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Within traditional drug and alcohol (D&A) treatment services, the majority of those accessing support are of white ethnicity, with only a small percentage of people from the British South Asian (BSA) and Muslim community engaging in treatment services. This paper aims to explore perceived barriers to accessing traditional D&A services within the British South Asian and Muslim communities, based on qualitative data from interviews with family members and a practitioner. Qualitative data were obtained via 11 semi-structured interviews involving a practitioner (n = 1), and family and friends (n = 10) of those with historic and current D&A use in the community. Reflexive thematic analysis revealed four themes: (1) awareness of drug and alcohol use in the community, (2) drug and alcohol use as a taboo topic and the impact of admitting use, (3) knowledge of services for treatment, (4) how to increase awareness and accessibility of treatment. There was an increasing awareness of D&A use in the BSA and Muslim community. Despite this, limited conversations and misconceptions around D&A use and recovery led to those using D&A and their family members feeling stigmatised within their community and unable to seek support. This paper concludes by recommending increased communication between the BSA and Muslim communities and D&A treatment services to ensure accessibility of treatment by improving cultural competency.

This paper addresses an under-explored area of sociologically oriented health research, namely, the mental health and physical activity (PA) experiences of new fathers. Drawing upon responses to an online qualitative survey from 32 fathers, aged 18 or over, and living in the UK, we show how the decline in these fathers' overall PA was associated with poor mental health and the changing constraints that characterised their increasingly complex networks of interdependence. These constraints corresponded with shifts in fathers' PA engagement from team sports towards individualised, flexible, and more recreationally oriented lifestyle activities like running and the gym. Fathers' engagement in these activities appeared to exacerbate the complex feelings of guilt and isolation that they already encountered as new fathers. These experiences were simultaneously associated with feelings of shame associated with being insufficiently active and fearing judgement about their engagement in fathering responsibilities. The paper has important policy implications, highlighting the need for tailored support for new fathers in the perinatal period, and implications for practice, suggesting that co-produced community-based PA programmes are potentially effective settings for engaging new fathers in PA and promoting their mental health.

Community transport comprises diverse local, not-for-profit, and primarily volunteer-run transport schemes that operate across the United Kingdom. These schemes support the travel needs of thousands of people, most of whom are older, live in rural areas, and have few other transport options. Further, this transport sector is unique in that most schemes are designed, created, and run by older people themselves. And yet, community transport has thus far received relatively little attention in both policy and research. Using semi-structured interviews with community transport providers in Oxfordshire, this paper proposes community transport as a practice guided by phronesis and argues that it has been made to hold a dual role as both a transport and a social scheme. The transport it provides is unique in being made low-cost, flexible, and functionally accessible. It has also been made into a social scheme as it helps those with few other options, provides benefits that extend beyond the transport realm, and fosters community. Though this dual role means that community transport has many cross-sectoral benefits, this type of service provision is found to be overlooked in both national and local policy, which has enabled the constitutive role of phronesis in community transport. Given this, there are challenges ahead for the sector in both ensuring its sustainability and maintaining its ability to respond closely to users' needs.

This paper presents a case study of Green Social Prescribing (GSP) in Walsall, a medium-sized urban area located in the West Midlands, UK. GSP is a means of enabling health professionals to refer people to a range of local non-clinical nature-based activities, e.g., community gardening and conservation volunteering. As a new practice to address multiple challenges in health and sustainability, GSP has been promoted by the UK government and the NHS in the past few years. There is as yet limited evidence and knowledge about how this approach is implemented at a local level. This paper addresses this gap of knowledge, by exploring how GSP is implemented in Walsall as a case study. Based on extensive engagement and research activities with the local partners to collect data, this paper reveals the local contexts of GSP, the referral pathways, and people's lived experience, discussing the challenges, barriers, and opportunities in delivering GSP at the local level. This study suggests that a more collaborative and genuine place-based approach is essential, and alongside GSP, investment into infrastructure is needed to move the health paradigm further from 'prevention' to 'promotion' so that more people can benefit from what nature can offer.

There has been an important drive towards embedding feedback and experience data to improve health services in the UK. The current paper examines the gap in evidence and the lack of adequate measures of inpatient CAMHS experience. It presents the context of inpatient CAMHS and what factors influence care experience, before exploring the current practices for measuring experience and the implications for young people and families. The paper explores the dialectic that-given the nature of the work balancing risk and restrictions in inpatient CAMHS-it is essential that patient voice is at the centre of quality measures, and achieving this comes with a great complexity. The health needs of adolescents are unique, as are the interventions of psychiatric inpatient care, but current measures in routine use are often not developmentally adapted and lack validity. This paper looks to interdisciplinary theory and practice to consider what the application of a valid and meaningful measure of inpatient CAMHS experience might incorporate. It makes the case that the development of a measure of relational and moral experience of inpatient CAMHS would have significant implications for the quality of care and safety of adolescents during a period of acute crisis.

A large body of literature suggests that children living with two married, biological parents on average have fewer behavior problems than those who do not. What is less clear is why this occurs. Competing theories suggest that resource deficiencies and parental selectivity play a part. We suggest that examining different contexts can help adjudicate among different theoretical explanations as to how family structure relates to child behavior problems. In this paper, we use data from the Growing Up in Australia: Longitudinal Study of Australian Children (LSAC), the UK Millennium Cohort Study (MCS), and the US Early Childhood Longitudinal Study (ECLS-K) to examine the relationship between family structure and child behavior problems. Specifically, we look at how living in several configurations of biological and social parents may relate to child behavior problems. Findings suggest both similarities and differences across the three settings, with explanations in the UK results favoring selectivity theories, US patterns suggesting that there is a unique quality to family structure that can explain outcomes, and the Australian results favoring resource theories.

Although several countries have experienced large-scale privatization initiatives, relatively little is known about the impact of these initiatives on the health and safety of workers and resident populations. Examining data on technical (as compared to natural) multi-fatality disasters collected in the WHO's Emergency Events Database (EM-DAT) for the UK and a number of European comparator countries for recent decades, this paper shows that the incidence of these disasters and the number of deaths resulting from them rose significantly in the UK during the period from 1979 to 1991 when the country engaged in extensive and aggressive privatization campaigns which were supported by several consecutive Conservative governments. This observed UK blip or abnormal increase in multi-fatality disasters is apparent for the UK both in terms of a "within-country" comparison (i.e., when we compare the privatization period of 1979 to 1997 with other periods), as well as when viewed in terms of comparisons with the comparable European countries of Germany, France, and Italy for the same period (1979 to 1997). Contrary to previous analyses which suggested that there is no clear link between privatization and deterioration of health and safety, this paper concludes that the UK privatization experience (1979-1997) provides robust country-specific evidence of privatization initiatives leading to increases in the number of multi-fatality technological disasters as well as related fatalities. This evidence should be seen as a deterrent to similarly extensive and aggressive initiatives which, particularly in less developed countries, could result in similarly disastrous outcomes., Competing Interests: The authors declare no conflict of interest.

