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Complex and enduring mental health problems require greater treatment resources, usually in the form of multidisciplinary support, including providing psychological therapies. This paper reports on an NHS, tertiary-level specialist psychotherapy service offering Psychodynamic therapies with longer-term, exploratory transdiagnostic approaches to support complexity and sustained personality functioning. This paper adopts a naturalistic study design evaluating the effectiveness of Psychodynamic therapy using pre- and post-outcomes across a 10-year period. A total of n = 474 participants self-report pre- and post-outcome measures were used as the marker of effectiveness along with therapist assessments during intake and engagement. The findings showed that Psychodynamic therapy was effective in reducing psychological distress based on service-user self-report and therapist assessments. While intake scores varied by socio-demographic factors, the rate of change across most groups was similar. There were several limitations relating to data quality and completeness which reflect the naturalistic design. Despite the limits of a naturalistic design, this study provides evidence of support for the place of Psychodynamic therapies within NHS mental health care, catering to those with complex and enduring mental health problems. [ABSTRACT FROM AUTHOR]

Since the outbreak of Covid-19 health communicators around the globe have had to reach, urge, and persuade individuals and communities to adopt appropriate health protective behaviors. They have used a mix of communication channels, including outdoor media and public signage which are the focus of this paper. Drawing on a comparative linguistic landscape analysis, this paper critically examined the amount, content, and prominence of Covid-19 signage in Hackney, a London borough severely hit by the first wave of the pandemic. Having analyzed 1288 signs collected between May and July 2020, we found significant differences in Covid-19 signage between deprived and less deprived areas. These differences (e.g., in messaging about staying at home) have created inequalities in access to Covid-19 related health information and guidance. We also explored the changes in Covid-19 signage over time and the tailoring of risk and health messages to minority communities. [ABSTRACT FROM AUTHOR]

The findings presented here derive from a wider study that sought to establish a baseline understanding of mental health and wellbeing among the agricultural community in England and Wales. This paper focuses on selected questions that investigated levels of anxiety and associated stress factors among farm women, a group which has been relatively neglected within previous research on farming mental health in the United Kingdom. A questionnaire survey was widely distributed to members of the agricultural community in England and Wales (n = 15,296) in both paper and online formats. The survey included a number of standardised instruments to assess mental health and wellbeing, including the Generalised Anxiety Disorder-7 scale (GAD-7). Focusing on a sub-sample of female respondents (n = 3487), this paper details the findings from the GAD-7, alongside those from a selection of other questions investigating sources of stress, loneliness and perceived business viability. A significant proportion of female respondents were experiencing anxiety at the time of survey completion, with 23.3% reaching the threshold for clinically relevant anxiety based on their GAD-7 scores (medium or severe anxiety, scores≥10). A further 34.6% were classified as experiencing mild anxiety (scores 5–9) whilst 42.1% were not suffering from anxiety (scores 0–4). Medium/severe anxiety was identified as being associated with a number of stress factors, feelings of loneliness and pessimistic perceptions of farm business viability. There were important age-based differences, with working-aged women identified as more likely to suffer from anxiety, loneliness and certain stressors than older women. The findings reported here indicate concerning levels of anxiety among farming women and this should be seen as a call to action. There are clear associations between anxiety and a range of stressors and, although we cannot ascertain causality, these point to issues that demand attention in efforts to improve mental health within this social group. The factors contributing to anxiety are, however, multiple and complex and farm women may be affected by particular gender-based challenges that have not yet been explicitly explored in relation to mental health. Further research is needed to investigate and understand these issues in greater depth. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic led to an increase in the use of online platforms for Christian worship and emphasised the need for a simple psychometric instrument that is sufficiently general to assess affect responses to a range worship services. This paper reports on the development of the six-item Scale of Perceived Affect Response to Online Worship (SPAROW) during the third UK pandemic lockdown in 2021. The scale items were included in an online survey completed from January to July 2021 by 2,017 Anglicans living in England and 1713 Roman Catholics from the UK or the Republic of Ireland. Exploratory Factor Analysis (principal components extraction and varimax rotation) in the Anglican sample indicated a single-dimensional scale that had excellent internal consistency reliability for those who accessed pre-recorded services (α =.90, n = 1238) and live-streamed services (α =.91, n = 1492). Confirmatory Factor Analysis on the Roman Catholic sample using a Structural Equation Model showed a good fit to a single-dimensional scale. [ABSTRACT FROM AUTHOR]

In this paper, we use a UK case study to explore how the COVID-19 pandemic affected the mental health (emotional, psychological, social wellbeing) of farmers. We outline the drivers of poor farming mental health, the manifold impacts of the pandemic at a time of policy and environmental change, and identify lessons that can be learned to develop resilience in farming communities against future shocks. We undertook a survey answered by 207 farmers across the UK, focusing on drivers of poor mental health and the effect of the COVID-19 pandemic. We also conducted 22 in-depth interviews with individuals in England, Scotland and Wales who provide mental health support to farmers. These explored how and why the COVID-19 pandemic affected the mental health of farmers. These interviews were supplemented by 93 survey responses from a similar group of support providers (UK-wide). We found that the pandemic exacerbated underlying drivers of poor mental health and wellbeing in farming communities. 67% of farmers surveyed reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, and 12% felt more suicidal. The primary drivers of poor mental health identified by farmers during the pandemic included decreased social contact and loneliness, issues with the general public on private land, and moving online for social events. Support providers also highlighted relationship and financial issues, illness, and government inspections as drivers of poor mental health. Some farmers, conversely, outlined positive impacts of the pandemic. The COVID-19 pandemic is just one of many potential stressors associated with poor farming mental health and its impacts are likely to be long-lasting and delayed. Multiple stressors affecting farmers at the same time can create a tipping point. Therefore, there is a need for long-term support and ongoing evaluation of the drivers of poor mental health in farming families. [ABSTRACT FROM AUTHOR]

