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Cognitive control is a predictor of later‐life outcomes and may underpin higher order executive processes. The present study examines the development of early cognitive control during the first 24‐month. We evaluated a tablet‐based assessment of cognitive control among infants aged 18‐ and 24‐month. We also examined concurrent and longitudinal associations between attentional disengagement, general cognitive skills and cognitive control. Participants (N = 60, 30 female) completed the tablet‐task at 18‐ and 24‐month of age. Attentional disengagement and general cognitive development were assessed at 5‐, 8‐, 12‐, 18‐ and 24‐month using an eye‐tracking measure and the Mullen Scales of Early Learning (MSEL), respectively. The cognitive control task demonstrated good internal consistency, sensitivity to age‐related change in performance and stable individual differences. No associations were found between infant cognitive control and MSEL scores longitudinally or concurrently. The eye‐tracking task revealed that slower attentional disengagement at 8‐month, but faster disengagement at 18‐month, predicted higher cognitive control scores at 24‐month. This task may represent a useful tool for measuring emergent cognitive control. The multifaceted relationship between attention and infant cognitive control suggests that the rapid development of the attentional system in infancy results in distinct attentional skills, at different ages, being relevant for cognitive control development. [ABSTRACT FROM AUTHOR]

International collaboration is sometimes encouraged in the belief that it generates higher quality research or is more capable of addressing societal problems. Nevertheless, while there is evidence that the journal articles of international teams tend to be more cited than average, perhaps from increased international audiences, there is no science‐wide direct academic evidence of a connection between international collaboration and research quality. This article empirically investigates the connection between international collaboration and research quality for the first time, with 148,977 UK‐based journal articles with post publication expert review scores from the 2021 Research Excellence Framework (REF). Using an ordinal regression model controlling for collaboration, international partners increased the odds of higher quality scores in 27 out of 34 Units of Assessment (UoAs) and all Main Panels. The results therefore give the first large scale evidence of the fields in which international co‐authorship for articles is usually apparently beneficial. At the country level, the results suggests that UK collaboration with other high research‐expenditure economies generates higher quality research, even when the countries produce lower citation impact journal articles than the United Kingdom. Worryingly, collaborations with lower research‐expenditure economies tend to be judged lower quality, possibly through misunderstanding Global South research goals. [ABSTRACT FROM AUTHOR]

Background: The Social Motivation Theory proposes that social reward processing differences underlie autism. However, low social motivation has also been linked to higher anxiety. Given the co‐occurrence between autism and anxiety, it is possible that anxiety drives the association between social motivation and autistic characteristics. This study tests the mechanisms underlying the association between social motivation and autistic traits. Methods: Participants were 165 adolescents (71 male), aged 10–16 years, from the Mapping profiles of cognition, motivation and attention in childhood (C‐MAPS) study, enriched for autistic traits (70 participants with an autism diagnosis, 37 male). Participants completed a battery of online experimental tasks, including a Choose‐a‐Movie social motivation task and social cognition measures (theory of mind; emotion recognition), alongside parent‐reported child anxiety and autistic traits. Results: Higher social motivation was significantly associated with lower autistic traits (β = −.26, p <.001). Controlling for social cognition did not change the association between social motivation and autistic traits. Controlling for anxiety did significantly reduce the strength of the association (unstandardized coefficient change: p =.003), although social motivation remained associated with autistic traits (β = −.16, p =.004). Post hoc analyses demonstrated differential sex‐effects: The association between social motivation and autistic traits was significant only in the females (β = −.38, p <.001), as was the attenuation by anxiety (unstandardized coefficient change: p <.001). Conclusions: The association between social motivation and autistic traits could be partially attributed to co‐occurring anxiety. Sex‐specific effects found in females may be due to environmental factors such as increased social demands in adolescent female relationships. Results are consistent with self‐report by autistic individuals who do not identify as having reduced social motivation. [ABSTRACT FROM AUTHOR]

Objectives: This qualitative sub‐study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis‐GBMSM) and transgender people who reported non‐consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing. Methods: SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV‐self testing among cis‐GBMSM and transgender people. Semi‐structured interviews were conducted, audio‐recorded, transcribed, and analysed through a framework analysis, as a qualitative sub‐study. We identified narratives of NCS from interviews and investigated experiences of cis‐GBMSM and transgender people accessing health care services following sexual assault. Results: Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non‐consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post‐exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS. Conclusions: Sexual health care providers should take care to more fully address the issue of NCS with cis‐GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic (2020–2021) resulted in isolation due to social distancing rules and lockdowns, during which technology was used to enable families and friends to maintain contact. Despite loneliness being high in parents, little is known about which parents are more likely to experience loneliness and strategies to support them. Method: This mixed‐methods study examines which parents were lonely during the pandemic and how digital technologies were used to reduce loneliness and social isolation. Data were collected during the first UK lockdown from May to July 2020 via an online survey (N = 145) and follow‐up interviews (n = 13). Results: Loneliness reported during lockdown was greater than retrospective reporting of loneliness for all respondents, but it was higher in single parents, those caring for children with specific needs, and those with lower household incomes before and during lockdown. Parents rapidly adapted to and experimented with using technology for social connection during the lockdown, which helped to reduce feelings of isolation and loneliness. Video calling was found to be useful for making connections and enhancing social presence, but parents also experienced anxieties and difficulties with its use. There were mixed views about technology use; some were keen to continue using technology for socializing after the lockdown ended, but for others, it was only a temporary measure. Conclusion: Although technology was invaluable during the pandemic, it was not a panacea, and the way parents used it was influenced by their approach to technology and existing social behaviors and networks. [ABSTRACT FROM AUTHOR]

Objectives: People with Alzheimer's Disease (AD) experience changes in their level and content of consciousness, but there is little research on biomarkers of consciousness in pre‐clinical AD and Mild Cognitive Impairment (MCI). This study investigated whether levels of consciousness are decreased in people with MCI. Methods: A multi‐site site magnetoencephalography (MEG) dataset, BIOFIND, comprising 83 people with MCI and 83 age matched controls, was analysed. Arousal (and drowsiness) was assessed by computing the theta‐alpha ratio (TAR). The Lempel‐Ziv algorithm (LZ) was used to quantify the information content of brain activity, with higher LZ values indicating greater complexity and potentially a higher level of consciousness. Results: LZ was lower in the MCI group versus controls, indicating a reduced level of consciousness in MCI. TAR was higher in the MCI group versus controls, indicating a reduced level of arousal (i.e. increased drowsiness) in MCI. LZ was also found to be correlated with mini‐mental state examination (MMSE) scores, suggesting an association between cognitive impairment and level of consciousness in people with MCI. Conclusions: A decline in consciousness and arousal can be seen in MCI. As cognitive impairment worsens, measured by MMSE scores, levels of consciousness and arousal decrease. These findings highlight how monitoring consciousness using biomarkers could help understand and manage impairments found at the preclinical stages of AD. Further research is needed to explore markers of consciousness between people who progress from MCI to dementia and those who do not, and in people with moderate and severe AD, to promote person‐centred care. Key points: Consciousness and Arousal in MCI: This study found that patients with Mild Cognitive Impairment (MCI) show reduced neural complexity and arousal levels, as measured by LZsum and theta‐alpha ratio (TAR), respectively. These reductions correlate with the severity of cognitive impairment.Correlation with Cognitive Tests: There is a significant correlation between the LZsum and TAR biomarkers and the Mini‐Mental State Examination (MMSE) scores, both overall and within the MCI group, indicating that these neural markers can reflect the extent of cognitive decline.Potential Early Indicators: The biomarkers used in the study not only showed a significant difference between MCI patients from controls, but are also sensitive to the degree of cognitive impairment, supporting their use in monitoring the early stages of dementia and suggesting that disruptions in consciousness may begin in preclinical stages.Implications for Management and Support: The findings underscore the importance of understanding subtle changes in arousal and awareness in MCI for patient‐cantered care. Such insights could help develop interventions to improve the daily functioning and quality of life of patients with MCI and Alzheimer's disease (AD), particularly as these changes in consciousness can affect decision‐making capacity, caregiver stress, and overall relationship quality. [ABSTRACT FROM AUTHOR]

