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Background: In electoral contexts, mental health topics have recently attracted sociopolitical relevance, influenced by policy developments, election-related psychopathology and popular discourse about individual candidates. Yet, whether this reflects generalised trends or is contingent on election-specific and contextual factors remains difficult to ascertain. Aims: This study sought to examine correlations between Google Trends (GT) data on mental health and four national elections in the US and the UK from 2008 to 2020. This was intended to yield preliminary insights into the relevance of mental health topics amongst voters and the potential impact of electoral cycles on patterns of online engagement with these issues. Methods: Monthly and daily Search Volume Indexes (SVI) were gathered from the 'Mental Health' category on GT in the US and UK from 2008 to 2023. SVI were evaluated around the past four national ballots, comparing election-year intervals and baseline data from the preceding year. Statistical tests were conducted to assess SVI and short- and long-term dynamics. Findings: The results showed heterogeneous SVI patterns related to mental health during elections in the US and the UK. In the US, there were statistically significant SVI increases proximal to the majority of elections as compared to data in the same calendar year, but these did not typically exceed baseline SVI. However, interestingly, divisive US contests showed correlations with several elevated SVI measures in the same and previous years. Conversely, there was a lack of consistent longitudinal trends in UK elections, perhaps informed by its disparate sociopolitical landscape. Conclusions: These findings underline the composite relationship between electoral politics and popular engagement with mental health topics around national votes, suggesting that this is driven more by situational factors rather than a recurrent electoral effect or signs of burgeoning engagement. Detailed research is required to understand the nuances and causality behind these dynamics and their wider implications. [ABSTRACT FROM AUTHOR]

Objective: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. Background: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. Methods: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. Results: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). Conclusions: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. Trial registration: NA. [ABSTRACT FROM AUTHOR]

Purpose: The management of geriatric femoral neck fractures, which includes options like hemiarthroplasty (HA), total hip arthroplasty (THA), and fixation, exhibits regional and healthcare setting variations. However, there is a lack of information on global variations in practice patterns and surgical decision factors for this injury. Methods: Survey data were collected from April 2020 to June 2023 via Orthobullets Case Studies, a global clinical case collaboration platform hosted on a prominent orthopedic educational website. Collaboratively developed standardized polls, based on the best available evidence and a comprehensive, peer-reviewed, evidence-based item list, were used to capture surgeons' treatment preferences worldwide. Subsequent analyses explored preferences within subspecialties and practice settings. Multivariable regression analysis identified associations between subspecialty, practice type, the likelihood of choosing THA, and the preferred femoral fixation method. Results: Our study encompassed 2595 respondents from 76 countries. Notably, 51.5% of participants (n = 1328; 51.5%, 95% CI 49.6–53.4%) leaned towards THA and 44.9% for HA, while 3.6% favoured surgical fixation. Respondents affiliated with academic institutions and large non-university-affiliated hospitals were 1.74 times more likely to favour THA, and arthroplasty specialists exhibited a 1.77-fold preference for THA. There was a 19-fold variation for cemented femoral fixation between the United Kingdom (UK) and USA with the UK favouring cemented fixation. Conclusion: Our study reveals a significant shift towards THA preference for managing geriatric femoral neck fractures, influenced by subspecialty and practice settings. We also observed a pronounced predominance of cement fixation in specific geographic locations. These findings highlight the evolving fracture management landscape, emphasizing the need for standardization and comprehensive understanding across diverse healthcare settings. [ABSTRACT FROM AUTHOR]

This study explores the mediating role of self-regulation in the relationship between bullying victimization and depressive symptoms among adolescents, considering the moderating effects of gender and region. A cross-sectional analysis was conducted with 3984 adolescents aged 12–18 from the United Kingdom, Hong Kong, Taiwan, and the Netherlands. Data were collected via an online survey administered through Qualtrics. The survey included validated measures such as the Illinois Bullying Scale (IBS) to measure bullying victimization, the Adolescent Self-Regulatory Inventory (ASRI) to measure self-regulation, and the Patient Health Questionnaire (PHQ) to measure depression. The SPSS macro PROCESS was employed for data analysis, with model 4 used for testing the mediating effects of self-regulation and model 1 for assessing the moderating effects of gender and region. The results demonstrated significant associations between bullying victimization, self-regulation, and depressive symptoms. Self-regulation mediated the positive association between bullying victimization and depression, with notable variations across genders and regions. Specifically, male students in Hong Kong exhibited an increased susceptibility to depression when subjected to bullying. These findings underscore the protective role of self-regulation in mitigating the adverse effects of bullying victimization on adolescent mental health. Implications for interventions and prevention strategies targeting adolescent depression are discussed. [ABSTRACT FROM AUTHOR]

Aim: In order to understand the global variations in the growth trajectories of cerebral palsy patients, this study aimed to compare the growth patterns of cerebral palsy patients in Saudi Arabi with United States and United Kingdom counterparts. Method: Anthropometric data from 107 participants with cerebral palsy in Saudi Arabia were collected, including age, gender, cerebral palsy type, Gross Motor Function Classification System level, birth weight, weight at assessment, height at assessment, body mass index, and head circumference at assessment. Results: This study found discrepancies between the growth patterns of Saudi Arabian children with cerebral palsy and United Kingdom and the United States growth charts, particularly among those with severe cerebral palsy. Significant differences were observed in weight, height, and body mass index z-scores when comparing Saudi Arabian data with the United kingdom and United States reference data. Interpretation: These findings emphasize the importance of validating growth charts across different populations to ensure accurate monitoring and clinical management of children with cerebral palsy. Additionally, this study highlights the need for region-specific growth references to better address the diverse needs of individuals with cerebral palsy worldwide. [ABSTRACT FROM AUTHOR]

Physical activity and healthy eating are important for physical and mental health, yet long-standing inequalities constrain the ability of ethnic minorities in the United Kingdom (UK) to adopt these behaviours. Programmes aimed to improve these behaviours have also often not been engaged with by these communities. This study therefore aimed to: (1) identify the values underlying the physical activity and healthy eating behaviours of UK ethnic minorities and (2) explore how structural, socio-economic and environmental factors interact with these values to influence their physical activity and healthy eating behaviours. The study adopted a relativist ontological and subjectivist epistemological philosophical assumption. Qualitative interviews were used to address research objectives. A total of 10 group and five individual interviews were conducted with 41 participants. All participants were from an ethnic minority background (Black, Asian or Mixed according to the UK Office for National Statistics classification), recruited purposively and aged between 18 and 86 years and were living in England and Wales. Data were analysed using inductive thematic analysis. Community engagement was embedded throughout the study. We found that culture and family, community and social life, and health are important values underlying the physical activity and healthy eating behaviours of UK ethnic minority communities. External factors, including racism and access (geographical, social and economic), interact with these values to drive health behaviours. Using an illustrative guide, we conclude the paper with policy and practice recommendations on how public health programmes on physical activity and healthy eating can be aligned with these values to ensure relevance for ethnic minority communities. [ABSTRACT FROM AUTHOR]