Children's experience of harm and abuse has a profound impact on their health and well-being. In response, school-based prevention programmes have been developed and delivered by external organisations with the aim of improving children's awareness and understanding of forms of harm and abuse which may affect them, encouraging them to seek help if needed. In September 2020, Relationships Education became statutory within the primary school curriculum in England and this ratification is likely to increase demand for externally delivered classroom-based programmes, which address the broad range of topics to be covered within this field. However, evidence is required to understand the impact and acceptability of such programmes. This paper presents qualitative findings from a larger mixed-methods study. Focus group discussions with 29 children explored their responses to one Healthy Relationships programme delivered to primary school children aged 10 and 11 in England. Analysis focuses specifically on responses to the topics of sexual abuse prevention and help-seeking. Children's widespread support for the programme indicates that topics are relevant and the opportunity to explore these issues is valued. However, for effective programme implementation, schools and parents need to be prepared, and prevention messages should continue to be embedded throughout children's school lives. [ABSTRACT FROM AUTHOR]

There is renewed optimism about the development of policy and practices related to promoting health in prison settings, driven by the epidemiological data which suggests that the health of people in prison remains very poor. In England and Wales, the focus of this paper, independent prison inspections, conducted by Her Majesty's Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. This includes efforts within prisons to promote health and well-being. This paper, using content and thematic analysis, analyses one year (2018) of inspection reports in 38 male prisons. Analysis demonstrates that a 'whole-prison approach' to promoting health and well-being is poorly understood, with only 41% of prisons showing characteristics of this approach. Of the male prisons inspected in 2018, there was good availability of disease prevention activities and screening programmes (88%) and smoking cessation support (94%). The provision of peer support mechanisms, access to condoms and access to health information was highly variable across prisons. The paper makes several conclusions about the state of health promotion in prison and moreover the current criteria adopted by HMIP to assess health and well-being which seems to offer a very narrow biomedical perspective. [ABSTRACT FROM AUTHOR]

A growing number of researchers are trying to provide explanations for continuity and change in drug policy in different contexts. Such research predominantly falls in the pluralist realm of public policy where various actors compete to have their policy proposals accepted. Using a critical framework called Policy Constellations (PC), developed by Stevens and Zampini, this paper attempts to explain reactions of the British Government to Novel Psychoactive Substances (NPS) between 2008 – 2016. Qualitative data comes from in-depth interviews with stakeholders (N = 15), including NGO workers, a former Home Secretary, drugs ministers, governmental advisors, a former senior police officer, former Deputy Drug Coordinator, and a former Advisory Council for the Misuse of Drugs (ACMD) member. Two 'constellations' competed in British NPS policy setting. The PC framework illustrates power imbalances between these competing stakeholders. Abstinence orientated actors (the conservative constellation) enjoyed strategic advantages and media power which allowed them to create a favourable policy setting. These advantages were not enjoyed by the liberal constellation who struggled to access the policy setting and influence policy developments. The prohibitive nature of the policy used to counter NPS can be explained with the domination of actors whose values align with the conservative constellation. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

In the last ten years the use of the internet as a health resource has transformed, and while patients increasingly consult online resources for health decision-making, less is known about how healthcare professionals (HCPs) currently discuss decision-making with internet informed patients (IIPs). In this paper we examine how HCPs perceive IIPs and specifically how bringing online information into appointments can prompt different communicative strategies around decision-making. Ten HCPs with experience working across different healthcare roles, took part in semi-structured interviews and discussed their interactions with IIPs around decision-making. Vignettes based on descriptions of real patients bringing online health information to their HCPs were used to prompt further discussion. The analysis identified two themes in relation to communication: (i) being honest about information sources and (ii) from compliance to coconstruction: improving communication around decision-making. HCPs were overwhelmingly positive toward IIPs and encouraged patients to be transparent about their online searching to understand their motivations, priorities, and concerns. Although compliance remains part of the narrative, HCPs recognized practical ways in which discussing online health information could improve HCP-patient communication around shared decision-making. We discuss the findings in relation to early work on communicative strategies between HCP’s and patients bringing resources to their consultations. We argue that for HCPs the concept of the internet as a provider of health information is no longer seen as inherently damaging or risky. There is growing acceptance of pre-consultation internet searching with the caveat that any information sourced online should inform rather than dictate decision-making with HCPs. [ABSTRACT FROM AUTHOR]

Older carers play a vital role supporting population health and protecting health and social care systems, yet there has been little research on understanding the effect of the pandemic on this group. In this paper, we investigate caring as a factor contributing to mental and self-rated health. We investigate cross-sectional and longitudinal associations between provision of family care and mental health and wellbeing using longitudinal data from 5,149 members of the English Longitudinal Study of Ageing who responded to Wave 9 (2018/2019) and two COVID-19 sub-studies (June/July 2020; November/December 2020). We use logistic or linear regression models depending on outcome measures, controlling for pre-pandemic socioeconomic, demographic, and health-related variables. Before the pandemic, 21% of respondents cared for family or friends. Older people caring for someone inside the household mostly continued to provide care during the pandemic, with more than a quarter reporting an increase in the amount of care provided. Co-resident carers were disproportionately female, older, in the lowest wealth quintile, and more likely to report disability and chronic conditions. Both cross-sectional and longitudinal analyses suggest that, compared to those caring for people living outside the household, co-resident carers were significantly more likely to report poorer mental health and self-rated health. The health of older carers worsened disproportionately in the first year of the pandemic, a period also characterised by disruptions to support and closure of respite services. Support for carers' mental and physical health requires greater policy attention, especially in pandemic conditions. [ABSTRACT FROM AUTHOR]