This article analyses a set of videos which featured public figures encouraging racially minoritised people in the UK to take the COVID‐19 vaccine or get involved in related research. As racially targeted health communication has both potentially beneficial and problematic consequences, it is important to examine this uniquely high‐profile case. Using a purposive sample of 10 videos, our thematic content analysis aimed to reveal how racially minoritised people were represented and the types of concerns about the vaccine that were expressed. We found representations of racialised difference that centred on 'community' and invoked shared social experiences. The expressed concerns centred on whether ethnic difference was accounted for in the vaccine's design and development, plus the overarching issue of trust. Our analysis adopts and develops the concept of 'racialisation'; we explore how 'mutuality' underpinned normative calls to action ('ethico‐racial imperatives') and how the videos 'responsibilised' racially minoritised people. We discuss two points of tension in this case: the limitations for addressing the causes of mistrust and the risks of reductivism that accompanied the ambiguous notion of community. Our analysis develops scholarship on racialisation in health contexts and provides public health practitioners with insights into the socio‐political considerations of racially targeted communications. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the experiences of women with kidney disease, residing in the United Kingdom (UK), living through the first 18 months of the COVID‐19 pandemic with specific focus on preconception decision‐making, family planning, and parenting. Methods: We conducted a mixed‐methods study, comprising an online survey and follow‐up interviews, with UK‐resident women aged 18–50. Results: We received 431 surveys and conducted 30 interviews. Half (n = 221, 51%) of the survey respondents considered that COVID‐19 influenced the quality of communication with healthcare professionals and 68% (n = 295) felt that the pandemic disrupted their support networks. Interview participants indicated that delayed and canceled appointments caused anxiety, grief, and loss of pregnancy options. Women's perception of themselves as (good) mothers as well as their capacity to have and raise a child, meet partners, and sustain healthy relationships was negatively affected by the "clinically extremely vulnerable" label. Women's trust in their healthcare was dismantled by miscommunication and variation in lockdown rules that caused confusion and increased worry. Women reported that COVID‐19 contributed to postnatal depression, excessive concern over infant mortality, preoccupation over others following rules, and catastrophising. Conclusion: Some women in the UK with chronic kidney disease lost or missed their opportunity to have children during the pandemic. Future pandemic planners need to look more holistically and longer term at what is and is not classed as an emergency, both in how services are reconfigured and how people with chronic conditions are identified, communicated with, and treated. [ABSTRACT FROM AUTHOR]

Background: People living with mesothelioma have a high symptom burden that can affect dietary intake and the development of malnutrition, subsequently impacting on patient‐related and treatment outcomes. The present study aimed to develop a better understanding of the experiences of diet and appetite in people living with mesothelioma and their informal carers. Methods: Twenty‐three participants took part in semistructured interviews including 12 people living with mesothelioma (10 pleural and 2 peritoneal) aged 56–83 years and 12 informal carers, predominantly their spouses. Open ended questions focussed on experiences of appetite and diet, as well as approaches to maintain adequate food intake. Thematic analysis was applied. Results: Four themes were generated that included unintentional weight loss and poor appetite during diagnosis and when undergoing medical intervention. Participants managed their appetite and diet by taking each day at a time and this was influenced by the physical and emotional experiences of mesothelioma. The informal carer took on the lead role of managing their relatives' diet and implemented their own nutritional strategies and there were challenges with dietary advice. Conclusions: Appetite was viewed as a multidimensional experience and was grounded within the biopsychosocial model. The findings offer important insights into opportunities informing the development of effective interventions that provide meaningful benefits for individuals living with mesothelioma and their family. Key points: Weight loss and appetite problems are common in mesothelioma and comprise a multidimensional experience.Better management of patient's symptoms may improve appetite.There is scope to develop effective interventions that provide meaningful benefits for people living with mesothelioma and their family. [ABSTRACT FROM AUTHOR]

Introduction: Provision of school‐ and community‐based counselling services differs in terms of funding, implementation and eligibility criteria across the UK. The existing evidence of the effectiveness of counselling services is mixed, with little consideration of service context, implementation or acceptability. This rapid review seeks to address the gaps in the extant evidence syntheses by exploring the effectiveness, implementation and acceptability of school‐ and community‐based counselling services in the UK. Methods: A systematic literature search was conducted in five electronic databases. Grey literature searches were conducted in 23 national government and third‐sector organisational websites. The searches focussed on studies examining counselling interventions aimed at children aged 7–18 years that examined either effectiveness, implementation, acceptability or context. Results: Fifty‐four studies were included in the review. The few RCT studies suggest that there is no clear evidence of effectiveness of the therapeutic approach, due to mixed findings. There is some tentative evidence for weaker study designs that counselling may have positive impacts across different settings. The service is highly valued by learners, teachers and parents and is believed to improve well‐being; however, it is often seen as a discrete service that is not well‐embedded within the education system. Conclusions: There is mixed evidence for the effectiveness of school‐ and community‐based counselling. However, this needs to be understood in the context of acceptability and implementation. Future work is needed to improve the implementation of services by considering the wider complexity of the systems in which these services are embedded. [ABSTRACT FROM AUTHOR]

Background: Statutory options for restricting alcohol advertising include limiting it to product‐orientated information and requiring health warnings. We assess the impact of removing positive contextual factors from alcohol advertising and including a health warning among adults in the United Kingdom (UK). Methods: We conducted a 2 × 2 online between‐group experiment with adults (18+) (n = 2421) recruited from a non‐probability research panel in the United Kingdom. Participants were randomized to see an alcohol (vodka) advertisement (advert) which varied by context (no context vs. imagery depicting positive social interactions around alcohol) and message (multiple text health warning vs. "drink responsibly"). The multiple text health warning, based on recent legislation in Ireland, comprised three separate warnings (liver disease, cancers, drinking during pregnancy) and a web address for alcohol‐related information and support. The "drink responsibly" control reflected the self‐regulatory messages commonly used by alcohol companies. Participants rated the advert on 7‐point scales for advert attractiveness, product appeal, trial intentions, perceived harm, and whether it made drinking alcohol seem enjoyable. Results: Removing the positive social context reduced positive advert and product reactions (difference in estimated marginal means [EMM]: −1.57 [makes drinking alcohol seem enjoyable] to −0.23 [intention to try]). Including the multiple text health warning also reduced positive advert and product reactions (difference in EMM: −0.55 [advert attractiveness] to −0.25 [intention to try]) and increased perceived product harm (difference in EMM: +0.25). There were no interactions between advert context and message for any outcome. Conclusions: Restricting content and including a multiple text health warning (compared to a "drink responsibly" message) may attenuate the persuasive impact of alcohol advertising and increase perceived product harm. Further research is needed to examine different degrees of content restrictions, alternative warning content and design, generalizability to different alcohol products and advert formats, and whether the impact of content controls varies among population subgroups. [ABSTRACT FROM AUTHOR]

Background: Seventy‐five per cent of UK suicides are completed by men, and associated masculinity beliefs are well researched. The self‐regulatory executive functioning (S‐REF) model of distress is governed by metacognitive beliefs about mental processes, such as worry and rumination. Little is known about metacognition in male suicidality and how these processes interact with masculinity beliefs, suicidal ideation and behaviour. Aims: To identify which aspects of the S‐REF model were present in a sample of men experiencing suicidality, and to consider how these processes interact with masculinity beliefs, suicidal ideation and behaviour. Method: Fifteen men experiencing suicidal ideation or behaviour were recruited from a home‐based treatment team. Semi‐structured interviews and self‐report measures were administered to identify metacognitive processes and masculinity beliefs. Interviews were analysed using the framework approach. Results: The S‐REF model was identified across three super‐ordinate themes; 'the cognitive attentional syndrome (CAS) and maladaptive coping', 'metacognitive beliefs about worry, uncontrollability and danger' and 'consequences'. Thirteen sub‐ordinate themes included processes such as 'worry' and 'rumination', metacognitive beliefs such as 'worrying helps me avoid problems' and 'worry is dangerous for me' and emotional consequences such as 'overwhelm', 'emasculation' and 'escape'. Conclusion: Perseverative thinking and erroneous metacognitive beliefs were associated with reduced functioning, which was incompatible with masculinity beliefs about leadership and strength, and suicide was considered as re‐establishing control. Further research into metacognitive processes in male suicidality would enhance theoretical understanding. [ABSTRACT FROM AUTHOR]

