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This study aimed to determine whether caffeine gum influenced perceptual-cognitive and physical performance during the extra-time period of simulated soccer match-play. Semiprofessional male soccer players (n = 12, age: 22 ± 3 years, stature: 1.78 ± 0.06 m, mass: 75 ± 9 kg) performed 120-min soccer-specific exercise on two occasions. In a triple-blind, randomized, crossover design, players chewed caffeinated (200 mg; caffeine) or control (0 mg; placebo) gum for 5 min following 90 min of soccer-specific exercise. Perceptual-cognitive skills (i.e., passing accuracy, reaction time, composure, and adaptability) were assessed using a soccer-specific virtual reality simulator, collected pre- and posttrial. Neuromuscular performance (reactive-strength index, vertical jump height, absolute and relative peak power output, and negative vertical displacement) and sprint performance (15 and 30 m) were measured at pretrial, half-time, 90 min, and posttrial. Caffeine gum attenuated declines in reaction time (pre: 90.8 ± 0.8 AU to post: 90.7 ± 0.8 AU) by a further 4.2% than placebo (pre: 92.1 ± 0.8 AU to post: 88.2 ± 0.8 AU; p <.01). Caffeine gum reduced composure by 4.7% (pre: 69.1 ± 0.8 AU to post: 65.9 ± 0.8 AU) versus placebo (pre: 68.8 ± 0.8 AU to post: 68.3 ± 0.8 AU; p <.01). Caffeine gum did not influence any other variables (p >.05). Where caffeine gum is consumed by players prior to extra-time, reaction time increases but composure may be compromised, and neuromuscular and sprint performance remain unchanged. Future work should assess caffeine gum mixes with substances like L-theanine that promote a relaxed state under stressful conditions. [ABSTRACT FROM AUTHOR]

This study investigates the value of the public library service, and library buildings in particular, in qualitative terms, with a focus on how the public library can address issues of loneliness and belonging. A qualitative narrative approach is taken to develop "library stories" and provide a deeper understanding that complements quantitative studies and library statistics. A three-stage research approach is taken: an initial literature analysis to identify issues and themes leads to a directed content analysis of some of this material to generate micro-narratives, which are complemented by an evocative autoethnography. Interrelated connections emerge concerning where our bodies belong and regarding vulnerable and marginalized users. New types of knowledges are identified. This is a novel combination of methods for library/information research, with the potential to highlight in new ways the value of library services and buildings. The study deals with UK public libraries between 2000 and 2021. [ABSTRACT FROM AUTHOR]

Over the past 25 years, a hermeneutic struggle has unfolded in English football between those spectators who wish to stand at matches and the risks associated with this practice in all-seated stadia. Amid this tension, fans have had to negotiate a neoliberal and authoritarian regime. However, the struggles of supporters against social control in football are characterized by the building of a long-term social movement against all-seating. In seeking to break down the state's disciplinary power and its marketization of football, this movement, "Safe Standing," has achieved several recent policy-based victories in the United Kingdom and Europe and is now firmly embedded within sports stadia developments and the demands of fans in North America and Australasia. Although these different contexts are temporally and culturally sensitive, they are interdependently linked through relational time frames and discursive practices that make up the modern consumption of football. This research applies relational sociology to analyze the fan networks that successfully built this movement across the U.K. fan activist scene, characterized by relational collective action, which complicates the individual and collective dimensions of activism. [ABSTRACT FROM AUTHOR]

This theme issue collects together papers summarising the conceptual design of the Spherical Tokamak for Energy Production (STEP). In 2019, the UK government funded the first design stages of a prototype fusion powerplant based on a compact toroidal geometry, called STEP. The primary technical aims of STEP are to produce net energy, to be self-sufficient in tritium fuel and to demonstrate a maintenance regime that would extrapolate to appropriate availability for commercial powerplants. After 5 years and over 1000 person-years of detailed scientific and engineering conceptual design, this theme issue acts as a compendium of the current design basis for STEP, noting that this is a snapshot in time and that the design will continue to evolve. This article is part of the theme issue 'Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)'. [ABSTRACT FROM AUTHOR]

The UK's fusion energy approach has developed over the past 5 years to include government policy initiatives and a range of public sector investments designed to be delivered in partnership with the private sector. These have aimed to create an environment that stimulates innovation and investment to deliver economic as well as scientific and environmental benefits throughout the lifetime of the public sector fusion energy programme. The Spherical Tokamak for Energy Production acts as a focus and anchor for both public and private sector efforts to develop fusion energy, developing the supply chain and potential for Intellectual Property development and export opportunities well ahead of the anticipated STEP completion date of 2040. This is maximized by the UK's approach to a holistic research and innovation programme backed up by a regulatory and skills programme. This article is part of the theme issue 'Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)'. [ABSTRACT FROM AUTHOR]

Success of the UK's Spherical Tokamak for Energy Production (STEP) programme requires a robust plasma control system. This system has to guide the plasma from initiation to the burning phase, maintain it there, produce the desired fusion power for the desired duration and then terminate the plasma safely. This has to be done in a challenging environment with limited sensors and without overloading plasma-facing components. The plasma parameters and the operational regime in the STEP prototype will be very different from tokamaks, which are presently in operation. During fusion burn, the plasma regime in STEP will be self-organizing, adding further complications to the plasma control system design. This article describes the work to date on the design of individual controllers for plasma shape and position, magneto hydrodynamic instabilities, heat load and fusion power. Having studied 'normal' operation, the article discusses the philosophy of how the system will handle exceptions, when things do not go exactly as planned. This article is part of the theme issue 'Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)'. [ABSTRACT FROM AUTHOR]

This paper argues that a data-driven, niche-focused approach to strategy development will assist Higher Education Institutions to direct their financial resources to greater effect by providing a more tailored service to students, therefore, increasing student satisfaction and creating brand loyalty. This approach will give institutions greater stability and prosperity in a constantly changing market. It is, however, the cultural risks which remain the biggest barrier to trying this approach in the UK and this paper aims to open the debate. [ABSTRACT FROM AUTHOR]

Background: Enhancing long-term support for post-stroke cognitive impairment is a top research priority. Addressing current gaps in UK post-stroke cognitive care provision requires a pragmatic and scalable intervention that can be integrated within the existing stroke care pathway. This study aimed to develop consensus on an initial set of core features for a UK-based monitoring and psychoeducational intervention for cognitive changes after stroke. Methods: An expert panel of UK healthcare professionals and researchers participated in an online modified Delphi survey. Candidate intervention features were identified from clinical guidelines, existing literature, research team/collaborator expertise, and PPI group lived experience. Survey participants indicated whether they agreed/disagreed/had no opinion about including each candidate feature in the intervention and free-text responses were invited. We analysed responses for consensus (≥ 75% agreement) using descriptive statistics, with items not reaching consensus carried into subsequent rounds. Template analysis was used to identify similarities/differences in viewpoints for items that did not reach consensus. Results: Three survey rounds were completed by 36, 29 and 26 participants, respectively. Participants agreed reviews should include a stroke-specific cognitive screen (97% agree) and assessment of other psychological changes (low mood, anxiety, fatigue: 94%, 90%, 89% agree, respectively). They agreed stroke survivors should be offered at least one review, regardless of their cognitive profile in hospital. They agreed on the importance of various cognition-focused psychoeducation topics, and formal (100% agree) and informal (79% agree) training for those conducting reviews. Consensus was not reached on the review mode (in person/remote options: 67% agree), offering reviews one-year post-discharge to patients without acute cognitive impairments (68% disagree), or including a dementia screen (63% disagree) and/or neuropsychological assessment battery (58% disagree). However, there were similarities in participant viewpoints. For example, participants emphasised the importance of onwards referral where clinically indicated. Conclusions: The UK-based post-stroke monitoring and psychoeducation intervention was originally conceptualised as a cognitive care pathway, but expert participants agreed on the importance of simultaneously addressing related psychological changes (e.g. low mood, anxiety). There was clear consensus on a minimum set of intervention features. Recommendations outlined here may usefully inform local service improvements. [ABSTRACT FROM AUTHOR]

