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Background: Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health. Aims: To assess the experiences of amateur singers, their use of warm‐up and cool‐down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment. Methods and Procedures: A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm‐up and cool‐down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment. Outcome and Results: Most choirs used warm‐up sessions but few used cool‐down. Singers who participated in choir warm‐ups experienced significantly less vocal symptoms. Individual warm‐ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy. Conclusions and Implications: Warm‐up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact. WHAT THIS PAPER ADDS: What is already known on this subject: Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge: This survey demonstrates that choir warm‐ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work?: We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well‐being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia‐related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. Aims: To establish the current practices of SLTs managing dementia‐related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. Methods & Procedures: An anonymous, cross‐sectional web‐based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open‐ended questions were analysed using conventional content analysis. Outcomes & Results: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self‐rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. Conclusions & Implications: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well‐being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper addsWhat is already known on the subjectResearch indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice.What this paper adds to existing knowledgeThis paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints.What are the potential or actual clinical implications of this work?These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia‐related dysphagia and mealtime difficulties effectively. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: An innovative Community Kidney Service has been running since 2016 in four health regions in East London, United Kingdom. This paper focuses on the patient education (self‐management) programme within the service. Objective: To understand the experiences of people with stage 1–3b chronic kidney disease invited to individual or group education sessions. To assess the usefulness of the programme's educational resources to primary care nurses. Design: A mixed‐method project. A steering group involving patients shaped both survey and interview questions. Participants: Paper surveys (n = 266) were sent to patients 7–19 months after they had attended. Semi‐structured interviews were undertaken with patients who returned the survey and indicated they were willing to be interviewed (n = 9). Survey links were sent electronically to primary care nurses. Results: Fifty‐four surveys were returned from patients. The education session increased self‐reported knowledge about kidney disease and two‐thirds of patients reported making lifestyle changes. Analysis of interview data identified recognition of kidney disease, motivation to change and reliance on "experts" as key themes. Surveys were returned from 21 nurses. Most were aware of the community kidney service but only one‐third had used the education resources with their patients. Conclusion: Secondary care nursing involvement in primary care‐based education for people with kidney disease is rare in the United Kingdom and internationally. This educational intervention, developed with patients, supports people to make changes that have the potential to reduce progression of kidney disease and our findings have significance for other teams working in chronic kidney disease management. [ABSTRACT FROM AUTHOR]

ABSTRACT The meanings of social problems like poverty develop within the public sphere. This paper uses the theory of social representations to examine how poverty is represented in British newspapers. Poverty has been discussed and interpreted in numerous ways, and newspapers not only provide a platform for these elaborations but also contribute to shaping public understanding on the issue. The study sampled news coverage on poverty in four British newspapers during two randomly chosen one-month periods in the years 2001 and 2011. The data set of news reports ( n = 274) was thematically analysed to examine representations of poverty. The study found that in the domestic context, media represents poverty as a problem limited to vulnerable groups such as children and the elderly. With a lack of discussion on the wider socio-economic causes and contributing factors, poverty within the UK appears as an 'orphan phenomenon' with an unknown genesis. In contrast, the representations of poverty outside the UK are vivid and elaborate, and the news reports hold the socio-political inefficiency of countries responsible for poverty. The study also found that the media uses poverty to make sense of catastrophic events in society: the September 11, 2001 terrorist attacks in the United States and the London riots of 2011 were both anchored using poverty. This paper discusses the representational dynamics of these findings and argues that the media representations distance general society from poverty, representing it as a problem of the other. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Significant proportions of young people experience body dissatisfaction, which has implications for psychological and physical well‐being. Lesson content and perceived competence may be important variables for the experience of body dissatisfaction, yet these have been underexplored in physical education. The aim of this cross‐sectional study is to identify the relationships between body dissatisfaction and perceptions of competence, and to explore whether body dissatisfaction depends on lesson content. METHODS: A paper‐and‐pencil questionnaire was completed by 446 (210 boys, 236 girls) 13‐ to 14‐year‐old pupils from 37 physical education classes. The questionnaire assessed body dissatisfaction and perceived competence in physical education. Lesson content was also recorded. Twenty‐nine of the classes were engaged in team activities, eg, ball games. Eight classes were engaged in individual activities, eg, fitness. RESULTS: Multilevel analysis identified a significant negative association between body dissatisfaction and perceptions of competence in physical education. Lesson content did not significantly predict variations in body dissatisfaction scores. CONCLUSIONS: Teachers should focus on enhancing pupils' perceptions of competence in physical education to support the development of body satisfaction. [ABSTRACT FROM AUTHOR]

Background This paper describes the impact of a family-centred intervention that used video to enhance communication in a young girl with cerebral palsy. This single case study describes how the video-based intervention worked in the context of multimodal communication, which included high-tech augmentative and alternative communication (AAC) device use. This paper includes the family's perspective of the video intervention and they describe the impact of it on their family. Methods This single case study was based on the premise that the video interaction guidance intervention would increase attentiveness between participants during communication. It tests a hypothesis that eye gaze is a fundamental prerequisite for all communicative initiatives, regardless of modality in the child. Multimodality is described as the range of communicative behaviours used by the child and these are coded as AAC communication, vocalizations (intelligible and unintelligible), sign communication, nodding and pointing. Change was analysed over time with multiple testing both pre and post intervention. Data were analysed within INTERACT, a computer software to analyse behaviourally observed data. Behaviours were analysed for frequency and duration, contingency and co-occurrence. Results Results indicated increased duration of mother's and girl's eye gaze, increased frequency and duration in AAC communication by the girl and significant change in frequency [χ2 (5, n = 1) = 13.25, P < 0.05] and duration [χ2 (5, n = 1) = 12.57, P < 0.05] of the girl's multimodal communicative behaviours. Contingency and co-occurrence analysis indicated that mother's eye gaze followed by AAC communication was the most prominent change between the pre- and post-intervention assessments. Conclusions There was a trend for increased eye gaze in both mum and girl and AAC communication in the girl following the video intervention. The family's perspective concurs with the results. [ABSTRACT FROM AUTHOR]

Background Long-term sickness absence (LTSA) in the United Kingdom labor market has become a major health issue in recent years. In contrast to short-term sickness absence, rates for LTSA have been on the increase. This paper, part 1 of a two-part paper, identifies individual domain barriers to returning to work (RTW) from LTSA across the work disability timeline in the UK labor market. Methods This is a retrospective cohort study of 6,246 workers from an occupationally diverse Police Force within the UK using a large administrative database. A series of chisquared analyses were conducted to analyze the between and within group associations. Next, multiple logistic regression analyses using the Enter method were performed to develop a predictive model for RTWand Absence Phase. Results Findings substantiated the presence of individual domain barriers to RTW and predictors of RTW outcome and established the absence phase specificity of a number of risk factors of prolonged work disability. In particular, injury/illness especially mental ill health (MIH), physical job demands, sex, and number of episodes of LTSA are significant individual domain barriers to RTW and represent important risk factors for prolonged work disability. Conclusions Duration of work disability is associated with medical diagnosis, especially MIH, physical job demands, sex, and number of LTSA episodes. Findings also support the importance of using the outcome measure of absence phase of risk factors in addition to RTW outcome. [ABSTRACT FROM AUTHOR]

