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Introduction: The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self‐management of stoma‐related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Methods: Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self‐management intervention. Results: Nineteen young people, aged 19–33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty‐nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7‐point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Conclusions: Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self‐management resource for young people with an IBD stoma and have relevance for the clinical management of stoma‐related distress in this population. Patient or Public Contribution: Three patient contributors are co‐authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2‐h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self‐manage distress related to stoma surgery. [ABSTRACT FROM AUTHOR]

This paper calls for greater attention to the interpersonal aspects of youth activism through a sociological and Black feminist exploration of peer relationships within youth political engagement. Drawing on a multi‐method qualitative research, the work foregrounds the perspectives and experiences of Black girls and girls of colour involved in an anti‐racist Scottish youth work charity. I argue that community and friendship ties cultivated participants' activism. Moreover, participants sought to enact social change by undertaking activist educational practices with their peers. This paper demonstrates how studying young people's peer relationships can engender a better understanding of youth activism and support it. [ABSTRACT FROM AUTHOR]

Background: Big data research requires public support. It has been argued that this can be achieved by public involvement and engagement to ensure that public views are at the centre of research projects. Researchers should aim to include diverse communities, including seldom‐heard voices, to ensure that a range of voices are heard and that research is meaningful to them. Objective: We explored how researchers involve and engage seldom‐heard communities around big data research. Methods: This is a qualitative study. Researchers who had experience of involving or engaging seldom‐heard communities in big data research were recruited. They were based in England (n = 5), Scotland (n = 4), Belgium (n = 2) and Canada (n = 1). Twelve semistructured interviews were conducted on Zoom. All interviews were audio‐recorded and transcribed, and we used reflexive thematic analysis to analyse participants' experiences. Results: The analysis highlighted the complexity of involving and engaging seldom‐heard communities around big data research. Four themes were developed to represent participants' experiences: (1) abstraction and complexity of big data, (2) one size does not fit all, (3) working in partnership and (4) empowering the public contribution. Conclusion: The study offers researchers a better understanding of how to involve and engage seldom‐heard communities in a meaningful way around big data research. There is no one right approach, with involvement and engagement activities required to be project‐specific and dependent on the public contributors, researchers' needs, resources and time available. Patient and Public Involvement: Two public contributors are authors of the paper and they were involved in the study design, analysis and writing. [ABSTRACT FROM AUTHOR]

Paternal incarceration (PI) is recognised as a severely stigmatising event that undermines social connections leaving affected children isolated and vulnerable. However, few studies have explored social group membership as a potential mediator of positive outcomes. This paper analysed data from two national contexts, Scotland and the United States, to examine the potential for social group membership in childhood to mediate the association between PI and child behavioural and emotional outcomes. Study 1 reported on cross‐sectional data from the Growing Up in Scotland dataset of children aged 12 years. Study 2 used longitudinal data from the Fragile Families cohort study (USA) of children aged 9 years and then 15 years. Children and parents completed measures of PI, children's group membership, as well as positive functioning. In Study 1, a mediated indirect effect of PI on prosocial behaviour via children's group membership was observed. In Study 2, children's reported social group membership mediated the effect of PI on positive adolescent functioning longitudinally. Whilst experiences of PI at age 9 were linked with lower group membership at age 15, group membership was associated with higher levels of positive adolescent functioning. This has implications for the support families receive when a parent is incarcerated to avoid children serving sentences for 'the sins of their fathers'. [ABSTRACT FROM AUTHOR]

Background: As digital tools are increasingly used to support COVID‐19 contact tracing, the equity implications must be considered. As part of a study to understand the public's views of digital contact tracing tools developed for the national 'Test and Protect' programme in Scotland, we aimed to explore the views of groups often excluded from such discussions. This paper reports on their views about the potential for contact tracing to exacerbate inequalities. Methods: A qualitative study was carried out; interviews were conducted with key informants from organizations supporting people in marginalized situations, followed by interviews and focus groups with people recruited from these groups. Participants included, or represented, minority ethnic groups, asylum seekers and refugees and those experiencing multiple disadvantage including severe and enduring poverty. Results: A total of 42 people participated: 13 key informants and 29 members of the public. While public participants were supportive of contact tracing, key informants raised concerns. Both sets of participants spoke about how contact tracing, and its associated digital tools, might increase inequalities. Barriers included finances (inability to afford smartphones or the data to ensure access to the internet); language (digital tools were available only in English and required a degree of literacy, even for English speakers); and trust (many marginalized groups distrusted statutory organizations and there were concerns that data may be passed to other organizations). One strength was that NHS Scotland, the data guardian, is seen as a generally trustworthy organization. Poverty was recognized as a barrier to people's ability to self‐isolate. Some participants were concerned about giving contact details of individuals who might struggle to self‐isolate for financial reasons. Conclusions: The impact of contact tracing and associated digital tools on marginalized populations needs careful monitoring. This should include the contact tracing process and the ability of people to self‐isolate. Regular clear messaging from trusted groups and community members could help maintain trust and participation in the programme. Patient and Public Contribution: Our patient and public involvement coapplicant, L. L., was involved in all aspects of the study including coauthorship. Interim results were presented to our local Public and Patient Involvement and Engagement Group, who commented on interpretation and made suggestions about further recruitment. [ABSTRACT FROM AUTHOR]

Adoption and permanence planning has been a key feature of Scotland's policy in relation to children and young people who are "looked after." Although policy and law has significantly developed in recent years, there has been comparatively little research on permanence processes in Scotland. This paper outlines key findings from the first comprehensive study of permanence planning in Scotland. It examines the process for two cohorts of children where adoption or other types of permanence orders were made. The children were selected under the long standing Adoption (Scotland) Act 1978 and the more recent Adoption and Children (Scotland) Act 2007. In total, 300 cases were examined, analysing data from the children's first contact with services through to the order made by the Scottish Courts. This paper pays particular attention to the timescales found at key stages under the two sets of legislation and asks what difference the change in legislation has made. [ABSTRACT FROM AUTHOR]