Maternity services cannot be postponed due to the nature of this service, however, the pandemic resulted in wide-ranging and significant changes to working practices and services. This paper aims to describe UK midwives' experiences of working during the COVID-19 pandemic. This study forms part of a larger multiple phase research project using a cross-sectional design based on an online survey. The online survey used validated psychometric tools to measure work-related quality of life, wellbeing, coping, and burnout as well as open-ended questions to further understand the experiences of staff working during the pandemic. This paper reports the qualitative data collected from the open-ended questions. The qualitative data were subjected to thematic analysis and the four main themes that emerged were 'relentless stress/pressure', 'reconfiguration of services', 'protection of self and others', and 'workforce challenges'. The key conclusions were that midwives experienced a reduction in quality of working life and significant stress throughout the pandemic due to a range of factors including staffing shortages, restrictions placed on women's partners, changes to services and management support, all of which compounded workforce pressures that existed prior to the pandemic. This research recommends consultation of front-line midwives in relation to possible changes in practice and workforce planning in preparation for crises such as a pandemic and to ensure equitable and supportive management with access to practical and psychological support.

The working life of individuals is now longer because of increases to state pension age in the United Kingdom. Older workers may be at particular risk in the workplace, compared with younger workers. Successful workplace interventions to reduce occupational stress amongst older workers are essential, but little is known about their effectiveness. The aim is to evaluate current evidence of the effectiveness of interventions for reducing stress in older workers in non-healthcare settings. Four database searches were conducted. The search terms included synonyms of "intervention", "workplace" and "occupational stress" to identify original studies published since 2011. Dual screening was conducted on the sample to identify studies which met the inclusion criteria. The RoB 2.0 tool for RCTs was used to assess the risk of bias. From 3708 papers retrieved, ten eligible papers were identified. Seven of the papers' interventions were deemed effective in reducing workplace stress. The sample size for most studies was small, and the effectiveness of interventions were more likely to be reported when studies used self-report measures, rather than biological measures. This review indicates that workplace interventions might be effective for reducing stress in older workers. However, there remains an absence of high-quality evidence in this field.

Background: Physical activity during childhood is associated with multiple short- and long-term health benefits. Physical activity levels decline throughout primary school emphasising a need for effective strategies to promote more activity in children. Children have rarely been involved in the intervention development process. This gap is an important omission and there is much to be learnt from existing qualitative studies with children, which could serve as a starting point for specific projects. This systematic review aimed to synthesise qualitative studies with primary school children in the United Kingdom to identify children's perspectives on why physical activity is important, the factors that influence their physical activity and what they like when it comes to physical activity., Methods: A search of seven databases (conducted in October 2019) identified 26 papers for inclusion. Data extraction and synthesis were conducted using qualitative thematic synthesis. The quality of papers was assessed using the Critical Appraisal Skills Programme checklist for qualitative research., Results: Across the diverse range of studies, several key themes were identified in relation to the three research questions. Children have a comprehensive understanding of the various benefits of physical activity, including benefits for health, fitness and skills development. A range of social agents and practical issues influence children's physical activity, with friend and peer influences being particularly salient. Most children like to have choice over the activities they undertake and the opportunities for creative physical play such as making up active games., Conclusions: The findings suggest that future interventions should utilize peer relationships, ensure a variety of activities are offered to cater to a broad range of children's physical activity preferences and incorporate child-led activities where possible. The included studies also highlight a need for more diversity in qualitative research in this area, particularly in terms of ethnicity and age, and combining traditional qualitative methods with creative methods, such as photography, may provide richer insights than when using a single mode of data collection. We also highlight several methodological challenges, and in particular, the need for greater acknowledgement of the role of the researcher in qualitative work with children.

Food-based analyses of the healthiness, environmental sustainability and affordability of processed and ultra-processed foods are lacking. This paper aimed to determine how ultra-processed and processed foods compare to fresh and minimally processed foods in relation to nutritional quality, greenhouse gas emissions and cost on the food and food group level. Data from the National Diet and Nutrition Survey nutrient databank year 11 (2018/2019) were used for this analysis. Median and bootstrapped medians of nutritional quality (NRF8.3 index), greenhouse gas emissions (gCO2-equivalents) and cost (in GBP) were compared across processing categories. An optimal score based on the medians was created to identify the most nutritional, sustainable, and affordable options across processing categories. On a per 100 kcal basis, ultra-processed and processed foods had a lower nutritional quality, lower greenhouse gas emissions, and were cheaper than minimally processed foods, regardless of their total fat, salt and/or sugar content. The most nutritious, environmentally friendly, and affordable foods were generally lower in total fat, salt, and sugar, irrespective of processing level. The high variability in greenhouse gas emissions and cost across food groups and processing levels offer opportunities for food swaps representing the healthiest, greenest, and most affordable options.

This paper explores occupational safety and health regulation in Great Britain following the UK's exit from the European Union. In particular, the paper focuses on the credibility of regulatory enforcement. The prospects raised by the UK's exit from the European Union have long been part of a free-market fantasy-even obsession-of right-wing politicians and their ideologues. As the UK's relationship with the EU is recalibrated, this will present right-wing opportunists with a new rationale for undermining health and safety law and enforcement. The paper uses empirical evidence of Great Britain's record in health and safety law enforcement to evidence a drift towards an extreme form of self-regulation. It deepens this evidence with a detailed analysis of key international policy debates, arguing that Brexit now raises an imminent threat of the UK entering a 'race to the bottom'. The paper concludes that the 2021 EU/UK Trade and Co-operation Agreement may enable the UK to evade its formal health and safety responsibilities under the treaty because of the lack of the prospect of significant retaliatory 'rebalancing' measures. Should minimal health and safety requirements cease to apply in the post-EU era, then the UK Government will be free to pursue a system of self-regulation that will allow health and safety standards to fall even further behind those of other developed economies.