Background: There is a marked male preponderance in autism spectrum conditions. The extreme male brain theory and the fetal androgen theory of autism suggest that elevated prenatal testosterone exposure is a key contributor to autistic traits. The current paper reports findings from two separate studies that test this hypothesis. Methods: A parent-report questionnaire, the Childhood Autism Spectrum Test (CAST), was employed to measure autistic traits in both studies. The first study examined autistic traits in young children with congenital adrenal hyperplasia (CAH), a condition causing unusually high concentrations of testosterone prenatally in girls. Eighty one children with CAH (43 girls) and 72 unaffected relatives (41 girls), aged 4–11 years, were assessed. The second study examined autistic traits in relation to amniotic testosterone in 92 typically developing children (48 girls), aged 3–5 years. Results: Findings from neither study supported the association between prenatal androgen (testosterone) exposure and autistic traits. Specifically, young girls with and without CAH did not differ significantly in CAST scores and amniotic testosterone concentrations were not significantly associated with CAST scores in boys, girls, or the whole sample. Conclusions: These studies do not support a relationship between prenatal testosterone exposure and autistic traits. These findings augment prior research suggesting no consistent relationship between early androgen exposure and autistic traits. [ABSTRACT FROM AUTHOR]

Background: People with a total laryngectomy (PTL) rely on a permanent opening in their neck (stoma) to breathe. This altered anatomy may increase susceptibility to contracting and transmitting SARS-CoV-2. Aims: To report on (1) the frequency and characteristics of PTL who tested positive for COVID-19, (2) the receipt of advice regarding shielding and patient selfreports of shielding, (3) hospital admissions and length of stay, and (4) mortality rates in this group during the first UK national lockdown. Methods & Procedures: This is a cross-sectional survey and case note review. National Health Service (NHS) centres providing care to PTL were invited to participate via the Royal College of Speech and Language Therapists' (RCSLT) Head & Neck Clinical Excellence Networks and through socialmedia. PTL were reviewed by their speech and language therapist either in person or via telehealth between 30 March and 30 September 2020. Data were collected within the time frame covered by the Control of Patient Information (COPI) notice issued for COVID-19 and included information on COVID-19 testing, shielding, hospital admissions, length of stay and deaths. Information was submitted to the lead NHS site using a custom designed data-capture worksheet. Analysis was performed using descriptive statistics, including proportions and frequency counts. Pearson's Chi squared tests were used to compare categorical data using a 5% significance level. Outcomes & Results: Data were obtained from 1216 PTL from26 centres across the UK.Atotal of 81%were male;mean agewas 70 years (28-97 years). Of the total group, 12% received a COVID-19 test. A total of 24 (2% of total sample) tested positive for COVID-19. Almost one-third of PTL (32%) received a government letter or were advised to shield by a healthcare professional. During the data collection time frame, 12% had a hospital admission (n = 151) with a median length of stay of 1 day (1-133 days), interquartile range (IQR) = 17 days. A total of 20 of these admissions (13%) had tested positive for COVID-19 with a median length of stay of 26 days, IQR = 49 days. The overall mortality was 4% (41 patients), with eight deaths occurring within 28 days of testing positive for COVID-19. Conclusions & Implications: This study highlighted the lack of routine national data for neck-breathers with which to compare the current findings. Greater testing in the community is necessary to understand the prevalence of COVID-19 in PTL and if this group is indeed more susceptible. The potential for nasopharyngeal and tracheal aspirates to show differing results when testing for COVID-19 in neck-breathers requires further investigation. [ABSTRACT FROM AUTHOR]

Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of data to show that participation in school‐based counselling is associated with significant reductions in psychological distress. However, this cannot be taken as evidence that school‐based counselling is effective, as improvements may have happened without the intervention. Aims: The purpose of this study was to develop a method of estimating the amount of ‘natural’ change that might be expected in young people who would attend school‐based counselling, such that the effects of the intervention over and above this amount could be identified. Method: Young Person's CORE (YP‐CORE) scores from 74 participants allocated to waiting list control conditions in four pilot trials of school‐based counselling in the UK were re‐analysed using regression models, and a formula was found for estimating the outcomes for young people were they not to receive counselling. This was termed their Estimated Non‐intervention Outcome (ENO), and could then be compared against the young person's Actual Outcome (AO), to give an estimated intervention effect (EIE). Results: The formula for the ENO was 4.17 + 0.64 × baseline score. Using this, we calculated a mean EIE for 256 young people in a cohort evaluation study of school‐based counselling, which showed that the counselling was associated with large and significantly greater change than would be expected without the intervention (Cohen's d = 0.91). Discussion: The method presented in this paper is a simple means for improving the accuracy of estimations of treatment effectiveness, helping to adjust for changes due to spontaneous recovery and other non‐treatment effects. [ABSTRACT FROM AUTHOR]

How do organizational responses to environmental disruptions affect employees' job-related well-being? As the COVID-19 pandemic has led to new ways of working, increased health concerns, and added responsibilities, employees are facing important challenges in doing their work that can affect their job-related well-being. This study aims to understand how different types of work support (i.e., perceived organizational support and supervisor accessibility) in response to environmental disruption interact with personality traits (i.e., core self-evaluations and future focus) to influence changes in employees' affective commitment to their organization and in their job-related well-being. We develop a moderated mediation model and test it on data collected from 295 individuals working in the United Kingdom. We find that work support for the COVID-19 pandemic, both perceived organizational support and supervisor accessibility, is associated with more positive changes in employees' jobrelated well-being and that this effect is mediated by changes in employees' affective commitment to their organization. Furthermore, we find that personality traits moderate the relationships between these two types of support and changes in affective commitment to the organization, with those relationships being more positive for employees with low core self-evaluations and for those with a high future focus. [ABSTRACT FROM AUTHOR]

Formula fed infants experience gastrointestinal infections at higher rates than breastfed infants, due in part to bacteria in powdered infant formula (PIF) and bacterial contamination of infant feeding equipment. The United Kingdom National Health Service (UK NHS) has adopted the World Health Organization recommendation that water used to reconstitute PIF is ≥70°C to eliminate bacteria. We used community science methods to co‐design an at home experiment and online questionnaire ('research diary') to explore the safety of PIF preparation compared to UK NHS guidelines. 200 UK‐based parents of infants aged ≤12 months were recruited; 151 provided data on PIF preparation, and 143 were included in the analysis of water temperatures used to reconstitute PIF. Only 14.9% (n = 11) of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users (p < 0.001). The mean temperature of water dispensed by PIF preparation machines was 9°C lower than kettles (Machine M = 65.78°C, Kettle M = 75.29°C). Many parents did not always fully follow NHS safer PIF preparation guidance, and parents did not appear to understand the potential risks of PIF bacterial contamination. Parents should be advised that the water dispensed by PIF preparation machines may be below 70°C, and could result in bacteria remaining in infant formula, potentially leading to gastrointestinal infections. PIF labelling should advise that water used to prepare PIF should be ≥70°C and highight the risks of not using sufficiently hot water, per WHO Europe advice. There is an urgent need for stronger consumer protections regarding PIF preparation devices. Key points: Only 14.9% (n = 11) of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users (p < 0.001).The mean temperature of water dispensed by PIF preparation machines was 9°C lower than kettles (Machine M = 65.78°C, Kettle M = 75.29°C).Most parents routinely washed and sterilised bottles and teats.Many parents did not always fully follow NHS safer PIF preparation guidance, including 21.8% washing their hands half the time or less, and 14.6% regularly pre‐preparing bottles.Most parents did not appear to understand the risks of PIF bacterial contamination. [ABSTRACT FROM AUTHOR]