Objectives: This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities. Methods: Forty‐six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis. Results: Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia. Discussion: The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home. Key points: Neighbourhoods begin within homes and are interconnected. This relationship has important implications for the discourse of ageing in place.'Home' for people living with dementia holds the same meanings for those without dementia, but with some notable differences. It is important to recognise the shifting dynamics of home and to recognise the complexity of home in the context of dementia. There is not a fixed solution to the challenges of ageing at home with dementia, but support and understanding need to evolve alongside people with lived experience.Homes are a site of renegotiation where new meanings are created to reflect the changing nature of home and the lived experience of home for those with dementia.The study has provided findings through innovation in the research design. The employment of creative methods enabled people living with dementia to participate in sharing their own narratives of home.The work provides evidence where there is a current gap in understanding 'what matters' about home for people living with dementia. [ABSTRACT FROM AUTHOR]

This paper estimates the impact of spousal bereavement on hospital inpatient use for the surviving bereaved by following the experience of 94,272 married Scottish individuals from 1991 until 2009 using a difference-in-difference model. We also consider the sample selection issues related to differences in survival between the bereaved and non-bereaved using a simple Cox Proportional-Hazard model. Before conducting these estimations, propensity score approaches are used to re-weight the non-bereaved to generate a more random-like comparison sample for the bereaved. We find that those bereaved who survive are both more likely to be admitted and to stay longer in hospital than a comparable non-bereaved cohort. Bereavement is estimated to induce on average an extra 0.24 (95% CI [0.15, 0.33]) hospital inpatient days per year. Similar to previous studies, we estimate the bereaved have a 19.2% (95% CI [12.5%, 26.3%]) higher mortality rate than the comparable non-bereaved cohort. [ABSTRACT FROM AUTHOR]

This paper presents the findings from an analysis of 56 significant case reviews (SCRs) in Scotland. In contrast to England and Wales where national analyses have been undertaken for many years, until this study was undertaken, the findings from SCRs had not previously been collated nationally. The paper discusses child, parent, environmental and agency factors that were identified in the SCRs and, whilst noting that the pathways to death or harm will be unique in individual cases, tries to further our understanding of the ways in which these different factors may interact to result in death or harm. A significant finding was the high number of SCRs that relate to the care and protection of children living in families whose lives are dominated by drug use and the associated issues this brings, including criminality and neighbourhood problems. Another challenging finding was the lack of suitable resources for the placement and support of troubled teenagers. Finally, a number of SCRs involved long-term neglect and/or sexual abuse of school or nursery age children who had been known to statutory services for many years. [ABSTRACT FROM AUTHOR]

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Context Health care organisations are increasingly conceptualised as complex, indivisible entities made up of web-like networks of staff that connect to each other in changeable ways. This study draws on the theoretical framework of activity theory and the concept of knotworking to illustrate how health professionals improvise collaboratively to negotiate everyday challenges and contribute positively to patients' health priorities. Objectives The aim of this paper is to contribute to evolving ideas about collective learning, change and improvement in secondary care by exploring how health professionals work and learn together and how this compares with earlier findings from primary care. Methods This study applied a constructionist methodology within the research paradigm of interpretivism. Qualitative data were gathered through 26 hours of observations and 17 field interviews within the natural environment of a working hospital over a 3-month period. The research site encompassed a medical receiving ward, a chronic ward, an out-patient clinic and the connecting corridors. Staff participants included a range of clinical, nursing, ancillary and clerical staff. Results The study found a recurring pattern of spontaneous team forming and interprofessional shared learning to respond to care needs within the hospital as they arise. These are presented in four analytical themes: motion, flux and the unpredictability of 'team spirit'; adaptive, responsive learning through seeing, doing and asking questions; the collective learning gap between doctors and other staff; and frustration, compassion and the desire for improvement. Conclusions Health care professionals in the hospital setting both create and experience complex inclusion and exclusion behaviours that define who is empowered to act with professional authority in any given moment of care. This paper discusses issues of power, the particular exclusion of doctors from interprofessional knotworking, and the greater emphasis on questions as the pivotal aspect of shared collective learning when compared with primary care. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to uncover perspectives on the COVID‐19 pandemic and the responses implemented by the UK and Scottish Governments to help control the spread of infection. Such understanding could help to inform future responses to pandemics at individual, community and national levels. Method: Q methodology was used to elicit perspectives from people in England and Scotland with different experiences of the pandemic including public health officials, key workers, those on furlough, those who were unvaccinated or vaccinated to different levels, those who were 'shielding' because they were at higher risk and people with different scientific expertise. Participants rank‐ordered phrases about different aspects of COVID‐19 according to their viewpoint. Factor analysis was then conducted in conjunction with interview material from the same respondents. Results: A four‐factor solution was statistically supported and was interpretable alongside the qualitative accounts of participants loading on these factors. These four perspectives are titled Dangerous and Unaccountable Leadership, Fear and Anger at Policy and Public responses, Governing Through a Crisis and Injustices Exposed. Conclusion: The four perspectives demonstrate plurality and nuance in views on COVID‐19 and the associated policies and restrictions, going beyond a binary narrative that has been apparent in popular and social media. The four perspectives include some areas of common ground, as well as disagreement. We argue that understanding the detail of different perspectives might be used to build cohesion around policy initiatives in future. Patient or Public Contribution: The development of the statement set, which is rank‐ordered by participants in a Q study, and factor interpretations were informed by views of the general public. The statement set was initially developed using existing publicly available material based on members of the general public experiencing the pandemic first hand. It was then piloted with members of the public experiencing different challenges as a result of COVID‐19 and the subsequent lockdown and updated based on feedback. Finally, interpretations of the identified factors were presented publicly and edited according to their feedback. [ABSTRACT FROM AUTHOR]

