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Background During the pandemic, countries utilized various forms of statistical estimations of coronavirus disease-2019 (COVID-19) impact. Differences between databases make direct comparisons and interpretations of data in different countries a challenge. We evaluated country-specific approaches to COVID-19 data and recommended changes that would improve future international collaborations. Methods We compared the COVID-19 reports presented on official UK (National Health System), Israeli (Department of Health), Latvian (Center for Disease Prevention and Control) and USA (Centers for Disease Control and Prevention) health authorities' websites. Results Our analysis demonstrated critical differences in the ways COVID-19 statistics were made available to the general and scientific communities. Specifically, the differences in approaches were found in the presentation of the number of infected cases and tests, and percentage of positive cases, the number of severe cases, the number of vaccinated, and the number and percent of deaths. Conclusion Findability, Accessibility, Interoperability and Reusability principles could guide the development of essential global standards that provide a basis for communication within and outside of the scientific community. [ABSTRACT FROM AUTHOR]

Motivation Summary statistics from genome-wide association studies enable many valuable downstream analyses that are more efficient than individual-level data analysis while also reducing privacy concerns. As growing sample sizes enable better-powered analysis of gene–environment interactions, there is a need for gene–environment interaction-specific methods that manipulate and use summary statistics. Results We introduce two tools to facilitate such analysis, with a focus on statistical models containing multiple gene–exposure and/or gene–covariate interaction terms. REGEM (RE-analysis of GEM summary statistics) uses summary statistics from a single, multi-exposure genome-wide interaction study to derive analogous sets of summary statistics with arbitrary sets of exposures and interaction covariate adjustments. METAGEM (META-analysis of GEM summary statistics) extends current fixed-effects meta-analysis models to incorporate multiple exposures from multiple studies. We demonstrate the value and efficiency of these tools by exploring alternative methods of accounting for ancestry-related population stratification in genome-wide interaction study in the UK Biobank as well as by conducting a multi-exposure genome-wide interaction study meta-analysis in cohorts from the diabetes-focused ProDiGY consortium. These programs help to maximize the value of summary statistics from diverse and complex gene–environment interaction studies. Availability and implementation REGEM and METAGEM are open-source projects freely available at https://github.com/large-scale-gxe-methods/REGEM and https://github.com/large-scale-gxe-methods/METAGEM. [ABSTRACT FROM AUTHOR]

Good social work benefits the recipients of the social worker role, social workers themselves, their employing organisations and society more broadly. However, it is difficult to conduct consistently good social work when social workers have been shown to have chronically poor working conditions. This article, therefore, outlines UK social worker working conditions and well-being from 2022, as well as comparing these results to surveys conducted in 2017 and 2018. We, therefore, report a series of cross-sectional surveys, in addition to open-ended questions, to collect data from 533 respondents in 2022, and compare these to findings from similar surveys in previous years. Results demonstrate that working conditions improved slightly between 2018 and 2022, although these conditions are still very poor compared with other occupations. Qualitative analyses suggest that work-load, resources, lack of respect and lack of consistent and good quality reflective supervision are significant issues for respondents. As such, we argue that policy makers and employers need to provide greater support for social worker working conditions and well-being, and that this support would likely negate current high levels of turnover and sickness absence. Additionally, however, for the first time in these surveys, poor pay also emerged as an issue needing attention. [ABSTRACT FROM AUTHOR]

With roots as a public health campaign in the United Kingdom, "Dry January" is a temporary alcohol abstinence initiative encouraging participants to abstain from alcohol use during the month of January. Dry January has become a cultural phenomenon, gaining increasing news media attention and social media engagement. Given the utility of capturing naturalistic discussions around health topics on social media, we examined Twitter chatter about Dry January and associated temporary abstinence experiences. Public tweets were collected containing the search terms "dry january" or "dryjanuary" posted between 15 December and 15 February across 3 years (2020–2). A random subsample stratified by year (n  = 3145) was pulled for manual content analysis by trained coders. Final codebook accounted for user sentiment toward Dry January, user account type, and themes related to Dry January participation. Engagement metadata (e.g. likes) were also collected. Though user sentiment was mixed, most tweets expressed positive or neutral sentiment toward Dry January (74.7%). Common themes included encouragement and support for Dry January participation (14.1%), experimentation with and promotion of nonalcoholic drinks (14.0%), and benefits derived from Dry January participation (10.4%). While there is promise in the movement to promote positive alcohol-related behavior change, increased efforts to deliver the campaign within a public health context are needed. Health communication campaigns designed to inform participants about evidence-based treatment and recovery support services proven to help people quit or cut down on their drinking are likely to maximize benefits. [ABSTRACT FROM AUTHOR]

Background Being breastfed is associated with lower cardiovascular risk factors but, to date, no studies have demonstrated a protective effect on cardiovascular disease (CVD). This study aims to address the limitations of previous studies, specifically insufficient statistical power and residual confounding, to determine if such association exists. Methods This is a population-based retrospective cohort study of 320 249 men and women aged 40–69 years. Breastfeeding status was self-reported. CVD and myocardial infarction (MI) events and deaths based via linkage to hospitalization and death records. Results Overall, 28 469 (8.4%) participants experienced a CVD event and 5174 (1.6%) experienced an MI. Following adjustment for sociodemographic, lifestyle and early life confounders, breastfeeding was associated with a reduced risk of CVD events (HR 0.97, 95% CI 0.94–1.00, P  = 0.041), CVD deaths (HR 0.91, 95% CI 0.84–0.98, P  = 0.017), MI events (HR 0.93, 95% CI 0.87–0.99, P  = 0.033) and MI deaths (HR 0.81, 95% CI 0.67–0.98, P  = 0.026). Conclusions Child health benefits of breastfeeding are well established. However, the benefits of breastfeeding may extend into later life reinforcing the need to encourage and support breastfeeding. [ABSTRACT FROM AUTHOR]

Prior to the COVID-19 pandemic, social work and social care practitioners had some the worst working conditions of any sector in the UK. During the pandemic, data revealed that social care occupations had higher COVID infection and mortality rates than the general population. The article reports the changing working conditions (measured via the Work-Related Quality of Life scale) and well-being (measured via the Short Warwich–Edinburgh Mental Well-being Scale) of UK social care and social workers across three timepoints between May 2020 and July 2021 through an online cross-sectional survey of working conditions and well-being. Analysis of variance demonstrated that both well-being and working conditions were significantly poorer in July 2021 (phase 3 [ n  = 1,606]) than the previous two phases (n  = 2,523 and n  = 2,424, respectively), suggesting that both working conditions and well-being worsened within the social care and social work workforce across the pandemic. Furthermore, each of career satisfaction, working conditions, control, general well-being and home–work interface predicted poorer well-being at Time 3. Whilst chronically poor working conditions can lead to poorer individual psychological and physiological health outcomes, our findings highlight continually poor conditions in this sector, with potential further impacts on organisations and the service users that social care workers support. It is therefore important that individuals, organisations and government develop mechanisms to support these critical workers during and following the pandemic. [ABSTRACT FROM AUTHOR]