While violence against children is a common occurrence only a minority of incidents come to the attention of the authorities. Low reporting rates notwithstanding, official data such as child protection referrals and recorded crime statistics provide valuable information on the numbers of children experiencing harm which come to the attention of professionals in any given year. In the UK, there has been a strong tendency to focus on child protection statistics while children as victims of crime remain largely invisible in annual crime reports and associated compendia. This is despite the implementation of a raft of policies aimed at improving the system response to victims and witnesses of crime across the UK. This paper demonstrates the utility of a more detailed analysis of crime statistics in providing information on the patterns of crime against children and examining case outcomes. Based on data made available by the Police Service for Northern Ireland, it highlights how violent crime differentially impacts on older children and how detection rates vary depending on case characteristics. It makes an argument for developing recorded crime practice to make child victims of crime more visible and to facilitate assessment of the effectiveness of current initiatives and policy developments. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Messages UK recorded crime is not routinely disaggregated by age and there is limited consideration of the changing patterns of crime against children., Practitioners working to reduce offending against children and to support victims through the criminal justice system are not being provided with the appropriate data to measure throughput through the system., Lack of information on the reasons why cases remain undetected means that strategies to reduce case attrition are essentially 'flying blind'. [ABSTRACT FROM AUTHOR]

Background Wirral University Teaching Hospital is a large district general hospital situated on the Wirral peninsula, UK. Because of the district's geographical and demographic characteristics, Wirral is an ideal location for population-based studies. Information on paediatric referrals, case mix and outcomes are scarce. We took advantage of our situation to conduct an epidemiological study of referrals to general paediatrics in Wirral in 1988 and again in 2006. A companion paper examines referrals to community paediatricians in the Department during the same period. Methods A prospective observational study of general paediatric outpatient referrals between 1 Feb and 31 May 2006 compared with the same period in 1988, using the same methodology. We included all children under the age of 15 offered a new patient appointment during the study period. Results The referral rate had increased significantly from 15.5 to 25.7 per thousand children under 15 per annum ( P < 0.01; Chi Squared). The most common conditions referred in 2006 were constipation (10.5%) and enuresis (7%) compared with asthma (15%) and heart murmurs (13.8%) in 1988. There were significantly fewer wasted appointments (5% vs. 12%), shorter waiting times (5% vs. 12% waited more than 12 weeks), faster treatment times (25% vs. 14% started treatment after the first appointment) and more discharges (41.2% vs. 30.5%) (all P < 0.01; Chi Squared). Conclusions More children were referred to paediatricians in 2006 compares with 1988. Services worked more efficiently, with better attendance, access and time to treatment. We provide information on changes in case mix that is not available elsewhere. This population-based study thus gives a unique insight into changes in referrals to UK general paediatricians. [ABSTRACT FROM AUTHOR]

Field CA, Gidley MD, Preshaw PM, Jakubovics N. Investigation and quantification of key periodontal pathogens in patients with type 2 diabetes. J Periodont Res 2012; 47: 470-478. © 2012 John Wiley & Sons A/S Background and Objective: Diabetes is a recognized risk factor for periodontitis. There are conflicting data regarding whether healthy diabetic patients or diabetic patients with chronic periodontitis have an altered subgingival microbiota compared with nondiabetic individuals. The aim of the present study was to detect quantitative differences in selected periodontopathogens in the subgingival plaque of diabetic patients using TaqMan quantitative PCR. Material and Methods: Type 2 diabetes mellitus patients with ( n = 9) or without chronic periodontal disease ( n = 15) were recruited and matched to nondiabetic control subjects ( n = 12 periodontally healthy, n = 12 chronic periodontitis). Subgingival plaque samples were collected from deep (> 4 mm probing depth) and shallow sites (≤ 3 mm probing depth) using paper points, and Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Porphyromonas gingivalis were quantified. Results: Forty-eight subjects (69 samples) were recruited. Marked differences were seen in the levels of all three bacterial species, relative to the total bacterial population, according to periodontal health status. Using real-time quantitative PCR, bacterial counts for P. gingivalis were significantly higher in deep pockets of diabetic and nondiabetic subjects compared with periodontally healthy subjects ( p < 0.05) but did not differ significantly between diabetics and nondiabetics. A. actinomycetemcomitans was detected in all groups in low quantities, and counts did not differ significantly between groups ( p > 0.05). F. nucleatum was abundant in all groups, with no clear significant differences between groups. P. gingivalis was found in higher quantities in periodontitis than in periodontally healthy subjects ( p < 0.05). Statistically significant positive correlations were identified between pocket depth and counts for all three species tested ( p < 0.05). Conclusion: A. actinomycetemcomitans, F. nucleatum and P. gingivalis were present in significantly different quantities and proportions in subgingival plaque, according to periodontal disease status. No significant differences were identified between the subgingival microbiota of type 2 diabetes mellitus patients compared with nondiabetic subjects. [ABSTRACT FROM AUTHOR]

Depression is a major problem for mental health. Empirical studies and clinical observations have shown that the symptoms of depression occur across four main domains-emotional, cognitive, somatic and interpersonal. However, commonly used depression assessment scales fail to address the evaluation of interpersonal symptoms, as summarized in this paper. Therefore, a new depression assessment scale, which aimed to evaluate all four domains of depressive symptomatology, was developed. In an initial analysis, a pilot 85-item questionnaire containing possible depressive symptoms was distributed for evaluation to experts from different mental health professions, from which 52 items were subsequently selected for the new multidimensional depression assessment scale. One hundred community participants completed the questionnaire along with the Beck Depression Inventory-II. The results indicated that the new depression scale had good psychometric properties. It was found to be reliable and valid for the assessment of depression severity and symptomatology, though it is emphasized that these data are only preliminary and based on a relatively healthy sample. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message [ABSTRACT FROM AUTHOR]

Background: A significant proportion of hospital deaths occur in intensive care units (ICU) and often follow a decision to limit or withdraw life‐sustaining treatment. Facilitating the preferred choice in place of death for babies/children is increasingly being advocated, although the literature on a home death is often limited to case reports. Aims and objectives: To examine (a) health care professionals' (HCPs) views and experience of transferring babies/children home to die from intensive care, (b) patient clinical characteristics that HCPs would consider transferring home and (c) barriers to transferring home. Design: A cross‐sectional descriptive web‐based survey. Methods: A total of 900 HCPs from paediatric and neonatal ICU across the United Kingdom were invited to participate. Results: A total of 191 (22%) respondents completed the survey; 135 (70.7%) reported being involved in transferring home to die. However, most (58.4%) had just transferred one or two patients in the last 3 years. Overall, respondents held positive views towards transfer, although there was some evidence of divided opinion. Patients identified as unsuitable for transfer included unstable patients (57.6%) and those in need of cardiovascular support (56%). There was statistically significant difference in views between those with and without experience, in that those with experience had more positive views. The most significant barrier was the lack of access to care in the community. Conclusions: HCPs view the concept of transferring critically ill babies/children home to die positively but have infrequent experience. Views held about transfers are influenced by previous experience. The clinical instability of patients and access to community care are central to decision‐making. Relevance to clinical practice: A home death for critically ill babies/children is occurring in the United Kingdom but infrequently. Experience of a transfer home positively influences views and increases confidence. Improved multi‐organizational collaboration between ICU and community care teams would assist decision‐making and facilitation for a transfer home. [ABSTRACT FROM AUTHOR]

