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Objective: To identify the 100 most-cited articles in DH and analyze their characteristics. Material and Methods: A search was performed on the Web of Science (WoS) and the 100 most-cited articles were selected. The following data were extracted: citations, year of publication, authorship, institution, country, journal, language, study design, topic of interest, conflict of interest (COI), and sponsorship. The VOSviewer software was used to visualize bibliometric networks. Poisson regression analysis was performed to measure associations between several citations and the characteristics of the studies. Results: The number of citations ranged from 346 to 48. The most-cited article was published in 1997 by Holland in the Journal of Clinical Periodontology. This journal published the most papers, followed by the Journal of Oral Rehabilitation and Journal of Dentistry. Laboratory research, review, and clinical trial were the study designs most prevalent. Reviews (p<0.05; PR= 1.853) and method development studies (p<0.05; PR= 1.853) had a more chance to present more citations. The main topics of interest were the clinical effectiveness of desensitizers and in vitro analysis of dentin morphology. Sponsorship and COI were underreported. England and USA presented the greatest number of citations and connections in the coauthorship network map. Conclusion: Most of the articles were original research, and their topics of interest were mainly the clinical effectiveness of desensitizing agents and dentin morphology. [ABSTRACT FROM AUTHOR]

Rhinosinusitis is a common condition with adults experiencing 2-5 episodes per year. The European Positional Paper on Rhinosinusitis and Nasal Polyps (EP3OS) published in 2005 and updated in 2007 provided evidence-based guidelines on the management of sinus disease promoting a conservative approach to treatment. This study examines the effect of EP3OS on sinus surgery uptake and acute admissions for sinusitis in England and Wales. A retrospective study using the national electronic health databases of England (Hospital Episodes Statistics, HES online) and Wales (Patient Episodes Database of Wales, PEDW) was undertaken from 2000 to 2010 using the OPCS-4 codes E12-E17 (sinus surgery) and ICD10 code J01 (acute admission for sinusitis). Data were analysed for effect following the introduction of the EP3OS in 2005 using linear regression and Chi squared analysis. 116,370 sinus procedures and 10,916 acute admissions for sinusitis were made during the study period. No significant decrease in sinus surgery procedures occurred following the introduction of the EP3OS as may have been expected ( p > 0.05), although subgroup analysis suggested a significant increase in Wales ( p < 0.05). In addition, significant increases in acute admissions for sinusitis were observed following the introduction of EP3OS ( p < 0.05). However, subgroup analysis suggested this was not the case in Wales ( p > 0.05). The EP3OS appears to have had little impact on the rates of sinus surgery but more conservative approaches to managing of sinus disease may have led to an increase in acute admissions. Further research is required to investigate whether changes in practice were adopted. [ABSTRACT FROM AUTHOR]

In England, there are proportionately more White British teachers than White British pupils, and so there is a mismatch between the proportion of teachers and pupils of each ethnic minority group. This mismatch may reduce the number of appropriate role models for some pupils and has been linked to differences in school processes and the behaviour and treatment of ethnic minority pupils. The evidence is weaker regarding any link between ethnic disproportionality and attainment. This paper uses school-level school workforce and pupil attainment data to assess this link. The results are presented as correlations between teacher/pupil characteristics and attainment scores at ages 11 and 16 and as regression models predicting attainment scores using teacher/pupil characteristics. There is no evidence here that ethnic (dis)proportionality is linked to discernible differences in pupil attainment once relative poverty is taken into account. However, as the data are linked at the school level rather than the individual level, we cannot separate the attainment of pupils of different ethnic origins, and the ethnic classification for teachers is simply binary. We are working to overcome these data limitations and hope to present future analyses based on individual data with more detailed ethnic groupings to provide a more definitive result. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices.Methods: The study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses' medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre- versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend.Results: Observations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3-6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9-5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1-2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8-4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications.Conclusions: Findings suggest no change in medication error rate, although ePA encourages certain types of errors and mitigates others. There was a statistically significant increase in documentation discrepancies which is likely to be due to adoption of new working practices with ePA. [ABSTRACT FROM AUTHOR]

Background: When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non‐attendance or non‐adherence that are multifactorial and variable dependent on, for example, population and intervention. Aims: To identify rates of non‐attendance and non‐adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. Methods: Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self‐efficacy), personal circumstances (socio‐demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non‐attendance rates were identified via local health records and non‐adherence ascertained using a specific parent‐reported measure within the treatment experience domain. Results: Participants (N = 199) were predominantly mothers, and were ethnically and socio‐economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non‐attendance was 25% and the main predictors of non‐attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non‐adherence in this cohort was 26% with parental rating of the importance of a recommendation and self‐efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. Conclusions & Implications: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS: What is already known on the subject: It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge: This study identified rates of parental non‐attendance and non‐adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non‐attendance. What are the potential or actual clinical implications of this work?: This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN. [ABSTRACT FROM AUTHOR]

Informal carers play a vital part to ensuring that individuals in need of care, due to illness or disability, continue to experience a good quality of life. Care provision has been studied extensively, however, little is known about the associations of discontinuing care. This knowledge is important not only to ensure that informal carers are supported, even after caring episode, but also to ensure the care‐recipients are not left without support. By conducting longitudinal analysis of the English Longitudinal Study of Ageing (ELSA), this paper uniquely starts to unveil the associations of discontinuing the caring role and the patterns of care provision prior to discontinuing. A multivariable binary regression analysis was conducted of the ELSA waves 7 (2015) to 8 (2017), total sample size of N = 6,687. 10.5% (n = 701) respondents were identified as discontinued carers. The dependent variable was care provided in wave 7 but not in wave 8 (a discontinued carer), compared to providing care in both waves (a continuing carer). Socio‐demographic, such as age, gender, marital status, economic activity and health acted and caring patterns, such as intensity and relationship with care‐recipient, acted as independent variables. Results showed nearly 30% of discontinued carers had provided care to a spouse. Nearly a quarter of continuing carers had transitioned between care‐recipients, which raises the question of a potential 'Serial Carer Trajectory'. The regression analysis noted that being divorced or widowed increased the odds of discontinuing care. Providing 20–49 hr of care per week was associated with lower odds of discontinuing the role. This paper suggests that policymakers should take a holistic approach to policies to support carers through all stages of their caring journey, including after discontinuing the caring role. This could ensure carers settle into life post‐caring and continue to feel valued and recognised. [ABSTRACT FROM AUTHOR]