Children's participation in decision making of all kinds is of increasing interest across the world as more and more countries seek to comply with Article 12 of the United Nations Convention on the Rights of the Child. The participation rights of children who are in the care of the state are of particular concern. Recent research in England suggests that Independent Reviewing Officers (IROs) can play a crucial role in ensuring that looked after and accommodated children are able to participate in care planning and review processes. This paper outlines the findings of the first Scottish study to investigate the role of Reviewing Officers in encouraging children's participation in reviews. Surveys were collected from social workers, Reviewing Officers and young people after 69 review meetings as part of an action research study. Follow-up qualitative interviews were then completed with 10 young people and a focus group held with the five participating Reviewing Officers. The findings suggest that participation in looked after reviews can best be understood as a cyclical and relational process and that taking part in action research may enhance participation practices. While the role of the Reviewing Officer was found to be important, the findings suggest that everyone involved in the care and support of the young person needs to encourage participation processes that are individualized. [ABSTRACT FROM AUTHOR]

Introduction: In the United Kingdom, fractures of the cervical dens process in older and/or frail patients are usually managed nonsurgically in a hard collar. However, hard collars can lead to complications and this management approach is now being questioned, with growing interest in maximising patients' short‐term quality‐of‐life. It is vital that patients' perspectives are considered; yet, there is a dearth of literature examining the aspect. To help inform wider decision‐making about use of collar/no collar management of dens fractures in older/frail people, we explored older/frail people's experience of the two management approaches and how they affected their perceived quality‐of‐life. Methods: We interviewed older and/or frail adults with a recent dens fracture (aged ≥65 years or with a clinical frailty score of ≥5) or their caregiver. Participants were recruited from both arms of a clinical trial comparing management using a hard collar for 12 weeks (SM) with early removal of the collar (ERC) and were interviewed following randomisation and again, 12–16 weeks later. Data were analysed using a framework approach. Results: Both participant groups (SM/ERC) reported substantial, negative quality‐of‐life (QoL) experiences, with the fall itself and lack of access to care services and information being frequent major contributory factors. Many negative experiences cut across both participant groups, including pain, fatigue, diminished autonomy and reduced involvement in personally meaningful activities. However, we identified some subtle, yet discernible, ways in which using SM/ERC reinforced or alleviated (negative) QoL impacts, with the perceived benefits/burdens to using SM/ERC varying between different individuals. Conclusion: Study findings can be used to support informed decision‐making about SM/ERC management of dens fractures in older/frail patients. Patient or Public Contribution: Public and patient involvement contributors were involved in the study design, development of interview topic guides and interpretation of study findings. [ABSTRACT FROM AUTHOR]

Objective The focus of simulation-based education ( SBE) research has been limited to outcome and effectiveness studies. The effect of social and cultural influences on SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical boot camp ( BC). Methods A rapid ethnographic study, employing the theoretical lenses of complexity and activity theory and Bourdieu's concept of 'capital', to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with faculty members ( n = 10, including the lead faculty member, session leaders and junior faculty members) and participants ( n = 19 core surgical trainees and early-stage residents). Results Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytical themes. First, the complexity of the surgical training system and wider health care education context, and how this influenced the development of the BC. Second, participants' views of the BC as a vehicle not just for learning skills but for gaining 'insider information' on how best to progress in surgical training. Finally, the explicit aim of faculty members to use the Scottish Surgical Bootcamp to welcome trainees and residents into the world of surgery, and how this occurred. Conclusions To the best of our knowledge, this is the first empirical study of a surgical BC that takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that a BC is as much about social and cultural processes as it is about individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research. [ABSTRACT FROM AUTHOR]

For migrant children, moving to a new country is marked by excitement, anxiety and practical challenges in managing this significant transition. This paper draws upon the concepts of social capital and social networks to examine migrant children's access to services post‐migration. Using data from a qualitative study with Eastern European families in Scotland, we identify a range of cumulative barriers that limit children's access to services and illustrate how their experiences are shaped by ethnicity, social class and place. The study shows that migrant children are often disadvantaged post‐migration and develop their own mechanisms to mitigate the impact of migration on their lives. We argue that migrant children's own social networks are relevant and they need to be analysed through a more individualised approach. [ABSTRACT FROM AUTHOR]

Introduction: Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross‐culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period. Methods: Manual maternity case note review to evaluate the 80% continuity of carer and 3% planned home birth rate targets. Results: Of 1466 women booking for maternity care, 69 joined the scheme. Forty‐four had a planned home birth (3% overall), of whom seven were originally deemed ineligible. Of the 44, eight (18%) also achieved 80% continuity of carer with the primary midwife; by including a home birth team colleague, the continuity rate rose to 73%. Women whose care achieved home birth and continuity targets had lower deprivation scores. Eligibility issues, women's changing circumstances, and data recording lapses were complicating issues. Conclusions: Targets must be both feasible and meaningful and should be complemented by assessing a broad range of outcomes while viewing the scheme holistically. By expanding eligibility criteria, the home birth rate target was met; including input from a home birth team colleague in the calculation meant the continuity target was nearly met. With dedicated and competent staff, adequate resource and political support, and when considered in the round, the scheme's viability within local services was confirmed. Other generalizable learning points included the need to standardize definitions and data recording methods. Comparability across schemes helps grow the evidence base so that the links between processes and outcomes can be identified. [ABSTRACT FROM AUTHOR]