This study compared higher education dental undergraduate student performance in online assessments with performance in traditional paper-based tests and investigated students' perceptions of the fairness and acceptability of online tests, and showed performance to be comparable. The project design involved two parallel cross-over trials, one in Year 3 ( n = 132) of the dental curriculum, one in Year 5 ( n = 134). A total of 266 students undertook related tests of the same knowledge base in both online and traditional paper formats. Order of presentation of the test form was randomized. One hundred and thirty-two students in Year 3 additionally completed questions concerning their perceptions of the acceptability and fairness of the online examination process. Focus group discussions were held with groups of students ( n = 30) from both Year 3 and 5 to explore their perceptions of the online format. The online tests were created using the commercial software package MaxExam (Bristol, UK). The results were analysed using repeated measures analysis of variance (ANOVA) with the order of presentation being entered as a variable in the analysis. The results of the study showed that for both Years 3 and 5 students there was a high degree of consistency in performance between the two versions of the tests, although a minority of students performed better in the online version of the test. Over 70% of students rated the online test as acceptable, and 90% felt that the online format did not disadvantage them even in a 'high-stakes' situation. From these results, we conclude that online assessment does not confer any disadvantage to students. Students perceive such assessment to be both fair and acceptable, and to have some advantages over the traditional paper-based methods of assessment. [ABSTRACT FROM AUTHOR]

This paper reports two studies that investigated children's conceptions of mental illness using a naíve theory approach, drawing upon a conceptual framework for analysing illness representations which distinguishes between the identity, causes, consequences, curability, and timeline of an illness. The studies utilized semi-structured interviewing and card selection tasks to assess 6- to I I-year-old children's conceptions of the causes and consequences (Study I ) and the curability and timeline (Study 2) of different mental and physical illnesses/ailments. The studies revealed that, at all ages, the children held coherent causal-explanatory ideas about the causes, consequences, curability, and timeline of both mental and physical illnesses/ailments. However, while younger children tended to rely on their knowledge of common physical illnesses when thinking about mental illnesses, providing contagion and contamination explanations of cause, older children demonstrated differences in their thinking about mental and physical illnesses. No substantial gender differences were found in the children's thinking. It is argued that children hold coherent conceptions of mental illness at all ages, but that mental illness only emerges as an ontologically distinct conceptual domain by the end of middle childhood. [ABSTRACT FROM AUTHOR]

This paper explores conceptions of commitment and styles of money management in heterosexual couples at two points in time: Just before the wedding (T1) and about a year later (T2). It also examines the potential effects of using FOCCUS as a form of marriage preparation (MP). Forty-two couples were recruited at T1 and randomly allocated to either A MP group and a group that would not be offered any marriage preparation - the Non-Marriage Preparation group (NMP). Individual, in-depth, semi-structured interviews were carried out at T1 and T2, recorded and fully transcribed. A thematic analysis (TA) yielded three themes or levels of commitment which were used to categorize couples at T1 and T2. Their money management styles were defined based on Pahl's (1989) typology. The results showed that conceptions of commitment had developed slightly overall by T2, and had been enhanced in the MP group. At T2, a more elaborated conception of commitment was associated with a greater tendency to treat money as a collective resource. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: Introduced species spreading to natural ecosystems is a leading cause of environmental change and a key feature of the Anthropocene. While there have been many studies of the traits of introduced and invasive species, less is known about the traits that affect a species' chances of reaching and establishing in new areas. We asked whether British species that are present in Australia have different traits to British species that are not present in Australia. Location: Great Britain and Australia. Methods: We compiled a list of all vascular plant species from Great Britain and divided them into those that are present in Australia (395 species) and those that are not present in Australia (1171 species). We compiled data for each species' seed mass, seedbank longevity, maximum plant height, flower size, flower colour and geographical extent in the British Isles. We conducted independent sample t‐tests for continuous variables and Chi‐squared tests for categorical variables to determine differences between groups. Results: We found British species present in Australia have, on average, larger geographic extents in the British Isles, longer periods of seed bank longevity (mean ~3 months as opposed to ~3 weeks), and maximum heights that are on average 36% taller than British species that are not present in Australia. However, British species present in Australia did not have significantly different flower size, flower colour or seed mass from British species that are not present in Australia. Main Conclusions: British species that are present in Australia and British species that are not present in Australia differ in several traits. These differences likely result from a combination of factors including introduction biases, environmental filters during establishment and stochasticity. Our results suggest that humans may be consciously and unconsciously selecting species for introduction. Some of the traits that are associated with an increased chance of a species being transported to/establishing in a new range also contribute to invasiveness. Thus, anthropogenic introduction biases could contribute to an increased risk of ecosystem invasion. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to understand the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings. Methods: A cross‐sectional study was conducted using data collected from an anonymous online survey. Participant agreement was measured using five‐point Likert scale (strongly disagree to strongly agree) against 38 belief statements informed by the Theoretical Domains Framework (TDF) of behaviour change. Results: From the complete responses (n = 119), 65% worked shifts without nights, 27% worked mixed shift rota including nights and 8% worked only night shifts. The statements ranked with the highest agreements were in the TDF domains: Environment Context/Resources (ECR) – mainly identified as a barrier to healthy eating, Behaviour Regulation (BR) and intention (IN) – identified as enablers to healthy eating. For the belief statement 'the available options for purchasing food are too expensive' (ECR), 80% of night workers and 75% non‐night workers agreed/strongly agreed. Taking their own food to work to prevent making unhealthy food choices (BR) had agreement/strong agreement in 73% of non‐night and 70% night workers; 74% non‐night workers and 80% of night workers agreed/strongly agreed with the statement 'I would like to eat healthily at work' (IN). Mixed shift workers agreed that following dietary advice was easier when working a non‐night compared to a night shift (p = 0.002). Conclusions: Access and affordability of food were identified as important determinants of dietary behaviour during shifts. The findings support interventions targeting the food environment for shift workers with T2D. Key points: The present study investigated the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings.The findings support previous findings from semi‐structured interviews, with the main domain influencing dietary behaviours being Environmental Context and Resources (i.e., physical and economic availability of food during shifts). The findings support interventions targeting the food environment across shift workers living with T2D. [ABSTRACT FROM AUTHOR]