Background This study aimed to understand the extent of household food insecurity amongst undocumented migrant families in Birmingham,UK. Methods Cross-sectional survey of households (n  = 74) with dependent children using the USDA 18-item household food security (HFS) module. All households had an irregular immigration status and were accessing an immigration advice drop-in service (n  = 98 adults; n  = 138 children) in Birmingham. Results About 95.9% of households were food insecure, and 94.6% of children lived in households with low or very low food security. Food insecurity varied within households. Around 91.8% of adults were food insecure, compared to 75.6% of children. Spearman's rank-order correlation indicated a statistically significant positive correlation between household food insecurity level and number of children (rho = 0.253, P  = 0.031). A Kruskal–Wallis H Test indicated no statistically significant difference (P  = 0.730) in HFS score between households supported by asylum support, children's social services or paid employment in the informal economy and those that had no regular income. Conclusions Prevalence of HFS was higher in this sample of undocumented migrant households with dependent children in Birmingham, UK, than in the wider population, and larger households were more food insecure. Households without a regular income were no more likely to be food insecure than households with financial support. [ABSTRACT FROM AUTHOR]

Background and Hypothesis It is argued that availability of diagnostic models will facilitate a more rapid identification of individuals who are at a higher risk of first episode psychosis (FEP). Therefore, we developed, evaluated, and validated a diagnostic risk estimation model to classify individual with FEP and controls across six countries. Study Design We used data from a large multi-center study encompassing 2627 phenotypically well-defined participants (aged 18–64 years) recruited from six countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions study. To build the diagnostic model and identify which of important factors for estimating an individual risk of FEP, we applied a binary logistic model with regularization by the least absolute shrinkage and selection operator. The model was validated employing the internal-external cross-validation approach. The model performance was assessed with the area under the receiver operating characteristic curve (AUROC), calibration, sensitivity, and specificity. Study Results Having included preselected 22 predictor variables, the model was able to discriminate adults with FEP and controls with high accuracy across all six countries (rangesAUROC = 0.84–0.86). Specificity (range = 73.9–78.0%) and sensitivity (range = 75.6–79.3%) were equally good, cumulatively indicating an excellent model accuracy; though, calibration slope for the diagnostic model showed a presence of some overfitting when applied specifically to participants from France, the UK, and The Netherlands. Conclusions The new FEP model achieved a good discrimination and good calibration across six countries with different ethnic contributions supporting its robustness and good generalizability. [ABSTRACT FROM AUTHOR]

Background Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental well-being after a motivational interviewing (MI) community-based PA intervention and the impact of signposting (SP) and social action (SA) (i.e. weekly group support) pathways. Methods Participants (n  = 2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental well-being data were collected at baseline (following an initial 30-min MI appointment), 12 weeks, 6 months and 12 months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models derived point estimates and 95% confidence intervals for outcomes at each time point and change scores. Results Participants increased PA and mental well-being at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12 weeks, but the SP pathway retained more participants at 6 and 12 months. Conclusions Both pathways produced similar improvements in PA and mental well-being; however, the addition of a control would have provided further insight as to the effectiveness. Due to lower resources yet similar effects, the SP pathway could be incorporated to support PA in primary care settings. [ABSTRACT FROM AUTHOR]

Background Unintentional carbon monoxide (CO) poisoning poses a public health challenge. The UK National Poisons Information Service (NPIS) provides advice to healthcare professionals via the online database, TOXBASE®, and a 24-hour telephone line. Our aim was to analyse all CO-related enquiries to the NPIS. Methods We analysed enquiries regarding unintentional CO exposure (1st July 2015-30th June 2019). Information on patient demographics, CO source and location, clinical features and poisoning severity was collected from telephone enquiries and TOXBASE accesses. Results 2970 unintentional non-fire-related CO exposures were reported. Exposures occurred commonly in the home (60%) with faulty boilers frequently implicated (27.4%). Although five fatalities were reported, 68.7% of patients experienced no or minor symptoms only (headache most frequently reported). Despite being the gold standard measurement, blood carboxyhaemoglobin concentration was only recorded in 25.6% patients, with no statistically significant correlation with severity. Conclusions Unintentional CO exposures in the UK commonly occur in domestic settings and although are generally of low severity, fatalities continue to occur. Carboxyhaemoglobin measurement is important to confirm exposure but further work is required to assess its validity as a prognostic indicator in CO exposure. Public health policy should continue to focus on raising awareness of the dangers of CO. [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]

Motivation It has become routine in neuroscience studies to measure brain networks for different individuals using neuroimaging. These networks are typically expressed as adjacency matrices, with each cell containing a summary of connectivity between a pair of brain regions. There is an emerging statistical literature describing methods for the analysis of such multi-network data in which nodes are common across networks but the edges vary. However, there has been essentially no consideration of the important problem of outlier detection. In particular, for certain subjects, the neuroimaging data are so poor quality that the network cannot be reliably reconstructed. For such subjects, the resulting adjacency matrix may be mostly zero or exhibit a bizarre pattern not consistent with a functioning brain. These outlying networks may serve as influential points, contaminating subsequent statistical analyses. We propose a simple Outlier DetectIon for Networks (ODIN) method relying on an influence measure under a hierarchical generalized linear model for the adjacency matrices. An efficient computational algorithm is described, and ODIN is illustrated through simulations and an application to data from the UK Biobank. Results ODIN was successful in identifying moderate to extreme outliers. Removing such outliers can significantly change inferences in downstream applications. Availability and implementation ODIN has been implemented in both Python and R and these implementations along with other code are publicly available at github.com/pritamdey/ODIN-python and github.com/pritamdey/ODIN-r, respectively. Supplementary information Supplementary data are available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

During their social work education, students engage in a number of stressful learning activities, often simultaneously, which can negatively impact their well-being, mental health and social work practice. Mindfulness practices are beginning to be integrated into social work curricula globally to enhance student self-care along with key social work practice skills and values. This mixed methods study examined the effects of a bespoke six-week online mindfulness-based social work and self-care (MBSWSC) programme on the stress, burnout, well-being, anxiety and depression levels of thirty social work students from two universities in the UK. This study also examined the effects of MBSWSC on a number of mindfulness-based mediators of change in these outcomes. Participant perceptions of the benefits of the MBSWSC programme on their well-being and social work practice are further explored via a thematic analysis of an open-ended questionnaire. Statistically significant changes in all variables were found post-programme except for depression and loss of empathy/depersonalisation, a facet of burnout. The qualitative data provided a deeper insight into the potential benefits of the programme for the enhancement of student well-being, mental health and anti-oppressive social work practice (AOP). [ABSTRACT FROM AUTHOR]

The British Heart Foundation's (BHF) annual statistical compendium is a comprehensive source of accessible epidemiological data in relation to cardiovascular disease (CVD) in the UK. Using datasets with multiple years of data from the compendium we have analysed trends in mortality, morbidity, and treatment for CVD within the UK. CVD mortality in the UK has consistently declined over recent decades, from 1045 deaths per 100 000 in 1969, shortly after the BHF was founded, to 255 per 100 000 in 2019. Despite this remarkable improvement, inequalities in CVD mortality persist in the UK nations, for example in 2019 the death rate in Scotland was 326 deaths per 100 000 compared with 246 per 100 000 in England. Improvements in CVD mortality have been paralleled by increased use of primary prevention medications (anti-hypertensives and statins) and interventional procedures. In recent years, progress in mortality outcomes has stalled, probably due to a combination of factors including a rise in risk factors such as obesity and diabetes. In terms of morbidity, CVD remains a significant burden in the UK, accounting for at least 1.18 million hospital admissions and reflects the enormous economic burden of CVD, estimated at £19bn in the UK. Our results highlight the importance of accessible and comprehensive statistics in relation to the burden of CVD and the value of the BHF's annual compendium in drawing out conclusions and opportunities for future research. One key area is to improve the data on which estimation of prevalence is based. There is also a need for ongoing work to better understand the root causes of disparity between socio-economic groups in relation to CVD. One important way to address this will be to improve the consistency of reporting of CVD health data across all nations of the UK. Understanding the causes will inform UK healthcare planning in addition to providing analytical insights that will be applicable in other countries. [ABSTRACT FROM AUTHOR]