Background: As most young teenagers grow up in families, parents might be well situated to facilitate and support their weight management and thereby prevent or manage obesity prior to adulthood. Aim: This paper explores parents' perceptions of, and views about, their teenage children's weight and the factors that influence parents' weight management strategies. Design, setting and participants: We conducted two qualitative studies in Scotland, UK, involving in‐depth interviews with the parents of overweight/obese and ‘normal’ weight 13–15 year olds (n = 69). Findings: Parents' concerns about their own weight provided useful context for understanding their attitudes or actions with regards to their teenage child. Some parents described their teenager's weight as being of concern to them, although puberty often introduced confusion about a child's weight status. Genetic explanations were very often put forward as a way of making sense of teenage weight or body size. Frustration about advising teenagers about weight management was expressed, and some parents worried about giving their growing child a ‘problem’ if they directly raised concerns about weight with them. Discussion: Parents' views about their own weight as well as social and moral norms about labelling a teenager as overweight or as needing help with their weight could usefully inform patient‐centred service development. Parent/teenage partnerships and supporting parents to create a healthy home in which teenagers can make healthier choices are suggestions for intervention development. Conclusion: The study highlights the importance of taking parents' perceptions into account when developing family‐based interventions to address teenage overweight and obesity. [ABSTRACT FROM AUTHOR]

Children rarely disclose sexual abuse. Hence, studies of children's abuse experiences are relatively rare. This paper reports on a qualitative analysis of 2986 cases of self-disclosure of sexual abuse from children, aged 5-18 years, who contacted Child Line Scotland, a free, confidential telephone counselling service. Children discussed their feelings regarding the abuse, the impact of abuse on their health and well-being, sources of support, disclosure, coping strategies, the context in which abuse occurs and the various ways in which they were groomed or their compliance in abuse was gained. Children's narratives contained detailed contextual information on their experiences of sexual abuse, perpetrators of sexual abuse and the circumstances in which sexual abuse occurs. The way in which children communicated about sexual abuse was found to differ quite considerably, and the terminology they employed was often markedly different from adult constructs. Nonetheless, children of all ages were able to describe their experiences and their feelings around the abuse in considerable detail. This study provides a rare insight into children's accounts of sexual abuse. The findings illustrate the profound impact that sexual abuse has on the lives of children and their understandings of the circumstances in which abuse occurs. [ABSTRACT FROM AUTHOR]

ABSTRACT Until recently, little was known about kinship care in the UK. Research has begun to illuminate the circumstances which lead to children being cared for by relatives, and the stresses and strains experienced by carers. However, most UK research has only considered 'looked-after' children placed with formal approved kinship foster carers, although this group forms the smallest proportion of children in kinship arrangements. In this paper, we use microdata from the 2001 UK Population Census to examine the characteristics of kinship carers and children, and demonstrate that most children in kinship care are growing up in informal unregulated arrangements. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Little is known about the response of post-partum women from deprived backgrounds to weight management interventions, however behavioural intervention trials in disadvantaged communities are often characterised by recruitment difficulties. Recruitment and retention is key to the robust conduct of an effective trial, and exploratory work is essential prior to a definitive randomised controlled trial. This paper describes strategies used to recruit to the WeighWell feasibility study, which aimed to recruit 60 overweight or obese post-partum women living in areas of deprivation to a trial of a weight-loss intervention. Recruitment strategies included the following: (1) distribution of posters and 'business cards'; (2) newspaper advertisements; (3) visits to community groups; and (4) personalised letters of invitation sent via the National Health Service (NHS). Potential participants were screened for eligibility following response to a Freephone number. Body mass index was calculated using self-reported body weight and height. Over 6 months, 142 women responded of whom 65 (46%) met the eligibility criteria. The most effective methods for recruiting eligible women and those who went on to complete the study ( n = 36) were visits to community groups (37% and 42%, respectively), personalised letters (26% and 17%, respectively) and posters and 'business cards' (22% and 31%, respectively). These results emphasise the need to utilise a range of strategies beyond traditional NHS settings. Current approaches might be enhanced by sending personal contact letters via their General Practitioner to women identified as eligible at post-natal discharge. Under-reporting of body weight by self-report suggests that a threshold lower than 25 kg/m2 should be utilised for screening purposes. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 995-1005 Context A particularly onerous aspect of the transition from medical student to practising doctor concerns the necessity to be able to rapidly identify acutely unwell patients and initiate appropriate resuscitation. These are skills in which many graduates feel poorly prepared and are considered by some to be best learned on the job. This constructivist study investigated the factors that influence the behaviour of junior doctors in this context and initiated the development of a framework that promotes understanding of this important area. Methods Focus groups involving 36 clinicians with a variety of clinical experience were conducted and analysed using a qualitative, grounded theory approach. The complex relationships between emergent themes guided the development of a framework that was refined and validated by further interviews with participants. Results Six main themes, grouped under three broad headings, emerged from the data: 'transferring knowledge into practice' and 'decision making and uncertainty' (cognitive challenges); 'acts and omissions' and 'identity and expectations' (roles and responsibilities), and, finally, 'the medical hierarchy' and 'performing under stress' (environmental factors). The framework presented within this paper illustrates the complex relationships between these factors. Conclusions Although the potential of metacognitive strategies to reduce medical error is acknowledged, the framework promotes looking beyond the individual to consider the contributions to patient safety of identity issues, role uncertainty and the hierarchical clinical environment. A more distributed approach to situation awareness may help junior doctors to better tolerate complexity and uncertainty. The efficacy of simulation as an educational strategy may be improved by finding ways to recreate the hierarchical and stressful environment in which junior doctors practise. Junior doctors should be aware of the impact of affect and emotion on behaviour, and clinical supervisors should strive to ensure that roles and responsibilities are explicitly discussed. [ABSTRACT FROM AUTHOR]