The UK Biobank (UKB) is a large cohort study that recruited over 500,000 British participants aged 40–69 in 2006–2010 at 22 assessment centers from across the United Kingdom. Self-reported health outcomes and hospital admission data are 2 types of records that include participants' disease status. Coronary artery disease (CAD) is the most common cause of death in the UKB cohort. After distinguishing between prevalence and incidence CAD events for all UKB participants, we identified geographical variations in age-standardized rates of CAD between assessment centers. Significant distributional differences were found between the pooled cohort equation scores of UKB participants from England and Scotland using the Mann–Whitney test. Polygenic risk scores of UKB participants from England and Scotland and from different assessment centers differed significantly using permutation tests. Our aim was to discriminate between assessment centers with different disease rates by collecting data on disease-related risk factors. However, relying solely on individual-level predictions and averaging them to obtain group-level predictions proved ineffective, particularly due to the presence of correlated covariates resulting from participation bias. By using the Mundlak model, which estimates a random effects regression by including the group means of the independent variables in the model, we effectively addressed these issues. In addition, we designed a simulation experiment to demonstrate the functionality of the Mundlak model. Our findings have applications in public health funding and strategy, as our approach can be used to predict case rates in the future, as both population structure and lifestyle changes are uncertain. [ABSTRACT FROM AUTHOR]

Objectives: To explore how the use of, and trust in, different sources of advice and information on COVID-19 differed across the four UK nations and between different sociodemographic groups and their associations with COVID-19 vaccination status. Methods: We used a UK-wide representative survey conducted in July 2021, which included data on uptake of COVID-19 vaccination, trust in information sources, use of sources and geographical and sociodemographic variables. We used multivariate logistic regression to identify factors associated with completed or planned COVID-19 vaccination. Results: Trust in the NHS, followed by trust in scientists, were the strongest predictors of vaccination intention. NHS websites were the most used (56% across the UK); only the Scottish government website had a higher level of reported use (58%). Using either source was associated with a positive vaccination status as were use of the GP and television as sources of advice. Use of social media, family and friends, and 'none' of the sources enquired about, were all linked to a lower likelihood of being or intending to get vaccinated. Compared to those in England, respondents in other UK nations were less likely to trust the central UK government for advice on COVID-19. There was considerable variation by age in trust and use of some, but not all, sources of advice, with predicted probabilities ranging from 35% among the youngest age group to 62% among those aged 65 years or older. There were also significant differences by annual household income and by occupational class for trust in government, with higher incomes correlating with greater likelihood of trust. Conclusions: This study demonstrates high levels of trust in the key sources of public health advice and there was a positive association between using official sources of advice and vaccination intentions, even in the context of overall high vaccination rates. Our findings highlight the need for the UK and devolved governments to value the importance of public trust in the health system and take appropriate measures to avoid undermining such trust. [ABSTRACT FROM AUTHOR]

Pasteurised donor human milk is recommended for very low birthweight infants who do not have access to their mother's milk. Although the use of donor milk continues to increase, little is known about the donation experiences of milk bank donors. We aimed to describe and compare enablers, barriers and patterns of human milk donation and identify factors predicting donation volume in a convenience sample of approved milk bank donors in the United Kingdom and the United States. A cross‐sectional online survey was conducted from August 2022 to December 2022. Approved milk bank donors (n = 556) from three milk banks in the United States (n = 369, Mothers' Milk Bank of Florida, Mother's Milk Bank of North Texas and Northwest Mothers Milk Bank) and one milk bank in the United Kingdom (n = 187, Hearts Milk Bank) completed the survey. A substantial portion of donors in both settings reported participating in other forms of milk exchange (51% of U.S. donors vs. 39% of UK donors, p = 0.009). Top donation barriers reported in both settings were completing the serological screening and having enough space to store collected milk. Most donors started donating when their infant was 3 months old or older and reported donating mature milk. The most common source of information related to milk banking in each setting was the internet (United Kingdom–70% vs. United States ‐ 63%, p = 0.112). Variables that predicted lifetime donation volume differed between the United States and the United Kingdom, highlighting the importance of setting‐specific milk banking research. Key messages: Milk bank donors in the United Kingdom and the United States reported primarily receiving milk banking information from the internet and not their health care provider.A substantial portion of human milk bank donors in the United Kingdom and the United States participate in other forms of milk exchange, including sharing with a peer.Participating in other forms of milk exchange did not predict lower milk bank donation volumes.Barriers to donation and predictors of donation volume differed between donors in the United Kingdom and the United States, suggesting setting‐specific research is warranted to improve the donation process globally. [ABSTRACT FROM AUTHOR]

In daily interactions, individuals use irony and prosocial lies for various reasons, for example, to be humorous, to criticize, or to be polite. While some studies have examined individual differences in perceiving the politeness of such language, research using naturalistic, context-rich materials is lacking. To address this gap, we utilized short videos to assess politeness perception in literal, ironic, and prosocial lie scenarios while also exploring differences based on age, gender, and geographical location. Our sample included 288 participants from the United States and the United Kingdom. We focused on five different types of language: literal positive, blunt, sarcastic, teasing, and prosocial lies. Participants rated the politeness of these statements and completed surveys on communication preferences (Self-Reported Sarcasm Questionnaire and Conversational Indirectness Scale Questionnaire). While the demographic groups showed similarities, individual factors also shaped politeness perception. Older adults perceived teasing as less polite than middle-aged and younger adults, and male participants rated blunt and sarcastic statements as more polite. Geographical variations were found for prosocial lies, with U.K. participants rating them more polite than their U.S. counterparts. These findings underscore the importance of considering context-rich materials and individual factors in understanding the social functions of irony and prosocial lies. [ABSTRACT FROM AUTHOR]

Aims: To (1) explore the intramigration experience of HCWs within Nigeria, (2) explore the migration intention of health care workers (HCWs) in Nigeria and (3) identify the predictors of migration intention among HCWs in Nigeria. Design: Cross‐sectional study. Methods: The online survey was used to collect data from 513 HCWs in Nigeria between May and June 2023. Crude and adjusted logistic regression were used to identify factors associated with emigration intention. Analyses were performed on SPSS version 26 at a 95% confidence interval. Results: The study found that 34.4% had intramigration experience, and the rate of intention to emigrate to work in another country was 80.1%. The United Kingdom was the most preferred destination (109 HCWs), followed by Canada (92 HCWs) and the United States (82 HCWs). At the multivariate level, emigration intention was associated with the experience of burnout and duration of practice as a HCW. Nurses had higher emigration intentions than medical doctors. Conclusions: Many HCWs in Nigeria appear to have emigration intent, and nurses are more likely to be willing to migrate than doctors. The Nigerian government may want to explore strategies to reverse the emigration intent of the HCWs in Nigeria. [ABSTRACT FROM AUTHOR]