Effective reciprocal communication is a vital component in forming and maintaining social relationships. Peer social play may provide a particularly important context for communicative skill development, as sophisticated negotiation and exchange are required to coordinate play. We focus on connectedness, a property of conversation referring to the topical relation between speakers' turns, to understand how partners coordinate ideas to build a shared play experience. The present study uses a longitudinal secondary analysis approach to drive forward our understanding of the individual and shared influences that contribute to connectedness during peer social play. Using data from a three‐wave, longitudinal study of children's play and social relationships during the first 3 years of school in the United Kingdom (https://osf.io/3p4q8/), we coded connectedness from transcripts of video observations of 148 children playing in pairs at wave three (mean age 6.79 years) and model individual differences in language ability, theory of mind, and emotion comprehension from all three waves as potential predictors of connectedness. Our results show substantial dyadic effects on connectedness, but individual differences in socio‐cognitive measures were not significant predictors of connectedness. These findings indicate the importance of dyadic and partner effects in children's social interactions and implicate the dyad as an essential focus for future research. [ABSTRACT FROM AUTHOR]

The article discusses the overseas marketing performance of British industry during 1870-1914. Unfortunately there is no detailed empirical study of the composition and pattern of British trade on a market by market, product by product, basis in the 40 years before 1914. However, an insignificant chi-square test on the changing shares of British exports by continent throws doubt that British trade with Europe and North America declined, while rising with Asia, Australia and Africa. Similar statistical tests did not support the hypothesis that in the years before 1914 British exports shifted from the U.S. and German markets to the safe markets of India and Australia, or that exports shifted from industrial to non-industrial markets. Many of the British consular reports contain familiar indictments of commercial performance overseas. The lack of attention to marketing methods and techniques marks a serious omission in the debate on entrepreneurial failure. The traditional picture of the British industrialist employing amateurish marketing techniques and outdated selling institutions is misleading.

This paper empirically tested two hypotheses in order to evaluate the validity and applicability of the APT to the UK stock market using monthly individual price data from the LSE. Results obtained in this study support the first hypothesis (HI) that the risk free rates are equal to the corresponding estimated intercept terms of the models tested. As this inference could have resulted from weak test methodology, another set of tests was conducted to see if the intercept terms were equal to zero. The earlier inference was supported due to the finding that the intercept term was significantly different from zero. However, the results of testing the second hypothesis (H2) utilizing two different procedures (i.e., the Chi-square test and the t-test) show that the risk premia are not significantly different from zero. This latter finding does not support the APT and is in conflict with the results of Hughes (1982) with regard to the Canadian stock market and several other studies (e.g., Gehr, 1975; Roll and Ross, 1980; and Chen, 1983) based on US stock market data. Given the mixed results obtained in this study, no conclusive statements can be made regarding the validity and the applicability of the APT to the capital markets of the UK. It should be noted that the results of previous tests of the APT using US and Canadian stock market data are also mixed at best." The results obtained in this study and in the previous studies do not provide any conclusive evidence either to accept or reject the APT. Further research is required before any conclusive judgement is passed on this theory which appears to have great potential. [ABSTRACT FROM AUTHOR]

Who responds most strongly to supervisor social undermining? Building on self‐verification theory (Swann, 1983, 1987), we theorize that employees with positive views of the self (i.e., higher core self‐evaluations [CSEs]) who also maintain higher trust in workplace management are more likely to experience heightened stress and turnover intentions when undermined. We argue that this subset of employees (high CSE, high trust) are more likely to feel misunderstood when undermined by their supervisor and that this lack of self‐verification partially explains their stronger responses to supervisor undermining. We find initial support for the first part of our model in a study of 259 healthcare workers in the United States and replicate and extend our findings in the second study of 330 employees in the United Kingdom. Our results suggest that the employees Human Resources often wishes to attract and retain—employees with high CSE and high trust in workplace management—react most strongly to supervisor social undermining. [ABSTRACT FROM AUTHOR]

Previous studies show that the effects of (non‐transparent) nudges can spill over to later similar decisions without nudges. In the current study, we aimed to determine whether such nudge temporal spillover effects are affected by making nudges transparent. The latter is recommended to (partly) mitigate ethical concerns surrounding the use of nudges. In two experiments, we nudged participants to complete a longer version of a survey. Participants were randomly assigned to either a control, a non‐disclosed nudge (using a default to promote taking the longer survey) condition or a disclosed nudge (in which the use of the default nudge was explained) condition. In both Study 1 (N = 1270) and Study 2 (N = 1258) we observed a temporal spillover effect of the disclosed nudge, suggesting that transparency does not negatively affect the temporal spillover effect. [ABSTRACT FROM AUTHOR]

Multidisciplinary teams are increasingly advocated for in healthcare policy consequent to their capacity to develop innovative solutions to seemingly intractable service and care challenges. Recent arguments that inspirational leadership styles may foster innovation in multidisciplinary teams point to their potential value in this effort. However, inconsistency in the capacity of such leaders to engender innovation highlights the need to understand the mechanisms and boundary conditions that determine when such leadership generates positive effects. We argue that follower positive mood acts to mediate the path between inspirational leadership and innovation and may account for its variable effects. By increasing positive team mood, inspirational leaders can potentially bring about more flexible thinking and enhance innovation but can also increase reliance on less effortful information processing, undermining innovative potential. In an effort to address the dilemma posed by these contrasting effects, we propose that professional salience acts as an important boundary condition of this relationship such that only when profession is salient do inspirational leaders enhance multidisciplinary team innovation through positive mood. An analysis of survey data from 60 UK‐based multidisciplinary healthcare teams, investigating the inspirational leadership of practice‐based innovation, supports our moderated mediation model. Finally, the implications for HRM are considered, specifically for leader development and work team design. [ABSTRACT FROM AUTHOR]

Introduction: Two parallel versions (A and B) of the Oxford Cognitive Screen (OCS) were developed in the United Kingdom (UK) as a stroke‐specific screen of five key cognitive domains commonly affected post‐stroke. We aimed to develop the Australian versions A and B (OCS‐AU), including Australian cut‐scores indicative of impairment. We hypothesised there to be no difference in performance between the UK and Australian normative data cohorts. Methods: Our multidisciplinary expert panel used the UK pre‐defined process to develop the OCS‐AU versions A and B. We then conducted a cross‐sectional normative study. We purposively recruited community‐dwelling, Australian‐born, and educated adults; with no known cognitive impairment; representative of age, sex, education level, and living location; at seven sites (four metropolitan, three regional) across four Australian states. Participants completed one or both OCS‐AU versions in a randomised order. Australian cohorts were compared with the corresponding UK cohorts for demographics using Pearson's chi‐squared test for sex and education, and Welch two‐sample t test for age. For the cut‐scores indicating cognitive impairment, the fifth (95th) percentiles and group mean performance score for each scored item were compared using Welch two‐sample t tests. The pre‐defined criteria for retaining OCS cut‐scores had no statistically significant difference in either percentile or group mean scores for each scored item. Results: Participants (n = 83) were recruited: fifty‐eight completed version A [age (years) mean = 61,SD = 15; 62% female], 60 completed version B [age (years) mean = 62,SD = 13, 53% female], and 35 completed both [age (years) mean = 64,SD = 11, 54% female]. Education was different between the cohorts for version B (12 years, p = 0.002). Cut‐scores for all 16 scored items for the OCS‐AU version B and 15/16 for version A met our pre‐defined criteria for retaining the OCS cut scores. Conclusions: The OCS‐AU provides clinicians with an Australian‐specific, first‐line cognitive screening tool for people after stroke. Early screening can guide treatment and management. [ABSTRACT FROM AUTHOR]