Objective: Hearing loss in the older adult population is a significant global health issue. Hearing aids can provide an effective means to address hearing loss and improve quality of life. Despite this, the uptake and continued use of hearing aids is low, with non-use of hearing aids representing a significant problem for effective audiological rehabilitation. The aim of this study was to investigate the reasons for the non-use of hearing aids. Design and study sample: A cross-sectional survey was used to investigate the reasons given for the non-use of hearing aids by people with hearing loss (n = 332) and family members (n = 313) of people with hearing loss in Australia, the UK, and USA. Results: Survey results showed that hearing aid non-users generally cited external factors as reasons for non-use, whereas family members reported non-use due to attitudinal barriers. Past users of hearing aids and family members of past users both identified devices factors as barriers to use. Conclusions: Differences in reasons for non-use may provide further insight for researchers and clinicians and help inform future clinical practice in addressing the low uptake and use of hearing aids by people with hearing loss and the role of family members in audiological rehabilitation. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the goals, activities, and methods of EUMOVE project in developing a set of resources targeting both primary and secondary schools that allow the entire educational community to promote healthy lifestyles (HL). The EUMOVE project is an Erasmus+ program based in the Creating Active Schools (CAS) framework. The project lasted 3 years and was developed by 14 academic and non-governmental institutions from Spain, Portugal, France, Italy, and the UK. EUMOVE was divided into three phases. In the first phase, several work packages were carried out aimed to ensure the coordination/management of the project activities. In the second phase, seven educational resources strengthened by rigorous scientific research were developed to promote HL from schools. During the last phase, all the resources were disseminated through scientific seminars, workshops with families and teachers, and the online promotion by the non-governmental institutions of each country. The EUMOVE project developed and promoted a smartphone APP, video/activity repository of physically active lessons, active break virtual platform, learning units, and parent/teachers/school-leaders' guidelines to promote physical activity, active commuting, active school playgrounds, healthy diet, and sleep habits. To our knowledge, EUMOVE is the first European project to provide a set of practical tools based on scientific evidence to help schools or future school-wide interventions implement a paradigm shift based on the CAS framework for the promotion of HL. Future research will need to investigate the implementation, effectiveness, and scalability of this proposal. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Various anthropometric measures capture distinct as well as overlapping characteristics of an individual's body composition. To characterize independent body composition measures, we aimed to reduce easily‐obtainable individual measures reflecting adiposity, anthropometrics and energy expenditure into fewer independent constructs, and to assess their potential sex‐ and age‐specific relation with cardiometabolic diseases.Analyses were performed within European ancestry participants from UK Biobank (N = 418,963, mean age 58.0 years, 56% women). Principal components (PC) analyses were used for the dimension reduction of 11 measures of adiposity, anthropometrics and energy expenditure. PCs were studied in relation to incident type 2 diabetes mellitus (T2D) and coronary artery disease (CAD). Multivariable‐adjusted Cox regression analyses, adjusted for confounding factors, were performed in all and stratified by age. Genome‐wide association studies were performed in half of the cohort (N = 156,295) to identify genetic variants as instrumental variables. Genetic risk score analyses were performed in the other half of the cohort stratified by age of disease onset (N = 156,295).We identified two PCs, of which PC1 reflected lower overall adiposity (negatively correlated with all adiposity aspects) and PC2 reflected more central adiposity (mainly correlated with higher waist–hip ratio, but with lower total body fat) and increased height, collectively capturing 87.8% of the total variance. Similar to that observed in the multivariable‐adjusted regression analyses, we found associations between the PC1 genetic risk score and lower risks of CAD and T2D [CAD cases <50 years, odds ratio: 0.91 (95% confidence interval 0.87, 0.94) per SD; T2D cases <50 years, odds ratio: 0.76 (0.72, 0.81)], which attenuated with higher age (p‐values 8.13E‐4 and 2.41E‐6, respectively). No associations were found for PC2.The consistently observed weaker associations of the composite traits with cardiometabolic disease suggests the need for age‐specific cardiometabolic disease prevention strategies. [ABSTRACT FROM AUTHOR]

Background and aims: Smokers typically have a lower body mass index (BMI) than non‐smokers, while smoking cessation is associated with weight gain. In pre‐clinical research, nicotine in tobacco smoking suppresses appetite and influences subsequent eating behaviour; however, this relationship is unclear in humans. This study measured the associations of smoking with different eating and dietary behaviours. Design: A cross‐sectional analysis of data from health assessments conducted between 2004 and 2022. Setting: An independent healthcare‐based charity within the United Kingdom. Participants: A total of 80 296 men and women (mean ± standard deviation [SD]: age, 43.0 ± 10.4 years; BMI, 25.7 ± 4.2 kg/m2; 62.5% male) stratified into two groups based on their status as a smoker (n = 6042; 7.5%) or non‐smoker (n = 74 254; 92.5%). Measurements Smoking status (self‐report) was the main exposure, while the primary outcomes were selected eating and dietary behaviours. Age, sex and socioeconomic status (index of multiple deprivation [IMD]) were included as covariates and interaction terms, while moderate‐to‐vigorous exercise and sleep quality were included as covariates only. Findings Smokers had lower odds of snacking between meals and eating food as a reward or out of boredom versus non‐smokers (all odds ratio [OR] ≤ 0.82; P < 0.001). Furthermore, smokers had higher odds of skipping meals, going more than 3 h without food, adding salt and sugar to their food, overeating and finding it hard to leave something on their plate versus non‐smokers (all OR ≥ 1.06; P ≤ 0.030). Additionally, compared with non‐smokers, smoking was associated with eating fried food more times per week (rate ratio [RR] = 1.08; P < 0.001), eating fewer meals per day, eating sweet foods between meals and eating dessert on fewer days per week (all RR ≤ 0.93; P < 0.001). Several of these relationships were modified by age, sex and IMD. Conclusions: Smoking appears to be associated with eating and dietary behaviours consistent with inhibited food intake, low diet quality and altered food preference. Several of these relationships are moderated by age, sex and socioeconomic status. [ABSTRACT FROM AUTHOR]

Background and aims: UK‐based gambling policymakers have proposed affordability checks starting at monthly losses of £125. The present study combines open banking data with self‐reports of the Problem Gambling Severity Index (PGSI) and other relevant information to explore the harm profiles of people who gamble at different levels of electronic gambling behaviour. Design, setting and participants: This was a data fusion study in which participants consented to share their bank data via an open banking application programming interface (API) and who also completed relevant self‐report items. Hierarchical hurdle models were used to predict being an at‐risk gambler (PGSI > 0) and being a 'higher‐risk' gambler (higher PGSI scores among those with non‐zero scores) using four specifications of electronic gambling behaviour (net‐spend, outgoing expenditure, incoming withdrawals, interaction model combining expenditure and withdrawals), and by adding self‐reported data across two additional steps. The study took place in the United Kingdom. Participants were past‐year people who gamble (n = 424), recruited via Prolific. Measurements: Self‐report measures were used of gambling‐related harm (PGSI), depression [Patient Health Questionnaire 9 (PHQ‐9)], age and gender; bank‐recorded measures of income and electronic gambling behaviour. Findings Unharmed gamblers had an average monthly gambling net‐spend of £16.41, compared with £208.91 among highest‐risk gamblers (PGSI ≥ 5). Being an at‐risk gambler (PGSI > 0) was predicted significantly by all four types of gambling behaviour throughout all three steps [1.08 ≤ odds ratios (ORs) ≤ 2.92; Ps < 0.001), with only outgoing expenditure being significant in the interaction model (2.26 ≤ ORs ≤ 2.81; Ps < 0.001). Higher PHQ‐9 scores also predicted at‐risk gambling in steps 2–3 (1.09 ≤ ORs ≤ 1.10; Ps < 0.001), as did lower age (0.95 ≤ ORs ≤ 0.96; Ps < 0.001) and male gender identity in step 3 (2.51 ≤ ORs ≤ 2.95; Ps < 0.001). Being a higher‐risk gambler was predicted significantly by gambling behaviour only in the expenditure‐only (1.16 ≤ ORs ≤ 1.17; Ps ≤ 0.048) and withdrawal‐only (1.08 ≤ ORs ≤ 1.09; Ps ≤ 0.004) models, and was not predicted by income (0.98 ≤ ORs ≤ 1.14; Ps ≥ 0.601), age (0.98 ≤ ORs ≤ 0.99; Ps ≥ 0.143) or male gender identity (1.07 ≤ ORs ≤ 1.15; Ps ≥ 0.472). Conclusion: The UK government's proposed affordability checks for gamblers should rarely affect people who are not experiencing gambling‐related harm. At‐risk gambling is predicted well by different types of gambling behaviour. Novel insights about gambling can be generated by fusing self‐reported and objective data. [ABSTRACT FROM AUTHOR]