Objectives The relationship between smoking and RA has been confirmed. Most nations have ratified the Framework Convention on Tobacco Control. However, there are considerable regional differences in how effectively tobacco control measures were implemented. This study was carried out to estimate the spatiotemporal trends of smoking-related RA burdens. Methods Data were available from the Global Burden of Disease Study 2019 and were analysed by age, sex, year and region. Joinpoint regression analysis was applied to the analysis of temporal trends in the RA burden resulting from smoking over 30 years. Results From 1990 to 2019, the number of global RA cases increased each year. The age-standardized prevalence, death and disability-adjusted life-year (DALY) rates also increased. However, there was a wave in the changing trend of the age-standardized death rate, with the lowest point in 2012 and the highest point in 1990. Smoking, in particular, was responsible for 11.9% of total RA deaths and 12.8% of total DALYs in 1990 but only 8.5% of total RA deaths and 9.6% of total DALYs in 2019. A greater burden from smoking exposure was borne by men, older adults and people living in high-middle and high sociodemographic index (SDI) countries and regions. Moreover, the UK demonstrated the highest reduction in age-standardized death and DALY rates over the three decades. Conclusion There were reductions in the age-standardized burdens of RA caused by smoking worldwide. Nevertheless, this continues to be an issue in some areas, and efforts to reduce smoking should be made to lessen this growing burden. [ABSTRACT FROM AUTHOR]

Flashbulb memories (FBMs) refer to vivid and long-lasting autobiographical memories for the circumstances in which people learned of a shocking and consequential public event. A cross-national study across eleven countries aimed to investigate FBM formation following the first COVID-19 case news in each country and test the effect of pandemic-related variables on FBM. Participants had detailed memories of the date and others present when they heard the news, and had partially detailed memories of the place, activity, and news source. China had the highest FBM specificity. All countries considered the COVID-19 emergency as highly significant at both the individual and global level. The Classification and Regression Tree Analysis revealed that FBM specificity might be influenced by participants' age, subjective severity (assessment of COVID-19 impact in each country and relative to others), residing in an area with stringent COVID-19 protection measures, and expecting the pandemic effects. Hierarchical regression models demonstrated that age and subjective severity negatively predicted FBM specificity, whereas sex, pandemic impact expectedness, and rehearsal showed positive associations in the total sample. Subjective severity negatively affected FBM specificity in Turkey, whereas pandemic impact expectedness positively influenced FBM specificity in China and negatively in Denmark. [ABSTRACT FROM AUTHOR]

We conducted two studies to investigate how cultural differences based on country of origin influence the selection process in an asynchronous video interview (AVI) context. We drew upon the GLOBE cultural value dimensions and individual measures of prejudice to examine if raters evaluate job applicants who are more culturally dissimilar to them more negatively than culturally similar applicants. Professionals with hiring experience from the United Kingdom were recruited via the Prolific platform and asked to watch and evaluate pre‐recorded video responses from five culturally diverse applicants. Results across both studies were only somewhat consistent with the GLOBE framework. For instance, raters did demonstrate a strong preference for Canadian and South African interviewees over other countries. Right‐wing authoritarianism and social dominance orientation were non‐significant in moderating how evaluations were assigned; however, ethnocentrism levels did modestly impact evaluations in Study 2. This research is the first to investigate how cultural factors can impact the selection process in an AVI context. As the number of organizations that rely on virtual interviews increases and globalization makes it likely for applicants and interviewers to be from different cultural backgrounds, our research is highly relevant in understanding the impact of these elements on hiring decisions. [ABSTRACT FROM AUTHOR]

Background: Immunological responses to metal ions can occur in people with metal implantable devices. Nevertheless, patients are not routinely asked about metal hypersensitivity nor tested for it prior to surgical procedures. Moreover, we have not identified any published literature on patients' experiences with this condition. We undertook this study to better understand the experiences of patients with metal hypersensitivity and to determine what information would help them make an informed decision about implantable medical devices with metal compositions. Methods: This is a patient-oriented research using an interpretative phenomenological methodology. We enrolled 16 people from five countries (Canada, New Zealand, Spain, the UK, and the USA) who experienced metal hypersensitivity following implantable medical device. We collected data from in-depth, semi-structured interviews focused on pre-procedural patient education and postoperative experiences to elucidate the barriers and opportunities related to metal hypersensitivity. We analyzed the data using interpretative phenomenological analysis. Results: The majority were white biological women between the ages of 34 and 65. None of the participants were informed about immunological responses to metals in implants during the consenting process. They encountered many challenges when symptoms of metal hypersensitivity occurred. The outcomes for the few who had the implants removed were mixed. Conclusion: Hypersensitivity reactions to metal need to be discussed as part of the consenting process, and additional strategies are needed to mitigate this issue in the health system. [ABSTRACT FROM AUTHOR]

BACKGROUND: Long-term survival after spinal cord injury (SCI) has been extensively studied in the US and UK. OBJECTIVE: To compare SCI epidemiology and survival results between the US and UK for the same time period and patient groups. METHODS: We restricted attention to persons injured at ages 18 and older who had survived at least 2 years post injury and were not ventilator dependent. We performed survival analysis using logistic regression on person-year data with time-dependent covariates. The resulting mortality rates were used to construct life tables in order to obtain life expectancies. RESULTS: The average age at injury, percentage male, and level/grade of injury were rather similar between the two countries. After adjustment for risk factors, UK mortality was 85% of that in the US (95% c.i. 80% to 91%, p < 0.0001). Mortality increased by 0.3% per year over the 1980 to 2012 study period (HR = 1.003); this was not statistically significant (p = 0.44). The US and UK life expectancies are nearly the same percentage of their respective general population values, differing by at most 2%. CONCLUSION: Long-term mortality after SCI in the UK is roughly 15% lower than that in the US. The general population mortality in the UK is also approximately 15% lower, however, and thus the percentages of normal life expectancy in the two countries prove to be strikingly similar. [ABSTRACT FROM AUTHOR]