Information and Communication Technologies (ICTs) permeated social work practice before coronavirus disease 2019 (COVID-19). In addition to ICT-based formal services (e.g. e-counselling), social workers used ICTs informally as an adjunct to face-to-face practice. Building on our previous research, our cross-sectional online survey examined social workers' informal use of ICTs in four countries: Canada, the USA, Israel and the UK. The survey was administered through Qualtrics software among social workers across Canada (n  = 2,609), the USA (n  = 1,225), Israel (n  = 386) and the UK (n  = 134), and analysed using IBM SPSS Statistics version 26. The findings substantiate the ubiquitous use of informal ICTs in social work practice, as an adjunct to face-to-face treatment, across the four countries. Given the current, unprecedented context of COVID-19, we discuss the meaning of our findings related to access, ethical considerations (e.g. professional boundaries) and supervision in the context of restricted face-to-face practice. We discuss the implications for social work practice, education and research, and conclude that in the COVID-19 context, there is an even greater need for research, clinical discussion, supervision and policy on informal ICT use in social work practice. [ABSTRACT FROM AUTHOR]

Home visitors can support parents who have low levels of emotional well-being. While support may be effective for some families, the circumstances in which it is effective are less well understood. Longitudinal administrative data from Home-Start UK were analysed to identify how the nature of support was related to changes in parental emotional well-being, and whether these effects were the same for families with different risk factors. Sub-groups were identified of people experiencing problems with various aspects of emotional well-being: mental ill health (n  = 1,289), social isolation (n  = 1,413) and low self-esteem (n  = 1,400). Multiple linear regression models were used to explore the relationships between the nature of support and the rate of improvement. These effects were considered in subgroups of families with domestic violence problems, disabled parents, a disabled child, large family sizes or multiple risks. More frequent visits and support being provided by paid workers, as opposed to volunteers were related to faster improvements. Paid worker support was particularly related to faster improvements in families with domestic abuse, disabled parents and multiple risks. However, volunteer support seemed just as effective for large families and those with disabled children. These findings have implications for those providing and commissioning home visiting services. [ABSTRACT FROM AUTHOR]

Objectives X-Linked hypophosphataemic rickets (XLH) is a rare multi-systemic disease of mineral homeostasis that has a prominent skeletal phenotype. The aim of this study was to describe additional comorbidities in XLH patients compared with general population controls. Methods The Clinical Practice Research Datalink (CPRD) GOLD was used to identify a cohort of XLH patients (1995–2016), along with a non-XLH cohort matched (1 : 4) on age, sex and GP practice. Using the CALIBER portal, phenotyping algorithms were used to identify the first diagnosis (and associated age) of 273 comorbid conditions during patient follow-up. Fifteen major disease categories were used and the proportion of patients having ≥1 diagnosis was compared between cohorts for each category and condition. Main analyses were repeated according to the Index of Multiple Deprivation (IMD). Results There were 64 and 256 patients in the XLH and non-XLH cohorts, respectively. There was increased prevalence of endocrine [OR 3.46 (95% CI: 1.44, 8.31)] and neurological [OR 3.01 (95% CI: 1.41, 6.44)] disorders among XLH patients. Across all specific comorbidities, four were at least twice as likely to be present in XLH cases, but only depression met the Bonferroni threshold: OR 2.95 (95% CI: 1.47, 5.92). Distribution of IMD among XLH cases indicated greater deprivation than the general population. Conclusion We describe a higher risk of mental illness in XLH patients compared with matched controls, and greater than expected deprivation. These findings may have implications for clinical practice guidelines and decisions around health and social care provision for these patients. [ABSTRACT FROM AUTHOR]

Higher levels of 'service user' satisfaction are associated with more positive outcomes in many service settings. They are also an important measure of service quality in their own right. In this article, we report the results from a survey of 500 parents in relation to statutory child and family social work services in the UK. Our primary outcome measure was the Client Satisfaction Questionnaire, a valid instrument that has been used in a range of settings and types of service. Parents overall had relatively low levels of satisfaction, compared with research in other settings. Levels of dissatisfaction were higher for parents from lower socio-economic groups and parents of adolescents. The small number of parents in our survey who received short-breaks or residential care for their children gave higher satisfaction ratings. An important limitation of these results is that the sample is not representative. Parents from higher socio-economic groups were over-represented compared with the general population and were therefore very overrepresented compared with the population of families who receive a statutory social work service. These findings nevertheless suggest that parents are likely to be dissatisfied with the services they received and suggest a pressing need for more representative data to understand the experiences of parents across the UK. [ABSTRACT FROM AUTHOR]

The benefits of physical activity in school settings and its impact on health and academic outcomes are of interest from public health and educational contexts. This study investigates how physically active learning (PAL): (i) contributes to children's physical activity levels, (ii) impacts on academic outcomes and (iii) influences children's focus and concentration, defined as time on task (ToT). Methods : Over a 2-week period, participants were exposed to PAL and non-active learning (NAL) lessons in a counterbalanced design. Physiological responses and ToT behaviour were recorded throughout PAL and NAL lessons. Academic outcomes were assessed the week before, during and the week after each mode of delivery. Results : Children were more active during PAL (196 542 steps per week) compared to NAL (152 395 steps per week, P  = 0.003). The physiological demands of PAL (73% HRmax), were significantly greater (P  < 0.001) than NAL (51% HRmax). Children's ToT was significantly higher (P  < 0.001) with PAL (97%) than NAL (87%). There were no differences in academic outcomes when PAL and NAL were compared. Conclusions : Modest levels of PAL increased activity levels. No evidence was found to suggest PAL had a negative effect on children's academic outcomes, and PAL could positively impact on children's concentration. [ABSTRACT FROM AUTHOR]

Summary: A modern system of Revenue Administration requires an effective and efficient management of compliance which in turn requires a well‐designed taxpayers audit strategy. The selection of taxpayers to be audited by Revenue Authorities is a non‐standard sample size determination problem, involving an initial random sample from the population and, based on the statistical information derived from it, a risk‐based auditing scheme whose sole objective is to select for auditing the taxpayers with the highest estimated risk in the population. This paper provides a methodological approach that estimates the initial optimal random sample size such that the Revenue Administration Authority maximises their expected tax revenues. The methodology is illustrated using administrative data from the UK's Revenue Authority, Her Majesty's Revenue and Customs (HMRC). [ABSTRACT FROM AUTHOR]