Objective: Psychological formulation is a key competency for clinical psychologists. However, there is a lack of consensus regarding the key components and processes of formulation that are hypothesized to contribute to poor reliability of formulations. The aim of this study was to develop consensus on the essential components of a formulation to inform training for clinical psychologists and best practice guidelines. Methods: A Delphi methodology was used. Items were generated from the literature and discussed and refined with a panel of experts (n = 10). In round one, 110 clinical psychologists in the United Kingdom rated the importance of components of formulation via an online questionnaire. Criteria for consensus were applied and statements were rerated in round two if consensus was not achieved. Results: Consensus was achieved on 30 items, with 18 statements regarding components of a formulation and 12 statements regarding formulation process. Items that clinicians agreed upon emphasized the importance of integrating sociocultural, biological, strengths and personal meaning alongside well- established theoretical frameworks. Consensus was not reached on 20 items, including whether a formulation should be parsimonious or adhere to a model. Conclusion: Our findings provide mixed evidence regarding consensus on the key components of formulation. There was an agreement that formulation should be client- led and incorporate strengths and sociocultural factors. Further research should explore client perspectives on the key components of formulation and how these compare to the clinicians' perspectives. [ABSTRACT FROM AUTHOR]

Aim: The risk of Type 2 Diabetes is 10 times higher after a pregnancy with Gestational Diabetes. Physical activity can independently reduce this risk, yet engagement with physical activity remains low after Gestational Diabetes. Therefore, the present study aimed to explore the barriers and facilitators to the uptake of physical activity after Gestational Diabetes in the United Kingdom, using a socio‐ecological approach. Methods: The paper was written following the Standards for Reporting Qualitative Research. Patient and Public Involvement contributed to the study's conceptualisation and design. Participants were recruited through an audit of Gestational Diabetes cases at a local Teaching Hospital in 2020. Twelve participants took part in semi‐structured one‐to‐one interviews. Reflexive thematic analysis was used to generate themes in iterative rounds of refinement. The final themes were then organised using the socio‐ecological model. Results: Participants were all over 31 years old, predominantly self‐identified as White British and were all in employment but were evenly spread across UK‐based deprivation deciles. Ten themes were generated and organised according to the four levels of the socio‐ecological model: intrapersonal (beliefs about activity, recovering from birth), social (health care professionals, family and partner, role as a mother), organisational (access and cost, environment, childcare and work) and community (connecting women with recent Gestational Diabetes). Conclusions: Many of the amenable barriers and facilitators to physical activity were beyond the intrapersonal level, based on higher levels of the socio‐ecological model (social, organisational and community). Multi‐level interventions are needed to effectively address all barriers. [ABSTRACT FROM AUTHOR]

Background Study: Technology‐supported learning environments, act as significant observational and enabling indicators for evaluating and encouraging the digital revolution of education, are of vital importance in current educational research. Keeping track of the dynamics of technology‐supported learning environment research allows for the enrichment of theoretical studies and a prompt innovation of talent‐training environments. Objectives: The present study carried out a bibliometric analysis of the core collection of WoS database over the last two decades. Method: This study is a bibliometric research. We applied CiteSpace and VOSviewer for co‐occurrence and evolution analysis. In addition, we extracted the fundamental ideas and thoughts through reading and analysis. Results: First, the study found that technology‐supported learning environment research is in a growth phase, with core journals such as Interactive Learning Environments or Computers & Education. The findings show that a core research team comprised of such scholars as Hwang Gwo‐Jen, Lester James C. and Wong Lung‐Hsiang. Key nations of publishing and research strength are from China, the United States, the United Kingdom and the Netherlands. Second, the hot topics in research on technology‐supported learning environments were virtual learning environments, technology‐enabled learning environments and interactive learning environments. Nine study specifics were derived from these three topics such as moulding function, generating scenario, stimulating sensation, effect verification, design idea, research reflection, inquiry and research, virtual community, and mixed environment. Lastly, the frontier evolution offers a pattern of development from enhancing performance to changing mode to incorporating experience. Conclusion: Looking ahead, our research recommendations for the field of technology‐supported learning environments include a multifaceted approach. We should aim to enhance research designs and methodologies, develop contemporary guiding theories and strive for a balanced representation across various educational domains, expanding our scope to encompass all academic disciplines. In terms of practical application, it is imperative to focus on the design and implementation of technology‐supported learning environments from three critical perspectives: "change‐demand," "student‐learning" and "online‐offline." These approaches will collectively ensure that technology‐supported learning environments are both innovative and responsive to the diverse needs of the educational landscape. Lay Description: What is already known about this topic: Technology‐supported learning environments are currently a focal and hot research topic in the field of education.Although numerous studies have been conducted on the learning environment of technical support, there has yet to be a systematic and comprehensive review of the related research. What this paper adds: This study provides a comprehensive review of research on the technology‐supported learning environments over the past two decades.This study primarily presents an overview of research on the technology‐supported learning environments over the past two decades, focusing on main literature, research strength, hot topics and frontier evolution. Implications for practice and/or policy: Researchers need to further advance research on technology‐supported learning environments by enriching research designs and methods, constructing up‐to‐date guiding theories and achieving a balance across different educational domains while extending the reach to all disciplines.Educational practitioners need to pay attention to the design and implementation of technology‐supported learning environments from the three viewpoints of "change‐demand," "student‐learning" and "online‐offline." [ABSTRACT FROM AUTHOR]

Ensuring families of children with intellectual and/or developmental disabilities (e.g., developmental delay, intellectual disability, autism) can access early intervention and support is important. Current research indicates there are family‐level socioeconomic disparities of access to early intervention and support, however, there is limited evidence on the relationship between neighbourhood‐level socioeconomic deprivation and access to support. Therefore, the aim of this study was to examine the relationship between neighbourhood deprivation and families' access to and unmet need for early intervention and support. We collected cross‐sectional data using a survey of 673 parental caregivers of young children with suspected or diagnosed intellectual and/or developmental disabilities in the UK. Multiple regression models were fitted for three early intervention and support outcome variables: access to early intervention; access to services across education, health, social care, and other sectors; and unmet need for services. Each regression model included a neighbourhood deprivation variable based on the index of multiple deprivation and five control variables: family‐level economic deprivation, country, caregivers' educational level, developmental disability diagnosis, and informal support sources. Neighbourhood deprivation was a significant independent predictor of access to services, but neighbourhood deprivation was not a significant predictor of access to early intervention or unmet need for services. Families living in the most deprived neighbourhoods accessed fewer services than other families. Socioeconomic disparities of access to early intervention and support, at both a neighbourhood and family level, exist for families of young children with suspected or diagnosed intellectual and/or developmental disabilities in the UK. Future research should focus on policy and other interventions aimed at addressing socioeconomic disparities at the neighbourhood and family level, to ensure equitable access to early intervention and support. [ABSTRACT FROM AUTHOR]

Objectives: To describe the clinical epidemiology of COVID‐19 in people of black ethnicity living with HIV in the UK. Methods: We investigated the incidence and factors associated with COVID‐19 in a previously established and well‐characterized cohort of black people with HIV. Primary outcomes were COVID‐19 acquisition and severe COVID‐19 disease (requiring hospitalization and/or resulting in death). Cumulative incidence was analysed using Nelson–Aalen methods, and associations between demographic, pre‐pandemic immune‐virological parameters, comorbidity status and (severe) COVID‐19 were identified using Cox regression analysis. Results: COVID‐19 status was available for 1847 (74%) of 2495 COVID‐AFRICA participants (median age 49.6 years; 56% female; median CD4 cell count = 555 cells/μL; 93% HIV RNA <200 copies/mL), 573 (31%) of whom reported at least one episode of COVID‐19. The cumulative incidence rates of COVID‐19 and severe COVID‐19 were 31.0% and 3.4%, respectively. Region of ancestry (East/Southern/Central vs. West Africa), nadir CD4 count and kidney disease were associated with COVID‐19 acquisition. Diabetes mellitus [adjusted hazard ratio (aHR) = 2.39, 95% confidence interval (CI): 1.26–4.53] and kidney disease (aHR = 2.53, 95% CI: 1.26–4.53) were associated with an increased risk, and recent CD4 count >500 cells/μL (aHR = 0.49, 95% CI: 0.25–0.93) with a lower risk of severe COVID‐19. Conclusions: Region of ancestry was associated with COVID‐19 acquisition, and immune and comorbidity statuses were associated with COVID‐19 disease severity in people of black ethnicity living with HIV in the UK. [ABSTRACT FROM AUTHOR]