Background: Research evidence suggests aphasia therapy must be delivered at high intensity to effect change. Comprehensive therapy, addressing all domains of the International Classification of Functioning, Disability and Health, is also called for by people with aphasia and their families. However, aphasia therapy is rarely intense or comprehensive. Intensive Comprehensive Aphasia Programmes (ICAPs) were designed to address this challenge, but such programmes are not widely implemented. Aims: This study surveyed the views of UK‐based speech and language therapists (SLTs) regarding intensive and comprehensive aphasia therapy. It explored definitions of intensive and comprehensive therapy, patterns of provision, views about candidacy and barriers/facilitators. It also investigated awareness of ICAPs and perceived potential of this service model. Differences across UK regions and workplace settings were explored. Methods & Procedures: An e‐survey ran for 5 months. Quantitative data were analysed using descriptive and inferential statistics. Qualitative free text comments were analysed using content analysis. Outcomes & Results: Two hundred twenty‐seven respondents engaged in the e‐survey. Definitions of intensive aphasia therapy did not reach UK clinical guideline/research‐level thresholds for most of the sample. Those providing more therapy provided definitions with higher standards of intensity. Mean therapy delivered was 128 min/week. Geographical location and workplace setting influenced the amount of therapy delivered. The most frequently delivered therapy approaches were functional language therapy and impairment‐based therapy. Cognitive disability and fatigue were concerns for therapy candidacy. Barriers included lack of resources and low levels of optimism that issues could be solved. 50% of respondents were aware of ICAPs and 15 had been involved in ICAP provision. Only 16.5% felt their service could be reconfigured to deliver an ICAP. Conclusions & Implications: This e‐survey evidences a mismatch between an SLT's concept of intensity and that espoused by clinical guidelines/research. Geographical variations in intensity are concerning. Although a wide range of therapy approaches are offered, certain aphasia therapies are delivered more frequently. Awareness of ICAPs was relatively high, but few respondents had experience of this model or felt it could be executed in their context. Further initiatives are needed if services are to move from a low‐dose or non‐comprehensive model of delivery. Such initiatives might include but not be confined to wider uptake of ICAPs. Pragmatic research might also explore which treatments are efficacious with a low‐dose model of delivery, given that this model is dominant in the United Kingdom. These clinical and research implications are raised in the discussion. What this paper adds: What is already known on this subject: There is a gap between the high intensity of aphasia treatment provided in research versus mainstream clinical settings. A lower standard of 45 min/day set by UK clinical guidelines is also not achieved. Although speech and language therapists (SLTs) provide a wide range of therapies, they typically focus on impairment‐based approaches. What this study adds: This is the first survey of UK SLTs asking about their concept of intensity in aphasia therapy and what types of aphasia therapy they provide. It explores geographical and workplace variations and barriers and facilitators to aphasia therapy provision. It investigates Intensive Comprehensive Aphasia Programmes (ICAPs) in a UK context. What are the clinical implications of this work?: There are barriers to the provision of intensive and comprehensive therapy in the United Kingdom and reservations about the feasibility of ICAPs in a mainstream UK context. However, there are also facilitators to aphasia therapy provision and evidence that a small proportion of UK SLTs are providing intensive/comprehensive aphasia therapy). Dissemination of good practice is necessary and suggestions for increasing intensity of service provision are listed in the discussion. [ABSTRACT FROM AUTHOR]

During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n  = 416, 46.5% antenatal; n  = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives. [ABSTRACT FROM AUTHOR]

Aims and objectives: Surveillance of wound infection including signs of infection alongside antimicrobial usage (types, duration, frequency) can highlight knowledge gaps and inconsistencies. This manuscript aims to highlight these, identify and inform opportunities for practice improvement and to show impact of infection management practice may be having on the issue of antimicrobial resistance. Background: Infected wounds pose challenges to healthcare professionals. Balancing risk of wound deterioration and progression to systemic infection with appropriate use of antimicrobials is necessary to minimise development of resistance. Methods: Analysis consisted of a practice survey of 9661 wounds across 70 community sites over a period of one week. Data were collected from projects between 2017 and 2020. The form was available to providers within the UK, Ireland, Norway, Denmark, Sweden and Finland. EQUATOR research guidelines were followed; STROBE checklist for observational research reporting was completed. Results: Infection rates of 8.9% were reported from wounds assessed. These data indicate inconsistencies with diagnosis across practice with non‐specialists more likely to be unsure of wound infection. Greater confidence in infection identification was observed as number of signs increased. Inconsistencies were also observed in appropriate treatment; antimicrobials were used in 35% of wounds considered not infected and not used in 41% of wounds that were identified as infected. Conclusions: This investigation of infection management practice of over 9000 wounds provides an insight into diagnosis and treatment of infection. Inconsistencies in diagnosis and treatment of wound infections reported highlight the need for increased education, awareness of diagnosis and treatment of infection. Relevance to clinical practice: Variability in management of infected wounds highlights opportunities to aid more effective diagnosis and treatment of infected wounds. Incorporation of support tools or evidence‐based pathways into practice may enhance confidence in management of local infection, balanced with appropriate use, potentially minimising resistance and improving outcomes. [ABSTRACT FROM AUTHOR]

There is a paucity of data on research funding levels for male reproductive health (MRH). We investigated the research funding for MRH and infertility by examining publicly accessible web-databases from the UK and USA government funding agencies. Information on the funding was collected from the UKRI-GTR, the NIHR's Open Data Summary, and the USA's NIH RePORT web-databases. Funded projects between January 2016 and December 2019 were recorded and funding support was divided into three research categories: (i) male-based; (ii) female-based; and (iii) not-specified. Between January 2016 and December 2019, UK agencies awarded a total of £11,767,190 to 18 projects for male-based research and £29,850,945 to 40 projects for female-based research. There was no statistically significant difference in the median funding grant awarded within the male-based and female-based categories (p = 0.56, W = 392). The USA NIH funded 76 projects totalling $59,257,746 for male-based research and 99 projects totalling $83,272,898 for female-based research Again, there was no statistically significant difference in the median funding grant awarded between the two research categories (p = 0.83, W = 3834). This is the first study examining funding granted by main government research agencies from the UK and USA for MRH. This results should stimulate further discussion of the challenges of tackling male infertility and reproductive health disorders and formulating appropriate investment strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: As a direct consequence of the COVID-19 pandemic, cancer screening programs, management of chronic disease and cancer treatments were either cancelled or delayed. 164 patients with hepatocellular cancer (HCC) were evaluated to understand the impact of the first lockdown on treatment delays, and 1-year survival. We observed that 70% of patients were not treated within 31 days, with the median time to treatment being 49 days. This was particularly true of those with early-stage disease undergoing surgical or interventional radiology treatment. However, we noted that delay to treatment had no impact on mortality at 1-year. Given the diversity of the patients included in the study, we investigated possible factors influencing treatment delay, such as age, ethnicity, and geographical location. None of these factors were found to be associated with treatment delays. Future studies with longer follow-up are needed to assess whether delay to treatment had a negative impact on patients' survival. Our study allows a better understanding of treatment delays and short-term impact on survival during severe health services disruptions. Findings from this study highlight the need for better prioritisation of HCC treatment services particularly for the management of early-stage disease during any future pandemic lockdown. Introduction: The COVID-19 pandemic has caused severe disruption of healthcare services worldwide and interrupted patients' access to essential services. During the first lockdown, many healthcare services were shut to all but emergencies. In this study, we aimed to determine the immediate and long-term indirect impact of COVID-19 health services utilisation on hepatocellular cancer (HCC) outcomes. Methods: A prospective cohort study was conducted from 1 March 2020 until 30 June 2020, correlating to the first wave of the COVID-19 pandemic. Patients were enrolled from tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDM) were identified. Any delay to treatment (DTT) and the effect on survival at one year were reported. Results: The median time to receipt of therapy following MDM discussion was 49 days. Patients with Barcelona Clinic Liver Cancer (BCLC) stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed, but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate into reduced survival in patients. Conclusion: Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay in therapy in those receiving curative therapy. [ABSTRACT FROM AUTHOR]