There has been little research on social workers' views and experiences of managing contact for children in public care, and none focused in Scotland, where different institutional and legal features provide contrast with the rest of the UK. This study explored the views of 19 social work practitioners and managers and three Reporters to the Children's Hearing system regarding the management of contact for children in non-permanent placements, using semi-structured interviews and a focus group. The paper focuses on the themes of the supervision and assessment of contact, risks associated with contact and contact via ICT-e-mail and the internet. It suggests improvements in assessing contact are needed and concludes that while there are strengths in practitioners' current awareness of risks, a risk-based conception of contact, as exemplified by most respondents' views about the use of new technology, is in tension with the thrust of current legislation; conceptions of contact need to be flexible enough to embrace the variety of purposes contact might serve. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims: To evaluate whether adding financial incentives to usual care is cost‐effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone. Design: Cost‐effectiveness analysis (CEA) and cost–utility analysis (CUA) from a health‐care provider's perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long‐term analyses were conducted from the same perspective, using an existing Markov model over a life‐time horizon. Setting: Seven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom. Participants: In the short‐term analysis, CPIT III participants were assessed: women 16 years or older, self‐reporting as smokers, fewer than 24 weeks pregnant and English‐speaking (n = 944). The same population was used for the life‐time analysis, plus their infants. Measurements Costs included financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was a biochemically verified quit rate for the CEA and quality‐adjusted life‐years (QALYs) for CUA. Costs are presented in 2020 GBP sterling (£). Data for the life‐time analysis came from the trial and were combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied. Findings The short‐term incremental cost per quitter was £4400 and cost per QALY was £150 000. Results of sensitivity analyses confirmed these results. The long‐term analysis combined costs and outcomes for mother and infants; results showed a cost saving of £37 [95% confidence interval (CI]) = £35–106] and increase in QALYs of 0.171 (95% CI = 0.124–0.229). These findings indicate that, over a life‐time, financial incentives are cost‐saving and improve health outcomes. Conclusions: In the United Kingdom, offering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking appears to be highly cost‐effective over a life‐time for mother and infants. [ABSTRACT FROM AUTHOR]

The comprehensive analysis of social identity cannot simply focus on individuals' cognitive self‐definition. Rather it should also theorize the social conditions that affect individuals' opportunities to act in terms of those self‐definitions. We argue that the social distancing interventions associated with Covid‐19 provide an opportunity to explore the significance of otherwise taken‐for‐granted social factors which routinely support and sustain individuals' identity enactments. Using qualitative data gathered with 20 members of the Scottish Muslim community (19 diary entries and 20 post‐diary interviews), we explore their experiences of restricted access to community‐relevant social spaces (e.g., mosques and prayer rooms). Our analysis shows that while these regulations could result in new opportunities for Muslims' religious identity enactments, they also impeded their abilities to act in terms of their religious identification. Addressing such impediments, we develop our understanding of the contextual factors that shape individuals' abilities to enact identity‐defining norms and values. [ABSTRACT FROM AUTHOR]

Introduction: Health professional identity transitions involve a dynamic period of liminality prompting a time of considerable uncertainty and self‐doubt. For postgraduate trainees in the United Kingdom, the transition to medical registrar can be a significant deterrent to recruitment and retention. Narrative analysis offers insight into identity work during transitions with potential to inform strategies for developing professional identities. This study aimed to use narrative analysis to explore trainees' experiences and their sense of agency during the liminal phase of this transition. Methods: Following ethical approval, internal medicine (IM) trainees in their second year of IM training were interviewed. Transcripts were audio recorded, transcribed verbatim and analysed to identify narratives describing liminality during the transition to the role of medical registrar, including examples of rejecting and claiming identity grants. Narrative analysis, as described by Riessman and influenced by James Gee's units of discourse, was undertaken, with an agentive lens applied to the data. Results: Between January 2021 and February 2022, 19 IM trainees were interviewed. Given the in‐depth analysis, four narratives were purposively selected to present, including trainees rejecting and claiming the medical registrar role. Trainees tended to describe negative experiences, but those with a higher sense of agency demonstrated positive reflection and identity construction through narrative. There was often identity dissonance between how trainees defined their stage in the transition to medical registrar and how their narrative illustrated their identity work. Conclusion: This study exemplifies narrative analysis' linguistic and agentive lenses in exploring the experience of the liminal identity transitional period. The findings reflect the identity dissonance experienced by trainees during this time and sheds light on their sense of agency throughout. It heralds a need to acknowledge the significant liminality experienced during transitions throughout medical training and to empower a sense of agency to support identity work. The authors' narrative analysis reveals identity dissonance experienced by trainees, as they transition to medical registrar, in ways that herald need to empower a sense of agency to support identity work. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in the assessment of health‐related quality of life (QoL) in the care of patients treated with home parenteral nutrition (HPN). However, it is not known whether healthcare professionals (HCPs) have embedded QoL assessment into routine clinical practice in line with current guidelines to favour a more holistic approach to HPN care. The aim of this study was to assess knowledge, current practice and the opinions of HCPs regarding QoL in care of patients on HPN. Methods: An online survey was distributed via email to HCPs working with HPN patients throughout England, Scotland, Wales and Northern Ireland. Participants were identified using a mailing list for the British Intestinal Failure Alliance, a specialist group within the British Association for Parenteral and Enteral Nutrition. Results: The survey was completed by 67 professionals comprising 24 dietitians, 17 nurses, 14 gastroenterologists, 6 pharmacists, 5 surgeons and 1 psychologist. Of these, 54 (80%) participants agreed that the measurement of QoL is useful. In contrast, 38 (57%) of all participants, including 27 (50%) of those participants who agreed that the measurement of QoL was useful, never measured QoL. Knowledge of QoL literature was rated as poor or very poor by 27 (40%) participants. Conclusions: Despite the perceived usefulness and importance of QoL assessment, very few HCPs embed it into clinical practice. Knowledge of QoL literature and QoL tools is variable, and there is significant variability in QoL practice. This is clear in terms of the frequency of QoL assessments and heterogeneity in methodology. In contrast, there was almost unanimous agreement that the complications associated with HPN contribute to poorer QoL. There is a need for specific, evidence‐based, clinical practice guidelines detailing how to define and measure QoL in this patient population. Key points: There is significant variability in quality‐of‐life (QoL) practice for patients treated with home parenteral nutrition (HPN).Our findings suggest that very few healthcare professionals are embedding QoL assessment into clinical practice.Evidently, there appears to be a need for specific, evidence‐based, clinical practice guidelines detailing how to define and measure QoL in HPN patients. [ABSTRACT FROM AUTHOR]