Summary: We studied the association between non-osteoporotic fractures and future major osteoporotic fractures, using UK health records. Non-osteoporotic fractures were found to increase the risk of major osteoporotic fractures, although to a lesser extent than osteoporotic fractures. This highlights the importance of considering all previous fractures in assessing future fracture risk. Purpose: Previous studies demonstrated that osteoporotic fractures—minor and major—increase the risk for future major osteoporotic fractures; we test whether non-osteoporotic fractures are also associated with such increased risk. Methods: The study is a retrospective cohort study using UK primary care electronic health records. Exposure groups were defined according to fracture location prior to the year 2011 (index date): major, minor, and non-osteoporotic. The outcome of incident major osteoporotic fractures following the index date was compared between the exposure groups and the general population. Results: The general study population included 1,951,388 patients. The exposure groups included 39,931 patients with a prior major osteoporotic fracture, 19,397 with a prior minor osteoporotic fracture, and 50,115 patients with a prior non-osteoporotic fracture. The standardized Incidence Rate Ratio for future major osteoporotic fractures was 2.73 (95% confidence interval: 2.64–2.82), 2.43 (2.32–2.54), and 1.83 (1.74–1.92), respectively. Conclusion: Non-osteoporotic fractures are significantly associated with increased risk for future major osteoporotic fractures relative to the general population, yet to a lesser extent compared to major and minor osteoporotic fractures. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK). Methods: Semi-structured interviews were conducted with eight working age (46–64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis. Results: The analysis led to three Group Experiential Themes: "The Solitude of the Pain Experience," "Unsatisfactory Healthcare and the Need for Self-Care" and "The Development of Pain Acceptance." Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain. Conclusions: The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions. IMPLICATIONS FOR REHABILITATION: Post-stroke pain is an invisible disability, difficult to describe to others and therefore often overlooked and misunderstood by others. Differential pain diagnoses should be given to patients with clear explanations of the underlying mechanism, characteristics and prognosis. Treatments other than pharmacology, such as a pain management programmes, peer support, family therapy and psychological interventions, should be considered and patients should be supported in finding a way to live a meaningful life despite the pain. Healthcare professionals, particularly in primary healthcare services would benefit from training on post-stroke pain. [ABSTRACT FROM AUTHOR]

Purpose: Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. Method: Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton–Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs. Findings: Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14–1⋅74], p = 0⋅002). Conclusion: Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs. IMPLICATION FOR REHABILITATION: To our knowledge this is the first prospective cohort study of trajectories of disability in activities of daily living (ADL) in advanced respiratory disease, including recruitment during the Covid-19 pandemic. It adds to existing evidence by identifying individual variability in trajectories of ADL disability which are undetected at group level. The identification of mobility limitation as a predictor of increasing ADL disability, while controlling for malignant or non-malignant respiratory disease, is novel and has practical utility. Our findings have implications for clinical care, as early identification of functional decline through use of mobility limitation tools could flag early referral to rehabilitation services, potentially preventing or delaying forthcoming functional decline and avoiding reactive crisis management. Mobility limitation is a predictor of increasing disability in activities of daily living in advanced disease, which could be used to flag early referral to rehabilitation services, to help prevent or delay forthcoming functional decline and avoid reactive crisis management [ABSTRACT FROM AUTHOR]

Rationale: The National Health Service (NHS) Long Term Plan was published in January 2019. One of its objectives was restructuring outpatient services, as part of an Outpatient Transformation initiative. Monitoring of trusts' adherence to the objectives of the Long Term Plan is therefore required to benchmark progress against national objectives. Aims and Objectives: We aimed to explore whether outpatient transformation initiatives and phlebotomy services that are managed by outpatients are appropriately staffed and to evaluate trusts' adherence to the objectives outlined in the Long Term Plan. Method: A freedom of information (FOI) request was sent in January 2023 to 153 trusts across Great Britain (time span: 1 January 2022–31 December 2022). Parameters requested included number of outpatients seen/discharged, phlebotomy episodes, number of sites/wards covered by phlebotomy, target/actual did not attend (DNA) rates, time since inception of the outpatient transformation project (OTP), advice and refer (A&R) and patient‐initiated follow‐up (PIFU), phlebotomy and outpatient managerial establishment and use of electronic notes and patient portals. Results: A total of 117 trusts (76.5%) provided responses to the FOI request. The mean number of new outpatients seen face‐to‐face was 185,810. Of 73 trusts reporting both actual and target DNA rates, 62 (84.9%) did not meet their DNA targets. The actual DNA rate was significantly greater than the target DNA rate across trusts (p < 0.001, mean: 8.8% vs. 6.5%, respectively). A total of 58 different electronic systems and 29 patient portals were utilised across trusts. Thirty‐six trusts (30.3%) did not have an outpatient transformation project manager and 16 trusts (13.7%) did not initiate an OTP. With phlebotomy provision, the mean number of outpatient phlebotomy episodes was lower than inpatient episodes (83,383 vs. 91,020, respectively). Conclusion: There are deficiencies in current outpatient establishments that may hinder the achievement of objectives set in the NHS Long Term Plan. Changes at all levels of healthcare are required, with increased reliance on technologies and investment in support for transformation management. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHR) are frequently used for epidemiological research including drug utilisation studies in a defined population such as the population with knee osteoarthritis (KOA). We sought to describe the process of defining a cohort of patients with KOA from a large UK primary care database and estimate the annual incidence of diagnosed KOA between 2000 and 2015. Method: This was a retrospective study using data from the clinical practice research datalink (CPRD). CPRD is a large primary care longitudinal electronic medical records' database that contains anonymous records of patients from general practices across United Kingdom. Five different cohort definition strategies were applied including symptoms‐based or diagnosis‐based strategies or a combination of both. To validate results, the annual incidence of KOA was estimated and compared to published data. Results: The study defined 898,690 patients when symptoms‐based strategy was applied, 137,541 patients when diagnosis based and 83,294 when a combination of both strategies were applied. The final cohort was defined using a diagnosis‐based strategy that avoided overestimation (with symptoms‐based definition) or underestimation (with a combination of symptoms and diagnosis). The incidence of KOA ranged from 1.33 per 1000 CPRD registrants in 2000, 1.76 in 2008 and 1.45 patients in 2015. Conclusion: This study logically/sensibly defined a cohort of patients with diagnosed KOA through the application of several strategies. This was an essential step to avoid subsequent over or underestimation of the prevalence of drug utilisation and the associated adverse clinical outcomes within primary care patients with KAO. [ABSTRACT FROM AUTHOR]