In 2018, an NHS Trust (UK) implemented an innovative Nursing System Framework (NSF). The NSF formalized a two‐year strategy, which provided teams with clear aims and measurable objectives to deliver care. Failures of coordination of nursing services are well‐recognized threats to the quality, safety and sustainability of care provision. Aim: To evaluate the efficacy of introducing a NSF in an NHS Trust, using nursing sensitive indicators and pre‐selected mortality, data outcome measures. Design: A before and after implementation, observational study. Methods: 105,437 admissions were extracted at an admission record level. Data was extracted from 1st September 2018 through to the 31st August 2019. Results: Using SQUIRE guidelines to report the study, insufficient evidence was found to reject a null hypothesis with a chi‐squared test of association between in‐hospital death and the NSF intervention period, with a p‐value of.091. However, trends were seen in the data, which suggested a positive association. Conclusion: The NSF is a complex intervention, which provides direction for improvements but requires further research to understand the benefits for nurses, Midwives, Health Visitors and patients. [ABSTRACT FROM AUTHOR]

Aim: To determine the incidence of cervical cancer in women referred through the 2‐week‐wait pathway for postcoital bleeding and abnormal appearance of the cervix. Methods: A retrospective cohort study was conducted of women with postcoital bleeding, or abnormal appearance of the cervix referred to colposcopy clinics through the 2‐week‐wait pathway for suspected cervical cancer at Cambridge University Hospitals in the United Kingdom over 5 years. Women were identified from a departmental database. Clinical and demographic data were collected. Categorical data was analyzed with chi‐squared or Fisher's exact tests and predictive values were calculated. Results: Of the 604 women referred, 1.16% were diagnosed with cervical cancer. None of the women who were up‐to‐date with cervical screening were diagnosed with cervical cancer, while 6.25% of women out‐of‐date with cervical screening or outside the screening age group were diagnosed with cervical cancer (p < 0.001). The positive predictive value for diagnosing cervical cancer was 1.70% for postcoital bleeding (95% confidence interval [CI] 0.64–3.7) and 0.31% for abnormal appearance of the cervix (95% CI 0.0008–1.7). Conclusions: The incidence of cervical cancer in women referred through the 2‐week‐wait pathway for postcoital bleeding and abnormal appearance of the cervix is low. These referrals have considerable implications for both patients and clinicians, and have a low predictive value for diagnosing cervical cancer. In light of emerging evidence and changing practices, referral guidelines should be reviewed based on up‐to‐date data and current practices. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective In a previous study we found that compulsory inpatient treatment was associated with an increase in the number of deaths over the following 5 years when compared to non-compulsory admission. This study aimed to examine the longer term mortality of patients admitted compulsorily. Method The mortality outcome of patients with a compulsory admission ( n = 81) and a comparison group ( n = 81) of patients admitted to the specialized eating disorder unit at the Maudsley Hospital in the period 1983-95 was traced over two decades through the National Register held by the National Health Service (NHS) Central Register. Results Approximately 20 years following admission there were 27 deaths in the series. The standardized mortality rate in the compulsory treatment group no longer differed significantly from that of the non-compulsory group. The suicides were not particularly linked with compulsory admission. Discussion Although the mortality in the 5 years following a compulsory admission is higher than that seen in the non-compulsory patients, this difference is attenuated over time. The overall standardized mortality rate remains elevated. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:860-865) [ABSTRACT FROM AUTHOR]

Background: Rabbits are popular pets, but research into their welfare is limited. This study analysed the potential association(s) between the provision of suitable housing and owner demographic factors. Methods: Data from 2017, 2018 and 2019 PDSA Animal Wellbeing (PAW) report surveys gave a sample of 1333 UK rabbit owners. Whether the rabbit housing was adequate or inadequate was ascertained by asking owners to indicate images of hutch and run size or indoor environment type that were similar to their own. The owner demographic factors collected included gender, education, household income and deprivation. Chi‐squared tests and binary logistic regression (univariable and multivariable) were used to investigate factors associated with adequate/inadequate housing. Results: One‐third (31.2%) of rabbits lived in inadequate housing and half were housed alone (51.4%). Male owners were more likely to report providing inadequate housing than females (odds ratio [OR] = 1.795, 95% confidence interval [CI] 1.319–2.441, p < 0.001). Compared to owners over 55 years old, those aged 25–34 years were more likely to house their rabbits inadequately (OR = 2.050, 95% CI 1.286–3.267, p = 0.003). Owners with a household income below average were more likely to report providing inadequate housing compared to those with a household income above average (OR = 1.406, 95% CI 1.025–1.928, p = 0.035). Conclusion: The findings identify that inadequate rabbit housing is provided by owners of all ages, genders and deprivation levels but highlight some particular owner demographics that could be useful to target if resources are limited. [ABSTRACT FROM AUTHOR]

In the context of a wider trend to individualize human resource management, this article examines the relationship between flexible working arrangements and individual performance. Drawing on a range of theories, this article also examines potential indirect effects on employee performance via job satisfaction and organizational commitment and analyzes whether these relationships vary according to whether the arrangement was set up through a formal process or negotiated informally between the employee and his or her line manager. Extant research has tended to focus on formal arrangements, however, informal arrangements are widespread and may better accommodate work-life preferences, thereby potentially fostering more positive attitudes from employees. Survey data from 2,617 employees in four large organizations with well-established flexible working policies are analyzed. Results from structural equation models show average positive indirect effects from informal flexible working, but also negative direct effects from formal flexible working. When two forms of flexible working amenable to being set up by both formal and informal means are examined separately, formal arrangements for flexibility over working hours are found to be negatively associated with performance, but also a source of greater job satisfaction; informal remote working arrangements have positive indirect effects via organizational commitment and job satisfaction on worker performance. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background Voice output communication aids (VOCAs) are a key form of aided communication within the field of augmentative and alternative communication (AAC). In recent years, rapid developments in technology have resulted in an explosion of devices available commercially, yet little research has been conducted into what people who use VOCAs think about them. Aims The aim of this research was to explore the perceptions of communication aid design from the perspective of end users and AAC professionals, with the objective being to inform and influence the design of future devices. Methods & Procedures A two-part study was conducted: interviews were undertaken with people who use VOCAs, and questionnaires were distributed to those who use aided communication and to AAC professionals. Analysis of the interview data was carried out using a qualitative method based on framework analysis, whilst descriptive statistics were generated from the questionnaire data. Interview participants were an opportunity sample of VOCA users within a defined region of the UK. Those recruited were over the age of 12 years and able to engage in the interview process; they were identified through the caseloads of local Speech and Language Therapists specializing in AAC. The questionnaire was marketed to the AAC community throughout the UK. Respondents were self-selecting as those using aided communication, their carers and AAC professionals. Outcomes & Results Eighteen people participated in the interviews. Questionnaires were completed by 43 people who use aided communication and 68 AAC professionals. The data suggest that current devices are considered to be neither reliable nor durable by users and professionals. Although features given a higher importance ranking are more likely to be perceived as available, a number of important design deficits are identified by users and/or professionals. Simplicity of design (and use) and the desire for devices which support communication that is as fast and spontaneous as possible also emerge as key requirements. Synthesis of the data produced a framework with three main themes covering the range of issues which influence the successful use of a VOCA: specific aspects of the design of a device; the consideration of the wider picture around the person; and the personal context in which someone uses their device. Conclusions & Implications Although the original aim of the project was to establish the user requirements of VOCA design, the data indicate that the characteristics of the device cannot be considered in isolation. Those factors uncovered highlight questions about whether the design of communication aids is truly effective in meeting the needs of the people who use them. Based on these data, an initial specification for future device design is proposed. [ABSTRACT FROM AUTHOR]