In England, drug use in young people increased significantly between 2014 and 2017. This upward trend continues despite implementation of drug use policies to reduce supply, possession and manufacture of illicit drugs. Taking the view that drug use is a learnt behaviour, the purpose of this paper is to evaluate whether social learning (SL) factors explain drug use in English adolescents across: a) nine regions b) by age (11 to 15 years) and c) by gender using the Social Structure Social Learning (SSSL) theory as a framework. This study addresses a gap in the literature on English adolescent students by identifying the strongest SL pathway to drug use (imitation, parental reinforcement, attitudes, peer association). Cumulative mediation analyses were carried out on data from the Smoking Drinking Drug Use Survey 2016 (N = 12,051) on adolescents aged 11–15 years across England. The results show that imitation, peer association, attitudes and parental reinforcement mediate drug use at ages 12–14 and for some regions but not for gender. Drug use is a socially learnt behaviour in adolescents students living in England. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

Infants' experience of the early caregiving environment is fundamental to the development of positive social and emotional functioning. The Leeds Infant Mental Health Service was established to provide early intervention to infantsunder two and their caregivers, where there are concerns about the attachment relationship. This paper describes preliminary data to evaluate its effectiveness. Improved parent-infant relationships and parental well-beingare achieved by asmall multidisciplinary workforce through direct therapeutic work with infants and their caregivers and by up-skilling other professionals who are in contact with infants, through specialist training and consultation. Launched in 2012, the service has trained over 2500 professionals.Over 500 reflective case discussions and 200 case consultations have been delivered to practitioners, many of whom work with vulnerable infants. Ascreening tool has been developed to enable health visitors to identify infants at risk of developing poor attachment relationships with their caregivers. Direct therapeutic work has been completed with over 531 families, the majority (71%) before the infant was 6 months old. Caregivers and professionals are positive about the service. The model represents a clinically and cost-effective way to deliver city-wide infant mental health provision. Future research is needed on effectivess, particularly long-term outcomes. [ABSTRACT FROM AUTHOR]

This paper is based on a research study which explores Social Workers' feelings about professionals touching children during statutory child protection visits to clients' homes in one part of a southern English county. The study focussed on Social Worker visits to children aged between two and ten years who were subject to child protection plans following Section 47 enquiries of the Children Act 1989. A convenience sample of ten completed questionnaires recorded the types of touch, which were reported during the last visit made by the social worker. Semi-structured interviews followed with a further ten Social Workers. Analysis of the data revealed that most of the Social Workers in the study did touch children in a range of ways and for a variety of reasons during visits. 'Touch' was a term which some found uncomfortable and this paper considers whether terminology obstructs open reflection on the topic. Practitioners were keen to discuss the subject more amongst their peers in order to share best practice. [ABSTRACT FROM AUTHOR]

Previous research with older gay men has overlooked their concerns about dating. This paper addresses the gap by analysing in-depth interviews conducted with 25 self-identified single gay men over the age of 50, who lived in England. The paper focuses on the research question: “What factors do older, single gay men consider when they contemplate dating?”. Five factors were identified which affected their decisions about whether to date. Because the same factors operated simultaneously to encourage and to discourage them to contemplate dating, feelings of tension and ambivalence were reported by participants. Although some of these issues are similar to the ones older straight people considered, some of the concerns identified in this study were distinctively different for older gay men. The findings can help to make therapists aware that being single among older gay men is not only a personal experience, but is heavily influenced by social ideals and historical development of gay rights. It also can inform therapists of the factors that encourage and discourage older gay men from contemplating dating. This awareness can help therapists with developing effective strategies for working with clients on the topic of relationships. [ABSTRACT FROM PUBLISHER]

This paper reports on a six-year qualitative study of social worker's perspectives on factors influencing decision-making in children and families social work in England. Data collected between 2010 and 2016 reflect frontline practice during a period of substantial change and reform in UK social work. This paper builds on an earlier analysis with data from all three stages of the study capturing the lived experiences of practitioners ranging from student social workers to qualified advanced practitioners in management roles. Data from 9 focus groups comprising 51 participants were analysed using grounded theory. Data analysis generated four representative categories: developing agency in the social work role; troubling emotions; transitions in the development of expertise and the impact of organisational cultures in children and families social work services. An emerging theoretical framework is presented. This identifies the significance of transitions and threshold concepts in the development of the social work professional from the role of students as 'outside players looking in' through to the expertise of qualified practitioners as 'inside players' within organisations. Recognising periods of liminality, transitional learning and uncertainties in developing decision-making expertise may be of significant benefit to social work education and the profession. [ABSTRACT FROM AUTHOR]

This paper explores the psychometric properties of the seven-item Astley-Francis Scale of Attitude toward Theistic Faith among Muslim secondary school students (N = 1,146) in England, surveyed alongside Christian (N = 575) and religiously unaffiliated (N = 361) students, in a sample in which Muslim students comprise the majority. The data demonstrated a satisfactory level of internal consistency reliability among all three groups, although less good among the Muslim students: Muslim (α =.79), Christian (α =.92), and religious unaffiliated (α =.86). The shorter five-item Astley-Francis Scale of Attitude toward Theistic Faith Revised provided a higher level of internal consistency reliability across all three groups: Muslim (α =.85), Christian (α =.94), and religiously unaffiliated (α =.95) and is commended for further use. [ABSTRACT FROM AUTHOR]