There has been little agreement on the role that socioeconomic factors play in the aetiology of cardiovascular diseases (CVDs), obesity, and diabetes among migrants in the United Kingdom (UK). We systematically reviewed the existing evidence on this association to contribute to filling this gap in the literature. Two reviewers were involved at each stage of the review process to ensure validity. We comprehensively searched through several electronic databases and grey literature sources to identify potentially eligible papers for our review. We extracted data from our finally included studies and appraised the methodological rigour of our studies. A narrative synthesis approach was used to synthesise and interpret the extracted data. We sieved through 2485 records identified from our search and finally obtained 10 studies that met our inclusion criteria. The findings of this review show that there is a trend towards an association between socioeconomic factors and CVDs, diabetes, and obesity among migrants in the UK. However, the picture was more complex when specific socioeconomic variables and migrant subgroups were analysed. The evidence for this association is inconclusive and its causal relationship remains speculative. There is, therefore, the need for further research to understand the exact association between socioeconomic factors and CVD, diabetes, and obesity among migrants in the UK.

Fatality rates such as fatalities per full-time equivalent workers are officially used to compare the risk level of the construction industry among various countries. However, each country evaluates the fatality rate using different conditions. This paper presents the comparison of fatality rates of various countries using conventional (national data) and pair (equivalent condition) methods through a time-series approach. The research was conducted in three stages. The risk level was evaluated in order in South Korea (1.54), Japan (0.84), Mexico (0.83), China (0.70), United Kingdom (0.15), and Singapore (0.13) in terms of national data. However, the risk level was re-evaluated in order in China (2.27), South Korea (2.05), Mexico (1.23), Singapore (0.98), Japan (0.80), and United Kingdom (0.47) in terms of equivalent conditions. The risk level of each can be changed when the fatality rate is compared under given equivalent conditions.

Objective: This study aimed to analyze the progression and trends of multimorbidity in the elderly in China and internationally from a bibliometric perspective, and compare their differences on hotspots and research fronts., Methods: Publications between January 2001 and August 2021 were retrieved from WOS and CNKI databases. Endnote 20 and VOSviewer 1.6.8 were used to summarize bibliometric features, including publication years, journals, and keywords, and the co-occurrence map of countries, institutions, and keywords was drawn., Results: 3857 research papers in English and 664 research papers in Chinese were included in this study. The development trends of multimorbidity in the elderly are fully synchronized in China and other countries. They were divided into germination period, development period, and prosperity period. Research literature in English was found to be mainly focused on public health, and the IF of the literature is high; In China, however, most research papers are in general medicine and geriatrics with fewer core journals. Co-occurrence analysis based on countries and institutions showed that the most productive areas were the United States, Canada, the United Kingdom, and Australia, while the Chinese researchers have made little contribution. The clustering analysis of high-frequency keywords in China and around the globe shows that the hotspots have shifted from individual multimorbidity to group multimorbidity management. Sorting out the top 10 highly cited articles and highly cited authors, Barnett, K's article published in Lancet in 2012 is regarded as a milestone in the field., Conclusion: Multimorbidity in the elderly leads to more attention in the world. Although China lags behind global research the research fronts from disease-centered to patient-centered, and individual management to population management is consistent.

Background: The COVID-19 pandemic has disproportionately affected people from more deprived communities. The experience of Long COVID is similarly distributed but very few investigations have concentrated on the needs of this population. The aim of this project was to co-produce an acceptable intervention for people with Long COVID living in communities recognised as more deprived., Methods: The intervention was based on a multi-disciplinary team using approaches from sport and exercise medicine and functional rehabilitation. The co-production process was undertaken with a stakeholder advisory group and patient public involvement representation. This study identified participants by postcode and the indices of multiple deprivation (IMD); recruitment and engagement were supported by an existing health and wellbeing service. A virtual 'clinic' was offered with a team of professional practitioners who met participants three times each; to directly consider their needs and offer structured advice. The acceptability of the intervention was based on the individual's participation and their completion of the intervention., Results: Ten participants were recruited with eight completing the intervention. The partnership with an existing community health and wellbeing service was deemed to be an important way of reaching participants. Two men and six women ages ranging from 38 to 73 were involved and their needs were commonly associated with fatigue, anxiety and depression with overall de-conditioning. None reported serious hardship associated with the pandemic although most were in self-employment/part-time employment or were not working due to retirement or ill-health. Two older participants lived alone, and others were single parents and had considerable challenges associated with managing a household alongside their Long COVID difficulties., Conclusions: This paper presents the needs and perspectives of eight individuals involved in the process and discusses the needs and preferences of the group in relation to their support for self- managed recovery from Long COVID.

Research reports high levels of mental health problems faced by young people in the UK. Schools provide a range of mental health support services, although these are often not robustly evaluated. This paper aims to explore the mental health provision of secondary schools across two large regions in the North of England and provide comparisons to the mental health questionnaire scores of their pupils. Results are part of a wider study providing an overview of the mental health of secondary school pupils. Measures include the Strengths and Difficulties Questionnaire, distributed to year 8, 9, and 11 pupils attending secondary schools and a bespoke mental health service provision questionnaire for school staff at the same schools. A total of 6328 pupil questionnaires and 36 staff questionnaires were returned from 21 schools. Results showed a non-significant correlation between provision and young people's mental health scores and highlight a range of factors to take into consideration. There is a need to improve the evaluation and recording of school-based mental health provision. Mental health difficulties in young people are prevalent in schools. Future research is needed to elucidate which types of services are most helpful in preventing, supporting, and signposting those with mental health problems.

(1) Background: UK Armed Forces personnel provide first response, support and protection during national and international disasters and conflicts. They thus have a psychologically challenging role which requires them to maintain a good state of mental health and wellbeing. HeadFIT is a preventative initiative developed to help foster mental fitness through various self-help tools and resources online including techniques to de-stress and increase drive. This paper reports on an independent service evaluation of HeadFIT to examine feasibility and acceptability among Ministry of Defence (MOD) personnel. (2) Methods: Qualitative interviews were held with the HeadFIT beneficiaries, including military personnel and civil servants. The beneficiaries provided feedback on HeadFIT through questionnaires and interviews, and website traffic data were also collected. Qualitative data were analysed using framework analysis. (3) Results: Beneficiaries generally reported positive views on the HeadFIT initiative, with most agreeing that the tools could support them to foster their mental fitness. However, concerns were raised around the uptake of HeadFIT and participants suggested methods to improve usability. (4) Conclusions: Several recommendations were made to improve the resources, usability, uptake, and implementation and communication of HeadFIT.