Background: Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it. Aims: This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England. Methods & Procedures: Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post‐recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift. Outcomes & Results: Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials. Conclusions & Implications: Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long‐term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined. WHAT THIS PAPER ADDS: What is already known on the subject: The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge: A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work?: Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the impact of COVID-19 related employment disruption on individuals' retirement planning and whether these experiences differ by occupational social class. Design/methodology/approach: To explore these issues, this study linked data from those who were employed in wave 9 of the English Longitudinal Study of Ageing (ELSA) main study with wave 1 of the ELSA COVID-19 study (N = 1,797). Multinominal regression analyses were conducted to explore whether the interaction between employment disruption and occupational social class was associated with planning to retire earlier or later than previously planned. Findings: The results show that stopping work because of COVID-19 is associated with planning to retire earlier. However, there were no statistically significant interactions between occupational social class and employment disruptions on whether respondents planned to retire earlier or later. Originality/value: This paper's original contribution is in showing that the pandemic has had an impact on retirement decisions. Given the known negative effects of both involuntary early labour market exit, the findings suggest that the COVID-19 related employment disruptions are likely to exacerbate social inequalities in health, well-being in later life and, consequently, can help anticipate where there will be need for additional support in later life. [ABSTRACT FROM AUTHOR]

This paper explores public sentiment towards strike action among healthcare workers, as a result of their perceived inadequate pay. By analysing survey data collected in England between 2022 and 2023, the study focuses on NHS nurses and junior doctors, due to their critical role in delivering essential public services. Results indicate higher public support for strikes by nurses and junior doctors compared to other professions such as postal workers, teachers, rail workers, airport workers, civil servants and university lecturers. However, variation in support for strikes by healthcare workers is observed across societal segments. Significant disparities in support are linked to individual political affiliations, left–right ideological positions and trust in the NHS. In short, nonconservative voters, individuals leaning towards left‐wing politics and those with greater trust in the NHS demonstrate higher likelihoods of supporting strikes by health workers. These findings carry implications for future strike decisions and highlight specific target groups for enhanced communication efforts to garner increased public support. [ABSTRACT FROM AUTHOR]

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n  = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n  = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider some possible reasons for the relatively high rate in Wales of children looked after by local authorities. Design/methodology/approach: Selected potential explanations for Wales having higher rates were tested against aggregate data from published 2021 Government statistics. Wales was compared with England and English regions for area deprivation, local authority spending, placements at home and kinship foster care. Descriptive statistics were produced, and linear regression was used where appropriate. Findings: Wales has higher overall children looked-after rates and a bigger recent increase in these than any English region. Deprivation in Wales was higher than in most English regions. However, a smaller percentage of Welsh variation in local authority looked-after rates was explained by deprivation than was the case for England. Spending on preventative services has increased in recent years in Wales whilst decreasing in England, and there was not a clear relationship between spending on preventative services and the looked-after rate. Wales had a higher rate of care orders placed at home and more children per head of population in kinship foster care than any English region. Some of the explanations that have been suggested for Wales's particularly high looked-after rates seem to be supported by the evidence from aggregate data and others do not. Practice variation is likely to also be an important part of the picture. Originality/value: This is an original comparison of Wales, England and English regions using aggregate data. More fine-grained analysis is needed using individual-level data, multivariate analysis and qualitative methods. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Service users who behave violently may suffer. This is because violence can lead to unnecessary medication, seclusion on the ward and strained relationships with other people. It can also affect a service user's self‐esteem and lead to feelings of shame.Service users who behave violently can also make life frightening and unpredictable for members of staff, and other service users on the ward.It is important to gain a sound understanding of violence in order to help reduce it. What the paper adds to existing knowledge?: Previous research has shown that having a past history of violence, being admitted to PICU and being admitted to hospital under section is associated with violent behaviour on the ward.We identified several new factors associated with violent behaviour, such as engaging in self‐harm, being the target of another person's violence and being referred to a Psychiatric Liaison Team. Implications for practice: For some service users, behaving violently may be a response to previous trauma and an expression of distress.It is therefore important that mental health nurses are supported by their employers to work with service users in a trauma‐informed manner.Nurses employed across a range of psychiatric settings could benefit from direct interventions such as comprehensive trauma‐informed care training and psychological debrief spaces, or systemic interventions to address staff shortages and improve ward conditions. Introduction: Instances of violence in acute psychiatric settings are frequent, can be devastating for service users and staff, and are costly. Such settings would benefit from a greater understanding of violence. Aim: We analysed the association between current and historical variables and rates of inpatient violence. To address gaps in current research, we included instances of self‐harm and being the target of violence. We also included seldom used service metrics. Method: Data were extracted on admissions to acute adult wards and PICUs 2017–2020 within South London and Maudsley NHS Foundation Trust. A zero‐inflated negative binomial regression mixed model was used to analyse the impact of variables on rates of violence. Results: Variables associated with an increased rate of violence were as follows: an increased number of violent incidents in the year before admission, being admitted on MHA section, being admitted to PICU, instances of self‐harm, being the target of violence and referral to a Psychiatric Liaison Team. Discussion: The novel associations found between enacting violence, self‐harm and being the target of violence indicate trauma‐informed care is crucial to reduce violent presentations of distress. Implications for practice: System level interventions are crucial to ensure mental health nurses are supported to provide trauma‐informed care. [ABSTRACT FROM AUTHOR]

Objectives: The National Health Service Bowel Cancer Screening Programme (NHS BCSP) in England has replaced guaiac faecal occult blood testing by faecal immunochemical testing (FIT). There is interest in fully exploiting FIT measures to improve bowel cancer (CRC) screening strategies. In this paper, we estimate the relationship of the quantitative haemoglobin concentration provided by FIT in faecal samples with underlying pathology. From this we estimate thresholds required for given levels of sensitivity to CRC and high-risk adenomas (HRA). Methods: Data were collected from a pilot study of FIT in England in 2014, in which 27,238 participants completed a FIT. Those with a faecal haemoglobin concentration (f-Hb) of at least 20 µg/g were referred for further investigation, usually colonoscopy. Truncated regression models were used to explore the relationship between bowel pathology and FIT results. Regression results were applied to estimate sensitivity to different abnormalities for a number of thresholds. Results: Participants with CRC and HRA had significantly higher f-Hb, and this remained unchanged after adjusting for age and sex. While a threshold of 20 μg/g was estimated to capture 82.2% of CRC and 64.0% of HRA, this would refer 7.8% of participants for colonoscopy. The current programme threshold used in England of 120 μg/g was estimated to identify 47.8% of CRC and 25.0% of HRA. Conclusions: Under the current diagnostic policy of dichotomising FIT results, a very low threshold would be required to achieve high sensitivity to CRC and HRA, which would place further strain on colonoscopy resources. The NHS BCSP in England might benefit from a diagnostic policy that makes greater use of the quantitative nature of FIT. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC. [ABSTRACT FROM AUTHOR]