The facilitation of children's emotional intelligence (EI) through social and emotional learning (SEL) and wider pastoral support schemes is common practice in schools. Although the benefits of enhanced EI have been widely reported, little is known about its 'dark side': emotional manipulation, or how this may manifest in school settings. Focus group and individual interview data gathered from staff members working across case study schools located in a town in the North West of England inform the points raised in this paper. The article explores the extent to which emotional manipulation takes place in the strategies and forms of support utilised by schools to enhance children's social, emotional and behavioural skills. The ramifications of emotionally manipulative behaviours are discussed and recommendations for future directives are made. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are common amongst people who use alcohol and other drugs, but treatment options are limited. This paper explores how people in residential treatment for alcohol and other drug problems perceived and described 'non-problematic' sleep to provide insights that might inform sleep interventions for this population. Methods: Qualitative interviews were conducted with 28 residents (19 women, 9 men; ages 24–83 years) in two residential drug and alcohol treatment centres in England during 2014/15. Interviews were audio-recorded, transcribed, and coded. Accounts of non-problematic sleep were then analysed inductively. Results: Non-problematic sleep comprised three linked components: i. personal sleep patterns and routines; ii. sleep perceptions; and iii. sleep metacognitions. Some participants reported they slept well; others described their sleep as problematic but improving. Participants believed that sleep improved naturally with residential treatment and abstinence, but perceptions of 'good' sleep varied greatly. Participants used a range of metacognitive strategies (e.g. downgrading the importance of sleep; adapting their sleeping patterns; and focusing on sleep quality alongside sleep quantity) to manage sleep problems and render them non-problematic. Conclusions: Metacognitive strategies that focus on changing perceptions of sleep can potentially inform sleep interventions for people with a history of alcohol and other drug use. [ABSTRACT FROM AUTHOR]

In mental health, communication is thesine qua non, not only for considering a diagnosis, but also for developing a treatment plan. Words, on the one hand, and the relationship between the clinician and the service user, on the other, are two of the main components of mental health and therapeutic treatment. The presence of an interpreter has the potential to have an effect on the dynamics of the mental health or therapeutic encounter. This may pose a series of challenges and opportunities for all three members of the triad. This paper reports on a study conducted with interpreters working with recent migrants, mainly refugees and asylum seekers at two organisations based in the South of England. Two focus-groups with interpreters were conducted. Several differences between interpreting in mental health and interpreting in other settings were noted by the interpreters. Five overarching themes were identified in this study. These were: the role of the interpreter in the mental health encounter, the dynamics within the therapeutic triad, the interpreter-clinician relationship, power and alliances within the room and the personhood of the interpreter. The first two themes are presented within this paper, although the themes are not entirely discrete categorisations. [ABSTRACT FROM PUBLISHER]

A number of current developments in the field potentially provide opportunities for preventative relationship and family interventions to be integrated into primary care. In this context, it is important to understand what family counselling is and how it might differ from family therapy. Thus, this paper investigates how the service of one low-intensity family counselling provider, Relate, is conceptualised and practised by counsellors on the ground. Questions about practice were posed to five focus groups of family counsellors and these were analysed using thematic analysis. The findings suggest that Relate family counselling is seen as ‘family therapy lite’, with a flexible, eclectic and integrative use of concepts and techniques within a systemic framework. Implications of this conceptualisation of family counselling for training, practice and research are discussed. [ABSTRACT FROM PUBLISHER]

Background: A play about dementia care was taken on tour, funded by the Big Lottery through Arts Council England, to six cities. This paper explores its impact, mainly on professional carers. Methods: Mixed methods were applied; semi-structured self-completion questionnaires and subsequent telephone interviews to a stratified sample of respondents. Framework analysis was used, paying particular attention to critical comments. Results: Post-show questionnaires were submitted by 1035 (19%) and 64 people were later interviewed. Audience members expressed heightened awareness of the needs of people with dementia, with greater appreciation of the care process itself and of the challenges faced by professional dementia carers in hospitals and other long-term settings. Conclusions: This production ofInside Out of Mindafforded an effective medium for knowledge transfer. It engaged audiences with key issues – including dignity, identity and loss – and enabled them to reflect on these issues, while encouraging appropriate practical responses. [ABSTRACT FROM AUTHOR]

This paper focuses on the evaluation of the therapeutic use of photocards by prisoners and facilitators in a counselling psychology led European project, based on responses to open-ended questionnaires. It is part of a wider project, involving seven partner organisations in six European countries (England, Finland, Greece, Italy, Malta and Romania), which developed and trialled four different approaches to using photography in the context of counselling in prisons. Of the 51 inmates that participated in the project, 48 (94%) completed the questionnaires; of those, 39 (77%) were available for individual analysis due to prison restrictions in one partner organisation only allowing group data. Of those 39, who returned their completed questionnaires, over 92% found the therapeutic use of photographs either very helpful (56.4%) or helpful (35.9%), and the remaining 7.7% described it as average. From the thematic analysis, main themes emerging regarding inmates’ experiences of working with photocards were that it: facilitates emotional expression and sharing; unlocks memories and reconnects with life outside; fosters insight, reflection and self-growth; breaks the monotony of prison life and, overall aids emotional learning. A thematic analysis of 11 psychological therapists/facilitators’ perspectives showed that the use of photocards: gives clients a voice; provides a safe and collaborative frame and a therapeutic relationship; and, provides a useful icebreaker, helpfully overcoming anxieties of both client and psychotherapist/facilitator. Overall, photocards were considered useful as their projective nature can help facilitate prisoners’ strong need for expression in a context where there are limited opportunities and trust is fragile. [ABSTRACT FROM PUBLISHER]

