intentions to improve hygiene behaviour. Conclusion: Community youth groups are a suitable setting for IP and antibiotics education. The AGYB was officially launched in March 2020 and promoted for use with home-schooling children and remote youth group meetings to educate about IP during the coronavirus disease 2019 (COVID-19) pandemic. [ABSTRACT FROM AUTHOR]

While a number of previous studies have compared sexual homicides to nonlethal sexual offenses, there have been few studies comparing sexual and nonsexual homicides. This study examines whether sexual homicide offenders differ from nonsexual homicide offenders in Scotland regarding characteristics of the offender, the victim, and the homicide incident. Unlike previous studies, only homicides committed by males against females were examined. Data from a national police database were used to compare 89 male sexual homicide offenders who killed adult females with 306 male nonsexual homicide offenders who had also killed adult females using bivariate and multivariate (logistic regression) analyses. The findings revealed not only some similarities between the two groups, particularly regarding some victim variables, but also significant bivariate and multivariate differences. Sexual homicides appeared to be associated with indicators of instrumentality and sexual deviance. We conclude that sexual homicide offenders might be considered a distinct group of homicide offenders, more similar to sexual offenders than to other homicide offenders. [ABSTRACT FROM AUTHOR]

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients' logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components. [ABSTRACT FROM AUTHOR]

Objective: Attention control comparisons in trials of stroke rehabilitation require care to minimize the risk of comparison choice bias. We compared the similarities and differences in SLT and social support control interventions for people with aphasia. Data sources: Trial data from the 2016 Cochrane systematic review of SLT for aphasia after stroke Methods: Direct and indirect comparisons between SLT, social support and no therapy controls. We double-data extracted intervention details using the template for intervention description and replication. Standardized mean differences and risk ratios (95% confidence intervals (CIs)) were calculated. Results: Seven trials compared SLT with social support (n = 447). Interventions were matched in format, frequency, intensity, duration and dose. Procedures and materials were often shared across interventions. Social support providers received specialist training and support. Targeted language rehabilitation was only described in therapy interventions. Higher drop-out (P = 0.005, odds ratio (OR) 0.51, 95% CI 0.32-0.81) and non-adherence to social support interventions (P < 0.00001, OR 0.18, 95% CI 0.09-0.37) indicated an imbalance in completion rates increasing the risk of control comparison bias. Conclusion: Distinctions between social support and therapy interventions were eroded. Theoretically based language rehabilitation was the remaining difference in therapy interventions. Social support is an important adjunct to formal language rehabilitation. Therapists should continue to enable those close to the person with aphasia to provide tailored communication support, functional language stimulation and opportunities to apply rehabilitation gains. Systematic group differences in completion rates is a design-related risk of bias in outcomes observed. [ABSTRACT FROM AUTHOR]

Violence and aggression toward nurses are global concerns. Despite repeated research on causal factors and widespread zero tolerance campaigns, rates of violence and aggression have not declined. Violence and aggression toward nurses can negatively affect their health and ultimately patient care. Media reporting of violence and aggression toward nurses might shape people's perceptions of the profession, perhaps impeding nurse recruitment and retention efforts in the face of global nursing shortages. The purpose of this study was to determine how print media in Scotland depicted reports of violence and aggression toward nurses. We used qualitative thematic analysis of newspaper articles and online news reporting of incidents of violence and aggression toward nurses between June 1, 2006 and May 31, 2016. Searches of Nexis and British Broadcasting Corporation (BBC) News Online databases returned 92 relevant newspaper articles. Standards for reporting qualitative research informed presentation of results. Key themes included blame (of perpetrator or senior management), helplessness (of nurses specifically or victimization), culture (social or organizational), and prevention and reduction measures. We concluded that media coverage of violence and aggression was overwhelmingly negative and reductionist. Normalization of violence and aggression was an accepted and acceptable part of the nursing role. We conclude with recommendations for policy and call for nurse leaders to challenge this culture of acceptability, especially to support recruitment and retention of nursing staff. [ABSTRACT FROM AUTHOR]