This paper examines the factors affecting the receipt of informal care among older people in China. It uses the second wave data of the China Health and Retirement Longitudinal Survey, which collected ageing and health-related information on a nationally representative sample of 8,906 older people aged 60 and over in 2013. Apart from the factors that have been examined in the contexts of developed countries, the paper further investigates two factors specific to Chinese society: rural–urban residence and regular financial assistance from children. Based on binary and multinomial logit regression analyses, the research findings are threefold: the determinants of receiving informal care differ remarkably according to the sources of care; disability and living arrangements are the most important determinants; rural–urban residence plays a vital role in the Chinese context, but regular financial assistance from children makes little difference. It is estimated that 53 million older people are receiving informal care each year, a figure equivalent to the entire population of England. With continuous population ageing, Chinese society will face huge pressure to meet the demand for social care among older people in the future. The Chinese government needs to build a well-rounded welfare system that tackles this challenge from multiple dimensions. The formal care services should aim to complement informal care in the short run and reduce inequality in social care in the long run. [ABSTRACT FROM AUTHOR]

This paper presents a statistical analysis of structural changes in the Central England temperature series, one of the longest surface temperature records available. A changepoint analysis is performed to detect abrupt changes, which can be regarded as a preliminary step before further analysis is conducted to identify the causes of the changes (e.g., artificial, human-induced, or natural variability). Regression models with structural breaks, including mean and trend shifts, are fitted to the series and compared via two commonly used multiple changepoint penalized likelihood criteria that balance model fit quality (as measured by likelihood) against parsimony considerations. Our changepoint model fits, with independent and short-memory errors, are also compared with a different class of models termed long-memory models that have been previously used by other authors to describe persistence features in temperature series. In the end, the optimal model is judged to be one containing a changepoint in the late 1980s, with a transition to an intensified warming regime. This timing and warming conclusion is consistent across changepoint models compared in this analysis. The variability of the series is not found to be significantly changing, and shift features are judged to be more plausible than either short- or long-memory autocorrelations. The final proposed model is one including trend shifts (both intercept and slope parameters) with independent errors. The analysis serves as a walk-through tutorial of different changepoint techniques, illustrating what can be statistically inferred. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Literature on staffing levels and outcomes in psychiatric wards is limited and shows mixed associationsLack of economic evidence on conflicts and containment in psychiatric careData from the City‐128 study showed that regular qualified nurse staffing levels in the preceding shifts were associated with raised conflict and containment levels What this paper adds to existing knowledge?: This is the first economic analysis using the City‐128 data, with costs and outcomes data have been combined.Cost‐effectiveness of different staffing levels in relation to conflicts and containments in England, using data from the City‐128 studyBoth day and night shifts appeared to show that the low staff scenario was cost‐effective in terms of conflicts and containment averted, even after attempts were made to adjust for patient severity What are the implications for practice?: This paper could be an indication towards further investigation into how mental health inpatient care, specially nursing is organized in England. Introduction: Evidence from City‐128 study shows a positive association between staffing levels and conflicts/containment. Economic evidence on this topic is scarce, with no economic analyses combining costs and outcomes. Aim/Question: To assess the cost‐effectiveness of different staffing levels in relation to conflicts and containments in England, using City‐128 study data. Methods: Shifts were grouped into three groups based on staff‐to‐bed ratio. Cost information was combined with total conflicts and containment measures to assess cost‐effectiveness. Results: The cost‐effectiveness analysis of the three staffing scenarios for both day and night shifts appeared to show that the low staff scenario was cost‐effective in terms of conflicts and containment averted, even adjusting for patient severity. A production function analysis also revealed that increased staff numbers were associated with higher numbers of events. Discussion: Causation cannot be attributed and neither can recommendations be made on optimal staffing levels. The impact on other outcomes such as symptoms, functioning and length of stay, and other factors should be explored, and these may all benefit from increased staff numbers. Implications for practice: These results indicate that increasing staff numbers may not necessarily improve conflict and containment outcomes. They may produce positive outcomes in other domains. [ABSTRACT FROM AUTHOR]

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

This research investigates how saturation flow is affected by bus stops and analyses whether the standard equation used in the UK is adequate for estimating the saturation flow of an approach, especially in the presence of a downstream-side bus stop. As part of the study, we undertook a survey of saturation flows at several junctions in the city of Leeds in England and seek to explain the factors affecting them, taking into account the bus stop located nearby. We develop bootstrapping regression models to explain the difference between the observed and estimated saturation flows and propose an extension to the standard model, accounting for the bus stop located nearby. Finally, this paper illustrates the methods developed and reports on how performance can be improved by reconfiguring a junction. [ABSTRACT FROM AUTHOR]