Objectives:Subjective memory complaints (SMC) are common in older people and previous research has shown an association with mood problems, such as depression and anxiety. SMC form part of the criteria for many definitions of mild cognitive impairment (MCI), but there is controversy over whether they should be included as they may be related more strongly to mood than to objective cognitive impairment. This study aims to clarify the relationship between mood and SMC in people with MCI. Method:This paper reports an analysis of data from the Medical Research Council Cognitive Function and Ageing study. Structured interviews were conducted with community-dwelling older people to assess a range of aspects of cognitive functioning and mood. Data from two time points approximately 24 months apart were used in this analysis. At baseline, participants without dementia or severe cognitive impairment were categorised into three groups according to cognitive status. Mood was investigated by assessing symptoms of anxiety and depression which were defined using a diagnostic algorithm. Associations were tested using logistic regression and chi square analyses. Results:A clear association was shown between SMC and mood, both cross-sectionally and over time. The relationship between our two competing definitions of MCI suggested that mood problems were more strongly related to the presence of SMC than objective cognitive impairment. Conclusion:SMC may be a function of anxiety and depression rather than being related to objective cognitive function. This questions whether SMC should be included in definitions of MCI. [ABSTRACT FROM AUTHOR]

This paper explores the concept of reflection and its changing role in the journey of the student teacher. It presents part of the findings of a year-long investigation into the reflective practice of student teachers during their training year. Specifically, it investigates the reflections of the student teachers’ lessons during the PGCE (Post/Professional Graduate Certificate of Education) year at a higher education institution (HEI) in England. The strengths and weaknesses of the student teachers’ lessons are analysed and how these reflections change as they reach Newly Qualified Teachers (NQT) status. [ABSTRACT FROM PUBLISHER]

Background:Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method:Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results:Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions:This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support. [ABSTRACT FROM AUTHOR]

Objectives. Musculoskeletal (MSK) complaints are prevalent in law enforcement officers (LEOs), but research that examines their risk factors is limited. This study aimed to identify the self-reported MSK complaint prevalence and perceived causes in LEOs. Methods. The Nordic musculoskeletal questionnaire was used to identify the 12-month and 7-day prevalence of MSK 'trouble' (ache, pain, discomfort) for nine body sites. The perceived cause, participant characteristics and occupational role were reported. Body fat percentage was measured using bioelectrical impedance. Results. Complete submissions of 186 questionnaires were received (80% male, median age 40.6 years, interquartile range 10.1). Eighty-six per cent of officers reported having an MSK complaint in the last 12 months, where lower back, shoulder and neck complaint prevalence was 59.1, 48.4 and 42.5%, respectively. The occupational role was associated with the site and presence of complaints (p < 0.05), where armed officers presented with more shoulder, lower back and hip/thigh complaints. Age, sex and body fat did not impact complaint prevalence. Participants mainly attributed their complaints to occupation equipment or to sport and exercise. Conclusion. MSK complaints were highly prevalent in this cohort, particularly armed officers. Further research is required to establish the impact of these complaints and how they can be mitigated. [ABSTRACT FROM AUTHOR]

The paper presents an educational initiative to develop a separate well-being curriculum for a federation of schools in south-east London. A mixed-methods study was undertaken to evaluate the feasibility of the curriculum run biweekly in Year 7 (age 11–12,N = 96). The study utilised a non-randomised repeated measures design with a control group (N = 68) using general life satisfaction, domain life satisfaction and affect balance as outcome variables. In addition, semi-structured interviews were conducted with four students, two teachers and the principal of the intervention school. The results indicated significant buffering effect of the intervention in protecting students against the decline of satisfaction with self, satisfaction with friends, positive affect and the increase in negative affect throughout the first year of middle school. The qualitative data shed light on explicit learning, psychological outcomes and challenges associated with the programme. Overall, the data indicate a positive impact of the well-being curriculum. [ABSTRACT FROM PUBLISHER]

This paper describes a preliminary investigation on the effectiveness of Dynamic Interpersonal Therapy (DIT). The research was undertaken in an inner London primary care psychological therapies service. Outcome data on the symptoms of depression [Patient Health Questionnaire-9 (PHQ-9)] and anxiety [Generalised Anxiety Disorder-7 (GAD-7)] were collected from service-users (n = 24) at the first and last episodes of treatment. There were statistically significant reductions in depression (PHQ-9) and anxiety (GAD-7) associated with DIT, with medium and large effect sizes, respectively. Overall, 75% of patients showed an improvement on the PHQ-9 and GAD-7 following DIT. When this was calculated as statistically reliable change, the improvements reduced to 42% for anxiety and 25% for depression. As this study was uncontrolled, the significance cannot be reliably attributed to DIT. Future research may aim to investigate DIT's effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions. [ABSTRACT FROM PUBLISHER]

Across Europe and North America, few young people meet the recommended levels of physical activity (PA) of 1 hour of moderate to vigorous PA per day. However, the lives of young people cannot simply be polarised as either completely sedentary or active. Drawing on findings from the World Health Organization Health Behaviour in School-aged Children cross sectional international study, this paper examines the domains of adolescent life associated with young people's participation in overall PA, including health behaviours, social relationships and family activities. Consideration is also given to gender differences. Information in England was collected from 4404 students aged 11, 13 and 15 years, using anonymised self-completed questionnaires. Physical aspects of lifestyle were determined using internationally validated items for measuring PA that met international guidelines for activity and the frequency and duration of vigorous exercise undertaken during leisure activities. Separate analyses were conducted for boys and girls. Levels of PA and vigorous exercise were compared using the chi-squared test for trend. The findings draw attention to the value for the health and well-being of young people participating in some form of PA, even if they do not meet the recommended levels. Medium levels of PA appear to be associated with high levels of life satisfaction, self-rated health and an improved sense of body image. Significant health gains are likely to be made for adolescents in encouraging sedentary young people to undertake some form of PA. [ABSTRACT FROM PUBLISHER]

The COVID-19 has had an impact on almost every aspect of life throughout the world. The quarantine, limited social life, and fear of contamination have triggered psychological symptoms in societies. The need for mental health services has increased, and online psychological counselling, which provides psychological help with no risk of infection, has become more popular. The purpose of this study was to examine the impact of the COVID-19 on psychological counselling services and compare the general situation of publications on online psychological counselling before and during the pandemic. For this purpose, 463 publications related to online psychological counselling in the Web of Science (WoS) database were examined. The results were discussed in the context of trends and differences before and during COVID-19. [ABSTRACT FROM AUTHOR]