Wood dust is an established carcinogen also linked to several non malignant respiratory disorders. A major limitation in research on wood dust and its health effects is the lack of (historical) quantitative estimates of occupational exposure for use in general population-based case-control or cohort studies. The present study aimed to develop a multinational quantitative Job Exposure Matrix (JEM) for wood dust exposure using exposure data from several Northern and Central European countries. For this, an occupational exposure database containing 12653 personal wood dust measurements collected between 1978 and 2007 in Denmark, Finland, France, The Netherlands, Norway, and the United Kingdom (UK) was established. Measurement data were adjusted for differences in inhalable dust sampling efficiency resulting from the use of different dust samplers and analysed using linear mixed effect regression with job codes (ISCO-88) and country treated as random effects. Fixed effects were the year of measurement, the expert assessment of exposure intensity (no, low, and high exposure) for every ISCO-88 job code from an existing wood dust JEM and sampling duration. The results of the models suggest that wood dust exposure has declined annually by approximately 8%. Substantial differences in exposure levels between countries were observed with the highest levels in the United Kingdom and the lowest in Denmark and Norway, albeit with similar job rankings across countries. The jobs with the highest predicted exposure are floor layers and tile setters, wood-products machine operators, and building construction labourers with geometric mean levels for the year 1997 between 1.7 and 1.9 mg/m3. The predicted exposure estimates by the model are compared with the results of wood dust measurement data reported in the literature. The model predicted estimates for full-shift exposures were used to develop a time-dependent quantitative JEM for exposure to wood dust that can be used to estimate exposure for participants of general population studies in Northern European countries on the health effects from occupational exposure to wood dust. [ABSTRACT FROM AUTHOR]

Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire—measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake—was targeted to HCWs via social media platforms between May–July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity–Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity–Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were "unable to take time off work" for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. Methods: We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. Results: Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. Conclusions: The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. Trial registration: This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687. [ABSTRACT FROM AUTHOR]

Introduction: An analysis on the ECLS use for patients with respiratory or cardiac support in COVID-19 based on an international response to EuroELSO survey, aims to generate a more comprehensive understanding of ECLS role during the recent viral pandemic. Methods: EuroELSO announced the survey at the 10th annual congress in London, May 2022. The survey covered 26 multiple-choice questions. Results: The survey returned 69 questionnaires from 62 centers across 22 European countries and seven centers across five non-European countries. Most of the centers providing ECLS for COVID-19 patients had more than 30 runs for respiratory support since December 2019. In the same period, at least 31 runs in adult COVID-19 patients have been performed in 48 of 69 centers (69.6%). The reported pediatric data from 18 centers is limited to less than the patients per center. Conclusion: Majority of the COVID-19 patients received respiratory ECLS support and adult patients dominated. The indications and contraindications are broadly aligned with available guidelines. Most of the centers considered age >65 or biological age as a relative or absolute contraindication for ECLS in COVID-19. ECLS withdrawal criteria in COVID-19 are controversial because the long-term outcomes after ECLS in COVID-19 and the impact of critical illness and the impact of long-COVID are still not known. [ABSTRACT FROM AUTHOR]

To investigate the effect of home and away game travel on risk of concussion across different levels of rugby union. Exploration study across school, university, and professional rugby teams. Retrospective analysis of concussion incidence and symptomology of surveillance data and prospective data collection for potential concussions via surveys. Data was collected from school rugby teams (n = 344 matches, over 2 years), a university rugby (n = 6 matches), and a professional rugby team (n = 64 matches, over two seasons). School level rugby had an increased prevalence of concussions in away matches (p = 0.02). Likewise, there was a significant increase (p < 0.05) in concussions at away matches in university rugby. In addition, the professional rug by team had significant differences in recovery times and symptoms with away fixtures, including longer recovery times (p < 0.01), more initial symptoms (p < 0.01), as well as greater and more severe symptoms at 48 hours (p < 0.05). This research highlights an increased prevalence of concussion in school and university-aged rugby players away from home, as well as increased symptoms, symptom severity, and recovery times in professional rugby players. [ABSTRACT FROM AUTHOR]

This unique evaluation aimed to estimate, the financial impact of non‐attendance on a nation‐wide hospital lymphoedema service. Along with gaining some understanding of patient characteristics of those who Did Not Attend (DNA) and were subsequently discharged. The evaluation design interrogated existing performance data from 2012 to 2022. This information was used to estimate the costs incurred based on national published sources and pay scales. Staffing costs of over £1.1 m in one decade related to the financial impact of over 23 000 unattended lymphoedema appointments. The characteristics of 870 patients from 2019/2020 were also evaluated suggesting that those with a wound alongside complex lymphoedema were less likely to DNA appointments. Two‐thirds of patients were managing two or more comorbidities—obesity, cardiac conditions and diabetes being the most common. It seems likely that some DNAs are avoidable by adapting appointment administrative processes and greater understanding of patients' perception of value. However, the reasons for DNA are likely to be varied and nuanced so potentially a small proportion are unavoidable. Modernising appointment processes and identifying patient value may help minimise DNA costs in the future. [ABSTRACT FROM AUTHOR]

Background: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. Aim: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS‐R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. Study design: During January to August 2017 a cross‐sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. Methods: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. Results: Two hundred sixty‐six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P =.05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = −0.20, P =.02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = −0.28, P <.001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. Conclusion: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. Relevance to clinical practice: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses. [ABSTRACT FROM AUTHOR]

Aim: To analyse the current scientific knowledge and research lines focused on environmentally sustainable health systems, including the role of nurses. Background: There seem to be differences between creating interventions focused on environmentally sustainable health systems, including nurses, and the scarcity of research on this topic, framed on the Sustainable Development Goals. Methods: A bibliometric analysis was carried out, via three databases (Web of Science, Scopus and Pubmed), and the guideline recommendations were followed to select bibliometric data. Results: The search resulted in 159 publications, significantly increasing the trends from 2017 to 2021 (p =.028). The most relevant countries in this area were the United States, the United Kingdom and Sweden. Also, the top articles were from relevant journals, indexed in Journal Citation Report, and the first and the second quartiles linked to the nursing field and citations (p <.001). Conclusion: Education is key to achieving environmentally sustainable health systems via institutions and policies. Implications for Nursing Management: There is a lack of experimental data and policies on achieving or maintaining environmentally sustainable health care systems, indicating that nurses have an important role and should be consulted and included in decision‐making policies regarding sustainability in the health care systems. [ABSTRACT FROM AUTHOR]

Among older people, walking is a popular and prevalent activity. Walking is key to increasing physical activity levels and resulting physical and mental health. In the context of rapidly ageing populations, it is important to better understand what factors are associated with walking among older people, based on the socioecological model of health. We used data from Understanding Society (n:6450), a national panel survey of UK adults aged 65 years and over living in Great Britain. Slope Indices of Inequality (SII) were calculated for weekly walking hours for older people according to individual, social and area characteristics. These include health, loneliness and social isolation, previous walking and sporting activity, residential self-selection, contact with neighbours, number of close friends and social activity. Spatial area-level data described local area crime, walkability, and proximity to retail, greenspace, and public transport amenities. Multivariable models indicated that poor health, particularly requiring help with walking, was the strongest predictor of weekly walking hours (SII (95% CI) comparing those needing help vs. no help: −3.58 (−4.30, −2.87)). However, both prior sporting activity (most vs. least active: 2.30 (1.75, 2.88)) and walking for pleasure (yes vs. no: 1.92 (1.32, 2.53)) were strongly associated with increased walking several years later. Similarly having close friends (most vs. fewest, 1.18 (0.72, 1.77)) and local retail destinations (any vs. none: 0.93 (0.00, 1.86)) were associated with more weekly walking. Past engagement in physical activity and walking for pleasure are strong predictors of walking behaviour in older people, underscoring the importance of implementing and sustaining walking interventions across the lifespan to ensure continued engagement in later years and the associated health benefits. However, poor health significantly impedes walking in this demographic, emphasising the need for interventions that offer both physical assistance and social support to promote this activity. • Walking is a popular and prevalent activity amongst older people and is key to increasing physical activity levels. • We explored the individual, social and area level factors associated with older peoples walking. • Poor health, particularly requiring help with walking, was the strongest predictor of weekly walking hours. • Prior sporting activity, walking for pleasure and having close friends were associated with more weekly walking. • Walking interventions across the life course are important to support walking in older age. [ABSTRACT FROM AUTHOR]