Rationale: Advanced practice physiotherapy roles (Advanced Physiotherapy Practitioners [APPs] and First Contact Physiotherapists [FCPs]) are pivotal in supporting patients to manage their musculoskeletal (MSK) conditions. Having a greater understanding of how decisions are made by these practitioners will inform competency frameworks and improve the provision of patient‐centred care. Aim: To evaluate the current knowledge, views and use of shared decision‐making in MSK advanced physiotherapy practice in the United Kingdom. Methods: A cross‐sectional survey using an online questionnaire was used to collect demographic information, knowledge, views and self‐reported use of shared decision‐making (SDM) of APPs and FCPs who work with adults with MSK disorders in the United Kingdom. Results: Responses from 49 participants (25 APPs and 24 FCPs) were included in the study. In total, 80% of participants had received SDM training and overall high levels of knowledge were shown. Only 12% of participants used a communication model to facilitate SDM. In total, 80% of participants reported making decisions together with the patient either always or most of the time. FCPs favoured a more patient‐led approach to decision‐making compared to APPs who favoured collaborative decision‐making. The most commonly reported barriers to SDM included lack of time, lack of patient education resources, lack of access to patient decision aids and treatment pathway restrictions. Conclusions: The responses in this study showed that overall APPs and FCPs have good knowledge of SDM and report routine use of collaborative and patient‐led decision‐making approaches. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat‐free mass index (FFMI). Methods: A prospective, comparative, single‐centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. Results: A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. Conclusions: BIA is quick, non‐invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning. Key points: Bioelectrical impedance analysis could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. There is an opportunity with these interventions to better support frail patients and prevent deconditioning. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most frequent female malignancy in the UK. Around 20% of cases are linked to weight gain, excess weight and health behaviours. We designed a weight gain prevention, health behaviour intervention for young women at increased risk. Methods: The study comprised a single arm observational study over 2 months testing acceptability and usability of the intervention: online group welcome event, app and private Facebook group. Females aged 18–35 years at moderate or high risk of breast cancer (>17% lifetime risk) were recruited via invite letters and social media posts. The app included behaviour change techniques and education content. Online questionnaires were completed at baseline, as well as at 1 and 2 months. We also assessed feasibility of study procedures. Results: Both recruitment methods were successful. Thirty‐five women were recruited, 26% via social media posts. Median age was 33 (interquartile range = 28.2–34.5) years, the majority (94.1%) were of White ethnicity. Thirty‐four participants were included in the analyses, of which 94% downloaded the app. Median self‐monitoring logs per participant during the study period was 10.0 (interquartile range = 4.8–28.8). App quality mean (SD) score was 3.7 (0.6) at 1 and 2 months (scale: 1–5). Eighty‐nine per cent rated the app at average or above at 1 month and 75.0% at 2 months. Nineteen women (55.9%) joined the Facebook group and there were 61 comments and 83 reactions and votes from participants during the study period. Conclusions: This first iteration of the app and intervention was well received and is suitable to progress to the next stage of refining and further testing. Highlights: The newly developed intervention that focused on weight gain prevention and health behaviour change was tested in young women at increased risk of breast cancer and was well‐received by the target population.Both recruitment methods, by mailshot and social media, were successful.The study was unable to recruit and ethnically diverse population.Future research should retest the intervention in a larger population, after making refinements. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic put unprecedented pressure on weight management services. These services were required to adapt to continue to provide care for people living with obesity. This study sought to develop consensus recommendations on the best practice solutions adopted by weight management services in the United Kingdom during the COVID‐19 pandemic. Methods: This study utilised a semi‐structured interview and a modified Delphi methodology to develop a consensus of best practice recommendations identified by specialist weight management services during the pandemic. Results: Twenty‐three healthcare professionals working in weight management service across the United Kingdom participated in the study. Analysis of interview transcripts identified four key thematic domains: outpatient, patient education and support, perioperative care and team working. Of the initial 43 unique recommendations, 30 reached consensus agreement. Outpatient recommendations focused on communication strategies, patient self‐monitoring and remote patient tracking. Patient education and support recommendations addressed the development of online educational resources and support groups. Perioperative care recommendations emphasised case prioritisation, waiting list support and postoperative care. Team working recommendations targeted the use of digital collaboration tools and strategies for effective teamwork. Conclusion: Developing consensus recommendations on best practice is a critical step for weight management and outpatient services to achieve higher standards of care. These recommendations provide a springboard for departmental discussions, paving the way for improved experiences for individuals living with obesity as they progress along their weight management journey. Key points: During times of crisis, healthcare providers in weight management services can rapidly adopt innovative digital solutions to support good patient care.Thirty expert consensus recommendations relating to outpatient management, patient education and support, perioperative care and team working were found.Collaborative research is key to further guideline development on obesity management in areas of outpatient care, patient education, perioperative care and team working. [ABSTRACT FROM AUTHOR]

Background: Weight stigma is pervasive within healthcare and negatively impacts both access to care and the patient‐practitioner relationship. There is limited evidence on weight stigma among registered dietitians, particularly in the United Kingdom, though data show weight‐related prejudice towards people living with obesity. The aim of this study was to examine both explicit and implicit weight stigma in practicing dietitians in the United Kingdom, as well as the lived experience of weight stigma among dietitians, both towards themselves and towards others. Methods: An online cross‐sectional survey was disseminated between February and May 2022 using snowball sampling. Inclusion criteria were that participants were UK registered dietitians aged 20–70 years. Results: Four hundred and two dietitians responded to the survey (female [94.1%], mean age 40.2 years [standard deviation (SD) 10.7]; White ethnicity [90%]; median 12 years [interquartile range (IQR) 6, 22] within dietetic practice). Mean self‐reported body mass index was 25.1 kg/m² (SD 8.7). Most dietitians reported experiencing weight stigma prior to (51%) and postregistration (59.7%), whereas nearly a quarter (21.1%) felt that weight influenced their ability as a dietitian. Weight stigma was experienced across the weight spectrum. Overall participants reported explicit weight bias attitudes, moderate beliefs that obesity is controllable and implicit antifat bias. Within open‐ended responses, dietitians reported three key themes related to their personal experiences of weight stigma: (1) experiences of stigma in dietetic practice, (2) impact of weight stigma and (3) perception of weight, appearance and job. Conclusion: This study shows that UK dietitians exhibit both explicit and implicit weight bias towards people living with obesity. Dietitians reported experiencing weight stigma, which impacted their career‐related decisions and their perception of their own ability to perform as dietitians. The study highlights the need to address weight stigma and its implications within the dietetic profession. Key points: Dietitians personally experience weight stigma prior to and post registration. Experiencing stigma impacts on career‐related decisions, the area of expertise dietitians choose and their confidence in their own abilities to practise as dietitians.Weight stigma is experienced across the weight spectrum.These data show that dietitians have both explicit and implicit bias towards people living with obesity.Our data highlight the need for weight stigma to be addressed within dietetic practice, both from a patient‐practitioner and professional point of view.There is a need for dietetic associations to address how weight stigma impacts the profession. [ABSTRACT FROM AUTHOR]

In a rapidly changing healthcare environment, we need a robust evidence base to inform effective education and training. This study aimed to examine factors perceived to determine career progression in clinical education research in the UK. Six online focus groups were conducted, with 35 participants from a range of medical, dental, nursing, and allied health professions who identified as aspiring or early career clinical education researchers. Transcripts underwent thematic analysis. Two themes and associated subthemes were constructed to illustrate perceived factors impacting on career development: (1) A cultural challenge from clinical norms. Challenges included differences between the epistemological assumptions of biomedical and clinical research, and the underlying philosophy of education research, which is more closely aligned with the knowledge generation of the social sciences. This led to difficulty communicating the impact of education research to patient care. There were also blurred boundaries between education delivery and research, with the latter lacking a clearly defined group identity. (2) Structures, systems and relationships for career progression. Practical considerations included time and funding (or lack thereof), the opportunity to undertake formal training, networking and role models. This research highlights a number of systemic barriers and facilitators to careers in clinical education research and offers targets of intervention to enable a sustainable academic workforce in clinical education research. [ABSTRACT FROM AUTHOR]