Healthcare services for people living with dementia (PLWD) are stretched, and government promises of increased funding remain undelivered. With the UK dementia population to surpass 1 million by 2024, and dementia care costs predicted to almost treble by 2040, it is essential we understand differences in healthcare use among PLWD. This study aimed to explore social and spatial variations in healthcare use among people diagnosed with dementia (2002–2016). Data were derived from Electronic Health Records of Clinical Practice Research Datalink GP patients in England (n = 142,302). To standardise healthcare contacts, rates of healthcare contacts per year were calculated for three primary (GP observations and medications) and three secondary healthcare types [Accident & Emergency (A&E) attendances and, emergency and elective hospital admissions]. Fully-adjusted generalised linear regression models were used to identify healthcare use variation by social and spatial groups. Twelve models were generated, one for each healthcare type in early- and late-onset populations separately. This study highlights numerous social and spatial variations in healthcare use among PLWD. Among PLWD, several groups tended to have healthcare service use more closely associated with negative outcomes, including a greater likelihood of A&E attendances and emergency and elective hospital admissions. These groups include: men, people from White ethnicity groups and people from more deprived and rural areas. Systemic and social measures are needed to reduce variations in healthcare use inequalities in PWLD. These include greater healthcare continuity, health checks and medicines reviews, culturally appropriate services, better and more accessible treatment and improved infrastructure. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about the role of a psychiatrist are anecdotally widespread but have been under researched. Aims: This study aimed to establish views on training and working in psychiatry amongst preclinical medical students at a South London Medical School and amongst a general public sample. Methods: A semi-structured online questionnaire was used to survey medical students, with a similar paper questionnaire being used to survey members of the public in a general practice waiting room using a convenience sampling method. Results: Strikingly, the majority of the public thought that psychiatrists did not need a medical degree (54%) or postgraduate training (56%). There were significant misconceptions about treatments used in mental health, for example 16% of the public sample thought psychiatrists never use medication and 31% of medical students (and 14% of the public) thought psychiatrists never use electroconvulsive therapy (ECT). In response to 'do you believe a psychiatrist is able to know what people are thinking?', 45% of students and 57% of the public answered 'sometimes'. Conclusion: The results have important implications for public education, as lack of awareness about psychiatry may inhibit help seeking for mental illness, and have a negative impact on recruitment to psychiatry amongst medical students. [ABSTRACT FROM AUTHOR]

This study estimated the efficiency of implementing the EmERGE Pathway of Care for people living with medically stable HIV in Brighton, UK; an App enables individuals to communicate with caregivers via their smart-phone. Individual data on the use of HIV outpatient services were collected one-year pre- and post-implementation of EmERGE. Unit costs of HIV outpatient services were calculated and linked with mean use of services per patient year. Primary outcomes were CD4 count and viral load; patient activation and quality-of-life measures were secondary outcomes. 565 participants were followed up April 2017 - October 2018: 93% men, mean age at recruitment 47.0 years (95%CI:46.2–47.8). Outpatient visits decreased by 9% from 5.6 (95%CI:5.4-5.8) to 5.1 (95%CI:4.9-5.3). Face-to-face visits decreased and virtual visits increased. Annual costs decreased by 9% from £751 (95%CI: £722-£780) to £678 (95%CI: £653-£705). Including anti-retroviral drugs, total annual cost decreased from £7,343 (95%CI: £7,314–7,372) to £7,270 (95%CI: £7,245–7,297): ARVs costs comprised 90%. EmERGE was a cost-saving intervention, patients remained engaged and clinically stable. Annual costs were reduced, but ARVs continue to dominate costs. Extension of EmERGE to other people with chronic conditions, could produce greater efficiencies but these needs to be evaluated and monitored over time. [ABSTRACT FROM AUTHOR]

Background: A lack of consensus exists concerning how to identify "heavy users" of inpatient mental health services. Aim: To identify a statistical approach that captures, in a clinically meaningful way, "heavy" users of inpatient services using number of admissions and total time spent in hospital. Methods: "Simple" statistical methods (e.g. top 2%) and data driven methods (e.g. the Poisson mixture distribution) were applied to admissions made to adult acute services of a London mental health trust. Results: The Poisson mixture distribution distinguished "frequent users" of inpatient services, defined as having 4 + admissions in the study period. It also distinguished "high users" of inpatient services, defined as having 52 + occupied bed days. Together "frequent" and "high" users were classified as "heavy users". Conclusions: Data driven criteria such as the Poisson mixture distribution can identify "heavy" users of inpatient services. The needs of this group require particular attention. [ABSTRACT FROM AUTHOR]

The aim of this study is to critique and extend psychological approaches to resilience by examining retrospective accounts of LGBT people in England who had directly experienced or witnessed events that were salient as significantly negative or traumatic. Pre-screening telephone interviews identified ten individuals who matched inclusion criteria (mean age: 39 years; range 26–62 years) as part of a larger study. Interviews were semi-structured and informed by a literature review undertaken at the start of the study. We identified three themes of that extend the resilience literature for LGBTQ+ people: (1) identifying and foregrounding inherent personal traits – how non-contextual inborn qualities or attributes needed external effort to be recognised and operationalised; (2) describing asymmetric sources of social support and acceptance – the importance of positive environment is unequally available to LGBT people compared to heterosexuals, and uneven within the LGBT group; and (3) blurring distinctions between resilience and coping – experiential approaches to moving beyond distress. We suggest that narratives of resilience in the accounts of LGBT people can inform the development of resilience promotion models for minoritized individuals and support movement away from deficit-focused approaches to health policy. [ABSTRACT FROM AUTHOR]