European countries have developed a range of long-term care (LTC) policy responses to support the increasing share of older people. However, little is known about the effectiveness of LTC services and benefits, particularly their impact on older peoples' quality of life (QoL). This paper investigates the role of personal, care service and environmental characteristics on the effects of home care services on QoL across England, Finland and Austria. We used data from surveys conducted in England, Finland and Austria. In total, 811 older adults were included in the analysis. OLS regression including main effects and country-specific interactions was used to explore variation in gains in long-term care service-related quality-of-life (LTC-QoL). Explanatory variables were derived from the production of welfare framework and comprised home care service user socio-demographics, needs indicators, social support and environmental variables and characteristics of home care service provision. In all three countries, LTC-QoL gains increased with needs, indicating that home care services perform well, with additional gains declining the higher the needs. Also, better process quality contributed to LTC-QoL improvements in all three countries. In addition, the availability of informal care, social contact, financial household situation and living alone, were associated with changes in LTC-QoL only in one or two of the countries. Home care services increased service users' QoL in all three European countries. The increase in QoL, however, varied across the countries. The results also provide insights into the benefits and limits of home care service provision and areas for future improvements. JEL: I31, I38, J14 [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Research findings indicate the percentage of knowledge‐related errors in medicines management is high, accounting for approximately 75% of all errors, with insufficient knowledge levels one of the most significant contributors of medication errors. Patients should be able to trust nurses to engage therapeutically and actively listen to their needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon. However, without knowledge of pharmacology, it is impossible for nurses to be able to provide adequate advice. What the paper adds to the existing knowledge?: This study has examined an area that had not yet been systematically examined previously, which draws together previous research findings on mental health nurses' knowledge of adverse events, including side effects and medication errors, related to antipsychotic medication within NHS inpatient settings. What are the implications for practice?: A recent study has found that almost three‐quarters (73%) of patients taking antipsychotic medication reported side effects to some degree. This high number of people experiencing antipsychotic medication side effects is likely to compromise care, especially in situations where nurses have inadequate knowledge of side effects and are unable to provide effective advice to patients.The findings from this study allow the mental health nursing profession an opportunity to reflect on the best means to increase knowledge and increase patient safety awareness and benefits for mental health service users. Introduction: Antipsychotic medications play a significant role in the treatment and recovery of people with several psychiatric disorders. However, research findings indicate mental health nurses are insufficiently knowledgeable about antipsychotic medication side effects. Aim: To assess practising mental health nurses' knowledge of antipsychotic medication side effects using a Multiple‐Choice Questionnaire (MCQ) across National Health Service (NHS) Trusts in England. Hypothesis: Knowledge of antipsychotic medication side effects amongst registered mental health nurses is related to their academic qualification, clinical banding and length of experience. Method: A national survey of registered mental health nurses was carried out using an online questionnaire which was disseminated by Research and Development departments. Results: A total of 504 questionnaires were returned, 245 of which had full data and further analysed. The mean score for the sample was 14.4 and only 21 participants attained a mark of >80%. Implications for Practice: Two out of three of our hypotheses (that length of experience and clinical banding are directly related to knowledge of antipsychotic medication side effects) were supported. Our study found many nurses have a suboptimal working knowledge of antipsychotic medication side effects which has the potential to compromise care. Strategies need to be put in place to enhance pharmacology knowledge. [ABSTRACT FROM AUTHOR]

The English healthcare sector underwent extensive system reform over the period from 2010 to 2015, aimed principally at improving technical efficiency. This paper examines the effect of the reforms on foundation trusts in England with particular emphasis on technical efficiency. By employing data envelopment analysis (DEA) and a second-stage regression, we found evidence of an overall improvement in efficiency, notwithstanding some fluctuations. Specifically, we found that bed utilization had positive and statistically significant association with the efficiency of acute foundation trusts; suggesting that better management of patient flows and bed utilization might be expected to improve hospital efficiency. We also found evidence to suggest that efficiency might also be improved through better management of staff numbers, optimizing liquidity, and better utilization of assets such as buildings and information technology. [ABSTRACT FROM AUTHOR]

There is growing interest in factors which can contribute to the wellbeing of older adults. Participation in learning could have beneficial effects, but to date research on the benefits of learning has tended to focus on young people or those in mid-life and there is currently little evidence on the impact of learning on the wellbeing of older adults. In this paper we provide new, quantitative evidence on the relationship between participation in learning and the wellbeing of older adults. Our study used data from the English Longitudinal Study of Ageing (ELSA), a continuing, longitudinal survey of older adults. To measure wellbeing we used the CASP-19 instrument, a subjective wellbeing measure which is available at all waves of the ELSA survey. Respondents were asked about four types of learning activity: obtaining qualifications; attendance at formal education/training courses; membership of education, music or arts groups or evening classes; membership of sports clubs, gym and exercise classes. To take account of unobservable factors which might influence wellbeing, we applied fixed effects panel regressions to four waves of ELSA data. Learning was associated with higher wellbeing after controlling for a range of other factors. We found evidence that more informal types of learning were associated with higher wellbeing. There was no evidence that formal education/training courses were associated with higher wellbeing. [ABSTRACT FROM AUTHOR]

Background During the 1997–2010 Labour government, several policies were implemented to narrow health inequalities as part of a national health inequalities strategy. Many of these policies are likely to have had a disproportionately large impact on people aged 65 and over. We aimed to understand the association between the health inequalities strategy period and inequalities in mortality at age 65–69. Methods We use population at risk and mortality data covering 1991–2019 to calculate mortality rate at age 65–69 at the Local Authority level. We use the 2019 Index of Multiple Deprivation to examine geographical inequalities. We employ segmented linear regression models with marginal spline terms for the strategy period and interact these with an indicator of deprivation to understand how inequalities changed before, during and after the strategy. The reporting of this study adheres to STROBE guidelines. Results Mortality rates in each deprivation quintile improved continuously throughout the period of study. Prior to the programme (1991–9) there was no significant change in absolute inequalities. However, during the strategy (2000–10) there was a significant decrease in absolute inequalities of −9.66 (−17.48 to −1.84). The period following the strategy (2011–19) was associated with a significant increase in absolute inequalities of 12.84 (6.60 to 19.08). Our results were robust to a range of sensitivity tests. Conclusion The English health inequalities strategy was associated with a significant reduction in absolute inequality in mortality age 65–69. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach. [ABSTRACT FROM AUTHOR]

Objectives: Large-scale influxes of international immigrants into England have stimulated heated debate about whether the increasing ethnic diversity has undermined local residents’ life satisfaction and wellbeing. In this paper, we provide the first nationally representative evidence on the relationship between international immigration and local residents’ life satisfaction in England. Methods: We used multilevel linear regression models to analyze nationally representative data (2011-2012) from 23,143 respondents and neighborhood level data from the 2011 Census. Results: The results show that the local share of international immigrants who arrived in 2010-2011, in particular the non-white immigrants, has a significantly adverse impact on local people’s life satisfaction. Further analysis shows that the adverse impact of migration is particularly pronounced for local residents who do not have a job or from intermediate social class. Conclusions: This study enables a better understanding of the link between international immigration and life satisfaction, highlighting the need of public policies to be more targeted to areas that experienced great influxes of international immigrants by facilitating positive interactions and communication between international immigrants and the local residents. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe trends in the age-standardised mortality rate and life expectancy of people with learning disabilities in Sheffield over three decades and to compare these with trends in the general population of England and Wales. Design/methodology/approach – Data were extracted from the Sheffield Case Register and compared with data published by the Office for National Statistics for England and Wales. Findings – There was a sustained reduction in age-standardised mortality rates and a sustained increase in life expectancy for people with intellectual disabilities over the 33-year period. These changes are extremely similar to those observed in the general population of England and Wales. Originality/value – There is little evidence of any closing of the gap in age-standardised mortality rates or life expectancy between people with intellectual disabilities and the general population. [ABSTRACT FROM AUTHOR]