Despite strong policy support in Scotland, United Kingdom, key challenges to scaling up promotion, protection and support for breastfeeding remain. These include low breastfeeding rates and socioeconomic and regional inequalities. The Becoming Breastfeeding‐Friendly (BBF) process was implemented to highlight actions that could address these challenges. The Scottish BBF committee employed an iterative process of documentary analysis and evidence reviews supplemented by 18 interviews with key informants. The data were mapped to BBF benchmarks and each gear was scored accordingly. Nineteen draft recommendations addressing policy and practice gaps were prioritised. Ten recommendations were grouped into eight themes, which cross‐cut the BBF gears. The process took place from May 2018 to May 2019. The overall BBF Index score for Scotland was 2.4 indicating a strong scaling‐up environment for breastfeeding. Five gears were assessed as strong gear strength, and the remaining three were judged as moderate gear strength. Three recommendation themes illuminate strengths and areas for development. The theme 'reinforcing political will' showed effective leadership, strong policies and significant investment in supporting breastfeeding and highlights actions to sustain this. The theme 'strengthening and coordinating breastfeeding messages' revealed a need for coordination between government, health services and the third sector. The theme 'promoting a supportive return to work environment' highlighted that, while employment legislation is not devolved to the Scottish government, action could be taken by employers to optimise an enabling environment for breastfeeding. The BBF process identified strengths and triggered actions to enhance breastfeeding promotion, protection and support in Scotland. Key messages: Scotland has a strong scaling‐up environment for the promotion, protection and support of breastfeeding as assessed by the Becoming Breastfeeding Friendly process;The BBF process is a helpful tool that led to specific recommendations that together have the potential to improve the rates and experiences of breastfeeding in Scotland;Scotland has a strong political commitment to breastfeeding evidenced by effective leadership, strong policies and significant investment and this needs to be sustained;Further co‐ordination of breastfeeding activities and messages between government, health services and the third sector is needed;A supportive environment of breastfeeding women returning to work could be enhanced through employer guidelines and increasing women's awareness of their rights. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic had an unprecedented effect on those living and working in care‐homes for older people, as residents were particularly vulnerable to contracting the SARS‐CoV‐2 virus, associated with high morbidity and mortality. Often undervalued, care‐home nurses (RNs) are leaders, managing complex care while working in isolation from their professional peers. The pandemic made this more apparent, when care and treatments for COVID‐19 were initially unknown, isolation increased due to withdrawal of many professional health services, accompanied by staff shortages. Objective: To explore RNs' experiences of working in older people's care‐homes during the COVID‐19 pandemic. Design: Qualitative interview study. Setting: Care‐homes for older people in England and Scotland, UK. Methods: Recruitment via direct contact with care‐homes, social media, and links provided by national partners, then purposive sampling for age, gender, type of care‐home, and location. Data collected through one‐to‐one online interviews using topic guide developed collaboratively with care‐home nurses, focusing on how COVID‐19 impacted on nurses' resilience and mental wellbeing. Data analyzed thematically using Tronto's ethics of care framework to guide development of interpretative themes. Results: Eighteen nurses (16 female; 16 adult, and two mental health nurses) were interviewed March–June 2021; majority aged 46–55 years; mean time registered with Nursing and Midwifery Council: 19 years; 17 had nursed residents with COVID‐19. RNs' experiences resonated with Tronto's five tenets of ethical care: attentiveness, responsibility, competence, responsiveness, and solidarity. All nurses described being attentive to needs of others, but were less attentive to their own needs, which came at personal cost. RNs were aware of their professional and leadership responsibilities, being as responsive as they could be to resident needs, processing and sharing rapidly changing guidance and implementing appropriate infection control measures, but felt that relatives and regulatory bodies were not always appreciative. RNs developed enhanced clinical skills, increasing their professional standing, but reported having to compromise care, leading to moral distress. Broadly, participants reported a sense of solidarity across care‐home staff and working together to cope with the crisis. Conclusion: Care‐home nurses felt unprepared for managing the COVID‐19 pandemic, many experienced moral distress. Supporting care‐home nurses to recover from the pandemic is essential to maintain a healthy, stable workforce and needs to be specific to care‐home RNs, recognizing their unique pandemic experiences. Support for RNs will likely benefit other care‐home workers either directly through wider roll‐out, or indirectly through improved wellbeing of nurse leaders. Clinical relevance: The COVID‐19 pandemic, an international public health emergency, created many challenges for Registered Nurses (RNs) working in long‐term care facilities for older people, as residents were particularly vulnerable to the impact of the SARS‐CoV‐2 virus. Care‐home RNs faced challenges distinct from their hospital‐based nursing peers and non‐nursing social care colleagues due to their isolation, leadership roles, professional legal obligations, and ethical responsibilities, leading to psychological distress on the one hand, but also a newly found confidence in their existing and newly developed skills, and increased recognition by the wider health community of their specialisms. [ABSTRACT FROM AUTHOR]