To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic. People with dementia and their carers completed assessments before (July 2019–March 2020; 206 dyads) and after (July–October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline. In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness. Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed. [ABSTRACT FROM AUTHOR]

To establish whether ethnic inequalities exist in levels of self-reported hearing difficulty and hearing aid use among middle-aged adults. Cross-sectional data from the UK Biobank resource. 164,460 participants aged 40–69 who answered hearing questions at an assessment centre in England or Wales. After taking into account objectively assessed hearing performance and a corresponding correction for bias in non-native English speakers, as well as a range of correlates including demographic, socioeconomic, and health factors, there were lower levels of hearing aid use for people from Black African (OR 0.36, 95% CI 0.17–0.77), Black Caribbean (OR 0.38, 95% CI 0.22–0.65) and Indian (OR 0.60, 95% CI 0.41–0.86) ethnic groups, compared to the White British or Irish group. Men from most ethnic minority groups and women from Black African, Black Caribbean and Indian groups were less likely to report hearing difficulty than their White British or Irish counterparts. For equivalent levels of hearing loss, the use of hearing aids is lower among ethnic minority groups. Inequalities are partly due to lower levels of self-reported hearing difficulty among minority groups. However, even when self-reported hearing difficulty is considered, hearing aid use remains lower among many ethnic minority groups. [ABSTRACT FROM AUTHOR]

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This exploratory study examines how social work practitioners in England integrate service users' religion, belief and spiritual identities. The study involved 34 semi-structured interviews with Qualified Social Workers and took a qualitative investigational perspective. By means of thematic analysis, the study suggests that practitioners employ either avoidant or utilitarian approaches, which may indeed be a coping strategy before the vast religious plurality in practice. The study also highlights when professionals perceive religion, belief and spirituality important. Those times are a) initial assessments, b) conditional intervention, c) referrals and d) response to this subject when safeguarding and child protection issues arise. [ABSTRACT FROM AUTHOR]

Studies have highlighted an association between motor laterality and speech production laterality. It is thought that common demands for sequential processing may underlie this association. However, most studies in this area have relied on relatively small samples and have infrequently explored the reliability of the tools used to assess lateralization. We, therefore, established the validity and reliability of an online battery measuring sequence-based motor laterality and language laterality before exploring the associations between laterality indices on language and motor tasks. The online battery was completed by 621 participants, 52 of whom returned to complete the battery a second time. The three motor tasks included in the battery showed good between-session reliability (r ≥.78) and were lateralized in concordance with hand preference. The novel measure of speech production laterality was left lateralized at population level as predicted, but reliability was less satisfactory (r =.62). We found no evidence of an association between sequence-based motor laterality and language laterality. Those with a left-hand preference were more strongly lateralized on motor tasks requiring midline crossing; this effect was not observed in right-handers. We conclude that there is little evidence of the co-lateralization of language and sequence-based motor skill on this battery. [ABSTRACT FROM AUTHOR]

Evidence suggests that despite the popularity and influence of key health equity concepts, they often fail to shift the thinking and actions of health workforces towards the social and structural determinants of health inequalities. These findings tend to be attributed to institutional constraints, along with the role of influential discourses which promote a focus on individuals and behaviours. However, questions have also been raised about the clarity and utility of the concepts themselves, and the extent to which the language they use works (or indeed fails to work) in reorienting thinking and action. The purpose of this study was to explore how partners in an applied health research collaboration in England interpreted the popular 'upstream-downstream' story, and what it means to work 'upstream' to reduce health inequalities. Where participants were not familiar with its academic or technical usage, the story was taken to be a metaphor for prevention generally, or it prompted a root cause analysis of the more discrete ways in which inequalities were encountered in participants' research or work. Even in instances where participants did hold more socio-political perspectives, these were often not evoked by the metaphor itself. Two of the 18 participants were unable to equate the metaphor with particular actions or ways of working, while others found it to be a poor fit with how they understood inequalities. The study findings illustrate and explain the challenges that arise when technical metaphors from the health equity literature are opened-up to interpretation by wider audiences. [ABSTRACT FROM AUTHOR]

To continue growing the advanced clinical practitioner (ACP) role nationally, and similar roles internationally, there must be widely held trust in the level of practice and the roles worked in service by ACPs. This requires infrastructure to support ACPs through their training and ensure they are fit to qualify. This short report focuses on an evaluation of assessment processes in the acute sector in a county in England, to understand their feasibility and suitability. The qualitative research design was attendance at assessment panels and 17 semi-structured interviews with assessors and ACP trainees, from nursing, physiotherapy, paramedicine and operating department practice backgrounds based at two hospitals. Key themes identified through thematic analysis were the different approaches to assessment and the support required to engage effectively with assessment. One hospital had a well understood process, including ACPs with a clear identity. The other hospital had a credible assessment process that continues to be developed. The insights from this study enabled lessons to be drawn for those responsible for workforce development who are key to the future development of the ACP role and to ensure high standards of interprofessional care. [ABSTRACT FROM AUTHOR]

This study examined how lifestyle factors and gender affect kidney allocation to transplant patients by 99 British and Singaporean participants. Thirty hypothetical patients were generated from a combination of six factors (alcohol intake, smoking frequency, weight, exercise frequency, diet, and gender) and randomly paired four times. Participants saw 60 patient pairings and, in each pair, chose which patient would receive treatment priority. A Bradley-Terry model was used to derive coefficients for each factor per participant. A mean factor score (MFS) was then calculated across all participants for each factor. Participants gave lower priority to patients who drank more, were overweight, smoked more and exercised less. A patient's diet and gender had no significant effect on allocation. There were no significant cross-cultural differences. There were moderate correlations between participants' self-reported pre- and post-experiment ordering of decision criteria, and these measures and factor coefficients, suggesting a modest level of decision-making consistency. Between participants, moderate levels of concordance with respect to factor importance were observed for self-reported orderings of factors, and weaker agreement for model-derived coefficients. Very similar results were obtained for both British and Singaporean participants, and the implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