Background: Emergency general surgical patients are inherently at high risk of malnutrition. Early decision‐making with implementation is fundamental to patient recovery. For many patients, parenteral nutrition (PN) is the only feeding option available. The present study assessed the timing and outcomes of this decision‐making process. Methods: A sample of at least 10 consecutive adult patients admitted as a general surgical emergency to eight UK hospitals over 1 year who had received PN was identified. Patient demographics, basic descriptors and nutritional data were captured. Process measures regarding dates decisions were made or activities completed were extracted from records, as were outcome measures including PN complications. Six time frames examining the process of PN delivery were analysed. Associations between categorical and binary variables were investigated with a chi‐squared test with significance determined as p < 0.05. Results: In total, 125 patients were included. Intestinal obstruction was the most common diagnosis with 59% of all patients deemed high risk on nutritional assessment at admission. Median time to decision for PN was 5 days following admission (n = 122, interquartile range = 7). Patients received PN for a mean of 11 days. Eighty‐five percent of patients developed a complication, with a phosphate abnormality being the most commonly reported (54%). Only altered blood glucose levels appeared to correlate with a delay in starting PN (p < 0.01). Conclusions: The present study shows there are delays in the decision to use PN in the acutely ill surgical patient. Once initiated, the pathway is relatively short. There are high rates of electrolyte abnormalities in this population. [ABSTRACT FROM AUTHOR]

Objective: To explore the current practice and perceptions of health visitors in supporting multiple birth families. Design and sample: Practicing health visitors across the United Kingdom were invited to complete a cross‐sectional, descriptive, online survey. The questionnaire covered multiple birth caseload, education received about multiples and the experience of working with families. Two‐hundred and ninety health visitors completed the questionnaire. Descriptive and inferential statistics were used for analysis of the quantitative components and thematic analysis for the qualitative data. Results: Most health visitors had twins on their current workload. Most health visitors had not received any specific training or continuing professional development regarding the needs of multiple birth families. Supporting the families within the confines of reduced time and increased workload was challenging. Daily tasks of caring for multiples were the main areas that health visitors and parents wanted more information about. Conclusions: In the United Kingdom, health visitors are uniquely positioned to support multiple birth families, in particular during the more challenging early years. However, the findings of this study suggest that many health visitors are aware that the care and support that they are able to provide multiple birth families falls short of meeting their needs [ABSTRACT FROM AUTHOR]

The long‐term effects of childhood abuse have been well studied though the effects of abuse of specific types in adult psychiatric service users are less known. This study aimed to assess the association between childhood abuse and the development of harmful social and behavioural outcomes among adult psychiatric service users. Adult psychiatric service users were accessed from secondary mental health services in South London. A retrospective analysis was conducted of a randomly selected sample of 342 mental health records. Chi‐square tests and logistic regression models were used to examine associations between childhood abuse – sexual abuse, physical abuse and psychological/emotional abuse – and health and behavioural outcomes. This study identified that 109 (31.8%) psychiatric service users had some history of childhood abuse and more often presented with high‐risk or severe behaviours. Sexual abuse in childhood was linked with social isolation related to loss of friends (odds ratio (OR) = 2.68, P < 0.01), risky behaviours such as binge drinking (OR = 2.15, P < 0.05) and self‐harming (OR = 2.86, P < 0.01), while childhood physical abuse was associated with drug abuse in adulthood (OR = 1.88, P < 0.05). Revictimization (adult domestic violence) also impacted on service users' quality of life in terms of loss of housing (OR = 2.21, P < 0.05) and loss of friends/family contact (OR = 2.73, P < 0.01). These findings suggest childhood abuse may play an important role in shaping risk and vulnerability for mental health problems across a lifespan. In acute mental health services, the incorporation of a trauma‐informed nursing care model is necessary to generate a shift in culture in the delivery of care. [ABSTRACT FROM AUTHOR]

Background and Aims: Past research has found that young smokers are more likely to make quit attempts; however, there are conflicting findings regarding age and quit success. This study examined the degree to which smoker age is related to making quit attempts and quit success. Design Ten waves of the International Tobacco Control Policy Cohort survey (ITC‐4C) collected between 2002 and 2014, with nine wave‐to‐wave transitions with predictors at the first wave predicting quit attempts and success by the next wave. Setting: Canada, the United States, the United Kingdom and Australia. Participants: Data from 15 874 smokers categorized into four age groups at baseline (18–24, 25–39, 40–54 and 55+ years). Measurements Age, quit attempts and success (defined as ≥ 30 days abstinence confirmed, if possible, on a third wave for recent attempts). Findings Older smokers were more likely to smoke daily (χ2 = 1557.86, r = 0.136, P < 0.001) than younger smokers. Daily smokers were less likely to report quit attempts (38.1 versus 58.2%) and to achieve 30 days of abstinence (22.9 versus 34.3%) than non‐daily smokers. Older daily smokers were less likely to make quit attempts [0.61, confidence interval (CI) = 0.54–0.70, P < 0.001], even after controlling for indicators of nicotine dependence, country, sex, education, income, relationship status and household composition, than younger smokers. Younger smokers (< 25) were more likely to succeed for at least 30 days of abstinence, but only when compared with those aged 40–54 (OR = 0.83, 95% CI = 0.68–0.99). However, when controlling for heaviness of smoking the age effect disappeared. Significant interactions with age were found between age and intention when predicting quit attempts, and age and heaviness of smoking when predicting quit success. Conclusions: An international cohort study indicates that young smokers are more likely to attempt to quit and appear to have similar levels of success in abstaining from smoking compared with older smokers when controlling for dependence. Quit success in all ages is most predicted by lower levels of nicotine dependence. [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 article concerns rates of wage growth among women and minority groups and their impact on pay gaps. Specifically, it focuses on the pay progression of people with more than one disadvantaged identity, and on the impact of merit pay. Recent research indicates that pay gaps for people in more than one disadvantaged identity category are wider than those with a single-disadvantaged identity. It is not known whether these gaps are closing, at what rate, and whether all groups are affected equally; nor is it known whether merit pay alleviates or exacerbates existing pay gaps. In addressing these issues, the analysis draws on longitudinal payroll data from a large UK-based organization. Results show that pay gaps are closing; however, the rate of convergence is slow relative to the size of existing pay disparities, and slowest of all for people with disabilities. When the effect of merit pay is isolated, it is found to have a small positive effect in reducing pay gaps, and this effect is generally larger for dual/multiple-disadvantaged groups. These findings run counter to the well-established critique of merit pay in relation to equality outcomes. The implications of this are discussed, and an agenda for research and practice is set out. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background and aims: In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co‐use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non‐smokers and (2) investigate mental health problems among non‐users, tobacco‐only, cannabis‐only and co‐users of both substances. Design Cross‐sectional national on‐line survey (Action on Smoking and Health) fielded in February–March 2020. Setting: Great Britain. Participants: Adults in Great Britain aged ≥ 18 years (n = 12 809) Measurements Tobacco use status [smoker (daily or non‐daily) or non‐smoker (never or ex‐smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self‐reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. Findings In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non‐smokers [past‐year: 4.7%; adjusted odds ratio (aOR) = 10.07, 95% confidence interval (CI) = 8.4–12.0; daily: 0.7%; aOR = 24.6, 95% CI = 18.0–33.6)]. Co‐administration with tobacco was common (46.2% of non‐smokers, 80.8% of tobacco smokers). Co‐users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis‐only (45.8%), tobacco‐only (33.2%) and non‐users (22.7%; all P ≤ 0.05). Conclusion: Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non‐smokers. Co‐administration of cannabis and tobacco, via smoking, appears to be common, including among self‐identified non‐smokers. Mental health problems appear to be particularly common among dual users. [ABSTRACT FROM AUTHOR]