Objectives To assess the baseline care provided to patients with SLE attending UK Rheumatology units, audited against standards derived from the recently published BSR guideline for the management of adults with SLE, the NICE technology appraisal for belimumab, and NHS England's clinical commissioning policy for rituximab. Methods SLE cases attending outpatient clinics during any 4-week period between February and June 2018 were retrospectively audited to assess care at the preceding visit. The effect of clinical environment (general vs dedicated CTD/vasculitis clinic and specialized vs non-specialized centre) were tested. Bonferroni's correction was applied to the significance level. Results Fifty-one units participated. We audited 1021 episodes of care in 1003 patients (median age 48 years, 74% diagnosed >5 years ago). Despite this disease duration, 286 (28.5%) patients had active disease. Overall in 497 (49%) clinic visits, it was recorded that the patient was receiving prednisolone, including in 28.5% of visits where disease was assessed as inactive. Low documented compliance (<60% clinic visits) was identified for audit standards relating to formal disease-activity assessment, reduction of drug-related toxicity and protection against comorbidities and damage. Compared with general clinics, dedicated clinics had higher compliance with standards for appropriate urine protein quantification (85.1% vs 78.1%, P  ≤ 0.001). Specialized centres had higher compliance with BILAG Biologics Register recruitment (89.4% vs 44.4%, P  ≤ 0.001) and blood pressure recording (95.3% vs 84.1%). Conclusions This audit highlights significant unmet need for better disease control and reduction in corticosteroid toxicity and is an opportunity to improve compliance with national guidelines. Higher performance with nephritis screening in dedicated clinics supports wider adoption of this service-delivery model. [ABSTRACT FROM AUTHOR]

Dynamic prediction models provide predicted survival probabilities that can be updated over time for an individual as new measurements become available. Two techniques for dynamic survival prediction with longitudinal data dominate the statistical literature: joint modelling and landmarking. There is substantial interest in the use of machine learning methods for prediction; however, their use in the context of dynamic survival prediction has been limited. We show how landmarking can be combined with a machine learning ensemble—the Super Learner. The ensemble combines predictions from different machine learning and statistical algorithms with the goal of achieving improved performance. The proposed approach exploits discrete time survival analysis techniques to enable the use of machine learning algorithms for binary outcomes. We discuss practical and statistical considerations involved in implementing the ensemble. The methods are illustrated and compared using longitudinal data from the UK Cystic Fibrosis Registry. Standard landmarking and the landmark Super Learner approach resulted in similar cross‐validated predictive performance, in this case, outperforming joint modelling. [ABSTRACT FROM AUTHOR]

Background To guide decision-making about driving ability, some patients with Parkinson's disease (PD) undergo specialist driving assessment. However, decisions about driving safety in most patients need to be made without this definitive test. There is no consensus on what predicts unsafe driving in PD nor a validated prediction tool to guide clinician decision-making and the need to refer for further assessment. Objectives To describe the characteristics of patients with PD assessed at a Driving Mobility Centre and investigate factors that predict driving assessment outcome. Methods Retrospective cohort study of patients with PD assessed between 2012 and 2016. Descriptive analyses and logistic models to determine factors predicting a negative outcome. Results There were 86 assessments of patients with PD. The mean age was 70 years (±9.2), 86% were male, median disease duration 7 years (interquartile range 5–12.5 years) and 59% were referred by the Driver and Vehicle Licensing Agency. In total, 62% had a negative 'not drive' outcome. The Rookwood Driving Battery (RDB), depth of vision deficit, usual driving frequency, age, duration license held and response time were all predictors in univariable analysis. The RDB was the best predictor of assessment failure, conditional on other variables in a backward stepwise model (odds ratio 1.29; 95% confidence interval 1.05, 1.60; P  = 0.015). Conclusions This is the first study to describe patients with PD undergoing driving assessments in the UK. In this population, RDB performance was the best predictor of outcome. Future prospective studies are required to better determine predictors of driving ability to guide development of prediction tools for implementation into clinical practice. [ABSTRACT FROM AUTHOR]

Background We examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors. Methods We studied 4510 UK Biobank participants tested for COVID-19 (positive, n  = 1326). Multivariate logistic regression models including age, sex and ethnicity were used to test whether addition of (1) cardiometabolic factors [diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking and body mass index (BMI)]; (2) 25(OH)-vitamin D; (3) poor diet; (4) Townsend deprivation score; (5) housing (home type, overcrowding) or (6) behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status. Results There was over-representation of men and BAME ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations. Conclusions In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors. Factors which underlie ethnic differences in COVID-19 may not be easily captured, and so investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised. [ABSTRACT FROM AUTHOR]

Education programmes in mental health literacy can address stigma and misunderstanding of mental health. This study investigated self-rated differences in knowledge, attitudes and confidence around mental health issues following participation in a bespoke Mental Health First Aid (MHFA) training course for the Armed Forces. The mixed methods approach comprised quantitative surveys and qualitative interviews. A survey, administered immediately post-training (n = 602) and again at 10-months post-attendance (n = 120), asked participants to rate their knowledge, attitudes and confidence around mental health issues pre- and post-training. Quantitative findings revealed a significant increase in knowledge, positive attitudes and confidence from the post-training survey which was sustained at 10-months follow-up.Semi-structured telephone interviews (n = 13) were conducted at follow-up, 6-months post-attendance. Qualitative findings revealed that participation facilitated an 'ambassador' type role for participants. This study is the first to have investigated the effect of MHFA in an Armed Forces community. Findings show participants perceived the training to increase knowledge regarding mental health and to enhance confidence and aptitude for identifying and supporting people with mental health problems. Results suggest that such an intervention can provide support for personnel, veterans and their families, regarding mental health in Armed Forces communities. [ABSTRACT FROM AUTHOR]

Background There is insufficient evidence of sitting time in UK children from validated objective measures. This study explored sitting patterns in primary school children from Bradford, UK, using the validated activPAL inclinometer. Methods Overall, 79 children (9.8 (SD 0.3) years old, 52% boys; 70% South Asian) wore activPALs for 7 days. Total sitting time, sitting time accumulated in different bout lengths, and the proportion of wear time spent in these variables were explored and compared across different periods of the week. Results Children spent 614 ± 112 (median ± IQR) min/day on school days and 690 ± 150 min/day on weekend days sitting. The proportion of time spent sitting was significantly higher on weekend days compared to school days (mean±SD: 74 ± 10% versus 68 ± 8%, P < 0.001), as was the proportion of time accumulated in >30 min sitting bouts (mean±CI: 28 ± 27–33% versus 20 ± 20–22%, P < 0.001). The proportion of time spent sitting after school was significantly higher than during school time (mean±SD: 70 ± 8.4% versus 63 ± 8.3%, P < 0.001), as was the proportion of time spent in prolonged (>30 min) sitting bouts (mean±CI: 19 ± 16–22% versus 11 ± 10–14%, P < 0.001). Conclusions Children spent large proportions of their waking day sitting, often accumulated in prolonged uninterrupted bouts and particularly after school and on weekends. Interventions to reduce sitting time in children are urgently needed. [ABSTRACT FROM AUTHOR]