Background: The Scottish Government introduced a free Baby Box scheme for all new parents in 2017, modelled on the Finnish scheme, to give every baby 'an equal start in life'. There is little evidence that it results in better health outcomes, but there has been limited research into different perspectives and discourses on such schemes. Methods: Four focus groups were conducted with 21 parents in North‐East Scotland. Recordings were transcribed verbatim, anonymized and analysed thematically with NVivo 12 software. Our thematic analysis was both inductive and deductive—remaining open to themes identified by participants themselves but also informed by the social policy literature on universalism and social cohesion. Results: Across all the focus groups, we found a high degree of positivity about the principle of the Baby Box scheme, and for the most part the practical value of the contents. This was remarkably consistent across different communities and backgrounds. There was little evidence of the strongly polarized views present in media reporting. Parents seemed considerably less focused than the media on safety and health outcomes, and more focused on practical, material and social impacts. They reported little in the way of feeling patronized or monitored by the government. Conclusion: Our findings have important implications for future economic evaluations of the baby box. Such evaluations should broaden the valuation space beyond health outcomes to allow for the value of feelings of inclusion, solidarity and being part of a community. Patient or Public Contribution: This small project was designed in response to parent views already collected in the early roll‐out of the Baby Box scheme in Scotland, about their priorities and responses to the scheme. Additional views were sought on the topic guide for the focus groups, and local community groups advised us on recruitment and the best timing and location for the focus groups to be held. The focus groups themselves were conducted as research, but with the intent of ensuring parent views featured more prominently in a debate that has been largely dominated by clinical and public health perspectives. [ABSTRACT FROM AUTHOR]

Self‐harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self‐harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self‐cutting management compared with for disturbed behaviours in general using a cross‐sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self‐cutting management. Respondents disapproved of using each coercive measure for self‐cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self‐cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self‐cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self‐harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative. [ABSTRACT FROM AUTHOR]

Aims: To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods: Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results: The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions: The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice: The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services. [ABSTRACT FROM AUTHOR]

Embarrassment arises when we reveal an apparent flaw of the self in front of others, for instance, in a faux pas situation. An audience is crucial for embarrassment, but the group membership of the audience has not yet been studied. According to the social identity approach, we assign more importance to evaluations by ingroup than by outgroup members, particularly when we identify highly, and the outgroup is of lower status. A pilot study (N = 30) showed that embarrassment correlated positively with group membership of the audience and with identification. Studies 1 to 3 presented participants with several faux pas scenarios. In Study 1 (between-participants design; N = 75), participants reported higher embarrassment in ingroup (Norwegian) and equal-status outgroup (Swedish) conditions than in a lower-status outgroup condition (Polish). In Study 2 (within-participants design; N = 135), participants reported higher embarrassment when they imagined the audience to be other Scots (ingroup) than Americans or Poles (outgroups), particularly when they perceived the outgroup to be lower in status. In Study 3 (between-participants design; N = 59), high identifiers but not low identifiers showed the expected ingroup-outgroup audience effect. Implications for intergroup relations are discussed. Key Message: Embarrassment following faux pas situations depends on the group membership of the audience, relative status of the audience and ingroup identification. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: The introduction of screening in the UK and other high‐income countries led to a significant decrease in the incidence of cervical cancer and increase in survival rates. Minority ethnic groups are often underrepresented in screening participation for reasons that are poorly understood. Objective: To explore experiences of cervical screening participation and non‐participation of women from minority ethnic populations in Scotland and gain insights to support the development of interventions that could potentially support screening participation and thereby reduce inequalities. Design: Qualitative comparison group study using in‐depth, semi‐structured individual interviews that were thematically analysed. Setting and participants: This study took place in Scotland. Fifty women were purposively sampled from four ethnic minority groups: South Asian; East European; Chinese; and Black African or Caribbean. White Scottish women were also interviewed. Results: Many experiences described were common regardless of ethnicity, such as difficulties managing competing priorities, including work and care responsibilities. However, important differences existed across the groups. These included going abroad for more frequent screening, delayed introduction to screening and not accessing primary care services, language difficulties in health‐care settings despite proficiency in English and not being sexually active at screening commencement. Experiences of racism, ignorance and feeling shamed were also reported. Conclusions: Key differences exist in the experience of minority ethnic groups in Scotland. These offer potential opportunities to reduce disparity and support screening participation including maximizing co‐incidental interactions and developing outreach work. [ABSTRACT FROM AUTHOR]

Background: Rural health outcomes are often worse than their urban counterparts. While rural health theory recognizes the importance of the social determinants of health, there is a lack of insight into public perspectives for improving rural health beyond the provision of health‐care services. Gaining insight into perceived solutions, that include and go beyond health‐ care, can help to inform resource allocation decisions to improve rural health. Objective: To identify and describe shared perspectives within a remote‐rural community on how to improve rural health. Method: Using Q methodology, a set of 40 statements were developed representing different perceptions of how to improve rural health. Residents of one remote‐rural island community ranked this statement set according to their level of agreement. Card‐sorts were analysed using factor analysis to identify shared points of view and interpreted alongside post‐sort qualitative interviews. Results: Sixty‐two respondents participated in the study. Four shared perspectives were identified, labelled: Local economic activity; Protect and care for the community; Redistribution of resources; and Investing in people. Factors converged on the need to relieve poverty and ensure access to amenities and services. Discussion and conclusions: Factors represent different elements of a multifaceted theory of rural health, indicating that 'lay' respondents are capable of comprehending various approaches to health improvement and perspectives are not homogenous within rural communities. Respondents diverged on the role of individuals, the public sector and 'empowered' community‐based organizations in delivering these solutions, with implications for policy and practice. Public Contribution: Members of the public were involved in the development and piloting of the statement set. [ABSTRACT FROM AUTHOR]