This paper studies the interplay between social distancing and the spread of the COVID-19 disease-a global pandemic that has affected most of the world's population. Our goals are to (1) to observe the correlation between the strictness of social distancing policies and the spread of disease and (2) to determine the optimal adoption level of social distancing policies. The earliest instances of the virus were found in China, and the virus has reached the United States with devastating consequences. Other countries severely affected by the pandemic are Brazil, Russia, the United Kingdom, Spain, India, Italy, and France. Although it is impossible to stop it, it is possible to slow down its spread to reduce its impact on the society and economy. Governments around the world have deployed various policies to reduce the virus spread in response to the pandemic. To assess the effectiveness of these policies, the system's dynamics of the society needs to be analyzed, which is generally not possible with mathematical linear equations or Monte Carlo methods because human society is a complex adaptive system with continuous feedback loops. Because of the challenges with the other methods, we chose agent-based methods to conduct our study. Moreover, recent agent-based modeling studies for the COVID-19 pandemic show significant promise in assisting decision-makers in managing the crisis by applying policies such as social distancing, disease testing, contact tracing, home isolation, emergency hospitalization, and travel prevention to reduce infection rates. Based on modeling studies conducted in Imperial College, increasing levels of interventions could slow the spread of disease and infection. We ran the model with six different percentages of social distancing while keeping the other parameters constant. The results show that social distancing affects the spread of COVID-19 significantly, in turn decreasing the spread of disease and infection rates when implemented at higher levels. We also validated these results by using the behavior space tool with ten experiments with varying social distancing levels. We conclude that applying and increasing social distancing policy levels leads to a significant reduction in infection spread and the number of deaths. Both experiments show that infection rates are reduced drastically when social distancing intervention is implemented between 80% to 100%.

This review paper examines the extent of employer, worker, and labour union concerns to occupational health hazard exposure, as a function of previously reported and investigated complaints. Consequently, an online literature search was conducted, encompassing publicly available reports resulting from investigations, regulatory inspection, and enforcement activities conducted by relevant government structures from South Africa, the United Kingdom, and the United States. Of the three countries' government structures, the United States' exposure investigative activities conducted by the National Institute for Occupational Safety and Health returned literature search results aligned to the study design, in the form of health hazard evaluation reports reposited on its online database. The main initiators of investigated exposure cases were employers, workers, and unions at 86% of the analysed health hazard evaluation reports conducted between 2000 and 2020. In the synthesised literature, concerns to exposure from chemical and physical hazards were substantiated by occupational hygiene measurement outcomes confirming excessive exposures above regulated health and safety standards in general. Recommendations to abate the confirmed excessive exposures were made in all cases, highlighting the scientific value of occupational hygiene measurements as a basis for exposure control, informing risk and hazard perception. Conclusively, all stakeholders at the workplace should have adequate risk perception to trigger abatement measures.

In 2014, The National Institute for Health and Care Excellence (NICE) called for the development of a system to collate local data on exercise referral schemes (ERS). This database would be used to facilitate continued evaluation of ERS. The use of health databases can spur scientific investigation and the generation of evidence regarding healthcare practice. NICE's recommendation has not yet been met by public health bodies. Through collaboration between ukactive, ReferAll, a specialist in software solutions for exercise referral, and the National Centre for Sport and Exercise Medicine, which has its research hub at the Advanced Wellbeing Research Centre, in Sheffield, data has been collated from multiple UK-based ERS to generate one of the largest databases of its kind. This database moves the research community towards meeting NICEs recommendation. This paper describes the formation and open sharing of The National ReferAll Database, data-cleaning processes, and its structure, including outcome measures. Collating data from 123 ERSs on 39,283 individuals, a database has been created containing both scheme and referral level characteristics in addition to outcome measures over time. The National ReferAll Database is openly available for researchers to interrogate. The National ReferAll Database represents a potentially valuable resource for the wider research community, as well as policy makers and practitioners in this area, which will facilitate a better understanding of ERS and other physical-activity-related social prescribing pathways to help inform public health policy and practice.

A personal perspective is given on the processes involved in managing and sustaining a high-performing mental health recovery research group. The broader context of scholarship in the United Kingdom is outlined, in which academic productivity is commodified specifically in relation to peer-reviewed journal papers. Four leadership choices in developing a high-performing research group are discussed: optimal group size; sharing the workload; maintaining a programmatic focus; and performance expectations. Approaches to maximising innovation are identified, including emotional and intellectual engagement of team members, working with diverse stakeholders and convening communities of practice. We use a highly managed approach to publications from inception to acceptance, which is described in detail. The use of these approaches is illustrated in relation to the Recovery Research Team which was formed in 2009. Specific recovery-related issues covered include demonstrating the ability to develop a significant recovery research portfolio (our four current large [>UK£2 m] studies relate to recovery narratives, global mental health peer support work, digital interventions and Recovery Colleges); the positive implications of actively recruiting researchers with mental health lived experience; how performance issues are managed; our approach to involving lived experience co-authors in papers; and our decision to conduct mixed-methods rather than solely qualitative studies.

The development and enhancement of occupational health services (OHS) at the national level is central to ensuring the sustainable health, well-being and work engagement of the working population. However, due to differences in national health, social security and occupational safety and health systems, the content, capacity, coverage and provisions of OHS vary considerably across national contexts. Obtaining a better understanding in terms of such similarities and variations internationally is essential as such comparative information can help inform evidenced-based decision-making on OHS at both policy and practice levels. This paper therefore reviews and analyses the key policies, standards and approaches in OH systems and services, using both academic and grey literature, across 12 industrialised countries (Australia, Canada, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, United Kingdom and the United States of America). It provides a detailed overview and categorization of OHS in these selected countries in terms of the legal and policy context, organisation and financing and coverage and staffing while specifically discussing variations aimed at psychosocial risk management and the promotion of mental health and well-being at work. It draws conclusions on key development needs of OHS internationally to ensure psychosocial risk management and mental health promotion are prioritised effectively in a preventive manner.

Objective: This paper examines infrastructural and route environment correlates of cycling injury risk in Britain for commuters riding in the morning peak., Methods: The study uses a case-crossover design which controls for exposure. Control sites from modelled cyclist routes (matched on intersection status) were compared with sites where cyclists were injured. Conditional logistic regression for matched case-control groups was used to compare characteristics of control and injury sites., Results: High streets (defined by clustering of retail premises) raised injury odds by 32%. Main (Class A or primary) roads were riskier than other road types, with injury odds twice that for residential roads. Wider roads, and those with lower gradients increased injury odds. Guard railing raised injury odds by 18%, and petrol stations or car parks by 43%. Bus lanes raised injury odds by 84%. As in other studies, there was a 'safety in numbers' effect from more cyclists. Contrary to other analysis, including two recent studies in London, we did not find a protective effect from cycle infrastructure and the presence of painted cycle lanes raised injury odds by 54%. At intersections, both standard and mini roundabouts were associated with injury odds several times higher than other intersections. Presence of traffic signals, with or without an Advanced Stop Line ('bike box'), had no impact on injury odds. For a cyclist on a main road, intersections with minor roads were riskier than intersections with other main roads., Conclusions: Typical cycling environments in Britain put cyclists at risk, and infrastructure must be improved, particularly on busy main roads, high streets, and bus routes.