Background Driving is a common type of sedentary behaviour; an independent risk factor for poor health. The study explores whether driving is also associated with other unhealthy lifestyle factors. Methods In a cross-sectional study of UK Biobank participants, driving time was treated as an ordinal variable and other lifestyle factors dichotomized into low/high risk based on guidelines. The associations were explored using chi-square tests for trend and binary logistic regression. Results Of the 386 493 participants who drove, 153 717 (39.8%) drove <1 h/day; 140 140 (36.3%) 1 h/day; 60 973 (15.8%) 2 h/day; and 31 663 (8.2%) ≥3 h/day. Following adjustment for potential confounders, driving ≥3 h/day was associated with being overweight/obese (OR = 1.74, 95% CI: 1.64–1.85), smoking (OR = 1.48, 95% CI: 1.37–1.63), insufficient sleep (1.70, 95% CI: 1.61–1.80), low fruit/vegetable intake (OR = 1.26, 95% CI: 1.18–1.35) and low physical activity (OR = 1.05, 95% CI: 1.00–1.11), with dose relationships for the first three, but was not associated with higher alcohol consumption (OR = 0.94, 95% CI: 0.87–1.02). Conclusions Sedentary behaviour, such as driving, is known to have an independent association with adverse health outcomes. It may have additional impact mediated through its effect on other aspects of lifestyle. People with long driving times are at higher risk and might benefit from targeted interventions. [ABSTRACT FROM AUTHOR]

Objectives This analysis aims to calculate MTX monotherapy persistence and describe the occurrence of and factors associated with the occurrence of adverse drug reactions (ADRs) with MTX. Methods Patients with JIA starting MTX monotherapy from two UK studies were included. Patient characteristics, treatment details and ADR occurrence were collected at treatment start, 6 months, 1 year and annually. The following groups of ADRs were included: gastrointestinal, elevated liver enzymes, leukopenia, drug hypersensitivity, rash, needle phobia and any events leading to permanent MTX discontinuation. Treatment exposure was calculated from MTX start until MTX monotherapy cessation, last follow-up or 31 December 2017 (cut-off), whichever came first. Survival analysis assessed the time on MTX monotherapy and the time to the first ADR on MTX monotherapy within 2 years. Multivariable logistic regression assessed characteristics associated with any ADR and gastrointestinal ADRs. Results A total of 577 patients started MTX. At 2 years, 310 (54%) were no longer on MTX monotherapy. Reasons included ineffectiveness (60%; 161/185 started a biologic), adverse event (25%), remission (8%) and patient/family decision (3%). Over this time, 212 (37%) patients experienced one or more ADR; commonly gastrointestinal (68%) or elevated liver enzymes (26%). Lower physician global assessment and older age predicted any ADR and gastrointestinal ADR, respectively. Patients with polyarticular RF and JIA had reduced odds of both any ADR and a gastrointestinal ADR. Conclusion After 2 years, more than half the patients were no longer on MTX monotherapy, while more than one-third experienced one or more ADR, most commonly gastrointestinal. Research focusing on identifying which children will respond and/or experience ADRs is crucial to inform treatment decisions and management planning. [ABSTRACT FROM AUTHOR]

Background Infection with nontuberculous mycobacteria (NTM) is of growing clinical concern in people with cystic fibrosis (CF). The epidemiology of infection in children and young people remains poorly understood. Our goal was to investigate the epidemiology of NTM infection in the pediatric age group using data from the UK CF Registry. Methods Data from 2010–2015 for individuals aged <16 years (23200 observations from 5333 unique individuals) were obtained. Univariate analysis of unique individuals comparing all key clinical factors and health outcomes to NTM status was performed. The significant factors that were identified were used to generate a multivariate logistic regression model that, following step-wise removal, generated a final parsimonious model. Results The prevalence of individuals with a NTM-positive respiratory culture increased every year from 2010 (45 [1.3%]) to 2015 (156 [3.8%]). Allergic bronchopulmonary aspergillosis (odds ratio [OR], 2.66; P = 5.0 × 10−8), age (OR, 1.08; P = 3.4 × 10−10), and intermittent Pseudomonas aeruginosa infection (OR, 1.51; P =.004) were significantly associated with NTM infection. Conclusions NTM infection is of increasing prevalence in the UK pediatric CF population. This study highlights the urgent need for work to establish effective treatment and prevention strategies for NTM infection in young people with CF. [ABSTRACT FROM AUTHOR]

Background the electronic frailty index (eFI) has been developed and validated using routine primary care electronic health record data. The focus of the original big data study was on predictive validity as a form of criterion validation. Convergent validity is a subtype of construct validity and considered a core component of the validity of a test. Objective to investigate convergent validity between the eFI and research standard frailty measures. Design cross-sectional validation study using data from the Community Ageing Research 75+ (CARE 75+) cohort. Setting multi-site UK community-based cohort study. Subjects three hundred fifty-three community-dwelling older people (median age 80 years, IQR 77–84), excluding care home residents and people in the terminal stage of life. Median eFI score of participants was 0.22 (IQR 0.14–0.31). Methods convergent validities between the eFI and: a research standard frailty index (FI); the phenotype model of frailty; Clinical Frailty Scale (CFS) and Edmonton Frail Scale were assessed using scatter plots and Spearman's rank tests to estimate correlation coefficients (Spearman's rho, ρ) and 95% confidence intervals. Results results indicate strong correlation between the eFI and both the research standard FI (ρ = 0.68, 95% CI 0.62–0.74) and Edmonton Frail Scale (ρ = 0.63, 95% CI 0.57–0.69). There was evidence for moderate correlation between the eFI and both the CFS (ρ = 0.59, 95% CI 0.49–0.65) and phenotype model (ρ = 0.51, 95% CI 0.42–0.59). Conclusions This study provides evidence for convergent validity of the eFI, a core component of test validity. [ABSTRACT FROM AUTHOR]

Objective The purpose of this analysis was to evaluate the experience of opioid-induced constipation in younger patients and identify differences in the experience of opioid-induced constipation and its symptoms between younger patients (<50 years) and older patients (50–64 years). Design Post hoc analysis of data from a 24-week prospective, multinational, longitudinal observational cohort study (NCT01928953). Setting Outpatient clinics in the United States, Canada, Germany, and United Kingdom. Subjects Two age-based subgroups of adult patients with chronic noncancer pain receiving four or more weeks of daily opioid therapy and experiencing opioid-induced constipation within the previous two weeks. Methods The number of spontaneous bowel movements, frequency of constipation symptoms, amount of bother associated with symptoms, Patient Assessment of Constipation-Symptoms questionnaire, and health-related quality of life and function outcomes. Results Overall, 419 patients were included in this analysis (younger patients, N = 184; older patients, N = 235). Among younger and older patients, respectively, constipation occurred within the first week after initiating opioid therapy for 32.8% and 35.9%. At baseline, the mean numbers of spontaneous bowel movements/week were 1.3 and 1.5, and moderate opioid-induced constipation–related interference with pain management was reported by 46.6% and 44.5%. Younger patients generally reported that opioid-induced constipation symptoms were more bothersome than did older patients. The impact of opioid-induced constipation on health-related quality of life, work productivity, and day-to-day activities was comparable. Conclusions In these patients receiving opioid therapy for chronic noncancer pain, the burden of opioid-induced constipation was comparable or greater for patients aged <50 years compared with that for patients aged 50–64 years. [ABSTRACT FROM AUTHOR]