Hypertension is a leading risk factor for cardiovascular disease and is modulated by genetic variants. This study aimed to assess the effect of obesity genetic liability and physical activity on hypertension among European and African ancestry individuals within the UK Biobank (UKB). Participants were 230 115 individuals of European ancestry and 3239 individuals of African ancestry from UKB. Genetic liability for obesity were estimated using previously published data including genetic variants and effect sizes for body mass index (BMI), waist‐hip ratio (WHR) and waist circumference (WC) using Plink software. The outcome was defined as stage 2 hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥90 mmHg, or the use of anti‐hypertensive medications). The association between obesity genetic liability and the outcome was assessed across categories of self‐reported physical activity using logistic regression. Among European ancestry participants, there was up to a 1.2 greater odds of hypertension in individuals with high genetic liability and low physical activity compared to individuals with low genetic liability and high physical activity (p < 0.001). In individuals engaging in low levels of physical activity compared with moderate/high physical activity, the effect of BMI genetic liability on hypertension was greater (pinteraction = 0.04). There was no evidence of an association between obesity genetic liability and hypertension in individuals of African ancestry in the whole sample or within separate physical activity groups (p > 0.05). This study suggests that higher physical activity levels are associated with lower odds of stage 2 hypertension among European ancestry individuals who carry high genetic liability for obesity. This cannot be inferred for individuals of African ancestry, possibly due to the low African ancestry sample size within the UKB. [ABSTRACT FROM AUTHOR]

Background: While some people with mild cognitive impairment (MCI) progress to dementia, many others show no progression. The aim of this study was to identify factors associated with risk of dementia development in this population. Method: A large naturalistic retrospective cohort study was assembled from mental healthcare records in a south London catchment. Patients were selected at first recorded diagnosis of MCI and subsequent dementia diagnosis was ascertained from case notes or death certificate, excluding those with dementia diagnoses and deaths within 6 months of MCI diagnosis. A range of demographic and clinical characteristics were ascertained around MCI diagnosis and Cox proportional hazards models were used to investigate independent predictors of dementia, focussing on neuropsychiatric symptoms, contextual factors, and antidepressant treatment. Results: Of 2250 patients with MCI, 236 (10.5%) developed dementia at least 6 months after MCI diagnosis. Aside from older age, lower cognitive function, and activities of daily living impairment, impaired social relationships and recorded loneliness were associated with a higher risk of developing dementia. Patients of Black (compared to White) ethnicity were at a lower risk. For depression and antidepressant receipt, only tricyclic use compared to no antidepressant use was associated with an increased dementia risk. Conclusions: No evidence was found for co‐morbid affective disorders or different antidepressant classes as risk factors for dementia development following MCI diagnosis, but loneliness and social impairment were independent predictors and would be worth evaluating as targets for interventions to delay progression. Key points: Of 2250 patients with MCI, 10.5% received a recorded dementia diagnosis at least 6 months after MCI diagnosis.Older age, lower cognitive function and impaired ADLs were associated with dementia development.Problems with social relationships and loneliness led to a higher risk of developing dementia.Affective disorder diagnoses, antidepressant treatment, and choice of antidepressant did not affect dementia risk. [ABSTRACT FROM AUTHOR]

Background: Research has shown that many babies who die in neonatal units could have been potential tissue and/or organ donors. Despite the existence of guidelines supporting its implementation, the incidence of neonatal donation remains rare in the United Kingdom. Aim: The aim of this audit was to retrospectively determine potential eligibility for neonatal tissue and/or organ donation referral in infants who died in a single UK tertiary‐level neonatal unit between 2012 and 2021. Cause of death and documentation of any discussions held regarding referral for donation were also explored. Study design: An audit was undertaken to identify all neonatal deaths at a single tertiary‐level NICU in London from 2012‐2021. Infants who retrospectively could have been referred as potential tissue and/or organ donors were identified using current NHS Blood and Transplant inclusion and exclusion criteria. Results and conclusion: A significant missed potential for neonatal tissue and/or organ donation referrals was identified, which is likely not just limited to the unit audited. Causes of death were as expected for a tertiary level neonatal unit and centre for therapeutic cooling of babies born with hypoxic perinatal brain injuries. Only one documented conversation was found regarding neonatal donation. Relevance to clinical practice: To enable conversations regarding neonatal donation to become a routine part of end‐of‐life care discussions with families as appropriate, good links between neonatal healthcare professionals and Specialist Nurses in Organ Donation need to be established. This will facilitate the referral of all suitable neonates as potential donors and ensure that neonatal staff feel supported to care for babies identified as potential donors. [ABSTRACT FROM AUTHOR]

A decrease in wellbeing in the United Kingdom since the 2008 economic crisis has been compounded by the closure of community groups in socio‐economically deprived areas. This leaves churches as one of the few communal groups for fostering wellbeing, despite a dearth of research on religiosity and wellbeing in such areas. This article draws on semi‐structured interviews, supplemented with participant observations and ethnographic observations, to explore the social processes involved in shaping experiences of wellbeing amongst religious communities in socio‐economically deprived areas in North East England. It identifies the resources available for wellbeing and the points at which they are accessed. It also expands the existing conception of wellbeing by: (i) unpacking and refining a three‐tiered structure for understanding wellbeing; (ii) identifying a wellbeing paradox, whereby interpersonal vulnerability supports and undermines wellbeing; and (iii) mapping the relationships between the micro, meso and macro levels in shaping experiences of wellbeing, highlighting the need for more qualitative studies of subjective wellbeing. As it does so, this article offers practical insights that can guide those with pastoral responsibilities in areas of socio‐economic deprivation to foster higher levels of wellbeing in their communities. [ABSTRACT FROM AUTHOR]

Objective: The United Kingdom Eating Disorders Genetics Initiative (EDGI UK), part of the National Institute for Health and Care Research (NIHR) Mental Health BioResource, aims to deepen our understanding of the environmental and genetic etiology of eating disorders. EDGI UK launched in February 2020 and is partnered with the UK eating disorders charity, Beat. Multiple EDGI branches exist worldwide. This article serves the dual function of providing an in‐depth description of our study protocol and of describing our initial sample including demographics, diagnoses, and physical and psychiatric comorbidities. Method: EDGI UK recruits via media and clinical services. Anyone living in England, at least 16 years old, with a lifetime probable or clinical eating disorder is eligible to sign up online: edgiuk.org. Participants complete online questionnaires, donate a saliva sample for genetic analysis, and consent to medical record linkage and recontact for future studies. Results: As of September 2022, EDGI UK recruited 7435 survey participants: 98% female, 93.1% white, 97.8% cisgender, 65.9% heterosexual, and 52.1% have a university degree. Over half (57.8%) of these participants have returned their saliva DNA kit. The most common diagnoses are anorexia nervosa (48.3%), purging disorder (37.8%), bulimia nervosa (37.5%), binge‐eating disorder (15.8%), and atypical anorexia nervosa (7.8%). Conclusion: EDGI UK is the largest UK eating disorders study and efforts to increase its diversity are underway. It offers a unique opportunity to accelerate eating disorder research. Researchers and participants with lived experience can collaborate on projects with unparalleled sample size. Public Significance Statement: Eating disorders are debilitating and costly for society but are under‐researched due to underfunding. EDGI UK is one of the largest eating disorder studies worldwide with ongoing recruitment. The collected data constitute a resource for secondary analysis. We will combine data from all international EDGI branches and the NIHR BioResource to facilitate research that improves our understanding of eating disorders and their comorbidities. [ABSTRACT FROM AUTHOR]