The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing global health crisis with unmatched outcomes and effects. This pandemic has caused an infodemic of article publication in scientific journals. Dental journals have been active in the publication of COVID-19 related articles from the beginning of the pandemic. In this cross-sectional survey, we present an analysis of the scientific output of dental journals on COVID-19. The PubMed COVID-19 database was searched with the "Dental Journals" filter. Data including journal name, country, month of publication and number of citations were recorded. Science mapping analysis of the most used keywords was also performed. The search retrieved a total of 659 articles, of which 28 were excluded. Oral Diseases has published the most COVID-19 articles (15.1%), followed by the British Journal of Oral and Maxillofacial Surgery (8.6%) and the Journal of Dental Education (7.9%). Most of the articles were from researchers from the United States (168), United Kingdom (120) and Brazil (83). The number of citations of the published articles ranged from 0 to 406, with most articles (64.2%) having no citations. Science Mapping analysis revealed that the most used keywords were coronavirus infections, pandemics and humans. The dental community has been active in the publication of COVID-19 articles from the beginning of the pandemic. The papers published by dental journals explore issues such as the management of clinical practices during the outbreak, infection control in the dental setting, signs and symptoms of COVID-19 affecting the oral cavity, and the impact of the COVID-19 pandemic on educational and clinical programs.

Over the last few decades, citizen awareness and perception of chemical products has been a topic of interest, particularly concerning national and international policy decision makers, expert/scientific platforms, and the European Union itself. To date, few qualitative studies on human biomonitoring have analysed communication materials, made recommendations in terms of biomonitoring surveillance, or asked for feedback in terms of specific biomonitoring methods. This paper provides in-depth insight on citizens' perceptions of knowledge of biomonitoring, impact of chemical exposure on daily life, and claims on how results of research should be used. Four semi-structured focus groups were held in Austria, Portugal, Ireland, and the United Kingdom (UK). The cross-sectional observational qualitative design of this study allows for better understanding of public concern regarding chemicals, application, and use of human biomonitoring. The main findings of this study include citizens' clear articulation on pathways of exposure, the demand on stakeholders for transparent decision-making, and sensitivity in communication of results to the public. Validated and trustful communication is perceived as key to empowering citizens to take action. The results can be used to facilitate decision-making and policy development, and feeds into the awareness needs of similar and future projects in human biomonitoring. Furthermore, it also brings to light ideas and concepts of citizens' in shaping collaborative knowledge between citizens', experts, scientists, and policy makers on equal terms.

With the implementation of European integration policies such as the single market, the Euro and the Schengen Visa, the EU member states are developing closer economic ties through tourism, and their level of tourism integration is constantly improving. Taking the 28 EU member states as research objects, this paper constructs a tourism economic connection network among them, measures the strength of their tourism economic connections from 1995 to 2018 by using the modified gravity model and social network method, and analyzes the spatial structure characteristics and effects of the EU tourism economy. The results are as follows: (1) The tourism economic ties of EU member states are growing increasingly close, enhancing network stability. (2) Germany, France, Italy, Austria and the United Kingdom are the top five countries in the degree centrality and closeness centrality rankings, meaning that they are located in the center of the network and have great influence, and the network is becoming increasingly concentrated. Germany, Italy, Sweden, Austria and France play an important intermediary role in the network, and the centrality of most member states has increased. (3) The core areas are mainly concentrated in Western Europe, Southern Europe, Mediterranean mainland countries and Central Europe, while the marginal areas are mainly concentrated in Eastern Europe, Northern Europe and Mediterranean island countries; the network connection density of the core area, the network connection density of the marginal area, and the network connection density between the core and marginal area overall show an increasing trend. (4) Improvements in the complete network connectedness and a reduction in graph efficiency can significantly reduce differences in EU tourism economic development levels and improve spatial equity.

Nurses are a key workforce in the international health system, and as such maintaining optimal working conditions is critical for preserving their well-being and good performance. One of the psychosocial risks that can have a major impact on them is job insecurity. This study aimed to carry out a bibliometric analysis, mapping job insecurity in 128 articles in nursing, and to determine the most important findings in the literature. The search was conducted in the Web of Science Core Collection database using the Science Citation Index (SCI)-Expanded and Social Sciences Citation Index (SSCI) indexes on 6 March 2020. This field of discipline has recently been established and has experienced significant growth since 2013. The most productive and widely cited authors are Denton and Zeytinoglu. The most productive universities are Toronto University, McMaster University, and Monash University. The most productive countries are the United States, Canada, Australia, Finland, and the United Kingdom. The most widely used measure was Karasek's Job Content Questionnaire (JCQ). The main findings report negative correlations with job satisfaction, mental well-being, and physical health. Job insecurity is a recent and little-discussed topic, and this paper provides an overview of the field. This will enable policies to reduce psychosocial risks among nurses to be implemented.

PLAN-A is a cluster randomised controlled trial of a peer-led physical activity intervention which uses peer supporters to increase the physical activity of 13-14-year-old girls in the UK. This paper uses latent class analysis to identify classes in the whole study population and investigate how those selected as peer supporters in PLAN-A were drawn from different social groups. We identified five classes of girls, based on psychosocial variables (self-esteem, physical activity self-efficacy, motivation, physical activity values among friends and peer support for physical activity (PA) and physical activity behaviour variables (average minutes of weekday MVPA, sedentary time and screen viewing). Peer supporters were similar to the whole study population in terms of overall demographics, but were drawn unequally from the five classes. In addition, there was considerable variation in the distribution of peer supporters between schools. The selection of peer supporters is an integral component of peer-led interventions and should be explored and linked to underlying theory to understand the characteristics of those recruited. However, demographic representativeness is not necessarily the aim, and simple reporting of overall demographic comparisons may mask important differences within subgroups.

In recent years, UK public health messages about the risks of sunlight exposure (skin cancer) have been increasingly balanced by messages about its benefits (vitamin D production). Currently, data about the effects of this shift on public knowledge, awareness, and behaviour are scant. Thus, the objective of this paper is to report the findings of the first large-scale and representative survey of the awareness, knowledge, and behaviour of adults in Great Britain (England, Scotland, and Wales) ( n = 2024) with respect to sunlight exposure, vitamin D, and sunburn and skin cancer. The findings suggest that the public in Great Britain is much more aware of public promotion of the risks of sunlight exposure than its benefits. That said, knowledge about sunlight exposure and vitamin D is fairly strong, though not with respect to the detail of the 'little and often' approach. However, the survey also suggests that levels of sunlight exposure among the public are often excessive. The survey indicates that knowledge and behaviour are both less satisfactory among men and people in lower socio-economic groups. The paper concludes with recommendations for public health communications and for research in this area.