In England accountability measures have often been used to steer school behaviour in pursuit of policy goals. In 2010, the English Baccalaureate (EBacc) was introduced to increase uptake of traditional academic subjects at GCSE. These subjects, it was argued, would enhance students' future prospects, in part because they are favoured at A-level by high-ranking universities. However, such prospects are only likely to be accessible for students who achieve at least a grade C in these subjects since it is good grades that act as the primary gatekeepers for entry into higher education and employment. Hence, this paper seeks to problematise this claim using multilevel regression models to investigate the relationship between EBacc uptake and attainment. The findings are used to frame a discussion about the merits of encouraging more students to take the EBacc given the growing tension between the need to achieve good grades and the government-held view that all students should be studying this academic core. [ABSTRACT FROM AUTHOR]

Abstract: Research consistently shows that those in poor health are less likely to migrate over long distances, but analyses rarely consider what constitutes a long distance in this context. Additionally, the migration literature often fails to account for place of residence effects on migration behaviour. This paper addresses these issues through analysis of the distance of residential moves by working age adults in the year preceding the 2011 Census. Multilevel logistic regression models predict the odds of having moved long‐distance relative to short distance, for different definitions of long distance: ≥10 km, ≥20 km and ≥50 km. We test whether those reporting a limiting long‐term illness (LLTI) are less likely to move long distance in all models, controlling for local authority at the time of the 2011 Census. We find no evidence for health selection in long‐distance migration in the 10 and 20 km models, but uncover a significant effect in the 50 km model. By age, the odds of having moved long distance do not vary for middle‐working age adults (25–54) by LLTI, whereas those with an LLTI in the pre‐retirement age group (55–64) are less likely to move long distance in all models. We uncover clusters of local authorities where those with an LLTI are more likely to have moved long distance in the 10 and 20 km models, but in the 50 km model, only two of these areas remain significantly positive. We conclude that health selection in distances moved occurs above a cut‐off somewhere between 20 and 50 km. [ABSTRACT FROM AUTHOR]

Child protection systems monitoring is key to ensuring children's wellbeing. In England, monitoring is rooted in onsite inspection, culminating in judgements ranging from 'outstanding' to 'inadequate'. But inspection may carry unintended consequences where child protection systems are weak. One potential consequence is increased child welfare intervention rates. In this longitudinal ecological study of local authorities in England, we used Poisson mixed-effects regression models to assess whether child welfare intervention rates are higher in an inspection year, whether this is driven by inspection judgement, and whether more deprived areas experience different rates for a given inspection judgement. We investigated the impact of inspection on care entry, Child Protection Plan-initiation, and child-in-need status. We found that inspection was associated with a rise in rates across the spectrum of interventions. Worse judgements yielded higher rates. Inspection may also exacerbate existing inequalities. Unlike less deprived areas, more deprived areas judged inadequate did not experience an increase in the less intrusive 'child-in-need' interventions. Our findings suggest that a narrow focus on social work practice is unlikely to address weaknesses in the child protection system. Child protection systems monitoring should be guided by a holistic model of systems improvement, encompassing the socioeconomic determinants of quality. [ABSTRACT FROM AUTHOR]

Managing the demand for higher education has been a major concern of successive UK governments over the last 30 years. While initially they sought to increase demand, latterly the emphasis has been on widening participation to include demographic groups among which it has traditionally been low. There had long been an academic and policy interest in the drivers of demand, but an appreciation of the contrasting patterns between different geographical areas was relatively late to emerge. Little research has thus far focused on the extent to which demand within an area is a function of background factors with a spatial dimension. For example, while it is known that demand tends to be lower in deprived areas, it is not well understood what specific features of deprivation cause this. This paper reports the findings of a quantitative study using linear regression modelling to determine which localised factors played a significant role in the demand for higher education between 2004 and 2009 in English local authority areas. It concludes that attainment at 16, the proportion of working-age graduates and the ethnic profile are major explanatory variables, but that the nature of the local employment market also plays a role in explaining changes over time. Coinciding with other significant changes in the education sector, the abolition of the Aimhigher initiative in July 2011 marked the return of demand management back to individual universities, so the importance of spatial patterns in higher education demand are likely to be of renewed importance in coming years. [ABSTRACT FROM AUTHOR]

This paper concerns the relationship between the spatial distribution of older beneficiaries of Disability Living Allowance and Attendance Allowance and that of Income Deprivation in England, UK. Using data for 32,482 Local Super Output Areas in England, we used spatial regression methods to investigate whether these allowances would be benefiting more deprived geographical units. [ABSTRACT FROM AUTHOR]

Purpose – The transfer to partnership in public sector management has created significantly new modes of service delivery, and is suggested to be the best means of ensuring that disadvantaged groups are socially included. The purpose of this paper is to examine New Leisure Trust (NLT) structures in public leisure provision relative to direct, in-house managed facilities and privately run Leisure Management Contractor (LMC) facilities. In particular, NLTs receive significant government funds and subsidies through tax breaks that are not forthcoming to rivals, which raises questions as to whether NLTs deserve such aid for delivering upon the social inclusion agenda of the government. Design/methodology/approach – The research involved a national survey questionnaire to 1,060 public leisure service providers in England. Empirical testing through multiple analysis of variance and regression analysis was applied to the dataset. Findings – The authors find that NLTs do not follow social orientation strategies to any significantly greater degree than rivals, nor seem to create social inclusion to any greater degree. Further, NLTs have the least to gain in terms of business performance from creating social inclusion, whilst in-house (in particular) and LMC facilities stand to gain the most. Practical implications – Though each approach to provision examined places a considerable strategic emphasis on being socially oriented, they are not effective at increasing the social inclusion of recreationally disadvantaged groups. Originality/value – This paper calls for the current public leisure management playing field to be levelled in a rebalance of opportunity and investment through the removal of anti-competitive measures. [ABSTRACT FROM AUTHOR]