Objective: There are few existing studies that investigate the risk of systemic lupus erythematosus (SLE) associated with long‐term exposure to air pollutants. This study aimed to explore associations between long‐term exposure to air pollutants and incident SLE and further evaluate interactions and joint effects of genetic risk and air pollutants. Methods: A total of 459,815 participants were included from UK Biobank. The concentrations of air pollutants (fine particulate matter with diameter ≤2.5 μm [PM2.5], particulate matter diameter ≤10 μm [PM10], nitrogen dioxide [NO2], and nitrogen oxides [NOx]) were estimated by land‐use regression model. We applied Cox proportional hazards model to explore linkages of air pollutants and incident SLE. The polygenic risk score (PRS) was used for further assessing the interactions and joint effects of genetic risk and air pollutants. Results: A total of 399 patients with SLE were identified during a median follow‐up of 11.77 years. There were positive associations between air pollutant exposure and incident SLE, as the adjusted hazard ratios were 1.18 (95% confidence interval [95% CI] 1.06–1.32), 1.23 (1.10–1.39), 1.27 (1.14–1.41), and 1.13 (1.03–1.23) for each interquartile range increase in PM2.5, PM10, NO2, and NOx, respectively. Moreover, participants with high genetic risk and high air pollution exposure had the highest risk of incident SLE compared with those with low genetic risk and low air pollution exposure (adjusted hazard ratio: PM2.5, 4.16 [95% CI 2.67–6.49]; PM10, 5.31 [95% CI 3.30,–8.55]; NO2, 5.61 [95% CI 3.45–9.13]; and NOx, 4.80 [95% CI 3.00–7.66]). There was a significant multiplicative interaction between NO2 and PRS. Conclusion: Long‐term exposure to air pollutants (PM2.5, PM10, NO2, and NOx) may increase the risk of developing SLE. [ABSTRACT FROM AUTHOR]

Between 30 and 40% of 18-year olds in England, Wales and Northern Ireland enter tertiary education (university) each year. Young adulthood (ages 15 to 25) is the usual period in which problems with alcohol, drugs or other behaviors begin to emerge, and yet these issues have received limited study in the UK. Government policy dictates that a full continuum of treatment and recovery services should be available in each area of the country, but uptake of these services by university students appears to be limited. In this discussion paper we describe the background to, and components of, the Collegiate Recovery Program (CRP), an initiative that has grown rapidly in the USA in the past decade. We then describe how the first UK University-led CRP was set up, before outlining what has been learnt so far and the potential challenges facing this approach. [ABSTRACT FROM AUTHOR]

Introduction: Gender and sexual minority/minoritized groups are at a higher risk of substance misuse and related harm compared to the rest of the population. However, limited research has focused on understanding the extent of these issues and the support needs of all minoritized groups within the LGBTQ + population. Methods: This qualitative cross-sectional survey sought to explore LGBTQ + individuals' perspectives on substance use and treatment experiences. Researchers used a manual thematic analysis approach to thoroughly study the data, examining each part closely to uncover themes and patterns. Co-produced with stakeholders and developed with input from LGBTQ + individuals with lived experience, the survey included 38 participants across the UK. Results: Cannabis (83% n = 20), ecstasy (68% n = 15), and cocaine (67% n = 16) were commonly used substances, while some participants (19% n = 6) reported consuming high levels of alcohol. Many respondents highlighted the role of "stigma" and peer pressure within the LGBTQ + communities as a motivator for substance use. Participants expressed a preference for informal support due to fears of "discrimination" from formal treatment services. Conclusions: The study underscores the need for research inclusive of all LGBTQ + groups and highlights the importance of tailored interventions that address the diverse needs of LGBTQ + individuals. Further exploration of peer-led interventions is necessary to assess their effectiveness. The findings emphasize the necessity of person-centered treatment approaches that recognize the heterogeneity of service users. [ABSTRACT FROM AUTHOR]

Background: Alcohol use is a gendered behavior and motherhood is a life stage which may influence drinking motives. However, there are no drinking motive scales uniquely tailored to maternal populations. This work developed a new maternal drinking motives scale (M-DMS) and determined associations between the M-DMS and alcohol-related behavior. Methods: An online observational survey (n = 534) and online test–retest survey (n = 164) were conducted with adult, UK mothers. From the observational study, data on drinking motives was extracted to determine M-DMS items and factor loading. This was split into two data sets for exploratory and confirmatory factor analyses. Alcohol Use Disorders Identification Test (AUDIT) and Timeline Follow back data, taken from both surveys, were combined to determine the M-DMS's predictive validity. Results: Following a parallel analysis and exploratory factor analysis, a two-factor model (positive reinforcement motives, negative reinforcement motives) was deemed the best fit. Probability functional analysis identified items with problematic responses. These were removed before confirmatory factor analysis (on the second dataset) demonstrated a good fit for the two-factor model. All factor loadings were significant and positive (βs > 0.56). Reliability of the two subscales was excellent: negative reinforcement (ωT = 0.95), positive reinforcement (ωT = 0.89). Test–retest reliability was good for both negative (ICC = 0.84, 95%CI = 0.80–0.88) and positive (ICC = 0.77, 95% CI = 0.71–0.82) subscales. Both subscales predicted AUDIT and quantity of alcohol consumption (ps < 0.001). Conclusion: The first tailored Maternal Drinking Motives Scale (M-DMS) provides a more valid research tool for assessing psychological mechanisms of alcohol use in mothers. [ABSTRACT FROM AUTHOR]

Bed-sharing is a controversial but common parenting practice with claimed benefits for emotional and behavioral development. Using data from the UK Millennium Cohort Study (N = 16,599), this prospective study investigated whether bed-sharing at 9 months is associated with childhood internalizing and externalizing symptom trajectories. Children were grouped by their patterns of co-developing internalizing and externalizing symptoms from 3 to 11 years of age using a parallel process latent class growth analysis. There were no associations between bed-sharing at 9 months of age and internalizing and externalizing symptom trajectories across childhood. This finding suggests that bed-sharing at 9 months has no positive or negative influence on the development of internalizing and externalizing symptoms across childhood. Clinicians should inform parents that bed-sharing during the second half of the first year is unlikely to have an impact on the later emotional and behavioral development of the children. [ABSTRACT FROM AUTHOR]

Background: Mixed Arterial and Venous Leg Ulcers (MAVLU) are challenging. Clinical evidence specific to MAVLU management is scarce. We evaluated our recent experience with MAVLU patients and reviewed current data regarding MAVLU epidemiology, aetiology, diagnostic assessment and management options. Methods: A prospective leg ulcer database was retrospectively interrogated to determine the prevalence and clinical outcome of MAVLU over 2-year period (2021-2022). The literature was reviewed to determine if optimal treatment strategies. Results: 307 patients attended the ulcer clinic over a 2-year period. Most were venous leg ulcers (71%), 24% were arterial and 5% were MAVLU. The highest healing rate was in MAVLU (93%), followed by (74%) and (41%), in arterial and venous leg ulcer groups, respectively. Conclusion: Evidence-based guidelines for MAVLU remain lacking. Well-developed randomised controlled trials are warranted to guide current clinical practice. [ABSTRACT FROM AUTHOR]