This paper examines the linkages in financial markets during coronavirus disease 2019 (COVID-19) pandemic outbreak. For this purpose, daily stock market returns were used over the period of December 31, 2019-April 20, 2020 for the following economies: USA, Spain, Italy, France, Germany, UK, China, and Romania. The study applied the autoregressive distributed lag (ARDL) model to explore whether the Romanian stock market is impacted by the crisis generated by novel coronavirus. Granger causality was employed to investigate the causalities among COVID-19 and stock market returns, as well as between pandemic measures and several commodities. The outcomes of the ARDL approach failed to find evidence towards the impact of Chinese COVID-19 records on the Romanian financial market, neither in the short-term, nor in the long-term. On the other hand, our quantitative approach reveals a negative effect of the new deaths' cases from Italy on the 10-year Romanian bond yield both in the short-run and long-run. The econometric research provide evidence that Romanian 10-year government bond is more sensitive to the news related to COVID-19 than the index of the Bucharest Stock Exchange. Granger causality analysis reveals causal associations between selected stock market returns and Philadelphia Gold/Silver Index.

Health impact assessment (HIA) is a systematic and flexible tool, which is advocated by the World Health Organisation as a method through which to consider the impact of policies on the health and well-being of a population, and the inequalities that may arise because of it. In 2018, the HIA support unit in Wales carried out a comprehensive and unique HIA on the impact of Brexit in Wales. The aims were to understand the differential impacts that Brexit would have on the health and well-being of the population and to provide evidence to inform decision makers across a range of public bodies. It followed a five-step process for HIA and utilised a wide range of evidence sources and health intelligence including both quantitative and qualitative evidence. This paper reflects on the process of carrying out the HIA and the methods used. It discusses the stages of the HIA, and shares the findings and reflections of implementation which will be beneficial to other HIA practitioners and policy makers. It does not concentrate on the findings of the HIA in detail, but focusses on what worked and any challenges encountered. It has been used to progress the practice of HIA in Wales and demonstrates the value of HIA as a method to inform and influence complex decisions.

A substantial amount of attention has been devoted towards the potential sport legacy of the Olympic Games. In spite of the increasing academic interest in this topic, there is a knowledge gap as far as sport legacy is concerned by types of different sports. The authors bridge this gap by analysing the evolution of 43 different Olympic/Paralympic sport modalities in the two-year period after the London 2012 Olympics. By using data from the Active People Survey with a sample of 165,000 people annually, and considering some demographic variables and the effect of the economic environment, the paper aims to test the existence of a sport legacy. We have applied time series analysis and ARIMA models for controlling for economic influence and seasonal adjustment and for making comparisons among participation rates. The results show, for the total of the sports analysed, that there were 336,000 individuals who increased their frequency of participation, while there was no significant increase in the number of new participants in these sports. When we develop the analysis for types of sports, London 2012 is positively associated not only with the frequency of participation in some types of sport but also with an increase in the number of new sport participants. Gender and age differences are also detected. The results show the differences of sport legacy by type of sports. Moreover, this research has elucidated an important unrecognised aspect of the effect of the Olympic Games and perhaps major events: that they can become a major policy tool for reversing sporting inequalities.

Despite the improved understanding of the determinants of suicide over recent decades, the mean suicide rate within the United Kingdom (UK) has remained at 10 per 100,000 per annum, with about 28% accessing mental health services in the 12 months prior to death. In this paper, we outlined a novel systems-level approach to tackling this problem through objectively differentiating the level of severity for each suicide risk presentation and providing fast-track pathways to care for all, including life-threatening cases. An additional operational challenge addressed within the proposed model was the saturation of local crisis mental health services with approximately 150 suicidality referrals per month, including non-mental health cases. This paper discussed a service improvement initiative undertaken within a National Health Service (NHS) secondary care mental health provider's open-access 24/7 crisis and home treatment service. An organisation-wide bespoke "suicide risk triage" system utilising the Collaborative Assessment and Management of Suicidality (CAMS) was implemented across all services. The preliminary impacts on suicidality, suicide rates and service user outcomes were described.

Many epidemiological studies have shown an association between outdoor particulate air pollutants and increased morbidity and mortality. Inhalation of ambient aerosols can exacerbate or promote the development of cardiovascular and pulmonary diseases as well as other diseases, such as type 2 diabetes mellitus (T2DM) and neurodegenerative diseases. Occupational exposure to dust, fumes and diesel exhaust particulates can also cause adverse health outcomes and there are numerous occupations where workers are exposed to airborne particles that are similar to ambient air pollution. An individual's job title has normally been identified as a major determinant of workplace exposure in epidemiological studies. This has led to the development of Job-Exposure Matrices (JEMs) as a way of characterising specific workplace exposures. One JEM for airborne chemical exposures is the Airborne Chemical Exposure Job-Exposure Matrix (ACE JEM), developed specifically for the UK Biobank cohort. The objective of this paper is to evaluate the suitability of the ACE JEM in assessing occupational aerosol exposure of participants in the UK Biobank. We searched the scientific literature to identify exposure data linked to selected jobs in the ACE JEM and compared these data with the JEM assessments. Additionally, we carried out an independent expert-based assessment of exposure to compare with the JEM estimates. There is good published evidence to substantiate the high dust and biological dust assignments in the JEM and more limited evidence for diesel exhaust particulates. There is limited evidence in the published literature to substantiate moderate or low exposure assignments in the JEM. The independent expert-based assessment found good agreement at the two extremes of exposure in the JEM (high and no exposure), with uncertainty in all other classifications. The ACE JEM assignments are probably reliable for highly exposed jobs and for jobs assigned as unexposed. However, the assignments for medium and low exposures are less reliable. The ACE JEM is likely to be a good tool to examine associations between occupational exposures to particulates and chronic disease, although it should be used with caution. Further efforts should be made to improve the reliability of the ACE JEM.