Conventional transport modelling tools are relatively poor at forecasting pedestrian trips, partly because walking is only a realistic option within the immediate vicinity of an individual's origin. While it is possible to take this factor into account through some form of intervening opportunities models, this paper explores the potential for simpler spatial regression techniques and GIS to be used in tackling this problem. The variables used in explaining the proportion of walking trips to work include the characteristics of the local road network, car ownership, average age and population and jobs within a zone's catchment area. The results presented include plots of spatial correlation for proportion of walking trips, and plots of error terms for simple linear regression models and the Spatial Durbin Model, using Census data for the city of Leeds, UK. This work provides an unprecedented insight into the effect of spatial patterns on walking and it is shown that spatial regression models can produce improved modal split estimates at the trip generation stage by taking into account detailed spatial characteristics of surrounding zones. The results from this work are relevant to accessibility, land use and transport planning policies as well as to the wider application of GIS and spatial regression techniques in transport modelling. [ABSTRACT FROM AUTHOR]

Driven by a concern about the negative side effects of ethnic concentration neighbourhoods, many European governments aim to create more ethnically and socio-economically mixed neighbourhoods. At the same time, housing policy aims to give tenants more choice in how and where they live. The objectives of these two policies might conflict as offering people choice has the potential to increase self-segregation, especially across ethnic groups. This paper studies the effect of choice-based letting on (self) segregation in housing association stock in England. We analyse whether households who let their property under choice-based letting end up in neighbourhoods with different levels of ethnic concentrations than households who are matched to a dwelling using the traditional allocation system. We focus on how the effect of choice-based letting differs for ethnic minority households and non-ethnic minority households. Using unique data on all lettings made in the housing association sector in England in 2006/2007 and an ordered logit regression model we show that ethnic minority households are more likely to let a property in an ethnic concentration neighbourhood than non-ethnic minority households. Ethnic minorities letting their property under choice-based letting are the most likely to accept a dwelling in an ethnic concentration neighbourhood. [ABSTRACT FROM AUTHOR]

The paper analyses a time series of infant mortality rates in the north of England from 1921 to the early 1970s at a spatial scale that is more disaggregated than in previous studies of infant mortality trends in this period. The paper describes regression methods to obtain mortality gradients over socioeconomic indicators from the censuses of 1931, 1951, 1961 and 1971 and to assess whether there is any evidence for widening spatial inequalities in infant mortality outcomes against a background of an overall reduction in the infant mortality rate. Changes in the degree of inequality are also formally assessed by inequality measures such as the Gini and Theil indices, for which sampling densities are obtained and significant changes assessed. The analysis concerns a relatively infrequent outcome (especially towards the end of the period that is considered) and a high proportion of districts with small populations, so necessitating the use of appropriate methods for deriving indices of inequality and for regression modelling. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine the factors that vocational trainers regard as important in a 'good' dentist and to assess whether they think recent graduates were achieving these factors.Design: The study was based on a statistical analysis of returns from a postal questionnaire.Setting: Postal questionnaires were sent to all vocational advisors in England who then sent them on to a number of their vocational trainers.Materials and Methods: The questionnaire was analysed using various statistical techniques including factor analysis. Analysis was undertaken to determine whether student or trainer characteristics influenced the trainer's responses.Results: The vocational trainers judged that the group of skills that contribute to technical ability are the most important component in making a 'good' dentist. However, the most important single skill is communication with patients, closely followed by diagnostic skills and communication with the dental team. The areas where trainees are most likely to fall short in terms of actual as compared to desired performance are in areas of technical ability.Conclusion: Overall, recent trainees scored rather well when compared with an idealised good dentist. However, it is clear that more evaluation of vocational training is needed. Recent studies, including this one have looked at several different aspects of vocational training. However, the time seems ripe for a full-scale prospective evaluation. [ABSTRACT FROM AUTHOR]

Aims This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high-risk drinking, and motivation and attempts to reduce alcohol consumption in England. Design Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face-to-face surveys of representative samples of ~1700 adults in England. Measurements Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high-risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption. Findings Mean smoking prevalence over the study period was 18.6% and high-risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high-risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = -0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = −0.026, 95% CI = -1.348 to 1.296, P = 0.969). Conclusion Between 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high-risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption. [ABSTRACT FROM AUTHOR]

Background Stuttering and word-finding difficulty (WFD) are two types of communication difficulty that occur frequently in children who learn English as an additional language (EAL), as well as those who only speak English. The two disorders require different, specific forms of intervention. Prior research has described the symptoms of each type of difficulty. This paper describes the development of a non-word repetition test (UNWR), applicable across languages, that was validated by comparing groups of children identified by their speech and language symptoms as having either stuttering or WFD. Aims To evaluate whether non-word repetition scores using the UNWR test distinguished between children who stutter and those who have a WFD, irrespective of the children's first language. Methods & Procedures UNWR was administered to ninety-six 4-5-year-old children attending UK schools (20.83% of whom had EAL). The children's speech samples in English were assessed for symptoms of stuttering and WFD. UNWR scores were calculated. Outcomes & Results Regression models were fitted to establish whether language group (English only/EAL) and symptoms of (1) stuttering and (2) WFD predicted UNWR scores. Stuttering symptoms predicted UNWR, whereas WFD did not. These two findings suggest that UNWR scores dissociate stuttering from WFD. There were no differences between monolingual English-speakers and children who had EAL. Conclusions & Implications UNWR scores distinguish between stuttering and WFD irrespective of language(s) spoken, allowing future evaluation of a range of languages in clinics or schools. [ABSTRACT FROM AUTHOR]

We introduce a semi-parametric approach to ecological regression for disease mapping, based on modelling the regression M-quantiles of a negative binomial variable. The proposed method is robust to outliers in the model covariates, including those due to measurement error, and can account for both spatial heterogeneity and spatial clustering. A simulation experiment based on the well-known Scottish lip cancer data set is used to compare the M-quantile modelling approach with a disease mapping approach based on a random effects model. This suggests that the M-quantile approach leads to predicted relative risks with smaller root mean square error. The paper concludes with an illustrative application of the M-quantile approach, mapping low birth weight incidence data for English Local Authority Districts for the years 2005-2010., (Copyright © 2014 John Wiley & Sons, Ltd.)