Background: Children from disadvantaged backgrounds are at greater risk of attention‐deficit hyperactivity disorder (ADHD)‐related symptoms, being diagnosed with ADHD, and being prescribed ADHD medications. We aimed to examine how inequalities manifest across the 'patient journey', from perceptions of impacts of ADHD symptoms on daily life, to the propensity to seek and receive a diagnosis and treatment. Methods: We investigated four 'stages': (1) symptoms, (2) caregiver perception of impact, (3) diagnosis and (4) medication, in two data sets: UK Millennium Cohort Study (MCS, analytic n ~ 9,000), with relevant (parent‐reported) information on all four stages (until 14 years); and a population‐wide 'administrative cohort', which includes symptoms (child health checks) and prescriptions (dispensing records), born in Scotland, 2010–2012 (analytic n ~ 100,000), until ~6 years. We described inequalities according to maternal occupational status, with percentages and relative indices of inequality (RII). Results: The prevalence of ADHD symptoms and medication receipt was considerably higher in the least compared to the most advantaged children in the administrative cohort (RIIs of 5.9 [5.5–6.4] and 8.1 [4.2–15.6]) and the MCS (3.08 [2.68–3.55], 3.75 [2.21–6.36]). MCS analyses highlighted complexities between these two stages, however, those from least advantaged backgrounds, with ADHD symptoms, were the least likely to perceive impacts on daily life (15.7% vs. average 19.5%) and to progress from diagnosis to medication (44.1% vs. average 72.5%). Conclusions: Despite large inequalities in ADHD symptoms and medication, parents from the least advantaged backgrounds were less likely to report impacts of ADHD symptoms on daily life, and their children were less likely to have received medication postdiagnosis, highlighting how patient journeys differed according to socioeconomic circumstances. [ABSTRACT FROM AUTHOR]

Background: Experiences of racism are linked to negative physical and mental health outcomes among those exposed. According to quantitative research derived mainly from the United States, these negative outcomes can have cascading effects in families, when parents' experiences of racism indirectly impact offspring. New research is warranted for families in the United Kingdom, informed by a qualitative approach to canvassing community knowledge and perspectives, exploring how existing findings relate to lived experiences. Method: We conducted four online focus groups with 14 parents of school‐aged children and 14 adolescents who had experienced racism in the United Kingdom. Participants were asked what children know of parents' experiences of racism, and how these experiences can impact parent–child interactions, mental health and well‐being. Focus group recordings were transcribed, data coded and analysed through iterative categorisation. Results: Analyses drew four themes from participants' insights. Together, themes illuminated the pervasive nature of racism experienced by some families in the United Kingdom. Parent and child experiences of racism were connected and co‐occurring, with indirect effects impacting mental health and well‐being in both generations. These experiences were linked to both positive and negative changes in parenting behaviour and parent–child relationships, which could be moderated by intersecting identities such as the parent's generational status for immigration to the United Kingdom. Social cohesion, safe spaces and education programmes were highlighted for future intervention. Conclusions: Findings corroborate existing literature, while further emphasising a broader bidirectional picture, requiring a family system and intersectional approach to understanding the mental health impact of racism in families. Avenues for future research are discussed to support development of equitable intervention and support strategies to prevent racism and support those affected. [ABSTRACT FROM AUTHOR]

Research on gender‐fair language aims to identify language inclusive to a multitude of individuals, for example, increasing the visibility of women by using paired pronouns (he/she) instead of generic masculine forms (he). However, binary presentations like he/she might come with unwanted side effects and evoke what we label as normative gender bias. A normative gender bias is defined as when words lead to stronger associations with individuals with normative gender expressions than with individuals with non‐normative gender expressions, thus contributing to making non‐normative individuals invisible. In three experiments, we compared the extent to which the paired pronoun he/she (Swedish and English), the neo‐pronouns hen (Swedish), ze (English), and the generic pronoun singular they (English) evoked a normative gender bias. Swedish‐ (N = 219 and 268) and English‐ (N = 837, from the UK) speaking participants read about individuals referred to with the paired pronoun he/she or with hen, ze, or they. In Experiment 1 (Swedish), there was no main effect of condition on a normative bias, but in Experiment 2 (Swedish), the paired pronouns he/she evoked normative gender bias while hen did not. In Experiment 3 (English), both ze and singular they evoked normative gender bias, although normative associations were lower in these conditions compared to he/she. Furthermore, the normative bias was lower among participants who had knowledge about the use of ze as a nonbinary pronoun. Finally, neither ze nor they evoked a normative gender bias when their use was explicitly stated to be nonbinary. A potential explanation for why singular they did not generally result in less normative associations, despite almost all participants knowing about it, may include its more common use as a generic pronoun. Taken together, our results suggest that neo‐pronouns, but not paired pronouns, have the potential to evoke less normative associations, but that they must be both (1) actively created new words and (2) well‐known to language users as nonbinary pronouns. [ABSTRACT FROM AUTHOR]

Nirsevimab, a monoclonal antibody with an extended half‐life, is approved for the prevention of respiratory syncytial virus (RSV) disease in all infants in Canada, the EU, Great Britain, and the USA. A population pharmacokinetics (PK) model was built to describe the PK of nirsevimab in preterm and term infants, and to evaluate the influence of covariates, including body weight and age, in infants. Nirsevimab PK was characterized by a 2‐compartment model with first‐order clearance (CL) and first‐order absorption following intramuscular (IM) administration. The typical CL in a 5 kg infant was 3.4 mL/day. Body weight and postmenstrual age were the primary covariates on CL, with minor effects for race, second RSV season, and antidrug antibody status (deemed not clinically relevant). Congenital heart disease (CHD) and chronic lung disease (CLD) did not significantly impact nirsevimab PK. The final population PK model, based on 8987 PK observations from 2683 participants across 5 clinical trials, successfully predicted PK in an additional cohort of 967 healthy infants. Weight‐banded dosing (50 mg in infants <5 kg; 100 mg in infants ≥5 kg) was predicted to be appropriate for infants ≥1 kg in their first RSV season. Together, these data support weight‐banded dosing of nirsevimab in all infants in their first RSV season, including in healthy infants, infants with CHD or CLD, and in infants born prematurely. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK. Methods: Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale. We assessed the proportions of PLWH who screened as frail, prefrail or robust and compared patient characteristics across groups. All PLWH identified as frail were offered a comprehensive geriatric assessment delivered by a combined HIV geriatric clinic, and uptake was recorded. Results: A total of 456/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60–99) years and 21 (0–32) years, respectively. In total, 56 (12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust. A total of 10/56 (18%) people identified as frail declined an appointment in the geriatric clinic. Compared with non‐frail individuals, frail PLWH had been living with HIV for longer and had a greater number of comorbidities and comedications but were not chronologically older. Conclusions: Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society. More research is needed to determine if frailty screening can improve clinical outcomes of older PLWH and the use of the comprehensive geriatric assessment within HIV services. [ABSTRACT FROM AUTHOR]

Across a range of recent terrorist attacks in the United Kingdom, the question of how crowds behave in confined public space is an important concern. Classical theoretical assumptions are that human behaviour in such contexts is relatively uniform, self‐interested and pathological. We contest these assumptions by reporting on a study of public response to a marauding knife attack that occurred on London's underground rail network in 2015. The analysis draws primarily upon footage from 27 CCTV cameras positioned across the station footprint supplemented by social media, news footage, radio logs and incident reports. Using an innovative methodology, we topographically and chronologically mapped behaviours during the incident. The analysis demonstrates that while rapid egressions occurred as the threat escalated, at every phase of the incident members of the public intervened spontaneously with coordinated, purposeful, socially oriented actions. This behavioural pattern contrasts with classical assumptions of a chaotic and apathetic crowd in emergencies. We highlight eight complementary categories of actions in the public response that appeared functional for the collective safety of the crowd during the short period before the police arrived. The policy implications for emergency planning, and the methodological innovations involving the use of video data are discussed. [ABSTRACT FROM AUTHOR]

To attract and retain a more diverse workforce, organizations embrace diversity initiatives, expressed in diversity statements on their websites. While the explicit content of diversity statements influences attitudes towards organizations, much less is known about the effect of subtle cues such as emotions. In three pre‐registered studies, we tested the effect of positive emotionality in diversity statements on attitudes towards organizations. Study 1 focused on the degree to which 600 European organizations employed emotionality in their diversity statements, finding that although their statements differed in the level of emotionality, on average, organizations avoided highly emotional words. Study 2 (N = 220 UK participants) tested the effect of original diversity statements on readers' attitudes towards an organization, demonstrating that the level of emotionality in the existing statements did not influence positive attitudes towards the organization. In Study 3 (N = 815 UK participants), we thus modified the diversity statements so that they contained high levels of positive emotionality that triggered more positive emotions and resulted in more positive attitudes towards an organization. Taken together, highly emotional words (e.g. passionate; happy; wholeheartedly) are key in diversity statements if organizations wish to increase their attractiveness among potential employees. [ABSTRACT FROM AUTHOR]