One important indication of the strength of a discipline is the state of its doctoral research. An important milestone for the official recognition of social work in the UK has been its inclusion in Economic and Social Research Council (ESRC) doctoral funding schemes. The current study assesses the longer-term impact of these schemes, via a 2013 survey, following up a previous one in 2008. A web-based survey of social work doctoral candidates in the UK (n = 216) was conducted, to profile student demographics, research topics, methods, challenges of and supports for doctoral work. Most doctoral candidates (70 per cent) were using a primarily qualitative research strategy and only 4 per cent were using a primarily quantitative approach. Social work doctoral candidates were slightly less satisfied with their research degree programme than the general population of doctoral students. Key areas of similarity with the 2008 survey included the demographical profile (gender, age, ethnicity) and the percentage who were qualified social workers; key differences included increased percentages of candidates who were registered full time, funded by the ESRC and doing a Ph.D. as opposed to a professional doctorate. The findings highlight a need for capacity building in quantitative research methods and improved support for this academic community. [ABSTRACT FROM AUTHOR]

Mobile phone apps have been shown to increase physical activity (PA), but existing apps fail to target the emotional aspects of PA, which influence whether individuals are active. We developed an app that encourages individuals to focus on the emotional aspects of PA. We aimed to assess the acceptability of this app, and conduct a preliminary evaluation of efficacy. The app was developed in collaboration with users through focus groups. Seven users tested the app over 4 months and provided feedback on acceptability, aesthetics and functionality in a follow-up focus group. Results were summarized descriptively. Before testing the app, participants completed a questionnaire assessing their current PA and psychological antecedents of PA. A second questionnaire was completed at the follow-up focus group. Change scores are reported for each participant and overall. The social and reminder aspects facilitated motivation to be active and many found it easy to integrate into their lives. Most suggested modifications. Small improvements in number of minutes spent walking per week were observed (overall mean change +25 min) and some psychological antecedents of PA (overall mean change for social support for PA +0.14, self-efficacy for PA +0.17, outcome expectations about PA +0.20; all five-point scales), but reductions were seen in other domains. The app was acceptable to users, although developments are required. Testing with a small number of individuals, offering preliminary evidence of efficacy of this app, provides justification for further evaluation on a larger scale. [ABSTRACT FROM AUTHOR]

Aims: Promotion of lower risk drinking guidelines is a commonly used public health intervention with various purposes, including communicating alcohol consumption risks, informing drinkers' decision-making and, potentially, changing behaviour. UK drinking guidelines were revised in 2016. To inform potential promotion of the new guidelines, we aimed to examine public knowledge and use of the previous drinking guidelines, including by population subgroup. Methods: A demographically representative, cross-sectional online survey of 2100 adults living in England in July 2015 (i.e. two decades after adoption of previous guidelines and prior to introduction of new guidelines). Univariate and multivariate logistic regressions examined associations between demographic variables, alcohol consumption (AUDIT-C), smoking, and knowledge of health conditions and self-reported knowledge and use of drinking guidelines. Multinomial logistic regression examined the same set of variables in relation to accurate knowledge of drinking guidelines (underestimation, accurate-estimation, overestimation). Results: In total, 37.8% of drinkers self-reported knowing their own-gender drinking guideline, of whom 66.2% gave an accurate estimate. Compared to accurate estimation, underestimation was associated with male gender, lower education and AUDIT-C score, while overestimation was associated with smoking. Few (20.8%) reported using guidelines to monitor drinking at least sometimes. Drinking guideline use was associated with higher education, overestimating guidelines and lower AUDIT-C. Correctly endorsing a greater number of health conditions as alcohol-related was associated with self-reported knowledge of guidelines, but was not consistently associated with accurate estimation or use to monitor drinking. Conclusions: Two decades after their introduction, previous UK drinking guidelines were not well known or used by current drinkers. Those who reported using them tended to overestimate recommended daily limits. SHORT SUMMARY: We examined public knowledge and use of UK drinking guidelines just before new guidelines were released (2016). Despite previous guidelines being in place for two decades, only one in four drinkers accurately estimated these, with even fewer using guidelines to monitor drinking. Approximately 8% of drinkers overestimated maximum daily limits. [ABSTRACT FROM AUTHOR]

Background: Handgrip strength may provide an easily- administered marker of cognitive functional status. However, further population-scale research examining relationships between grip strength and cognitive performance across multiple domains is needed. Additionally, relationships between grip strength and cognitive functioning in people with schizophrenia, who frequently experience cognitive deficits, has yet to be explored. Methods: Baseline data from the UK Biobank (2007-2010) was analyzed; including 475 397 individuals from the general population, and 1162 individuals with schizophrenia. Linear mixed models and generalized linear mixed models were used to assess the relationship between grip strength and 5 cognitive domains (visual memory, reaction time, reasoning, prospective memory, and number memory), controlling for age, gender, bodyweight, education, and geographical region. Results: In the general population, maximal grip strength was positively and significantly related to visual memory (coefficient [coeff] = -0.1601, standard error [SE] = 0.003), reaction time (coeff = -0.0346, SE = 0.0004), reasoning (coeff = 0.2304, SE = 0.0079), number memory (coeff = 0.1616, SE = 0.0092), and prospective memory (coeff = 0.3486, SE = 0.0092: all P < .001). In the schizophrenia sample, grip strength was strongly related to visual memory (coeff = -0.155, SE = 0.042, P < .001) and reaction time (coeff = -0.049, SE = 0.009, P < .001), while prospective memory approached statistical significance (coeff = 0.233, SE = 0.132, P = .078), and no statistically significant association was found with number memory and reasoning (P > .1). Conclusions: Grip strength is signifi- cantly associated with cognitive functioning in the general population and individuals with schizophrenia, particularly for working memory and processing speed. Future research should establish directionality, examine if grip strength also predicts functional and physical health outcomes in schizophrenia, and determine whether interventions which improve muscular strength impact on cognitive and realworld functioning. [ABSTRACT FROM AUTHOR]

My experience with forensic statistics is largely through providing reports for civil cases. This article introduces the type of cases with which I have been involved, and the issues which have arisen, in a few jurisdictions. I wish to encourage more involvement, and debate on the contribution statistics might make in civil litigation, and what might be learned from criminal forensic statistics. [ABSTRACT FROM AUTHOR]

This study examined the association between obesity and deprivation in English children and whether cardiorespiratory fitness or physical activity (PA) can explain this association. Obesity was assessed using IOTF criteria in 8,398 10-16 year olds. Social deprivation was measured using the Index of Multiple Deprivation (IMD) (subdivided into 3 groups; high, mid and low deprivation). Obesity was analysed using binary logistic regression with stature, age and sex incorporated as confounding variables. Children's fitness levels were assessed using predicted VO2 max (20-metre shuttle run test) and PA was estimated using the PA Questionnaire for Adolescents or Children (PAQ). A strong association was found between obesity and deprivation. When fitness and PA were added to the logistic regression models, increasing levels in both were found to reduce the odds of obesity, although it was only by including fitness into the model that the association between obesity and deprivation disappeared. Including estimated PA into the model was found to be curvilinear. Initial increases in PA increase the odds of obesity. Only by increasing PA to exceed the 71st percentile (PAQ = 3.22) did the odds of being obese start to decline. In order to reduce deprivation inequalities in children's weight-status, health practitioners should focus on increasing cardiorespiratory fitness via physical activity levels in areas of greater deprivation [ABSTRACT FROM AUTHOR]