Planning for future health and social services (HSS) workforces must be informed by an understanding of how workers view their work within the context of their life and the challenges they will face across the course of life. There is a range of policies and provisions that states and organisations can adopt to create sustainable careers, support wellbeing at work, and extend working lives where appropriate, but the potential impact of these policies on the make-up of the workforce remains under investigation. This paper makes the case that service planners need to appreciate complex interplay between wellbeing and career decisions when planning the future workforce. It makes use of a recent survey of United Kingdom (UK) social workers ( n = 1434) to illustrate this interplay in two ways. First, we present the analysis of how social workers' perception of retirement and extended working lives are associated with dimensions of Work-Related Quality of Life (WRQL). We find that social workers who agreed that a flexible working policy would encourage them to delay their retirement scored lower on the Home-Work Interface and Control at Work dimensions of WRQL, while social workers who indicated a perception that their employer would not wish them to work beyond a certain age had lower Job and Career Satisfaction scores. Second, we propose a new typology of retirement outlooks using latent class analysis of these attitudinal measures. An 8-class solution is proposed, and we demonstrate the predictive utility of this scheme. Results are discussed in terms of the challenges for ageing Western populations and the usefulness of analysis such as this in estimating the potential uptake and impact of age-friendly policies and provisions.

Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical 'advanced clinical practitioner' (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs ( n = 9), general practitioners ( n = 8) and practice managers ( n = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK.

The science on the effects of global climate change and air pollution on morbidity and mortality is clear and debate now centres around the scale and precise contributions of particular pollutants. Sufficient data existed in recent decades to support the adoption of precautionary public health policies relating to fossil fuels including shale exploration. Yet air quality and related public health impacts linked to ethical and environmental justice elements are often marginalized or missing in planning and associated decision making. Industry and government policies and practices, laws and planning regulations lagged well behind the science in the United Kingdom. This paper explores the reasons for this and what shaped some of those policies. Why did shale gas policies in England fail to fully address public health priorities and neglect ethical and environmental justice concerns. To answer this question, an interdisciplinary analysis is needed informed by a theoretical framework of how air pollution and climate change are largely discounted in the complex realpolitik of policy and regulation for shale gas development in England. Sources, including official government, regulatory and planning documents, as well as industry and scientific publications are examined and benchmarked against the science and ethical and environmental justice criteria. Further, our typology illustrates how the process works drawing on an analysis of official policy documents and statements on planning and regulatory oversight of shale exploration in England, and material from industry and their consultants relating to proposed shale oil and gas development. Currently the oil, gas and chemical industries in England continue to dominate and influence energy and feedstock-related policy making to the detriment of ethical and environmental justice decision making with significant consequences for public health.

Good hand hygiene is necessary to control and prevent infections, but many children do not adequately wash their hands. While there are classroom communications targeted at children, the toilet space, the location of many hand hygiene activities, is neglected. This paper describes an initial evaluation of "123" persuasive space graphics (images and messages integrated within an architectural environment that encourage specific actions). The effectiveness (whether hand hygiene improves) and efficiency (the ease with which a setting can adopt and implement an intervention) is evaluated in three UK schools and one museum. Five evaluations (participant demographic, handwashing frequency, handwashing quality, design persuasiveness, stakeholder views) were conducted. In the school settings, persuasive space graphics increased the quality and frequency of handwashing. In the museum setting, frequency of handwashing slightly increased. In all settings children found the graphics persuasive, and stakeholders also believed them to be effective. Stakeholders considered persuasive space graphics a low-cost and time-efficient way to communicate. It can be concluded that persuasive space graphics are effective in increasing hand hygiene, particularly in school settings where children have a longer exposure to the graphics. Persuasive space graphics are also an efficient low-cost means of communicating hand hygiene.

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs that can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs that are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents: the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries; and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change.

This systematic review commissioned by the UK Department for the Environment, Food and Rural Affairs (Defra), considers how the evidence base for noise effects on health has changed following the recent reviews undertaken for the WHO Environmental Noise Guidelines. This systematic review assesses the quality of the evidence for environmental noise effects on mental health, wellbeing, and quality of life; birth and reproductive outcomes; and cognition for papers published since the WHO reviews (mid-2015 to March 2019), as well as for cancer and dementia (January 2014 to March 2019). Using the GRADE methodology (Grading of Recommendations Assessment, Development and Evaluation) most evidence was rated as low quality as opposed to very low quality in the previous reviews. There is now low-quality evidence for a harmful effect of road traffic noise on medication use and interview measures of depression and anxiety and low quality evidence for a harmful effect of road traffic noise, aircraft noise, and railway noise on some cancer outcomes. Many other conclusions from the WHO evidence reviews remain unchanged. The conclusions remain limited by the low number of studies for many outcomes. The quantification of health effects for other noise sources including wind turbine, neighbour, industrial, and combined noise remains a research priority., Competing Interests: CC1 and CC2 are environmental consultants undertaking environmental and health impact assessment for large infrastructure clients, amongst other consulting activities in the field of noise and health. The funder (Defra/HN) did not influence the design of the study or the collection or analyses or interpretation of data. The decision to publish was part of the original project scope. The authors declare no conflict of interest.

Background: There is greater dissatisfaction with health services by LGBT people compared to heterosexual and cisgender people and some of this is from lack of equality and diversity training for health professionals. Core training standards in sexual orientation for health professionals have been available since 2006. The purpose of this project is to systematically review educational materials for health and social care professionals in lesbian, gay, bisexual, and transgender (LGBT) issues., Methods: A protocol was developed and searches conducted in six databases., Selection Criteria: any studies reporting delivery or evaluation of UK education of health and/or social care professionals in LGBT issues, with no language or setting restrictions. Inclusions and data extraction were conducted in duplicate. Narrative synthesis of educational evaluations was used. Educational materials were assessed using thematic synthesis., Results: From the searches, 165 full papers were evaluated and 19 studies were included in the narrative synthesis. Three were successful action-research projects in cancer services and in residential care. Sixteen sets of educational/training materials have been available since 2010. These varied in length, scope, target audience, and extent of development as classroom-ready materials., Conclusions: Despite the availability of appropriate training programmes for post-qualifying staff, recommendations to undertake training, best practice examples, and statements of good intent, LGBT people continue to report that they are experiencing discrimination or direct prejudice from health and/or social care services. Better training strategies using behaviour change techniques are needed.

The water industry in every country aims to effectively and efficiently provide water with satisfactory quality in a sustainable and environmentally friendly manner. To this end, it is critical to achieve effective communication among the partners in water supply chain networks. In this paper, we focus on one of the UK's largest water utility companies and its eight main contractors and analyze the factors influencing partner and network communication in a managed programme of their asset supply chain. We employ social network analysis to conduct the cross-sectional and longitudinal analysis of partner communication. Factors found to influence the communication network are grouping of projects within the programme, individual's organisational affiliation, status, tenure, elapsed time through the programme lifecycle, and co-location. Our contributions to practice include demonstrating water programme management factors that influence communication and trust and how social network analysis can better inform them about intra- and interorganisational relationships. Moreover, the methodology introduced in this study may be applied to water management in other parts of the world.