Prejudice and discrimination against minorities can be a powerful tool for populistic and reactionary political movements, and it is therefore crucial to study its determinants. The aim of this research is to develop the understanding of a possible mechanism of such discrimination: cultural distance. In a pre‐registered survey experiment with a between‐subjects design, we draw on the large increase in intra‐European refugee migration from Ukraine, to test whether refugees from another ongoing conflict in (culturally distant) Yemen are treated differently than (culturally similar) Ukrainian refugees by British participants (N = 1545). We measured stated willingness to help and to hire refugees. Moreover, the participants were offered the chance to donate their own earnings from survey participation to real charity drives aimed at the respective refugee groups. Thus, we are able to examine both stated and actual helping behaviours that captured both autonomy‐ and dependency‐oriented forms of helping. As expected, participants were more willing to help, hire and donate money to Ukrainian refugees, and these effects were mediated by higher perceived similarity and lower perceived threat from Ukrainians compared with Yemenis. [ABSTRACT FROM AUTHOR]

The aim was to use a robust statistical approach to examine whether physical fitness at entry influences performance changes between men and women undertaking British Army basic training (BT). Performance of 2 km run, seated medicine ball throw (MBT) and isometric mid‐thigh pull (MTP) were assessed at entry and completion of Standard Entry (SE), Junior Entry‐Short (JE‐Short), and Junior Entry‐Long (JE‐Long) training for 2350 (272 women) recruits. Performance change was analyzed with entry performance as a covariate (ANCOVA), with an additional interaction term allowing different slopes for courses and genders (p < 0.05). Overall, BT courses saw average improvements in 2 km run performance (SE: −6.8% [−0.62 min], JE‐Short: −4.6% [−0.43 min], JE‐Long: −7.7% [−0.70 min]; all p < 0.001) and MBT (1.0–8.8% [0.04–0.34 m]; all p < 0.05) and MTP (4.5–26.9% [6.5–28.8 kg]; all p < 0.001). Regression models indicate an expected form of "regression to the mean" whereby test performance change was negatively associated with entry fitness in each course (those with low baseline fitness exhibit larger training improvements; all interaction effects: p < 0.001, ηp2$$ {\eta}_{\mathrm{p}}^2 $$ > 0.006), particularly for women. However, when matched for entry fitness, men displayed considerable improvements in all tests, relative to women. Training courses were effective in developing recruit physical fitness, whereby the level of improvement is, in large part, dependent on entry fitness. Factors including age, physical maturity, course length, and physical training, could also contribute to the variability in training response between genders and should be considered when analyzing and/or developing physical fitness in these cohorts for future success of military job‐task performance. [ABSTRACT FROM AUTHOR]

Introduction: Differential attainment is a well‐known phenomenon in medical education. Despite a strong impetus for institutions and researchers to move away from a 'student deficit model' when exploring the attainment gap, little attention has been given to understanding the experiences of Black, Asian and Minority Ethnic (BAME) medical students. Informed by the social construction of learning theory, this is the first national study to explore how multiple dimensions of the medical school environment impact academic performance of BAME undergraduate medical students across the UK. Methods: Using a sequential explanatory mixed‐methods approach, the authors conducted a survey and facilitated three focus groups across medical schools in the UK between 2020–2021. Participants self‐identified as being from BAME backgrounds. Quantitative analyses included descriptive statistics and bivariate analyses. Qualitative data were analysed using thematic analysis, subsequently identifying inductive themes. Results: Three hundred sixty‐two respondents completed the Phase 1 survey, and 17 participants participated in the Phase 2 focus groups. Although both survey and focus group participants identified facilitators to learning such as supportive relationships, students reported facing numerous barriers that they felt impeded their learning and performance. These barriers included limited access to educational resources, and undiversified curricula and medical school populations. Students also described both experiencing and witnessing various forms of racism throughout their educational journeys. Discussion: Students encountered various difficulties throughout their medical training that they felt impacted their learning and performance. This study offers novel insights into the experiences of BAME students and builds upon previous research. It also reveals the pervasive nature of racism within medical schools, highlighting the urgent need for institutional changes. Educators and institutions must go beyond merely recognising these barriers and facilitators; they must proactively innovate and adapt. In doing so, they pave the way for inclusive learning environments that truly foster a sense of belonging for BAME students. In this mixed‐methods study, @DrNariell, Machado and Blackburn explore UK BAME medical students‐ perspectives on the barriers and facilitators they experience during their training. #MedEd #MedTwitter [ABSTRACT FROM AUTHOR]

In March 2020, Coronavirus‐19 (COVID‐19) rapidly spread across the globe impacting the mental health of the population and putting an overwhelming pressure on health services. Much has been written about the impact of the pandemic on health‐care workers working in hospital settings but less attention has been paid to its effect on community mental health teams (CMHTs). This study is based on 21 remote interviews with community mental health professionals during the first wave of the COVID‐19 pandemic. Interviews were transcribed and analysed using a thematic analysis whereby codes of similar meaning were grouped into main themes. Analysis identified three major contributors to moral distress; changes in the nature of contact with service users, changes to the place of work, and difficulties of balancing risks to the families of CMHT staff and service users. This study demonstrates that necessary organizational changes instituted to minimize the spread of COVID‐19, required different ways of working which were not perceived to be in the best interests of service users or the families of CMHT staff. In order to comply with Government directives, CMHT staff were forced to behave in a way which did not match their moral values causing them to experience moral distress. [ABSTRACT FROM AUTHOR]

Objectives: Choices about which dental treatments to provide in a publicly funded system should be guided by the value that the general population place on those treatments. The aim of this study was to estimate United Kingdom (UK) general population willingness to pay (WTP) for dental check‐ups, and to investigate what factors influence WTP. Methods: WTP was elicited using a hypothetical question in an online survey. The sample consisted of 594 participants, nationally representative of the UK general population in terms of age and gender. Regression analysis was used to examine what factors are associated with WTP. Analyses were conducted including and excluding protest answers. Results: The mean WTP for a dental check‐up is £31.32 for the full sample and £33.17 excluding protest answers. Respondents on higher incomes and those with higher university education had higher WTP. Respondents in Scotland were WTP less than respondents living in the rest of the UK which may be the result of NHS dental check‐ups being free to patients in Scotland. Conclusion: The general UK population value dental check‐ups. This study provides estimates of WTP for dental check‐ups which can be used in Cost–Benefit Analyses. [ABSTRACT FROM AUTHOR]

Background: People with severe mental illness (SMI), such as schizophrenia, have higher rates of type 2 diabetes and worse outcomes, compared to those without SMI and it is not known whether diabetes self‐management interventions are effective for people who have both conditions. Research in this area has been impeded by a lack of consensus on which outcomes to prioritise in people with co‐existing SMI and diabetes. Aims: To develop a core outcome set (COS) for use in effectiveness trials of diabetes self‐management interventions in adults with both type 2 diabetes and SMI. Methods: The COS was developed in three stages: (i) identification of outcomes from systematic literature review of intervention studies, followed by multi‐stakeholder and service user workshops; (ii) rating of outcomes in a two‐round online Delphi survey; (iii) agreement of final 'core' outcomes through a stakeholder consensus workshop. Results: Seven outcomes were selected: glucose control, blood pressure, body composition (body weight, BMI, body fat), health‐related quality of life, diabetes self‐management, diabetes‐related distress and medication adherence. Conclusions: This COS is recommended for future trials of effectiveness of diabetes self‐management interventions for people with SMI and type 2 diabetes. Its use will ensure trials capture important outcomes and reduce heterogeneity so findings can be readily synthesised to inform practice and policy. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study was to determine whether the use of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) is associated with an increased risk of melanoma and nonmelanoma skin cancer, separately, compared with the use of sulfonylureas among patients with type 2 diabetes. Methods: Using the United Kingdom Clinical Practice Research Datalink (2007–2019), we assembled two new‐user active comparator cohorts. In the first cohort assessing melanoma as the outcome, 11,786 new users of GLP‐1 RAs were compared with 208,519 new users of sulfonylureas. In the second cohort assessing nonmelanoma skin cancer as the outcome, 11,774 new users of GLP‐1 RAs were compared with 207,788 new users of sulfonylureas. Cox proportional hazards models weighted using propensity score fine stratification were fit to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of melanoma and nonmelanoma skin cancer, respectively. Results: Compared with sulfonylureas, GLP‐1 RAs were not associated with an increased risk of either melanoma (42.6 vs. 43.9 per 100,000 person‐years, respectively; HR 0.96, 95% CI 0.53–1.75) or nonmelanoma skin cancer (243.9 vs. 229.9 per 100,000 person‐years, respectively; HR 1.03, 95% CI 0.80–1.33). There was no evidence of an association between cumulative duration of use with either melanoma or nonmelanoma skin cancer. Consistent results were observed in secondary and sensitivity analyses. Conclusions: In this population‐based cohort study, GLP‐1 RAs were not associated with an increased risk of melanoma or nonmelanoma skin cancer, compared with sulfonylureas. [ABSTRACT FROM AUTHOR]