Sexual violence against men has been significantly overlooked, and under-researched, with minimal attention paid to the influence of culture and ethnicity on survivors' experiences of abuse. This rapid review examines prevalence, disclosure, help-seeking, and criminal justice experiences of Black and Asian male survivors in the United Kingdom. Eight empirical studies published since 2003 involving Black and Asian sexual violence survivors were included through comprehensive database searches, including gray literature and reference lists. Findings suggest prevalence data underestimate the true extent of victimization in ethnic minority groups in the United Kingdom. Barriers to disclosure and help-seeking were associated with specific cultural factors unique to Black and Asian male experiences, as revealed by three qualitative studies. However, accessing and reporting to the criminal justice system remains largely unexplored for Black and Asian male survivors. Methodological limitations within existing studies emphasize the urgent need for substantial, high-quality research that addresses issues with inconsistent definitions, measurements, and lack of ethnic-specific approaches across prevalence, disclosure, help-seeking, and criminal justice experiences. Culturally informed professional training emerges as a critical requirement to sensitively address the unique challenges faced by ethnic minority male survivors. Additionally, targeted outreach initiatives hold the potential to engage minority male survivors more effectively. A collaborative, system-wide approach is vital to bring to the forefront the overlooked experiences of ethnic minority males, thereby promoting an environment of support, understanding, and recovery. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory syncytial virus (RSV) leads to significant morbidity in newborn infants in the United Kingdom (UK). Nirsevimab, a long-acting monoclonal antibody, received approval from the European Medicines Agency and has been licensed by the Medicines and Healthcare products Regulatory Agency for preventing RSV lower respiratory tract disease (LRTD) in neonates and infants during their first RSV season. The objective of this study was to assess the potential impact of nirsevimab on RSV-associated LRTDs, related costs, and loss of quality-adjusted life years (QALYs) in infants experiencing their first RSV season. Methods: The impact of administering nirsevimab across all infant populations compared to palivizumab in the high-risk palivizumab-eligible population was assessed via a static decision-analytic model specified for a UK birth cohort experiencing their first RSV season. The RSV-related health events of interest included primary care (PC), accident and emergency (A&E) visits, hospitalizations [including hospitalizations alone and those resulting in intensive care unit (ICU) admissions], recurrent wheezing in infants who were previously hospitalized, and all-cause LRTD hospitalizations. Results: Under the current standard of practice (SoP), RSV was estimated to result in 329,425 RSV LRTDs annually, including 24,381 hospitalizations and ICU admissions, representing £117.8 million (2024 GBP) in costs. Comparatively, universal immunization of all infants with nirsevimab could avoid 198,886 RSV LRTDs, including 16,657 hospitalizations and ICU admissions, resulting in savings of £77.2 million in RSV treatment costs. Considering the impact on all-cause LRTD of a universal immunization strategy, nirsevimab could be valued between £243 and £274, assuming willingness-to-pay (WTP) thresholds of £20,000 and £30,000 per QALY saved, respectively. Conclusions: This analysis demonstrated that the health and economic burden of RSV would be substantially reduced in all infants experiencing their first RSV season in the UK (including term, preterm, and palivizumab-eligible infants) as a result of a universal immunization strategy with nirsevimab. [ABSTRACT FROM AUTHOR]

This article sheds light on a notable first in the history of air power. On 18 October 1940, four Italian Savoia-Marchetti SM.82s took off from the Dodecanese Islands in the Eastern Mediterranean, attacked the refinery of Bahrain in the Arabian Gulf and landed safely in Eritrea on the Red Sea coast. It was the longest mission ever carried out in total autonomy of flight and the first three-continent mission in the history of air bombing. This remarkable feat caught the British by surprise. Bahrain was thought to be so far away from enemy bases that it needed no defences at all. And, although the raid caused very little damage, it highlighted the exposed nature of Bahrain's oilfields and refinery, forcing the hard-pressed British Empire to divert resources to defend an obscure theatre of war originally thought to be safe. This largely neglected mission is significant because in the course of the Second World War no other air forces managed to repeat this achievement or to equal this distance and because the Regia Aeronautica demonstrated an imaginative use of limited technology by upgrading the transport SM.82 planes into aircraft capable of carrying out bombing operations beyond the reach of its conventional bomber force. In this sense, it was a remarkable performance. But, at the same time, the bombing of Bahrain also illustrated how unprepared Italy's armed forces were. Although by the end of 1940 the Regia Aeronautica had conducted several raids across the Mediterranean, the Red Sea and the Arabian Gulf, it had failed to achieve anything significant. This failure exposed all the limitations of a war effort that had been imposed on the armed forces by Benito Mussolini despite conclusive evidence that Italy was not prepared to sustain a long conflict. [ABSTRACT FROM AUTHOR]

Background: Groups at high risk of severe illness/death from COVID-19 (older people and those identified as clinically extremely vulnerable: CEV) experienced increased restrictions, poor mental health and loneliness during the first UK lockdown. Methods: Seventeen older adults, eight CEV adults, one parent of a CEV child, and two family carers of CEV adults, shared their experiences of the first UK lockdown through various media: written reflections, interviews, poetry, videos, photographs, and visual artwork. Results: Through a positive psychology lens, five themes were identified: experiencing loss; community and connection; finding joy, hope and optimism; adapting to change; and sense- and meaning-making. Conclusion: High-risk groups fostered wellbeing and flourishing and formed a sense of coherence in a time of great loss. Engagement with artistic, creative, and cultural activities facilitated this. The arts not only provided a creative means of collecting data but was also identified as a central thread in the findings. [ABSTRACT FROM AUTHOR]

This paper provides an overview of UK Arabic language teaching in supplementary and mainstream schools from available research papers and provides a synopsis of recent developments in supporting Arabic teaching at school level and pathways to Higher Education. The largest study cited is the 2016 research collaboration between the British Council, the Universities of Leeds, Edinburgh, Goldsmiths, and London, and Alcantara Communications [Snowden et al. (2016. Teaching Arabic as a Foreign Language in the UK – Strand 1 Research: How Arabic is Being Taught in Schools. London: British Council)], exploring current teaching techniques, teachers' perceptions of diglossia and variation in Arabic, and these are incorporated when designing teaching activities and materials. With surveys, interviews and lesson observations, Snowden et al. show teachers believe in the importance of communication as a learning aim and are familiar with the communicative approach but many base learning activities on traditional writing tasks and less on listening and speaking. It shows that Arabic diglossia remains a challenge with teachers stating that learning dialects is important, yet they struggle to find appropriate approaches and materials for it. This paper presents challenges faced by Arabic teachers including foundational teacher training, continuous professional development and material design, concluding with recent developments in supporting teaching Arabic as a community language and recommendations for addressing current challenges. [ABSTRACT FROM AUTHOR]

This paper examines the language attitudes of first-wave members of the Ukrainian community in the UK towards the two varieties of Ukrainian present in the community (labelled Diasporic Ukrainian and Contemporary Ukrainian), and considers the language ideologies underpinning these attitudes. Drawing on the analysis of data obtained through semi-structured interviews with second- and third-generation community members, I demonstrate how attitudes towards the two varieties of Ukrainian are mixed, but internally consistent. Positive attitudes towards Diasporic Ukrainian coincide with negative attitudes towards Contemporary Ukrainian, which is considered 'Russified' and 'impure'. A contrasting set of attitudes is also identified, in which informants express negative attitudes towards 'archaic' Diasporic Ukrainian and positive attitudes towards Contemporary Ukrainian. I show that attitudes towards the two varieties of Ukrainian appear to be connected to attitudes towards Russian and are influenced by purist ideologies and interviewees' perceptions of the relationship between Ukrainian language and identity. I consider how the mixed nature of these language attitudes may have a negative impact on future language maintenance efforts in the community, as the choice to teach one variety of Ukrainian over another may prevent attendance at Ukrainian complementary schools, which play a key role in language maintenance in the community. [ABSTRACT FROM AUTHOR]

Aim: To comprehensively examine the associations of childhood and adulthood body size, and child‐to‐adult body size change with adult leucocyte telomere length (LTL). Methods: We included 453 602 participants from the UK Biobank. Childhood body size at the age of 10 years was collected through a questionnaire. Adulthood body size was assessed using body mass index (BMI), waist circumference (WC), waist‐to‐hip ratio (WHR), fat mass index (FMI), and fat‐free mass index (FFMI). Results: Individuals with plumper body size in childhood exhibited shorter LTL in adulthood (−0.0086 [−0.0017, −0.0004]). Adulthood BMI (−0.0286 [−0.0315, −0.0258]), WC (−0.0271 [−0.0303, −0.0238]), WHR (−0.0269 [−0.0308, −0.0230]) and FMI (−0.0396 [−0.0438, −0.0351]) were negatively associated with LTL, whereas FFMI (0.0095 [0.0039, 0.0152]) was positively associated with LTL. Compared to individuals consistently having an average/normal weight in both childhood and adulthood, those who maintained or developed overweight/obesity from childhood to adulthood had a shorter adult LTL, regardless of childhood body size. Notably, the LTL shortening effect was not observed in individuals with plumper body size in childhood but normal weight in adulthood. Conclusions: Childhood and adulthood obesity are both associated with LTL shortening in adulthood. Transitioning to or maintaining overweight/obese status from childhood to adulthood is associated with shorter adult LTL, whereas this effect can be reversed if plumper children become normal weight. [ABSTRACT FROM AUTHOR]