Increased stair climbing reduces cardiovascular disease risk. While signage interventions for workplace stair climbing offer a low-cost tool to improve population health, inconsistent effects of intervention occur. Pedestrian movement within the built environment has major effects on stair use, independent of any health initiative. This paper used pooled data from UK and Spanish workplaces to test the effects of signage interventions when pedestrian movement was controlled for in analyses. Automated counters measured stair and elevator usage at the ground floor throughout the working day. Signage interventions employed previously successful campaigns. In the UK, minute-by-minute stair/elevator choices measured effects of momentary pedestrian traffic at the choice-point ( n = 426,605). In Spain, aggregated pedestrian traffic every 30 min measured effects for 'busyness' of the building ( n = 293,300). Intervention effects on stair descent (3 of 4 analyses) were more frequent than effects on stair climbing, the behavior with proven health benefits (1 of 4 analyses). Any intervention effects were of small magnitude relative to the influence of pedestrian movement. Failure to control for pedestrian movement compromises any estimate for signage effectiveness. These pooled data provide limited evidence that signage interventions for stair climbing at work will enhance population health., Competing Interests: The authors declare no conflicts of interest.

The World Health Organization (WHO) strives to assist and inspire cities to become more "age-friendly", and the fundamentals are included in the Global Age-Friendly Cities Guide. An age-friendly city enables residents to grow older actively within their families, neighbourhoods and civil society, and offers extensive opportunities for the participation of older people in the community. Over the decades, technology has become essential for contemporary and future societies, and even more imperative as the decades move on, given we are nearly in our third decade of the twenty-first century. Yet, technology is not explicitly considered in the 8-domain model by the WHO, which describes an age-friendly city. This paper discusses the gaps in the WHO's age-friendly cities model in the field of technology and provides insights and recommendations for expansion of the model for application in the context of countries with a high human development index that wish to be fully age-friendly. This work is distinctive because of the proposed new age-friendly framework, and the work presented in this paper contributes to the fields of gerontology, geography urban and development, computer science, and gerontechnology.

There is no routine data collection in the UK on infant dietary diversity during the transition to solid foods, and health visitors (HVs) (nurses or midwives with specialist training in children and family health) have the potential to play a key role in nutrition surveillance. We aimed to assess items for inclusion in routine data collection, their suitability for collecting informative data, and acceptability among HVs. A mixed-methods study was undertaken using: (i) an online survey testing potential questionnaire items among parents/caregivers, (ii) questionnaire redevelopment in collaboration with community staff, and (iii) a survey pilot by HVs followed by qualitative data collection. Preliminary online questionnaires ( n = 122) were collected to identify useful items on dietary diversity. Items on repeated exposure to foods, aversive feeding behaviors, flavor categories, and sugar intake were selected to correspond to nutrition recommendations, and be compatible with electronic records via tablet. HVs surveyed 187 parents of infants aged 12 months. Semi-structured interviews indicated that HVs found the questionnaire comparable with standard nutrition conversations, which prompted helpful discussions, but questions on eating behavior did not prompt such useful discussions and, in some cases, caused confusion about what was 'normal.' Lack of time among HVs, internet connectivity issues, and fear of losing rapport with parents were barriers to completing electronic questionnaires, with 91% submitted by paper. Routine nutrition data collection via child health records seems feasible and could inform quality improvement projects.

The aim of this paper is to report on the lunchtime food purchasing practices of secondary school students and some of the factors related to this purchasing, including the influence of socio-economic status (SES) and the food environment within and around schools. A mixed-methods study incorporating an online purchasing recall questionnaire and multiple qualitative methods was undertaken at seven UK secondary schools. The analysis shows that SES was intricately woven with lunchtime food practices. Three-quarters of participants regularly purchased food outside of school; those at low SES schools were more likely to report regularly leaving school to buy food. Young people's perception of food sold in schools in areas of low SES was often negative and they left school to find "better" food and value for money. Taste, ingredients and advertisements were factors that mattered to young people at schools with low or mixed SES; health as a driver was only mentioned by pupils at a high SES school. For public health initiatives to be effective, it is critical to consider food purchasing practices as complex socio-economically driven phenomena and this study offers important insights along with suggestions for designing interventions that consider SES. Availability of food outlets may be less important than meeting young people's desires for tasty food and positive relationships with peers, caterers and retailers, all shaped by SES. Innovative ways to engage young people, taking account of SES, are required.

In recent years, the known distribution of vector-borne diseases in Europe has changed, with much new information also available now on the status of vectors in the United Kingdom (UK). For example, in 2016, the UK reported their first detection of the non-native mosquito Aedes albopictus , which is a known vector for dengue and chikungunya virus. In 2010, Culex modestus , a principal mosquito vector for West Nile virus was detected in large numbers in the Thames estuary. For tick-borne diseases, data on the changing distribution of the Lyme borreliosis tick vector, Ixodes ricinus , has recently been published, at a time when there has been an increase in the numbers of reported human cases of Lyme disease. This paper brings together the latest surveillance data and pertinent research on vector-borne disease in the UK, and its relevance to public health. It highlights the need for continued vector surveillance systems to monitor our native mosquito and tick fauna, as well as the need to expand surveillance for invasive species. It illustrates the importance of maintaining surveillance capacity that is sufficient to ensure accurate and timely disease risk assessment to help mitigate the UK's changing emerging infectious disease risks, especially in a time of climatic and environmental change and increasing global connectivity.

This is a discussion paper which examines the impact of austerity policies on the provision of mental health services in the United Kingdom. Austerity is a shorthand for a series of policies introduced by the Conservative and Liberal Democrat Coalition government in the UK from 2010 onwards. In response to the fiscal crisis following the bail out of the banks in 2008, it was argued that significant reductions in public spending were required. The background to these policies is examined before a consideration of their impact on mental health services. These policies had a disproportionate impact on people living in poverty. People with health problems including mental problems are overrepresented in this group. At the same time, welfare and community services are under increasing financial pressures having to respond to increased demand within a context of reduced budgets. There is increasing recognition of the role that social factors and adverse childhood experiences have in the development and trajectory of mental health problems. Mental health social workers, alongside other professionals, seek to explain mental distress by the use of some variant of a biopsychosocial model. The extent of mental health problems as a one of their measures of the impact of inequality. More unequal societies create greater levels of distress. There is a social gradient in the extent of mental health problems-the impact of severe mental illness means that many individuals are unable to work or, if they can return to work, they find it difficult to gain employment because of discrimination. The paper concludes that austerity and associated policies have combined to increase the overall burden of mental distress and marginalisation within the UK.