The impact of grandparenting on depression is mediated by both macro- and micro-level factors, however, their combined examination between different country contexts is relatively rare. This study examined whether country level income and grandparents' gender influenced the relationship between the transition to grandparenthood and individuals' depression across England, Europe and China. Multi-level linear regression analyses with restricted maximum likelihood estimation were performed covering 15 countries from the ELSA, the SHARE and the CHARLS 2010-15 in order to understand cross-country differences in this area. This study found significant cross-national variations in the effects of transitioning to grandparenthood on individuals' depression. Transitioning to grandparenthood reduced the depression score among both men and women in lower income countries, but increased it in higher income countries. Moreover, the gender gap in the effects of becoming a grandparent on one's depression was wider in lower income countries than higher income countries. Policymakers should pay attention to the support grandparents need, and systematically integrate childcare provided by grandparents into family policies. Policies supporting older people should take into account the way in which macro-level and micro-level factors combine to affect grandparents' well-being. [ABSTRACT FROM AUTHOR]

Purpose: To explore how speech-language pathologists and nurses share information about the communication support needs of stroke patients through structured information-sharing routes and to consider how the two disciplines view their roles and interdependencies in addressing these needs. Method: Speech-language pathologist and nurse information-sharing was explored in context using ethnography. Ethnography has been used by researchers from other disciplines to understand the context of inpatient care, but the methodology has rarely been adopted within speech-language pathology. Fieldwork (357 hours) was carried out on three stroke wards in England for 40 weeks from 2015 to 2017. Data included fieldnotes, interviews with 43 members of speech-language pathology and nursing staff, and the patient records of 19 patients. Result: The findings provide a thematically organised explanation for how information about communication travelled through structured routes on the wards (meetings, the patient record, bedside signs, education, and nursing handover). Limitations were identified that appear underpinned by disciplinary differences in (1) how speech-language pathologists and nurses engaged with the wards in time and space, and (2) perceptions of roles and interdependencies. Speech-language pathologists routinely used meetings and the patient record to share communication information, however these formal structures were not easily accessible during nurses' caregiving roles. In addition, both speech-language pathologists (SLPs) and nurses were ambivalent about the usefulness of signage SLPs sometimes left at the bedside for supporting communication. There was little interdependency between SLP and nursing roles in meeting the communication support needs of patients. Conclusion: In-depth exploration of the context within which SLPs and nurses share information has revealed limitations in the capacity of structured routes to enhance collective knowledge about patients' communication support needs. [ABSTRACT FROM AUTHOR]

Objectives: There is now a body of research into the attributions that carers make of the challenging behavior of people with intellectual disabilities; however the attributions that people with intellectual disabilities make have not been studied. This paper describes the attributions that people with intellectual disabilities make of challenging behavior and compares them to those of their carers. Methods: Twenty-three day-service staff and 34 adults with intellectual disabilities completed measures of attribution, optimism, emotion and need for help and gave open-ended responses to questions about the causes of and potential interventions for challenging behaviors. Results: The overall pattern of attribution, emotion, optimism and intention to help is similar for people with intellectual disabilities and staff. However, compared to staff, people with intellectual disabilities were less optimistic and less happy about challenging behavior. Conclusions: This area of research will help identify the impacts of challenging behavior on the well being of people with intellectual disabilities and may help structure support for people who live alongside those who challenge. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the relationship between impairment, disabling barriers and risk factors relating to hate crime incidents. The study analyses quantitative data collected in 2011–2012 where there were 81 incidents of disability hate crime reported in the Tyne and Wear area of England. The research discovered that in the Tyne and Wear region people with learning difficulties have a greater likelihood of experiencing hate crime than do people with other impairments. Although there was no significant difference between impairment and types of hate crime incidents recorded (i.e. verbal abuse/harassment, violence and criminal damage), there were distinct differences between police and victim support responses to victims which correlated to impairment categories (p ≤ 0.05). The study concludes by suggesting that owing to specific disabling barriers experienced by people with learning difficulties, this group is at increased risk of being victimised and is less likely to receive support from criminal justice agencies. [ABSTRACT FROM PUBLISHER]

This study evaluates the spectrum of visual impairment in stroke survivors. The Impact of Visual Impairment after Stroke (IVIS) study is a multi-centre, acute stroke unit, prospective epidemiology study. Comprehensive visual examination was offered to all stroke survivors. 1500 stroke admissions were recruited. 1204 stroke survivors had visual assessment. Reduced central vision was documented in 529, visual field loss in 308, ocular motility abnormalities in 533 stroke survivors, visual perception deficits in 59 stroke survivors and visual inattention in 315 stroke survivors. About half, regardless of visual impairment type, were visually asymptomatic. Recovery, whether full or partial, was best for central vision, ocular motility abnormalities and visual perception deficits (about 70% improvement) occurring over a mean follow-up period of 2–3 months. Incidence of impaired central vision, visual field loss, ocular motility disorders and visual inattention was 29.4%, 24.8%, 39.3% and 26.2% respectively. Visual impairment was more likely to occur in more severe stroke and older stroke survivors. Asymptomatic cases raise concerns for acute stroke units where robust specialist vision screening is not routine. Those with partial/no recovery require specialist follow-up and management whilst the wide range of abnormalities highlight the need for specialist visual assessment acutely. Visual impairment is a common consequence of stroke. Incidence of visual impairment is about 60%. Significant numbers of stroke survivors are visually asymptomatic, highlighting the need for standardised vision assessments. Many stroke survivors have persistent long-term visual impairment, necessitating referral and access to specialist eye care services. [ABSTRACT FROM AUTHOR]