The UK's city centre apartment markets have been affected by the coronavirus pandemic and a building safety crisis in ways not experienced by its suburban and rural housing markets. Sellers and estate agents have encountered falling demand and prices, elevated safety concerns, reluctant lenders and changes in buyers' preferences. Against this backdrop, we investigated the narratives and images used to sell what have sometimes appeared to be 'less sellable' homes. Analysing the textual and visual content of 100 adverts for city centre flats, we explored the possible effects of the pandemic on property advertising, the positioning within adverts of building safety and, noting growing interest in sustainability, the presence of sustainability messages. Findings suggest that the core narratives used to sell city centre flats remain largely unchanged from those deployed to first market the concept of 'city living' to UK buyers in the late 1990s. Messages about building safety and sustainability appear uncommon. The implications of the findings are considered. [ABSTRACT FROM AUTHOR]

Purpose: Postpartum depression (PPD) brings adverse and serious consequences to both new parents and newborns. Neuroticism affects PPD, which remains controversial for confounding factors and reverse causality in cross-sectional research. Therefore, mendelian randomization (MR) study has been adopted to investigate their causal relationship. Methods: This study utilized large-scale genome-wide association study genetic pooled data from three major databases: the United Kingdom Biobank, the European Bioinformatics Institute, and the FinnGen databases. The causal analysis methods used inverse variance weighting (IVW). The weighted median, MR-Egger method, MR-PRESSO test, and the leave-one-out sensitivity test have been used to examine the results' robustness, heterogeneity, and horizontal pleiotropy. The fixed effect model yielded the results of meta-analysis. Results: In the IVW model, a meta-analysis of the MR study showed that neuroticism increased the risk of PPD (OR, 1.17; 95% CI, 1.11–1.25, p < 0.01). Reverse analysis showed that PPD could not genetically predict neuroticism. There was no significant heterogeneity or horizontal pleiotropy bias in this result. Conclusion: Our study suggests neuroticism is the risk factor for PPD from a gene perspective and PPD is not the risk factor for neuroticism. This finding may provide new insights into prevention and intervention strategies for PPD according to early detection of neuroticism. [ABSTRACT FROM AUTHOR]

Gallantry medals are invested with deep significance not only by the armed forces but also by civilian society. In the last decade, there has been a debate in sociology about whether the medallic regime has become post-heroic or whether it has professionalized. This article contributes to these debates by focusing on the topic of fraudulent medals. Fake medals are very rare; there has been one proven case in the United Kingdom in the last 20 years. However, precisely because fake medals are the exception, their pathologies illustrate the processes by which medals are actually awarded with particular clarity. This analysis of the fake medal shows that gallantry awards have professionalized; in the UK medals have become more meritocratic, recognizing skill not status. The awarding process is also more objective. Yet, its very professionalism is ironically vulnerable to a specific type of fraud by skilful but cynical citation writers. [ABSTRACT FROM AUTHOR]

Background: Family carers of people living with comorbid dementia and cancer (CDC) play a vital supportive role, but this may be particularly burdensome and adversely impact their own health and wellbeing. Objective: To examine the experiences and psychosocial support needs of caregivers of people with CDC. Methods: A flyer advertising the study was distributed to relevant UK voluntary sector organisations and shared across social media. 13 carers of people with CDC were recruited. In-depth semi-structured interviews were conducted and transcripts were analysed using reflexive thematic analysis, underpinned by an inductive phenomenological approach. Results: Complex interactions of dementia and cancer resulted in heightened responsibility for carers, who played a crucial role in recognition/management of symptoms, performing difficult cancer-related care, and treatment decision-making that posed difficult ethical challenges. Care-recipients had reduced insight into their cancer diagnosis and prognosis, so carers often carried the emotional burden alone. Responsibilities faced by carers were compounded by a lack of targeted, accessible information/support for CDC. Carers expressed a desire to talk to and learn from others who understand the unique challenges of navigating cancer-related decision-making, treatment and care for people who are also living with dementia. Conclusions: Cancer alongside dementia presents complex challenges for carers, who desire more cancer-related information and support which is tailored to people living with dementia and their family caregivers. [ABSTRACT FROM AUTHOR]

Objective: To describe the association between dental caries and school readiness in 5‐year‐old children taking part in the Born in Bradford (BiB) birth cohort, UK. Methods: The Early Years Foundation Stage Profile (EYFSP) assesses the school readiness of young children and is strongly predictive of future academic attainment. Children are recorded as 'emerging' (below expected), 'expected', or 'exceeding' in five key learning areas. The Oral Health Survey of 5‐year‐olds (OHS5) is undertaken biennially in England, assessing caries experience at a dentine threshold (d3mft). EYFSP and OHS5 were available for a proportion of children participating in BiB. Odds ratios and confidence intervals for caries experience were established, and odds ratios adjusted for significant sociodemographic variables. Results: EYFSP and OHS5 data were available for 2.5% (n = 346) BiB participants. Nearly half (45.2%) had caries. A measure of socio‐economic status, receiving free school meals, was the only demographic variable strongly related to caries experience (OR: 2.8, 95% CI: 1.6–4.9). After adjustment, children 'emerging' in EYFSP learning areas had 1.6‐ to 2.2‐fold (95% CI: 1.0–3.8) higher odds of experiencing caries. Children 'exceeding' EYFSP learning areas had 2.3‐ to 4‐fold (95% CI: 0.1–0.9) lower odds of caries experience. Conclusion: This is the first study to explore the association between caries experience and school readiness using a holistic assessment tool. The association was found across different learning areas and was comparable to and independent of socio‐economic status. The findings indicate oral health‐related absenteeism is not a causative factor. EYFSP shows potential to enhance the targeting of preventive interventions at a child, class or school level. [ABSTRACT FROM AUTHOR]

Despite a growing consensus within the inclusion literature on the power of student voice, the way it is currently positioned in educational processes and systems remains problematic. This article argues that attention to student voice within a systemic analysis can deepen our understanding of young people's experience of educational systems. It draws on data from a field research study which explored in-depth the inclusive experiences of 12 students in 2 English and 2 Greek secondary schools. Using Bronfenbrenner's bio-ecological theory and a critical framework for reflecting on student voice as analytical tools, it examines the interplay between individuals' accounts of their experience on the one hand, and their characteristics, interactions and environmental systems on the other. It discusses the way these factors shape students' experiences of a system which is explicitly aiming towards inclusion, by highlighting issues of power and identity as well as contradictions between student and staff perspectives. Overall, the findings of this study suggest that reflecting systematically and critically on student voice provides opportunities for a deeper understanding of the experiences of students in diverse settings. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Co‐production aims to value service user voices and is increasingly used in healthcare.Less is known about how co‐production in nursing education is experienced by service users. What the paper adds to existing knowledge?: This paper shares the experience of one service user who teaches student nurses in a UK university.For the first author, the paper highlights that co‐producing nurse education has been valuable and rewarding for both a service user and students. What are the implications for practice?: Co‐production has the potential to benefit student nurses, including challenging their perceptions of 'difficult' patients. To achieve this, teaching sessions must be equally produced and delivered. By employing and including service users, universities have the potential to improve experiences for students and service users alike. Introduction: Co‐production is increasingly used in health care but there is less attention to a co‐produced mental health nurse education. Aim: This article sought to explore the co‐production experiences of a service user who teaches mental health nurses, alongside the benefits of this to nurse education. Methods: The article is a lived experience narrative co‐written with a nursing lecturer. Thesis: Co‐produced mental health nurse education challenges students' perceptions towards self‐harm and encourages empathy and understanding of service user distress. Implications for Practice: Co‐production has many benefits to nurse education including a positive student experience, and validation of the service user experience to support meaningful recovery. [ABSTRACT FROM AUTHOR]

Objectives: In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. Methods: We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy – that is, how different needs are deemed deserving of health service attention – was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. Results: Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. Conclusions: Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources. [ABSTRACT FROM AUTHOR]