The regression of mutually independent time series, whether stationary or non-stationary, will result in autocorrelation in the random error term. This leads to the over-rejection of the null hypothesis in the conventional t-test, causing spurious regression. We propose a new method to reduce spurious regression by applying the Cochrane-Orutt feasible generalized least squares method based on a bias-corrected method for a first-order autoregressive model in finite samples. This method eliminates the requirements for a kernel function and bandwidth selection, making it simpler to implement than the traditional heteroskedasticity and autocorrelation consistent method. A series of Monte Carlo simulations indicate that our method can decrease the probability of spurious regression among stationary, non-stationary, or trend-stationary series within a sample size of 10-50. We applied this proposed method to the actual data studied by Yule in 1926, and found that it can significantly minimize spurious regression. Thus, we deduce that there is no significant regressive relationship between the proportion of marriages in the Church of England and the mortality rate in England and Wales. [ABSTRACT FROM AUTHOR]

A monthly composite rainfall record for the period 1786–present representative of Manchester, northwest England is presented. The 235-year record ranks as the second-longest instrumental rainfall record available for northern England, and the fifth-longest for the UK, and contributes to a growing network of long homogenous rainfall series. A composite record is constructed, extended, and homogenised, and the record is analysed in terms of annual and seasonal variability, with a focus on extreme wet/dry events. Three primary meteorological stations in Manchester, located within 2 km of one another, form the basis of the reconstruction, with other records identified for infilling and extension based on their longevity, continuity, and proximity to the primary stations. A linear regression analysis is applied to produce a continuous record, and adjustment factors are applied to ensure homogeneity. Record homogeneity is assessed via cross-comparison with long-term records from the region (Carlisle, Chatsworth House and HadNWEP), and the methods are applied to assess relative homogeneity include the double-mass curve and Standard Normal Homogeneity tests. The Manchester record is deemed to be homogenous overall but includes two periods of increased uncertainty: 1786–1819, comprising the earliest observations and greatest number of different stations, and 1883–1911, which encompasses multi-year and multi-decadal drought events of (1883–1885 and 1890–1910) as identified by other long-term meteorological studies. The analysis of the entire record reflects long-term rainfall variability with an increasing, although not significant, trend in annual rainfall observed. Seasonally, a significant increase in winter rainfall is exhibited, in keeping with patterns observed in other regional studies. Seasonal rainfall totals are found to be highly variable at the decadal timescale. Several well-documented extreme wet (e.g., autumn 2000) and dry (e.g., summer 1976) seasons are identified, including historic events (e.g., the floods of summer 1872 and drought of summer 1887) from the less-well documented eighteenth and nineteenth centuries. [ABSTRACT FROM AUTHOR]

This paper examines the place of ethnicity in local authority foster care in the context of the sufficiency duty to secure adequate local placements for looked after children. The analysis draws on two main sources, namely Office for Standards in Education, Children's Services and Skills (OFSTED's) annual survey of fostering agencies and inspection reports for around half the local authority fostering services in England. Sufficiency is gauged in two main ways, comparing numbers of black and minority ethnic (BME) foster carers first with numbers of BME looked after children and second, with local adult (age 25–64) populations. Statistical analysis shows very wide variation on both measures and a significant minority of authorities that perform poorly in terms of the ethnic diversity of their foster carers. Inspection reports also vary widely in the degree and nature of attention given to issues of ethnicity with many offering limited (and sometimes no) challenge to poor performance. These findings are discussed within the broader context of recent trends towards de‐emphasizing the significance of ethnicity in child welfare. [ABSTRACT FROM AUTHOR]

Multi-dimensional Treatment Foster Care (MTFC), recently renamed Treatment Foster Care Oregon for Adolescents (TFCO-A) is an internationally recognised intervention for troubled young people in public care. This paper seeks to explain conflicting results with MTFC by testing the hypotheses that it benefits antisocial young people more than others and does so through its effects on their behaviour. Hard-to-manage young people in English foster or residential homes were assessed at entry to a randomised and case-controlled trial of MTFC ( n = 88) and usual care (TAU) ( n = 83). Primary outcome was the Children's Global Assessment Scale (CGAS) at 12 months analysed according to high ( n = 112) or low ( n = 59) baseline level of antisocial behaviour on the Health of the Nation Outcome Scales for Children and Adolescents. After adjusting for covariates, there was no overall treatment effect on CGAS. However, the High Antisocial Group receiving MTFC gained more on the CGAS than the Low group (mean improvement 9.36 points vs. 5.33 points). This difference remained significant ( p < 0.05) after adjusting for propensity and covariates and was statistically explained by the reduced antisocial behaviour ratings in MTFC. These analyses support the use of MTFC for youth in public care but only for those with higher levels of antisocial behaviour. Further work is needed on whether such benefits persist, and on possible negative effects of this treatment for those with low antisocial behaviour. Trial Registry Name: ISRCTN Registry identification number: ISRCTN 68038570 Registry URL: [ABSTRACT FROM AUTHOR]

Background: In 2005, the UK Department of Health recommended that a new role, the arrhythmia care coordinator (ACC), be created to guide patients through the diagnosis and treatment for arrhythmia. The belief was that this would improve the efficiency of care and improve their quality of life. The British Heart Foundation provided funding for 32 such posts, all of which were filled by arrhythmia specialist nurses, and commissioned an evaluation of the new service to assess its impact on patients. Aims: This paper focuses on the impact of the ACCs on their patients’ levels of anxiety and depression, hospital readmissions and costs to the National Health Service (NHS). Methods: From 2008 to 2010, using questionnaires, we conducted a longitudinal audit of the psychological status of the patients referred to the ACCs; we also assessed the ACCs’ impact on readmissions and cost benefits to the NHS using UK Hospital Episode Statistics. Results: We found high levels of anxiety and depression amongst patients. Nearly one-third were at the ‘borderline’ or ‘clinically anxious’ and 18% were at the ‘borderline’ or ‘clinically depressed’ level at their first assessment with small changes at follow-up. In arrhythmia specialist nurse sites, readmission rates were reduced by half. After deducting the cost of the ACCs and their support, the estimated annual saving was £29,357 per ACC. Conclusion: This evaluation has shown that the NHS saves £29,357 per year over and above the costs of employing a British Heart Foundation ACC and that all arrhythmia centres should be encouraged to employ an appropriate number of such specialists. [ABSTRACT FROM AUTHOR]