Gender-affirming healthcare can carry significant benefits for trans people. However, there are substantial geographical inequalities in the provision of and access to trans-specific healthcare across Europe. Comparative healthcare systems research has typically focused on universal services, neglecting provision which serves specific groups within populations (e.g., trans people). This study aimed to develop a comparative typology of trans-specific healthcare systems across 28 European countries (the EU 27 plus the UK), and to examine country-level correlates which may influence or be influenced by these systems. Using hierarchical and k-means cluster analysis, countries were classified into four types based on measures of trans-specific healthcare provision, regulation and access. Possible country-level correlates (including socio-political climate, medical outcomes, and the general healthcare system) were investigated. The cluster analysis identified four clusters of trans-specific healthcare systems in Europe, characterized as: 1) Centralized conservative (highly centralized, extensive range of treatments, few trans-specific government policies); 2) Centralized reformist (highly centralized, extensive range of treatments, multiple trans-specific government policies); 3) Decentralized marketized (highly decentralized, moderate range of treatments, few trans-specific government policies); 4) Underdeveloped (highly decentralized, limited range of treatments, few or no trans-specific government policies). We found statistically significant differences between the clusters in rates of: public support for trans people; gender identity concealment; treatment access; overall health expenditure; gender inequality. The study develops a novel typology of trans-specific healthcare systems in Europe. It also identifies a range of potential drivers and outcomes of geographical divergences and inequalities in trans-specific healthcare provision. Building on this typology, future comparative research should aim to link the structure of healthcare systems to outcomes for trans people. Comparative healthcare systems research must account for the distinctive forms taken by services and systems that provide healthcare to specific groups within populations. • Develops a novel typology of trans-specific healthcare systems in Europe. • Conceptualizes four distinct types of trans-specific healthcare systems. • Investigates potential drivers and outcomes of inequalities between systems. [ABSTRACT FROM AUTHOR]

Studies indicate that eating locations can influence food choices. However, the relationship with ultra-processed foods has been little explored. The objective was to assess the association between eating locations and ultra-processed foods consumption in the UK in 2014–2016. Data from 2,449 individuals aged 4 years or older from the NDNS were analysed cross-sectionally. Food consumption information was collected through 4-day food diaries. Recorded foods were classified into NOVA system. The eating locations were grouped into nine categories (home, institutional places, sit-down restaurants, on the go, coffee shops, leisure and sports clubs, fast food, friends and relatives' house, and other places). Linear regression models were carried out. The coefficients represent the increment in the contribution of ultra-processed foods to total energy intake for each percentage point increase in the contribution of each eating location to total energy intake. Among children, consumption at home was inversely associated with ultra-processed foods consumption (β: −0.10; 95% CI −0.17, −0.03), while in leisure and sports places (0.47; 0.20, 0.73) directly associated. For adolescents, eating at home (−0.12; −0.19, −0.05) was inversely associated with the consumption of ultra-processed foods, as well as sit-down restaurants (−0.21; −0.38, −0.03). Fast food (0.29; 0.12, 0.47) were directly associated with the consumption of ultra-processed foods for adolescents. Finally, for adults, sit-down restaurants (−0.13; −0.22, −0.03) showed to be inversely associated with the consumption of ultra-processed foods while in fast food restaurants (0.77; 0.38, 1.17) it was directly associated. Our results showed that the eating locations have different impacts on diet quality. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Background Measurement of UK food insecurity has historically been inconsistent, making it difficult to understand trends. This study contributes by reporting and analysing data from a national survey conducted in line with UN Food and Agriculture Organization (FAO) recommendations and standard methods, providing an internationally comparable pre-coronavirus disease 2019 (COVID-19) snapshot of food insecurity. Methods Data came from a nationally representative 2019 UK sample (N  = 2000) surveyed by Ipsos-Mori. Prevalence of food insecurity was assessed using the UN FAO Food Insecurity Experience Scale. Logistic regression was used to model food insecurity in relation to geographic and socio-demographic variables. Results Severe food insecurity was reported by 3% of the sample, an increase of 66.7% over the last directly comparable UK analysis (Gallup World Poll data from 2016 to 2018). Indication of some degree of food insecurity was reported by 14.2% of the sample and tended to be higher amongst younger age groups, those on lower incomes, and home renters (as opposed to owners). No geographic variables were significantly associated with food insecurity prevalence. Conclusions The finding that prevalence of severe food insecurity was already increasing before the COVID-19 pandemic, across all areas of the UK, is cause for concern. Our results provide an important benchmark for assessing the impact of COVID-19 on food insecurity. [ABSTRACT FROM AUTHOR]

The National Diabetes Prevention Program (NDPP) offers lifestyle change education to adults at risk for diabetes across the United States, but its reach is curbed due, in part, to limitations of traditional in-person programs. Diabetes Prevention Programs (DPPs) that are fully digital may increase reach by overcoming these barriers. The aim of this research was to examine the reach of Lark's DPP, a fully digital artificial-intelligence-powered DPP. This study assessed geographic features and demographic characteristics of a sample of Lark DPP commercial health plan members with complete data (N = 16,327) and compared several demographic features with a large composite sample of members from DPPs across the nation (NDPP; N = 143,489) and a National Health Interview Survey (NHIS) sample of prediabetic adults in the United States (NHIS; N = 2118). Examination of the Lark DPP sample revealed that 24.4% of members lived in rural areas, 30.8% lived in whole county health professional shortage areas, and only 7.6% of members lived in a zip code with an in-person DPP. When comparing the Lark sample with the NDPP and NHIS samples, Lark DPP enrollees tended to be younger and have a higher body mass index (BMI) (p's < 0.001). Lark provides convenient access to a DPP for individuals living in hard-to-reach areas who may face barriers to participating in in-person or telephonic DPPs or who prefer a digital program. Compared with the NDPP sample, Lark is also reaching younger and higher BMI users, who are traditionally difficult to enroll and have a high need for intervention. [ABSTRACT FROM AUTHOR]