Background Small-area analysis of National Health Service (NHS)-funded sight test uptake in Leeds showed significant inequalities in access among people aged <16 or ≥60. Methods Data were extracted from 604 126 valid General Ophthalmic Services (GOS)1 claim forms for eye examinations for Essex residents between October 2013 and July 2015. Expected GOS1 uptake for each lower super output area was based on England annual uptake. Poisson regression modelling explored associations in GOS1 uptake ratio with deprivation. Results People aged ≥60 or <16 living in the least deprived quintile were 15% and 26%, respectively, more likely to have an NHS funded eye examination than the most deprived quintile, although all are equally entitled. GOS1 uptake is higher in the more deprived quintiles among 16–59-year old, as means tested social benefits are the main eligibility criteria in this age-group. Inequalities were also observed at local authority level. Conclusions Inequalities in access among people ≥60 years were not as large as those reported in Leeds, although inequalities in <16-year old were similar. However, demonstrable inequalities in this data set over a longer time period and a larger and more diverse area than Leeds, reinforce the argument that interventions are needed to address eye examination uptake inequalities. [ABSTRACT FROM AUTHOR]

Background: The diagnostic and prognostic significance of the DSM-5-defined Attenuated Psychosis Syndrome (DSM-5-APS) in individuals undergoing an ultra high risk (UHR) clinical assessment for suspicion of psychosis risk is unknown. Methods: Prospective cohort study including all consecutive help-seeking individuals undergoing both a DSM-5-APS and a Comprehensive Assessment of At Risk Mental States (CAARMS 12/2006) assessment for psychosis risk at the Outreach and Support in South London (OASIS) UHR service (March 2013-April 2014). The diagnostic significance of DSM-5-APS was assessed with percent overall agreement, prevalence bias adjusted kappa, Bowker's test, Stuart-Maxwell test, residual analysis; the prognostic significance with Cox regression, Kaplan--Meier failure function, time-dependent area under the curve (AUC) and net benefits analysis. The impact of specific revisions of the DSM-5-APS was further tested. Result: In 203 help-seeking individuals undergoing UHR assessment, the agreement between the DSM-5-APS and the CAARMS 12/2006 was only moderate (kappa 0.59). Among 142 nonpsychotic cases, those meeting DSM-5-APS criteria had a 5-fold probability (HR = 5.379) of developing psychosis compared to those not meeting DSM-5-APS criteria, with a 21-month cumulative risk of psychosis of 28.17% vs 6.49%, respectively. The DSM-5-APS prognostic accuracy was acceptable (AUC 0.76 at 24 months) and similar to the CAARMS 12/2006. The DSM-5-APS designation may be clinically useful to guide the provision of indicated interventions within a 7%--35% (2-year) range of psychosis risk. The removal of the criterion E or C of the DSM-5-APS may improve its prognostic performance and transdiagnostic value. Conclusions: The DSM-5-APS designation may be clinically useful in individuals accessing clinical services for psychosis prevention. [ABSTRACT FROM AUTHOR]

In the article, the authors present their study which examined the influence of chronic pain on COVID-19 in univariable and multivariable Mendelian randomization (MR), taking into account the effects of smoking and body mass index (BMI). Also cited are the use of multisite chronic pain (MSCP) traits and inverse variance weighted method in exploring potential pleiotropy, and how chronic pain increased the risk of COVID-19 and hospitalization.

Background In the UK, initiating then discontinuing breastfeeding before two weeks post-partum is common. The aim of this longitudinal qualitative study was to explore which psychosocial factors may influence discontinuation. Methods A sample of 10 pregnant women intending to breastfeed were recruited. A longitudinal qualitative design was used to capture views prior to and two weeks following birth. Semi-structured interviews were conducted underpinned by the Theoretical Domains Framework to explore a comprehensive list of psychosocial factors. Results Four women discontinued breastfeeding at the time of the second interview. Pre-partum differences were identified between maintainers and discontinuers; discontinuers appeared to have stronger intentions to breastfeed based on their self-determination, selfconfidence and perception of fewer barriers to breastfeeding. Post-partum, discontinuers highlighted how they felt physically unable to carry on; their feeding experiences elicited negative emotions and pain. Negative emotions appeared to be exacerbated by original breastfeeding beliefs and advice given by healthcare professionals. Conclusions The women in this study who discontinued breastfeeding showed less cognitive flexibility, which appeared to exacerbate postpartum emotional distress, when they encountered difficulties. Women with strong intentions and self-determination might benefit from support in anticipating potential barriers and identifying ways of overcoming them. [ABSTRACT FROM AUTHOR]

Background The contemporary environment is a complex of interactions between physical, biological, socio-economic systems with major impacts on public health. However, gaps in our understanding of the causes, extent and distribution of these effects remain. The public health community in Sandwell West Midlands has collaborated to successfully develop, pilot and establish the first Environmental Public Health Tracking (EPHT) programme in Europe to address this 'environmental health gap' through systematically linking data on environmental hazards, exposures and diseases. Methods Existing networks of environmental, health and regulatory agencies developed a suite of innovative methods to routinely share, integrate and analyse data on hazards, exposures and health outcomes to inform interventions. Results Effective data sharing and horizon scanning systems have been established, novel statistical methods piloted, plausible associations framed and tested, and targeted interventions informed by local concerns applied. These have influenced changes in public health practice. Conclusion EPHT is a powerful tool for identifying and addressing the key environmental public health impacts at a local level. Sandwell's experience demonstrates that it can be established and operated at virtually no cost. The transfer of National Health Service epidemiological skills to local authorities in 2013 provides an opportunity to expand the programme to fully exploit its potential. [ABSTRACT FROM AUTHOR]

Policy makers and advocates in industrialised economies have increasingly couched arguments for addressing homelessness in cost-offset paradigms. In the USA, there is a robust body of evidence demonstrating cost offsets of supportive housing, whereas rigorous evidence from the UK, Europe and Australia is limited. The present article contributes to the evidence base with results drawn from a linked administrative data-set including: police, prison, probation, parole, courts, emergency department, hospitaladmitted patients, ambulance, mental health and homelessness services data. The results show that in twelve months when people were homeless, they used on average $48,217 (£25,776) worth of government services; in the twelve months as tenants of supportive housing, the cohort used on average, including the cost of supportive housing, $35,117 (£18,773) in government services. Although social work only infrequently draws on cost arguments to substantiate practice and intervention, the article argues that cost-offset evidence is consistent with social work's commitment to evidence base practice. Moreover, analysis of services that people use when securely housed compared to homeless adds further evidence to demonstrate that people's actions, and their status as clients, is mediated by resources and opportunities available. [ABSTRACT FROM AUTHOR]

Previous reviews have indicated that immigration from South Asian to Western countries leads to unhealthy changes in diet; however, these reviews have been limited by the methods used in some included studies. This critical narrative review summarizes findings from original research articles that performed appropriate statistical analyses on diet data obtained using culturally appropriate diet assessment measures. All studies quantitatively compared the diets of South Asian immigrants with those of residents of Western or South Asian countries or with those of South Asian immigrants who had varying periods of time since immigration. Most studies examined total energy and nutrient intake among adults. Total energy intake tended to decrease with increasing duration of residence and immigrant generation, and immigrants consumed less protein and monounsaturated fat compared with Westerners. However, findings for intakes of carbohydrate, total fat, saturated fat, polyunsaturated fat, and micronutrients were mixed. Studies that examine food group intake and include South Asians living in South Asia as a comparison population are needed. [ABSTRACT FROM AUTHOR]