Introduction: Those with severe and enduring mental ill health are at greater risk of long‐term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research. Methods: The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted. Results: This priority setting exercise guided by people's needs and lived experience has produced a set of well‐defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities. Conclusions: Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health. Patient or Public Contribution: This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops. [ABSTRACT FROM AUTHOR]

Background: Motor neuron disease (MND) (also known as amyotrophic lateral sclerosis) is a life‐limiting neurodegenerative condition. In up to 20% of people with MND, a pathogenic variant associated with autosomal dominant inheritance can be identified. Children of people carrying a pathogenic variant have a 50% chance of inheriting this and a higher, although harder to predict, chance of developing the disease compared to the general adult population. This paper explores the experience of living with the genetic risk of MND. Methods: We undertook a UK‐based interview study with 35 individuals, including: 7 people living with genetically‐mediated forms of MND; 24 asymptomatic relatives, the majority of whom had an increased risk of developing the disease; and 4 unrelated partners. Results: We explore how individuals make sense of genetic risk, unpacking the interplay between genetic knowledge, personal perception, experiences of the disease in the family, age and life stage and the implications that living with risk has for different aspects of their lives. We balance an emphasis on the emotional and psychological impact described by participants, with a recognition that the salience of risk fluctuates over time. Furthermore, we highlight the diverse strategies and approaches people employ to live well in the face of uncertainty and the complex ways they engage with the possibility of developing symptoms in the future. Finally, we outline the need for open‐ended, tailored support and information provision. Conclusions: Drawing on wider literature on genetic risk, we foreground how knowledge of MND risk can disrupt individuals' taken‐for‐granted assumptions on life and perceptions of the future, but also its contextuality, whereby its relevance becomes more prominent at critical junctures. This research has been used in the development of a public‐facing resource on the healthtalk.org website. Patient or Public Contribution: People with experience of living with genetic risk were involved throughout the design and conduct of the study and advised on aspects including the topic guide, sampling and recruitment and the developing analysis. Two patient and public involvement contributors joined a formal advisory panel. [ABSTRACT FROM AUTHOR]

Background: Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence‐based person‐centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom. Methods: This qualitative study was theoretically underpinned by a person‐centred framework and conducted over three stages: (1) Development of a draft UK‐specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid. Results: Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice‐centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options. Conclusions: Decision aids that are underpinned by interactive choice‐driven questions enhance a person‐centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision‐making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics. Patient and Public Involvement: Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA. [ABSTRACT FROM AUTHOR]

Background: Degree apprenticeships (DA) help employees gain new knowledge and skills by allowing them to study towards a university degree while working full time. For these programmes to be effective, the learning design should be adapted to the needs of these students, who are goal oriented (i.e. they want to gain only knowledge that can be applied within their workplace), have limited time for studying, and usually have not attended formal education for some time. As these programmes are relatively new, there is limited research on how these students can be supported to achieve the programmes' learning goals by using information and communication technologies. Objectives: This paper aims to understand whether a learning design that combines game‐based learning with online flipped classrooms can engage DA students in their learning and help them develop their reflective skills. Methods: Two focus groups were conducted with DA students that study at a UK Business School towards gaining the Chartered Manager status. The focus groups recordings have been analysed using reflexive thematic analysis. Results and Conclusions: The three main themes, "change can be helpful and challenging at the same time", "the ideal game", and "the effect of others", show that DA students find game‐based learning and online flipped classrooms useful, with the right support. Simulation games can be more fulfilling to DA students than quiz games, even if they take more of their out‐of‐class time. In addition, instructors are advised to work more closely with diverse teams to enable students share their work experiences and learn from each other. Lay Description: What is already known about this topic?: Online flipped classrooms offer flexibility in learning, but instructors need to find solutions to challenges, like students' limited e‐learning readiness and lack of motivation.Game‐based learning has been found to facilitate learning in general, but there is a need to identify the specific circumstances (i.e. settings, gaming elements) under which it is effective.Degree apprenticeship students need more support with their learning compared to traditional university students, as they face additional challenges in terms of family life‐work balance and connecting their learning to their working experience. What this paper adds?: Game‐based learning can be useful to degree apprenticeship students providing that focuses on the application of knowledge and provides feedback.Despite facing challenges related to maintaining work‐study‐life balance, degree apprenticeship students are willing to complete the flipped classroom's out‐of‐class activities, if they see a clear benefit from doing so.Online group activities can be challenging for degree apprenticeship students, if they are not able to form teams with other learners that work for the same organisation. The implications of study findings for practitioners: Avoid quiz‐like games and select the ones that use real‐life scenarios for degree apprenticeship students to help them link their learning to their practice.Formative feedback should be provided by both the instructor and the game to motivate degree apprenticeship students to spend the additional time to complete the out‐of‐class activities.Students should be reminded frequently of the purpose of any new learning elements (e.g. learning analytics) as they may not have the time to explore them on their own.When forming student teams based on students' workplace is not possible, spend more time in each breakout room to facilitate the online group discussion and help students bring their different working experiences together. [ABSTRACT FROM AUTHOR]

Background: Rates of mental health conditions are high among adults with learning disabilities relative to the general population, however research suggests mental health conditions may be missed or under‐identified in this population group. This review considers factors associated with the identification of mental health conditions among adults with learning disabilities in primary care. Methods: A scoping review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidance extension for scoping reviews (PRISMA‐ScR) We searched electronic databases (Cinahl, PsychINfo and Medline) for articles published between the years 2000 and 2022. Data were extracted, tabulated and themes were identified. Findings: The searches identified 3262 articles and 34 met inclusion criteria and were included in the review. Six broad themes were identified including (i) mental health screening in primary care, (ii) education, training and awareness raising for primary care staff, (iii) increasing access to psychological therapies (IAPT) through improved mental health condition case recognition in primary care and IAPT practitioner confidence, (iv) health checks and continuity of care, (v) specialist support for primary care providers, and (vi) awareness raising among adults with learning disabilities. Conclusions: There should be efforts to increase availability in primary care of mental health screening measures suitable for people with learning disabilities. Training opportunities for providers across different sectors of health and social care pathways, on the mental health needs of people with a learning disability are also required. The findings can be used to guide the development of services, for adults with learning disabilities and symptoms of mental health conditions in primary care. Accessible summary: Many people with learning disabilities have mental health conditions such as depression or anxiety.It can be difficult for doctors (general practitioners or GPs) to identify mental health conditions among people with a learning disability.Annual health checks, questionnaires to identify mental health conditions, and training on mental health, can all help doctors and health and care staff address this problem. [ABSTRACT FROM AUTHOR]

Paediatric cardiology practitioners and related experts report unusually young ages when they begin to inform children about their non‐urgent heart surgery and begin to respect children's consent or refusal. Research methods included observations in two paediatric cardiology units, audio‐recorded interviews with 45 experts, and qualitative data analysis. Significantly younger ages were cited than are usually recommended in the clinical and legal literature. Interviewed practitioners took seriously children's consent to or refusal of a heart transplant from around 6 years, and a child's firm refusal of induction of anaesthesia from around 4 years, when surgery might be postponed. [ABSTRACT FROM AUTHOR]