Online health behaviour interventions have great potential but their effectiveness may be hindered by a lack of formative and theoretical work. This paper describes the process of formative research to develop theoretically and empirically based health messages that are culturally relevant and can be used in an online intervention to promote healthy lifestyle behaviours among new university students. Drawing on the Theory of Planned Behaviour, a three-phase programme of formative research was conducted with prospective and current undergraduate students to identify (i) modal salient beliefs (the most commonly held beliefs) about fruit and vegetable intake, physical activity, binge drinking and smoking, (ii) which beliefs predicted intentions/behaviour and (iii) reasons underlying each of the beliefs that could be targeted in health messages. Phase 1, conducted with 96 pre-university college students, elicited 56 beliefs about the behaviours. Phase 2, conducted with 3026 incoming university students, identified 32 of these beliefs that predicted intentions/behaviour. Phase 3, conducted with 627 current university students, elicited 102 reasons underlying the 32 beliefs to be used to construct health messages to bolster or challenge these beliefs. The three-phase programme of formative research provides researchers with an example of how to develop health messages with a strong theoretical- and empirical base for use in health behaviour change interventions. [ABSTRACT FROM AUTHOR]

Background: Traditional measures of social status are predicated on position in the labour market. There has been less attention directed to the meanings of social position for people with a long-term condition whose relationship to employment is precarious. Previous research has demonstrated that the MacArthur scale is capable of capturing contextualised aspects of social status, which makes it a useful tool for exploring changes in meaning. Aims: The paper explores the meanings and experiences of social status of people living with a long-term condition with particular reference to employment status. Methods: A sample of 300 participants was drawn from diabetes and chronic heart disease registers of General Practices in North West England. A cross-sectional survey with nested qualitative interviews was used in collecting and analysing the data. Findings: Having financial independence and participating in valued activities are more important for people with chronic illness than power and status mediated through the labour market. Income and the lack and loss of employment were given a central role in respondents’ narratives reflecting the absence of acceptable alternative routes through which social status for those with a long-term condition can realistically be rebuilt outside of participation in the labour market. [ABSTRACT FROM AUTHOR]

Background: We evaluated the dose–response relationship between the level of attendance at the English National Health Service Diabetes Prevention Programme (DPP) and risk of progression to type 2 diabetes amongst individuals participating in the programme. Methods: We linked data on DPP attendance for 51,803 individuals that were referred to the programme between 1st June 2016 and 31st March 2018 and attended at least one programme session, with primary care records of type 2 diabetes diagnoses from the National Diabetes Audit up to 31st March 2020. Weibull survival regressions were used to estimate the association between the number of programme sessions attended and risk of progression to type 2 diabetes. Results: Risk of developing type 2 diabetes declined significantly for individuals attending seven of the 13 programme sessions and continued to decline further up to 12 sessions. Attending the full 13 sessions was associated with a 45.5% lower risk (HR: 0.545 95% CI: 0.455 to 0.652). Compared to individuals that only partially attended the programme, attendance at 60% or more of the sessions was associated with a 30.7% lower risk of type 2 diabetes (HR: 0.693 95% CI: 0.645 to 0.745). Conclusions: Reducing the risk of progression to type 2 diabetes through diabetes prevention programmes requires a minimum attendance level at seven of the 13 programme sessions (54%). Retaining participants beyond this minimum level yields further benefits in diabetes risk reduction. Commissioners may wish to consider altering provider payment schedules to incentivise higher retention levels beyond 60% of programme sessions. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of developing and implementing a care bundle intervention to improve care for patients with acute heart failure admitted to a large London hospital. The intervention comprised three elements, targeted within 24 hours of admission: Nterminal pro-B-type natriuretic peptide (NT-proBNP) test, transthoracic Doppler two-dimensional echocardiography and specialist review by cardiology team. The SHIFTEvidence approach to quality improvement was used. During implementation, July 2015--July 2017, 1169 patients received the intervention. An interrupted time series design was used to evaluate impact on patient outcomes, including 15 618 admissions for 8951 patients. Mixed-effects multiple Poisson and log-linear regression models were fitted for count and continuous outcomes, respectively. Effect sizes are slope change ratios preintervention and post-intervention. The intervention was associated with reductions in emergency readmissions between 7 and 90 days (0.98, 95% CI 0.97 to 1.00), although not readmissions between 0 and 7 days post-discharge. Improvements were seen in in-hospital mortality (0.96, 95% CI 0.95 to 0.98), and there was no change in trend for hospital length of stay. Care process changes were also evaluated. Compliance with NT-proBNP testing was already high in 2014/2015 (162 of 163, 99.4%) and decreased slightly, with increased numbers audited, to 2016/2017 (1082 of 1101, 98.2%). Over this period, rates of echocardiography (84.7-98.9%) and specialist input (51.6-90.4%) improved. Care quality and outcomes can be improved for patients with acute heart failure using a care bundle approach. A systematic approach to quality improvement, and robust evaluation design, can be beneficial in supporting successful improvement and learning. [ABSTRACT FROM AUTHOR]

The delivery of personalised support to vulnerable older people is largely contingent on those staff who provide direct care. These care workers play an invaluable role in supporting vulnerable older people that may have increasingly complex needs either at home or in care homes. Internationally, concern has been raised both about the recruitment and retention of care workers; and their skills and competencies because of their importance in the delivery of quality care services. Using both primary and secondary data, this paper explores commissioning and contracting arrangements for domiciliary care and care home provision in England and their influence on the recruitment and retention of staff in these services. The implications of the findings are discussed in the context of two factors which influence continuity of care, a proxy for quality services for older people: training opportunities for staff and factors affecting the supply of labour from which direct carers are traditionally recruited. It is suggested that some of the drivers of quality in the provision of care may not be susceptible to the influence of commissioners and providers. Nevertheless, training may aid the recruitment and retention of care workers and provide one way in which they can promote a higher standard of care for older people. [ABSTRACT FROM PUBLISHER]