Background: the first quality of life questionnaire specific to sarcopenia, the SarQoL®, has recently been developed and validated in French. To extend the availability and utilisation of this questionnaire, its translation and validation in other languages is necessary. Objective: the purpose of this study was therefore to translate the SarQoL into English and validate the psychometric properties of this new version. Design: cross-sectional. Setting: Hertfordshire, UK. Subjects: in total, 404 participants of the Hertfordshire Cohort Study, UK. Methods: the translation part was articulated in five stages: (i) two initial translations from French to English; (ii) synthesis of the two translations; (iii) backward translations; (iv) expert committee to compare the backward translations with the original questionnaire and (v) pre-test. To validate the English SarQoL®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability) and floor/ceiling effects. Results: the SarQoL questionnaire was translated without any major difficulties. Results indicated a good discriminative power (lower score of quality of life for sarcopenic subjects, P = 0.01), high internal consistency (Cronbach's alpha of 0.88), consistent construct validity (high correlations found with domains related to mobility, usual activities, vitality, physical function and low correlations with domains related to anxiety, self-care, mental health and social problems) and excellent test- retest reliability (intraclass coefficient correlation of 0.95, 95%CI 0.92-0.97). Moreover, no floor/ceiling has been found. Conclusions: a valid SarQoL® English questionnaire is now available and can be used with confidence to better assess the disease burden associated with sarcopenia. It could also be used as a treatment outcome indicator in research. [ABSTRACT FROM AUTHOR]

Successful public health initiatives require multi-sector collaboration. AVONet was a UK collaborative developed to provide evidence-based strategies for active ageing. This study explored the success of AVONet in the achievement of its objectives as perceived by all partners. A convergent parallel mixed-methods design was employed, utilizing a quantitative survey and qualitative semi-structured interviews. Data collection was undertaken in September 2010,18 months after establishing the collaborative and 6 months after funding had ceased. AVONet partners (n = 24) completed a 27-item survey. A sub-sample of four academics and four practitioners participated in semi-structured interviews. Quantitative and qualitative comparisons were made between academics' and practitioners' perceptions of success, potential for sustainability and satisfaction with structure and relationships. Participants perceived the AVONet collaborative positively. Significant between-group (academic v practitioner) differences in survey responses were observed for success (U = 19.5; p = 0.003) and structure (U = 125.5; p =0.001). Strong positive correlations were observed between success and structure and balance between information transfer and exchange (r =0.756; p<0.001). Interviews confirmed positive perceptions and perceived importance of the collaborative and highlighted the need for further integration and tangible outcomes for practitioners. Suggestions to enhance sustainability were provided, such as smaller working groups and local council-led governance. Perceived success in building a multi-sectoral collaborative can be achieved during a 10-month period, despite differing needs of contributors. For collaboratives developed as a result of external funding aimed primarily at facilitating research, involvement of practitioners at an early stage may help set more comprehensive goals, supportive communication strategies, and increase potential for sustainability. [ABSTRACT FROM AUTHOR]

Background Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID feasibility trial explored the processes of conducting a randomized control trial (RCT) with people who inject drugs (PWID) in a low-threshold agency. Feasibility of the intervention investigated whether offering PWID immediate access to OST via specialist primary care increased numbers in OSTat 3 months, compared with offering advice and case management. Methods Un-blinded RCTwas conducted at Bristol Drugs Project needle exchange. A total of 311 individuals were eligible and 100 consented to participate. Trial process outcomes involved exploring OST status at 3 months; secondary outcomes were substance use and health-related quality of life measures. Results Follow-up was 86%. At 3 months, 51% intervention and 47% of control participants were in OST (OR of success of intervention 1.17 (0.54-2.57)). Opioid use reduced by 79 and 73%, respectively (OR of intervention success 1.38 (0.5-3.7)). Physical and mental health improved but there was little differences between groups. Conclusions The feasibility of conducting the trial was a success, but there was insufficient evidence of an effect compared with intensive case management. Further development and evaluation of case management approaches in low-threshold agencies is warranted. [ABSTRACT FROM AUTHOR]

Introduction. Malignant pleural mesothelioma (MPM) is associated with severe pain. The underlying neurobiology of this is complex. The primary aim of this study was to characterize pain in MPM. Methods. This study was undertaken as part of a trial examining radiotherapy for the treatment of pain in MPM (ISRCTN 10644347). Patients had MPM with associated pain for which radiotherapy was planned and a worst pain score 4/10. The following assessments were undertaken: clinical neuropathic pain assessment, Brief Pain Inventory (BPI), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Short form of the McGill Pain Questionnaire (SF-MPQ), and Quantitative Sensory Testing (QST). The relationship of these characteristics and response to radiotherapy was assessed. Unless stated, medians and interquartile range (IQR) are used. Results. Thirty-seven patients were recruited. Average pain and worst pain was 4 (4-6) and 8 (6-8), respectively. Higher average pain and higher worst pain scores were associated with higher interference scores on the BPI, P< 0.001 and P< 0.0005. Twenty patients (54%) had a clinical diagnosis of neuropathic pain, and of these, only six patients (40%) screened positively for neuropathic pain using the LANSS. Patients with a high LANSS also had higher BPI and SF-MPQs. The presence of neuropathic pain (clinically or by LANSS) did not predict response to radiotherapy, P< 0.05. The SFMPQ scores were higher in those with abnormal cool sensation on QST (P50.016). Conclusion. Pain in mesothelioma varies among patients and may have neuropathic components. An adequate pain assessment is necessary to guide the clinician in the appropriate choice of analgesics. [ABSTRACT FROM AUTHOR]

We explore the existence of short- and long-term effects of retirement on health. Short-term effects are estimated with a regression discontinuity design which is robust to weak instruments and where the underlying assumptions of continuity of potential outcomes are uncontroversial. To identify the long-term effects we propose a parametric model which, under strong assumptions, can separate normal deterioration of health from the causal effects of retirement. We apply our framework to the British Household Panel Survey and find that retirement has little effect on health. However, our estimates suggest that retirement opens the gate to a sedentary life with an impoverished social component and this is a channel through which retirement could indirectly affect health in the long run. [ABSTRACT FROM AUTHOR]

We apply parametric and non-parametric regression discontinuity methodology within a multinomial choice setting to examine the effect of public healthcare user fee abolition on health facility choice by using data from South Africa. The non-parametric model is found to outperform the parametric model both in and out of sample, while also delivering more plausible estimates of the effect of user fee abolition (i.e. the 'treatment effect'). In the parametric framework, treatment effects were relatively constant-around 10%-and that increase was drawn equally from home care and private care. In contrast, in the non-parametric framework treatment effects were largest for large (and poor) families located further from health facilities-approximately 5%. More plausibly, the positive treatment effect was drawn primarily from home care, suggesting that the policy favoured children living in poorer conditions, as those children received at least some minimum level of professional healthcare after the policy was implemented. [ABSTRACT FROM AUTHOR]