Background: Chronic migraine is common but there is limited knowledge on associated comorbidities. Objectives: To examine mental and physical comorbidities in chronic migraine and the influence of socioeconomic status in a large, nationally representative dataset. Design: Analysis of cross-sectional primary healthcare data from 1,468,404 adults in Scotland. Chronic migraine, 31 other physical conditions, and seven mental health conditions we examined. Prevalence rates were standardized by age groups, sex, and socioeconomic deprivation, and adjusted odds ratio (aOR) and 95% confidence intervals (CI) calculated for those with chronic migraine compared with those without. Results: Chronic migraine patients had more conditions, with the biggest difference found for five or more conditions (chronic migraine 11.7% vs. controls 4.9%; aOR 3.00; 95% CI 2.78-3.22). Twenty-five of the 31 physical conditions were significantly more prevalent in the chronic migraine group. The biggest difference was for chronic pain (aOR 4.33; 95% CI 4.12-4.55). For mental health conditions, the biggest differences were for anxiety (aOR 2.95; 95% CI 2.76-31.5) and depression (aOR 2.94; 95% CI 2.81-3.08). Increasing deprivation was associated with more severe and complex comorbidity (five or more conditions), and with more combined mental and physical comorbidity in the chronic migraine group. Conclusions: In a large nationally representative sample in primary care, comorbidity was most common in those with chronic migraine compared with standardized controls, and this was exacerbated by living in areas of higher deprivation. [ABSTRACT FROM AUTHOR]

Introduction Many people require eye drops administered daily, yet many do not instil them as prescribed. This can be due to physical difficulty managing the delivery device yet little research has focused on this. Methods Participants from ophthalmology and rheumatology clinics at hospitals within two regions in Scotland (n = 206) were recruited and asked to complete a questionnaire about eye drop use and difficulties they experienced. Binary logistic regression was used to assess the independent relationship between key explanatory variables and the major outcome variable, which was difficulty in administration. Findings It was found that 62% of people who attended a rheumatoid arthritis (RA) clinic reported difficulty instilling eye drops and that they were four and a half times more likely to have difficulty than people who attended an ophthalmology clinic. A greater proportion of women and younger people attended the RA clinics than the ophthalmology clinics; however, the reasons given for having difficulty and the level of adherence did not differ between the two groups. Conclusion The number of people newly diagnosed with RA is increasing worldwide, particularly among women, and many need eye drops. Experiencing difficulty instilling them is therefore a significant international health issue. [ABSTRACT FROM AUTHOR]

There are 34,492 registered with severe or partial sight impairment in Scotland, with 75% aged over 65. With the ageing population, the proportion of those who will develop sight impairing disease will only increase. Therefore, early presentation and treatment are important. Recently, new sight saving treatments and community screening programmes for sight impairing disease have been introduced with concomitant advance in ophthalmic digital imaging.In order to assess older patients’ attendance of free eye tests, awareness of different sight impairing disease and treatments. We describe the first electronic visual healthcare system within any global public healthcare service – ‘The Scottish Eyecare Integration Project’ – and potential improvements along with the General Ophthalmic Service (GOS) contract.A 14-point questionnaire was devised to assess 100 patients’ awareness of free annual eye tests, and the three most common causes and treatment for severe sight impairment: age-related macular degeneration (ARMD), glaucoma, and diabetic retinopathy (DR).In all, 82% of patients were aware of the free annual eye tests; however, 31% had not attended community optometrist for over 2 years. There was good awareness of glaucoma (77%), but poor understanding of glaucoma treatment (24%), ARMD (43%) and ARMD treatment (17%). Only 39% of patients had heard of free annual DR screening, but there was a significant difference between the two groups (p = .0263), with increased awareness in the middle-aged group.More education is required to encourage the older population to use existing and new eye services. The Scottish Eyecare Integration Project along with the GOS contract is a significant step of change towards meeting the demand for a multidisciplinary approach, bringing ophthalmic care closer to home and into the community. [ABSTRACT FROM AUTHOR]