Both adverse childhood experiences (ACEs) and lifestyle factors have been associated with risk of cardiovascular diseases (CVDs) in later life, but whether and to what extent adherence to a healthy lifestyle in adulthood can offset the increased cardiovascular risk associated with ACEs is unclear. We aimed to determine whether and to what extent adopting to a healthy lifestyle in adulthood can offset the risk of CVDs in individuals according to their ACEs. A prospective cohort study included 143,869 participants aged 38–72 years, free of CVDs at baseline from the UK Biobank. The history of ACEs was assessed using the Childhood Trauma Screener. Participants were divided into three risk groups based on ACEs: low (no ACEs), intermediate (one or two ACEs), and high (three or more ACEs). A healthy lifestyle score in adulthood was constructed as the sum of four modifiable lifestyle factors (no smoking, adequate physical activity, healthy diet, no obesity), and participants were then categorized into three groups based on this score (unfavorable [0–1 point], intermediate [2–3 points], favorable [4 points]). Cox proportional hazard models were conducted to investigate the association between ACEs, healthy lifestyle, and incident CVDs. During a median follow-up of 12.49 years, 13,373 incident cases of overall CVDs were identified. This included 7521 cases of coronary heart disease (CHD), 6175 cases of atrial fibrillation (AF) and 1813 cases of stroke. Individuals with high ACEs had a greater risk of incident overall CVDs (hazard ratio [HR] = 1.39, [95%CI = 1.29 to 1.50]), CHD (1.50 [1.36 to 1.65]) and AF (1.18 [1.05 to 1.33]) compared to those with low ACEs. The risk of CVDs decreased moving from unfavorable to favorable lifestyle categories (P for trend<0.001), with the lowest risk observed among individuals with a favorable lifestyle (0.70 [0.66 to 0.74] for overall CVDs, 0.69 [0.64 to 0.75] for CHD, and 0.71 [0.65 to 0.78] for AF). Participants with high ACEs and a favorable lifestyle had a 39 %, 40 % and 47 % lower risk of developing overall CVDs (0.61 [0.48 to 0.76]), CHD (0.60 [0.44 to 0.81], and AF (0.53 [0.36 to 0.77]) than those with high ACEs and an unfavorable lifestyle. Having a healthy lifestyle in adulthood could substantially attenuate the increased risk of overall CVDs, CHD, and AF conferred by ACEs. • Adverse childhood experiences (ACEs) independently increased the risk of incident cardiovascular diseases (CVDs). • Adopting a healthy lifestyle was significantly associated with a decreased risk of CVDs, regardless of ACEs category. • While exposure to ACEs is unmodifiable, the potential CVD risk can be significantly reduced by adopting a healthy lifestyle. [ABSTRACT FROM AUTHOR]

This study focuses on the subjective well-being (SWB) of a sample of military veterans before and after their engagement with a nonclinical, alternative mental health therapies residential retreat in the United Kingdom. The study findings have relevance for trauma-exposed individuals globally. Military veterans will actively avoid seeking traditional mental health treatments due to factors such as stigma and life-long labels, as well as a reluctance to engage in talk therapies. This is despite the widespread occurrence of diagnosed and undiagnosed chronic mental health conditions such as posttraumatic stress disorder following periods of service. Moving beyond trauma-informed practice and embracing a healing-centered approach involving holistic therapies delivered during a retreat-type format has a positive impact on the SWB of service users. Positive changes in SWB were recorded using the Warwick–Edinburgh Mental Well-Being Scale and the lived experiences of the participants. A shared military identity contributes immeasurably to a veteran-centered approach to holistic therapy, healing, and recovery. [ABSTRACT FROM AUTHOR]

Aim: To assess the knowledge, attitudes and practices of Registered Nurses working in residential aged care facilities pertaining to pain management for residents living with dementia. Background: Sub-optimal pain management continues for people living with dementia in residential aged care. Registered Nurses are the pivotal staff responsible for complex assessment and management of people residing in residential aged care facilities. Design and methods: :This integrative literature review was informed by Whittemore (2005). Searching and screening followed the PRISMA guidelines. Results: Thirteen papers were identified, the major themes identified were gaps in knowledge and skills, uncertainty of assessment, and delays in treatment. Conclusion: Registered Nurses require education on pain management for people living with dementia in residential aged care. Broader issues in residential aged care contribute to the problem and require examination. Research pertaining to Registered Nurses' roles pain management for residents living with dementia is required. [ABSTRACT FROM AUTHOR]

Background: Accelerated biological aging has been verified to be a critical risk factor for a number of age-related diseases, but its role in dementia remained unclear. Whether it modified the effects of genetic factors was also unknown. This study evaluated the associations between accelerated biological aging and dementia and the moderating role of accelerated biological aging in the genetic susceptibility to the disease. Methods: We included 200,731 participants in the UK biobank. Nine clinical blood biomarkers and chronological age were used to calculate Phenotypic age acceleration (PhenoAgeAccel), which is a novel indicator for accelerated biological aging. The associations of PhenoAgeAccel with dementia, both young-onset and late-onset dementia, were assessed by Cox proportional hazard models. Apolipoprotein E (APOE) alleles and polygenic risk scores (PRS) were used to evaluate the genetic risk of dementia. The interactions between genetic susceptibility and biological aging were tested on both multiplicative and additive scales. Results: These findings showed individuals who were in the highest quartile of PhenoAgeAccel had a higher risk with incidence of dementia compared to individuals in the lowest quartile of PhenoAgeAccel (HR: 1.145 (95% CI: 1.050, 1.249)). Individuals with biologically older had a higher risk of dementia than individuals with biologically younger (HR: 1.069 (95% CI: 1.004, 1.138)). Furthermore, compared to individuals with biologically younger and low APOE ε4-related genetic risk, individuals with biologically younger and high APOE ε4-related genetic risk (HR:3.048 (95% CI: 2.811, 3.305)) had a higher risk of dementia than individuals with biologically older and high APOE ε4-related genetic risk (HR: 2.765 (95% CI: 2.523, 3.029)). Meanwhile, referring to low dementia PRS and biologically younger, the risk of dementia increased by 72.7% (HR: 1.727 (95% CI: 1.538, 1.939) in the biologically younger and high PRS group and 58.7% (HR: 1.587 (95% CI: 1.404, 1.793) in the biologically older and high PRS group, respectively. The negative interactions between PhenoAgeAccel with APOE ε4 and PRS were also tested on the additive scale. Conclusions: Accelerated biological aging could bring the extra risk of dementia but attenuate the effects of genetic risk on dementia. These findings provide insights for precise prevention and intervention of dementia. [ABSTRACT FROM AUTHOR]

Introduction: Traditionally, surgical procedures are explained through consultations between the surgeon and the patient to ensure informed consent. Patient education enhances engagement and knowledge, aiding informed decision-making. This study aimed to assess the effect of an educational video on preoperative patient knowledge and satisfaction in the context of total knee arthroplasty (TKA) as an adjunct to the consent process. Methods: A prospective randomized controlled study involving 100 patients in dedicated elective orthopedic units in UK-based hospitals was conducted. After consultation with a dedicated knee surgeon and a preoperative education day for TKA run by dedicated orthopedic nurse specialists, patients were randomized into one of two limbs (video vs no video) at a 1:1 ratio. The treatment group (video group) was shown a video about the principles and steps of the procedure, including the recovery time. Following this, a 10-point knowledge test was completed, and patients rated their satisfaction with the preoperative education on a scale of 0–10. Results: Patients in the video limb group had a significantly greater mean knowledge score and greater satisfaction with preoperative education than patients who did not view the video. The video group (n = 49) had a mean knowledge score of 8.73 +/− 0.159 compared to 7.68 +/− 0.281 for the nonvideo limb (n = 50) (p < 0.05). The video group had a mean satisfaction score of 9.00 +/− 0.123 compared to 8.40 +/− 0.121 for the nonvideo limb group (p < 0.05). Conclusion: Video-assisted consent in total knee arthroplasty improves preoperative knowledge and patient satisfaction when used as an adjunct in the consent process. A simple, standardized video, either pre- or post-consultation could reinforce information that the patient receives in a simple effective manner, allowing for true informed consent. [ABSTRACT FROM AUTHOR]