Background and Aim: Drinking alcohol may cause harm to an individual's health and social relationships, while a drinking culture may harm societies as it may increase crime rates and make an area feel less safe. Local councils in Greater Manchester, UK, developed the Communities in Charge of Alcohol (CICA) intervention, in which volunteers were trained to give alcohol‐related advice to the public and taught how to influence policies to restrict when, where and how alcohol is sold. As part of a larger study, the aim of the current project is to measure the impact of CICA on health and crime outcomes at the lower super output (LSOA) geographical aggregation. Design: Quantitative evaluation using four time series analytic methods (stepped‐wedge design, and comparisons to local controls, national controls and synthetic controls) with findings triangulated across these methods. A cost–benefit analysis was carried out alongside the effectiveness analysis. Setting and Participants: The general public in Greater Manchester, UK, between 2010 and 2020. Measurements: The primary outcome of interest was alcohol‐related hospital admissions. Secondary outcomes were accident and emergency (A&E) attendances, ambulance callouts, recorded crimes and anti‐social behaviour incidents. Findings Triangulation of the results did not indicate any consistent effect on area‐level alcohol‐related hospital admissions, A&E attendances, ambulance callouts, reported crimes or anti‐social behaviour associated with the implementation of CICA. The primary stepped‐wedge analysis indicated an increase in alcohol‐related hospital admissions following the implementation of CICA of 13.4% (95% confidence interval −3.3%, +30.1%), which was consistent with analyses based on other methods with point estimates ranging from +3.4% to 16.4%. Conclusion: There is no evidence of a measurable impact of the Communities in Charge of Alcohol (CICA) programme on area‐level health and crime outcomes in Greater Manchester, UK, within 3 years of the programme start. The increase in alcohol‐related hospital admissions was likely the result of other temporal trends rather than the CICA programme. Possible explanations include insufficient follow‐up time, too few volunteers trained, volunteers being unwilling to get involved in licensing decisions or that the intervention has no direct impact on the selected outcomes. [ABSTRACT FROM AUTHOR]

Video technology enabled professionals and patients to conduct consultations during the COVID‐19 pandemic when in‐person health care was minimised to reduce the spread of the virus. We present findings of a study of video‐consulting through in‐depth qualitative remote interviews with 40 health professionals, managers, support staff and 10 patients in health‐care services across the UK from 2020 to 2021. Drawing on Foucault's concept of the clinical gaze, Merleau‐Ponty's work on the phenomenology of perception and Ihde's postphenomenology we interpreted the ways in which remote consultations shaped patient–professional interactions, mediating and framing what was seen, revealed and known. We found that participating in video consultations not only involved creative adaption and adjustment to a virtual clinic but also changed how professionals and patients saw and were seen. We argue that this mode of consulting can transform boundaries and perceptions, alter aspects of clinical presence, knowledge and embodiment and thus both change and incorporate the clinical gaze. [ABSTRACT FROM AUTHOR]

In this article, we take forward sociological ways of knowing care‐in‐practice, in particular work in critical care. To do so, we analyse the experiences of staff working in critical care during the first wave of the COVID‐19 pandemic in the UK. This moment of exception throws into sharp relief the ways in which work and place were reconfigured during conditions of pandemic surge, and shows how critical care depends at all times on the co‐constitution of place, practices and relations. Our analysis draws on sociological and anthropological work on the material culture of health care and its sensory instantiations. Pursuing this through a study of the experiences of 40 staff across four intensive care units (ICUs) in 2020, we provide an empirical and theoretical elaboration of how place, body work and care are mutually co‐constitutive. We argue that the ICU does not exist independently of the constant embodied work of care and place‐making which iteratively constitute critical care as a total system of relations. [ABSTRACT FROM AUTHOR]

Introduction: Globally, back pain is the leading cause of years of disability. In the United Kingdom, over 20 million people live with musculoskeletal (MSK) pain, with low back pain being one of the most common causes. National strategies promote self‐management and the use of digital technologies to empower populations. Aims: To evaluate the uptake and impact of providing the SelfSTart approach (STarT Back and SelfBACK App) when delivered by a First Contact Physiotherapist (FCP) to people presenting with low back pain in primary care. Methods: Patients presenting with a new episode of low back pain underwent routine assessment and completion of a STarT Back questionnaire. Patients with low/medium scores were offered the SelfBACK App. A control population was provided by the MIDAS‐GP study. Patient Experience, outcome measures, healthcare utilisation and retention were captured through the app and clinical systems (EMIS). Interviews with five FCPs explored the experiences of using the SelfSTart approach. Results: SelfSTarT was taken up by almost half (48%) of those to whom it was offered. Compared to MIDAS‐GP, users were more likely to be younger, male, in work, and with higher health literacy. SelfSTarT users reported significant improved experiences relating to receiving an agreed care plan and receiving sufficient information. There were no significant differences in treatments offered. FCPs were positive about the app and felt it had value but wanted feedback on patient progress. They recognised that a digital solution would not be suitable for all. Conclusion: This approach offers an opportunity to empower and support self‐management, using robustly evaluated digital technology. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) promotion is a core element of musculoskeletal rehabilitation. Many people with musculoskeletal conditions do not meet PA guidelines, such as those provided by the World Health Organization (WHO). This study aimed to explore the level of awareness and perspectives on the WHO PA guidelines among people with musculoskeletal conditions and identify how patients can be supported with PA in clinical practice. Methods: A mixed‐method cross‐sectional survey was conducted using a uniquely developed questionnaire, which was disseminated to patients attending outpatient physiotherapy or occupational therapy appointments. The questionnaire collected data on participant characteristics, awareness and perspectives on the WHO guidelines and suggestions for supporting patients with PA in clinical practice. Descriptive statistics and content analysis were used to analyse the quantitative and qualitative data respectively. Results: One‐hundred and two responses were included in the analysis. Forty‐two percent of respondents were aware of the guidelines, 50% knew why they existed and 53% felt they were achievable. Perspectives varied, ranging from the guidelines being positive and aiding motivation to being unachievable. Some respondents felt an individualised approach is required. Suggestions for supporting patients with PA included facilitating social support, providing education, exercise groups and personalised advice, and signposting to community services. Conclusion: There is limited awareness of the WHO PA guidelines and a variety of perspectives on the guidelines among patients with musculoskeletal conditions. There is a need to enhance the promotion of the guidelines in clinical practice, whilst considering local context and individual patient's circumstances. [ABSTRACT FROM AUTHOR]

Introduction: Method choice is an important component of quality abortion care and qualitative research suggests that abortion stigma can influence provider preference and provision of abortion methods. This study is the first to explore the relationships between abortion providers' method preferences, their provision of medication or instrumentation abortion or both methods, and abortion stigma. Methods: We conducted secondary analysis of a survey of United Kingdom (UK) abortion providers (N = 172) to describe and compare providers' self‐reported method preferences and provision. We used multinomial logistic regression to assess the association between method preference and provider experiences of abortion stigma (measured using a revised Abortion Provider Stigma Scale (APSS)), adjusting for relevant provider and facility characteristics. Results: Almost half (52%) of providers reported that they only provided medication abortion care, while 5% only provided instrumentation abortion care and 43% provided both methods. Most (62%) preferred to provide both methods while 32% preferred to provide only medication abortion and 6% only instrumentation abortion. There was no significant difference in revised APSS scores by provider method preference or provision. Discussion: Most surveyed UK abortion providers prefer to offer both methods, but over half only provide medication abortion. This may reflect patients' preferences for medication abortion, and health system and legal constraints on instrumentation abortion. Addressing these systemic constraints on method provision could expand patient choice. Providers' method preference was not significantly associated with provider stigma but future research should consider the influence of structural stigma on method provision at the health system level. [ABSTRACT FROM AUTHOR]

This commentary reflects on research jointly conducted by the Development Geographies Research Group (DevGRG) and the Gender and Feminist Geographies Research Group (GFGRG) of the RGS‐IBG, which aimed to understand the challenges faced by academics with care responsibilities. We set out the effects of research funding policies and practices on researchers' ability to combine careers as academic geographers with care responsibilities, highlighting the specific effects in a field‐based subject such as Geography. We gathered data about a range of research funders' policies and how these are implemented (in various ways) in UK Geography departments. We also surveyed all UK university Geography departments to understand experiences of parental and adoption leave, including support from employers, impacts on career progression, and recommendations for support. Our data show that there is a need for a more consistent and comprehensive approach to recognising the costs of academics' caring responsibilities, to support their career progression and to mitigate the impacts disproportionately experienced by women. Funders and higher education institutes (HEIs) need to work collaboratively to develop policies and practices to address the individualised way in which (predominantly female) academics currently experience navigating the provision of funding for parental leave, and for covering costs of care during fieldwork. Our research highlights the need for consistent and progressive policies in relation to care and parental leave across all funding bodies – that can subsequently be embedded into institutional frameworks – in order to provide equity and consistency for staff across the UK higher education (HE) sector. We also emphasise the need for these policies to be more visible and transparent, making the task of navigating them more manageable for staff at an often uncertain time in their working lives. [ABSTRACT FROM AUTHOR]