Introduction: There is little discussion in the United Kingdom occupational therapy literature surrounding the topic of older people and alcohol, despite the growing prevalence of alcohol-related health problems in older adults resulting from an ageing population and changing patterns of consumption. Occupational therapists in physical health care settings are likely to work with older people whose drinking pattern may not be alcohol dependent, but may put their physical or psychological health at risk. Method: A survey methodology was employed using open and closed questions, recruiting occupational therapists (band 5 to 9) (n=122) working with older people (65þ years) in physical health care settings across all, except one, National Health Service Regional Health Boards in Scotland. Results: Responses highlight gaps in occupational therapists' knowledge around alternative 'safe limits' of alcohol intake for older people. Belief in professional role was evident, but the perception was that this was not supported by undergraduate education. Occupation focused theory and assessment were not prioritized when considering alcohol in the older adult. Conclusion: This study has highlighted a need to develop pre- and post-qualification education for occupational therapists, to enhance understanding of theory, assessment and knowledge of alcohol with older adults in physical health care settings. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to correlate the clinical findings in the Edinburgh Vein Study with the results of duplex scanning of the deep and superficial venous systems. Methods: An age-stratified random sample of 1566 people (699 men and 867 women) aged 16-64 were selected from computerized age-sex registers of participating practices (twelve general practices with catchment areas geographically and socioeconomically distributed throughout Edinburgh). Screening included clinical examination, photography and duplex ultrasonography of the superficial veins and the deep veins down to popliteal level. Telangiectasia and varicose veins were graded 1-3 according to severity. Results: Since there was good agreement between the duplex findings of the right versus left legs, the current analyses are based on 1092 subjects (486men and 606 women) with complete duplex scan data in their left legs. There was no significant trend of increasing incompetence in either the deep veins only (P = 0.214) or in the combined deep and superficial veins (P = 0.111) with increasing severity of the telangiectasia. There was a statistically significant trend for increasing incompetence in (a) the superficial veins (P = 0.006) and (b) either the superficial or deep veins (P < 0.001) to be associated with advancing grade of telangiectasia. When stratified by gender, significant trends were maintained for male superficial vein incompetence and for either superficial or deep incompetence in both genders. Examination of incompetence in individual venous segments showed that increasing severity of telangiectasia was significantly associated with an increasing proportion of reflux in the upper and lower great saphenous and femoral vein segments. There was no significant association between small saphenous incompetence and increasing grade of telangiectasia. Conclusion: There is a significant, but not wholly consistent, association between grade of telangiectasia and refiux in both the deep and superficial systems. This association does not apply to the small saphenous system. [ABSTRACT FROM AUTHOR]

Preoperative psychological distress has been reported to predict poor outcome and patient dissatisfaction after total hip arthroplasty (THA). The purpose of this study was to investigate if preoperative psychological distress was associated with adverse functional outcome after primary THR. We analysed the database of a prospective multi-centre study undertaken between January 1999 and January 2002. We recorded the Oxford Hip Score (OHS) and SF36 score preoperatively and up to five years after surgery for 1055 patients. We dichotomised the patients into the mentally distressed (Mental Health Scale score -- MHS ≤56) and the not mentally distressed (MHS >56) groups based on their pre-operative MHS of the SF36. 762 (72.22%). Patients (595 not distressed and 167 distressed) were followed up at 5 years. Both pre and post-operative OHS and SF-36 scores were significantly worse in the distressed group (both p<0.001). However, both groups experienced statistically significant improvement in OHS and MHS, which was maximal at 1 year after surgery and was maintained over the follow up (p=0.00). There was a substantial improvement in mental distress in patients who reported mental distress prior to surgery. The results suggest that pre-operative psychological distress did not adversely compromise functional outcome gain after THA. Despite having worse absolute values both pre and post operatively, patients with mental distress did not have any less functional gain from THA as measured by improvement in OHS. [ABSTRACT FROM AUTHOR]