Context: Athletes enter injury rehabilitation with certain expectations about the recovery process, outcomes, and the professional providing treatment. Their expectations influence the effectiveness of the assistance received and affect the overall rehabilitation process. Expectations may vary depending on numerous factors such as sport experience, gender, sport type, and cultural background. Unfortunately, limited information is available on athletes' expectations about sport-injury rehabilitation. Objective: To examine possible differences in athletes' expectations about sport-injury rehabilitation based on their country of residence and type of sport (contact vs noncontact). Design: Cross-sectional. Setting: Recreational, college, and professional athletes from the US, UK, and Finland were surveyed. Participants: Of the 1209 athletes ranging from 12 to 80 y of age (mean 23.46 ± 7.91), 529 US [80%], 253 UK [86%], and 199 Finnish [82%] athletes provided details of their geographical location and were included in the final analyses. Main Outcome Measures: The Expectations About Athletic Training (EAAT) questionnaire was used to determine athletes' expectations about personal commitment, facilitative conditions, and the expertise of the sports-medicine professional (SMP). Results: A 3 x 2 MANCOVA revealed significant main effects for country (P = .0001, ηp² = .055) and sport type (P = .0001, ηp² = .023). Specifically, US athletes were found to have higher expectations of personal commitment and facilitative conditions than their UK and Finnish counterparts. Athletes participating in contact sports had higher expectations of facilitative conditions and the expertise of the SMP than did athletes participating in noncontact sports. Conclusions: SMPs, especially those in the US, should consider the sport and environment when providing services. In addition, SMPs need to highlight and demonstrate their expertise during the rehabilitation process, especially for those who compete in contact sports. [ABSTRACT FROM AUTHOR]

Purpose: To examine rural and urban differences in cancer‐related self‐efficacy with UK cancer survivors following treatment. Methods: A cross‐sectional postal survey with posttreatment cancer survivors in the East Midlands of England. The survey collected data on demographics and cancer‐related self‐efficacy using the Cancer Survivors Self‐Efficacy Scale. Rural‐urban residence was determined using Office for National Statistics classifications. Linear Regression models were developed using a Directed Acyclic Graph that determined confounding variables. When the model deviated from normal the outcome variable was transformed using the Box‐Cox transformation. Findings: Of those surveyed, 227 responded, of whom 58% were female and 45% lived in a rural area. A linear regression model showed a significant increase in cancer‐related self‐efficacy in cancer survivors living in rural areas compared to urban residents (0.76, 95% CI: 0.25‐1.27), although the residual plot deviated from a normal distribution. A model of the effect of rural living on a Box‐Cox transformed outcome variable confirmed an increased cancer‐related self‐efficacy score in rural regions (9.06, 95% CI: 2.97‐15.14). Rural living remained significant (7.98, 95% CI: 1.78‐14.19) after adjustment for the respondents' income. Similarly adjusting for deprivation led to a significant increase in cancer‐related self‐efficacy in rural regions (8.64, 95% CI: 2.48‐14.79). Conclusion: This study has important implications when considering the impact of location of residence on cancer‐related self‐efficacy in cancer survivorship. The role of deprivation had some impact for sample respondents in both the urban and rural environment and merits further analysis. [ABSTRACT FROM AUTHOR]

Aims: To investigate changes in alcohol consumption during the first months of the COVID‐19 pandemic in Europe as well as its associations with income and experiences of distress related to the pandemic. Design Cross‐sectional on‐line survey conducted between 24 April and 22 July 2020. Setting: Twenty‐one European countries. Participants: A total of 31 964 adults reporting past‐year drinking. Measurements Changes in alcohol consumption were measured by asking respondents about changes over the previous month in their drinking frequency, the quantity they consumed and incidence of heavy episodic drinking events. Individual indicators were combined into an aggregated consumption‐change score and scaled to a possible range of −1 to +1. Using this score as the outcome, multi‐level linear regressions tested changes in overall drinking, taking into account sampling weights and baseline alcohol consumption [Alcohol Use Disorder Identification Test (AUDIT‐C)] and country of residence serving as random intercept. Similar models were conducted for each single consumption‐change indicator. Findings The aggregated consumption‐change score indicated an average decrease in alcohol consumption of −0.14 [95% confidence interval (CI) = −0.18, −0.10]. Statistically significant decreases in consumption were found in all countries, except Ireland (−0.08, 95% CI = −0.17, 0.01) and the United Kingdom (+0.10, 95% CI = 0.03, 0.17). Decreases in drinking were mainly driven by a reduced frequency of heavy episodic drinking events (−0.17, 95% CI = −0.20, −0.14). Declines in consumption were less marked among those with low‐ or average incomes and those experiencing distress. Conclusions: On average, alcohol consumption appears to have declined during the first months of the COVID‐19 pandemic in Europe. Both reduced availability of alcohol and increased distress may have affected consumption, although the former seems to have had a greater impact in terms of immediate effects. [ABSTRACT FROM AUTHOR]

Objectives To characterize the incidence of clinically diagnosed Paget's disease of bone in the UK during 1999–2015 and to determine variations in the incidence of disease by age, sex, geography and level of deprivation. Methods Incident cases of Paget's disease occurring between 1999 and 2015 were identified from primary care records. Overall crude incidence and incidence stratified by age and sex was calculated each year from 1999 to 2015. Direct age- and sex-standardized incidence was also calculated. We used Poisson regression to look at variations in incidence by deprivation and UK region. Results A total of 3592 incident cases of Paget's disease were identified between 1999 and 2015. Incidence increased with age and at all ages was greater in men than women. In women and men, respectively, crude incidence increased from 0.037 and 0.074/10 000 population per year among those 45–49 years of age to 3.7 and 6.3/10 000 population per year among those ≥85 years. The overall standardized incidence decreased from 0.75/10 000 person-years in 1999 to 0.20/10 000 person-years in 2015. After adjustment for age and sex, incidence was >30% higher in the most- compared with least-deprived quintile of deprivation. There was evidence of geographic variation, with the highest incidence in the North West of England, which persisted after adjustment for age, sex and level of deprivation. Conclusion The incidence of clinically diagnosed Paget's disease has continued to decrease since 1999. The reason for the decline in incidence remains unknown, although the rapidity of change points to an alteration in one or more environmental determinants. [ABSTRACT FROM AUTHOR]

The constituency work of British Members of Parliament (MPs) has long been referred to in political circles as a form of social work. This article reports on a qualitative study using semi-structured interviews with thirteen MPs. The aim of the research was to find out what characterises their constituency work to understand why it apparently bears comparison with social work. The article draws on the concepts of proximity and place from the mobilities paradigm to articulate the idea of 'politics as social work'. MPs in the study engaged in face-to-face emotional labour in which they formed and sustained empathic relationships with people and places to represent them. They practised judgement under uncertainty and risk work, and they were embedded in local organisational networks of risk and trust with local authorities and other agencies. The article argues that this analysis of politics as social work provides a deeper understanding of the politics of social work. In the era of the COVID-19 pandemic and its severe socio-economic impact, the importance for social work of the concept of emplaced empathy and the need for our reorientation to place is thrown into particularly sharp focus. [ABSTRACT FROM AUTHOR]

To characterize inpatient rehabilitation services for children with severe traumatic brain injury (TBI), we included 254 children, whose parents/guardians reported receipt of rehabilitation within a 12-month follow-up period, from a multinational observational study. Children discharged to an inpatient rehabilitation or skilled nursing facility after acute care were classified into the "inpatient rehabilitation" group, and children discharged home after acute care were classified into the "non-inpatient rehabilitation" group. Multivariable regression analyses determined the associations of sociodemographic and clinical characteristics with rehabilitation groups. Children receiving inpatient rehabilitation had a shorter length of acute hospitalization. Children from the UK were less likely to receive inpatient rehabilitation compared to children from the US. Future studies are warranted to extend current findings by identifying the reasons behind differential access to inpatient rehabilitation among children with severe TBI. [ABSTRACT FROM AUTHOR]