Social support and an emerging sense of community are common in flooding, but postflood group dynamics have not been fully addressed. In the context of a flooded community, we explore how social identification with one's community emerges and affects well‐being, collective efficacy, and social support. Results from a quantitative survey show that social identification was positively associated with common fate, collective efficacy, and well‐being through residents' expectations of support and shared goals. Importantly, social identification and disaster exposure interacted: For flooded residents, observing support was associated with providing support regardless of levels of social identification. For unaffected residents there was no association between observed and provided support, regardless of levels of social identification. However, for indirectly affected residents observing support was associated to providing support but only when they highly identified with the community. We argue that structural factors should also be considered when exploring the effects of group membership. [ABSTRACT FROM AUTHOR]

Maternal nutrition during the post‐partum period (PPP) is important for optimal health. The aim of this study was to explore dietary habits, lifestyle patterns and barriers to healthy eating in post‐partum women. An online survey exploring eating habits, weight status, sleep duration, breastfeeding, nutrition knowledge, physical activity, provision of advice and barriers to healthy eating was completed by 228 women (56.1% were 25–34 years, mean PPP of 5.73 ± 3.31 months). A sub‐sample of 34 women (50% were 35–44 years) completed an optional online multiple‐pass 24‐hour recall. At 6 months post‐partum (n = 60), 72.3% of participants weighed more than their pre‐pregnancy weight (mean 5.56 ± 4.61 kg). In addition, while 60.8% (n = 107) of women had a healthy body mass index (BMI) pre‐pregnancy, this dropped to 46.7% (n = 77) in the PPP. Only 2.2% of women were meeting current UK physical activity guidelines and 73.7% were not meeting the 5 A DAY fruit and vegetable recommendations. Consumption of high calorie snacks and meal skipping were significantly higher during the PPP compared to pre‐pregnancy (P < 0.01). Meal skipping was significantly associated with poor nutrition knowledge (P < 0.05). Women who were breastfeeding had significantly lower BMI than those who were bottle‐feeding after adjusting for age of baby, education, socio‐economic status and BMI pre‐pregnancy (P < 0.05). Fatigue, lack of time and feeling stressed were the most common self‐reported barriers to healthy eating, and these were greater for women with low combined household income and those having ≥3 children (P < 0.05). Dietary analysis showed that women were not meeting the national recommendations for energy, fibre, iron and vitamin D. Diet and lifestyle advice given to post‐partum women needs to be tailored to different sociodemographic characteristics, pre‐pregnancy health status and baseline nutrition knowledge, with a greater focus on those experiencing more barriers to healthy eating. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic and subsequent lockdown and social distancing led to changes to breastfeeding support available to women in the United Kingdom. Face‐to‐face professional support was reduced, and face‐to‐face peer support was cancelled. Anecdotal media accounts highlighted practices separating some mothers and babies in hospitals, alongside inaccurate stories of the safety of breastfeeding circulating. Meanwhile, new families were confined to their homes, separated from families and support networks. Given that we know breastfeeding is best supported by practices that keep mother and baby together, high‐quality professional and peer‐to‐peer support, and positive maternal well‐being, it is important to understand the impact of the pandemic upon the ability to breastfeed. To explore this, we conducted an online survey with 1219 breastfeeding mothers in the United Kingdom with a baby 0–12 months old to understand the impact of the pandemic upon breastfeeding duration, experiences and support. The results highlighted two very different experiences: 41.8% of mothers felt that breastfeeding was protected due to lockdown, but 27.0% of mothers struggled to get support and had numerous barriers stemming from lockdown with some stopped breastfeeding before they were ready. Mothers with a lower education, with more challenging living circumstances and from Black and minority ethnic backgrounds were more likely to find the impact of lockdown challenging and stop breastfeeding. The findings are vital in understanding how we now support those women who may be grieving their loss of breastfeeding and are affected by their negative experiences and how we can learn from those with a positive experience to make sure all breastfeeding women are better supported if similar future events arise. [ABSTRACT FROM AUTHOR]

Background: Illness and death are part of life for everyone, including people with intellectual disabilities. This study investigated the extent to which staff communicate about death with people with intellectual disability facing terminal illness or bereavement. Method: Staff who support people with intellectual disability in the UK (n = 690) completed an electronic survey. Detailed data were obtained from staff where a client had died in the past 12 months (n = 111), was terminally ill (n = 41) or had been bereaved (n = 200). Analysis included descriptive and chi‐squared statistics. Results: 52.6% of people with intellectual disability who were terminally ill were told about their illness, and 18.1% were told they would die. Of those experiencing an anticipated bereavement, 32.4% of staff said no one talked about this with them beforehand. A quarter of staff had received training on end of life or bereavement. Conclusion: Death affects many people with intellectual disability. Staff require training and support in communicating death. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

BACKGROUND Teachers report higher levels of stress than most occupational groups. Burnout is a specific psychological condition that results from chronic job stress characterized by emotional exhaustion, low personal accomplishment, and depersonalization. This study considers associations between aspects of the school environment and teacher burnout. METHODS: Exploratory analysis of baseline data from a cluster randomized controlled trial of 40 schools and 2278 teachers in the United Kingdom. Multilevel methods were used to consider the associations between different compositional and contextual aspects of the school environment and teacher burnout. RESULTS: There was evidence for school effects on teacher burnout, evidenced by ICCs and likelihood ratio tests, supporting the association between school environment and teacher burnout. The factors most consistently associated with teacher burnout in our study were teachers' perceptions of the school's safety and support and student attitudes to learning. CONCLUSIONS: The school environment does influence teacher burnout. More research is needed to develop and test causal pathways between the school environment and teacher burnout, and to understand ecological and individual predictors of teacher burnout and the interaction between the two. [ABSTRACT FROM AUTHOR]

Background: Primary progressive aphasia (PPA) describes a heterogeneous group of language‐led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. Aims: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. Methods & Procedures: A 37‐item, pilot‐tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. Outcomes & Results: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke‐related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment‐focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision‐making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. Conclusions & Implications: This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence‐based care pathways for people with PPA in order to advocate for further commissioning of clinical services. [ABSTRACT FROM AUTHOR]