Pandemics threaten world stability; however, spread is mitigated with prevention behaviors. We introduce "personally relevant knowledge" to explain the knowledge–behavior gap (i.e., objective and subjective knowledge on information acquisition and behavioral change). Hypotheses are derived from prior knowledge literature, economic psychology, and relevance theory. Multimethod analysis (survey data, partial least squares structural equation path modeling [PLS-SEM], and an asymmetric information theoretic statistical analysis) is applied to H1N1 data from the USA and Australia. Personally relevant knowledge is an important addition to prior knowledge conceptualizations, and information theory uncovers asymmetric variable relationships concerning the knowledge–behavior gap, not captured by PLS-SEM. [ABSTRACT FROM AUTHOR]

In this paper we explore whether the recent rise in food bank usage in the UK has been induced by the roll-out of Universal Credit. We bring together official statistics on the introduction of Universal Credit with data on food bank usage from the UK's largest food bank network. We test the relationship between Universal Credit and food parcel distribution using a range of causal identification strategies (such as fixed-effects model, Granger causality tests, and matching designs) and consistently find that an increase in the prevalence of Universal Credit is associated with more food parcel distribution. We also find that the relationship between Universal Credit and food parcel distribution is stronger in areas where food banks are active, suggesting food insecurity arising from Universal Credit may be hidden in places where food banks are largely unavailable. Though it is challenging to implement any large-scale change to social security, our analysis suggests systemic and persistent problems with this new system. Whilst the logic of Universal Credit is intuitively appealing, it has also proven to be unforgiving, leaving many struggling to make ends meet. [ABSTRACT FROM AUTHOR]

Background: Facebook is a frequently used social media platform and is often used for human health information, yet little research has been conducted on how pet owners use Facebook pet groups to obtain and share pet health information. Method: This study was designed to assess how pet owners use dog and cat Facebook groups to provide and receive pet health advice and their perception of these groups' trustworthiness. Two comparable questionnaires (dog and cat owners) were developed and distributed through an online survey platform. Results: Results suggest that Facebook groups are a common source of pet health information, with 56.2% of dog owners and 51.8% of cat owners reporting receiving health information through Facebook groups. Similar numbers report giving health information through Facebook groups: 55.0% of dog owners and 57.9% of cat owners. Dog health information most commonly exchanged related to dermatology, gastroenterology and orthopaedics and the most common cat health information focused on gastroenterology, renal and urinary‐related issues. While the majority of Facebook users report feeling that Facebook groups are not a trustworthy source of pet health information, a substantial minority of users do appear to be influenced by these groups. Conclusion: Approximately 50% of cat and dog owning respondents either give or receive pet health advice through Facebook groups. These results suggest that many owners deem Facebook groups as useful, but not entirely trustworthy, sources of information. [ABSTRACT FROM AUTHOR]

This study evaluated the effect of game venue and starting status on precompetitive psychophysiological measures in elite rugby union. Saliva samples were taken from players (starting XV, n = 15, and nonstarters, n = 9) on a control day and 90 min before 4 games played consecutively at home and away venues against local rivals and league leaders. Precompetition psychological states were assessed using the Competitive State Anxiety Inventory-2. The squad recorded 2 wins (home) and 2 losses (away) over the study period. Calculated effect sizes (ESs) showed higher pregame cortisol- (C) and testosterone- (T) difference values before all games than on a baseline control day (ES 0.7-1.5). Similar findings were observed for cognitive and somatic anxiety. Small between-venues C differences were observed in starting XV players (ES 0.2-0.25). Conversely, lower home T- (ES 0.95) and higher away C- (ES 0.6) difference values were observed in nonstarters. Lower T-difference values were apparent in nonstarters (vs starting XV) before home games, providing evidence of a between-groups effect (ES 0.92). Findings show an anticipatory rise in psychophysiological variables before competition. Knowledge of starting status appears a moderating factor in the magnitude of player endocrine response between home and away games. [ABSTRACT FROM AUTHOR]

Context: Existing theoretical frameworks and empirical research support the applicability and usefulness of integrating mental skills throughout sport injury rehabilitation. Objective: To determine what, if any, mental skills athletes use during injury rehabilitation, and by who these skills were taught. Cross-cultural differences were also examined. Design: Cross-sectional design. Setting: College athletes from 5 universities in the United States and a mixture of collegiate, professional, and recreational club athletes from the United Kingdom and Finland were recruited for this study. Participants: A total of 1283 athletes from the United States, United Kingdom, and Finland, who participated in diverse sports at varying competitive levels took part in this study. Main Outcome Measures: As part of a larger study on athletes' expectations of injury rehabilitation, participants were asked a series of open-ended and closed-ended questions concerning their use of mental skills during injury rehabilitation. Results: Over half (64.0%) of the sample reported previous experience with athletic training, while 27.0% indicated that they used mental skills during injury rehabilitation. The top 3 mental skills reported were goal setting, positive self-talk/positive thoughts, and imagery. Of those athletes that used mental skills, 71.6% indicated that they felt mental skills helped them to rehabilitate faster. A greater proportion of athletes from the United States (33.4%) reported that they used mental skills during rehabilitation compared with athletes from the United Kingdom (23.4%) and Finland (20.3%). A small portion (27.6%) of the participants indicated that their sports medicine professional had taught them how to use mental skills; only 3% were taught mental skills by a sport psychologist. Conclusions: The low number of athletes who reported using mental skills during rehabilitation is discouraging, but not surprising given research findings that mental skills are underutilized by injured athletes in the 3 countries examined. More effort should be focused on educating and training athletes, coaches, and sports medicine professionals on the effectiveness of mental training in the injury rehabilitation context. [ABSTRACT FROM AUTHOR]

We report findings of a mixed-method evaluation of Local Area Coordination (LAC) in one English Local Authority—an approach that draws on principles of earlier intervention, and place-, asset- and strengths-based activity. We drew on documentary materials, unstructured observation and qualitative interviews. In total, fifty-five qualitative interviews were conducted with professional stakeholders (including Coordinators, statutory agencies and community organisations), and a purposive sample of individuals supported by LAC. Positively, LAC is operating as intended. It is a flexible and agile approach, and one that is less constrained by the expectations and methods associated with traditional service delivery. Reported impacts include: tackling isolation and loneliness; building a positive vision of the future; identifying non-service solutions and being heard. We discuss the ongoing conceptual and methodological challenges to building the LAC evidence base, fostering professional support and understanding, and managing expectations of individuals and communities in furthering development. Resolving these would allow LAC to move beyond being a promising, local and small-scale transformative development for individuals and families. Its future trajectory is enmeshed in the implications of COVID-19 for individuals, families and communities: rising poverty and widening inequality, a fragile Third Sector, and concerns about community fatigue and erosion of trust. [ABSTRACT FROM AUTHOR]