Background: Cancer is rare amongst adolescents and young adults (AYA). Previous research has reported (healthy) AYA's knowledge of risk factors and symptoms as limited, with this potentially leading to delays in help‐seeking and diagnosis. Objectives: We explored AYA's views on their cancer knowledge prior to diagnosis and if/how they perceived this as having affected their experiences of diagnosis and care. Methods: We interviewed 18 AYA diagnosed with cancer (aged 16‐24 years). Interviews were recorded and transcribed verbatim. We undertook qualitative descriptive analysis, exploring both a priori topics and emergent themes, including cancer knowledge prior to diagnosis. Results: Adolescents and young adults characterized their knowledge of cancer and treatment prior to diagnosis and treatment initiation as limited and superficial. AYA perceived gaps in their knowledge as having profound consequences throughout their cancer journey. These included: hindering recognition of symptoms, thereby delaying help‐seeking; impeding understanding of the significance of tests and referrals; amplifying uncertainty on diagnosis; and affording poor preparation for the harsh realities of treatment. Conclusions: Adolescents and young adults perceived their limited cancer knowledge prior to diagnosis as affecting experiences of diagnosis and initial/front‐line care. These findings prompt consideration of whether, when and how, AYA's knowledge of cancer might be improved. Two broad approaches are discussed: universal education on AYA cancer and/or health; and targeted education (enhanced information and counselling) at and after diagnosis. Patient or Public Contribution: Our work was informed throughout by discussions with an advisory group, whose membership included AYA treated for cancer. [ABSTRACT FROM AUTHOR]

Objective: To review quality of care in births planned in midwifery-led settings, resulting in an intrapartum-related perinatal death.Design: Confidential enquiry.Setting: England, Scotland and Wales.Sample: Intrapartum stillbirths and intrapartum-related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013-16 (freestanding midwifery units and home births).Methods: Multidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics.Results: Sixty-four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review.Conclusions: These confidential enquiry findings do not address the overall safety of midwifery-led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations.Tweetable Abstract: Confidential enquiry of intrapartum-related baby deaths highlights areas where care in midwifery-led settings can be made even safer. [ABSTRACT FROM AUTHOR]

This study exploits a natural experiment in Scotland where the legal blood alcohol content (BAC) limit was reduced from 0.8 to 0.5 mg per 100 ml of blood while staying constant in all other parts of the United Kingdom. Using a difference-in-differences design, we find that this change in the BAC level had no impact on either traffic accident or fatality rates. [ABSTRACT FROM AUTHOR]

Aim: To determine whether a food frequency questionnaire (FFQ) and a short dietary assessment tool can be used to accurately estimate the Eatwell Guide proportions (a plate‐based food model) of diets of adults living in Scotland. Methods: The cross‐sectional study was conducted as a follow up of the 2010 Scottish Health Survey (participants aged 18–65 years old). Proportions of the Eatwell Guide food groups (starchy carbohydrates, fruits and vegetables (F&V), dairy and alternatives, protein foods and oils and spreads) were calculated from the Scottish Health Survey Eating Habits Module (SHeS EHM), Scottish Collaborative Group FFQ (SCG FFQ) and a seven‐day estimated food diary (reference method), and compared using the Aitchison method and Wilcoxon Signed‐Rank Test. Bland–Altman analyses assessed mean difference and 95% limits of agreement between the methods for each food group. Results: Ninety‐six adults were included (mean (SD) age = 51.4 (11.1) years; body mass index = 27.1 (4.9) kg/m2; 58% female). The SCG FFQ scored a lower median Aitchison distance (1.47) than the SHeS EHM (1.99) (P < 0.001), showing greater agreement with the reference method (P < 0.001). Bland–Altman plots also showed better agreement for the SCG FFQ than the SHeS EHM. Poorest agreement was for starchy carbohydrates (both methods), protein foods (SHeS EHM) and dairy (SCG FFQ). Conclusions: The SCG FFQ could be used to estimate Eatwell Guide proportions and monitor compliance to the Eatwell Guide recommendations and could be improved with small changes. The SHeS EHM is less suitable, but additional questions on dairy foods, and oils and spreads would improve its ability to estimate the Eatwell Guide proportions. [ABSTRACT FROM AUTHOR]

Background: Little is known about the population prevalence of co‐occurring intellectual disabilities and autism, and its impact on general health status. The study aimed to investigate this, in comparison with the general population. Method: Whole country data from Scotland's Census, 2011, were analysed. Descriptive statistics were generated; chi‐squared tests were undertaken; and logistic regressions were undertaken both with the whole general population data, adjusted for age and gender, and within the population with co‐occurring intellectual disabilities and autism. Results: A total of 5709/5 295 403 (1.08/1000) people had co‐occurring intellectual disabilities and autism; 2.58/1000 children/young people and 0.74/1000 adults. The peak reported prevalence was at age 10 years (3.78/1000); 66.0% were male. Their general health status was substantially poorer than for the rest of the population, more so for children/young people, and they had more limitations in their day‐to‐day activities. Co‐occurring intellectual disabilities and autism had odds ratio = 48.8 (45.0–53.0) in statistically predicting poor health. Conclusion: This is the first study to report the population prevalence of coexisting intellectual disabilities and autism, and the substantial influence this double disadvantage has on general health status, apparent across the entire life course. This highlights a group in need of wider recognition for whom resources should be focused on and planned for, informed by evidence. Staff in services for people with either of these conditions need to be trained, equipped, resourced and prepared to address the challenge of working for people with this duality. This is essential, to address these substantial health inequalities. [ABSTRACT FROM AUTHOR]

Abstract: Background: Colorectal cancer (CRC) screening programmes using a guaiac faecal occult blood test (gFOBt) reduce CRC mortality. Interval cancers are diagnosed between screening rounds: reassurance from a negative gFOBt has the potential to influence the pathway to diagnosis of an interval colorectal cancer. Methods: Twenty‐six semi‐structured face‐to‐face interviews were carried out in Scotland and England, with individuals diagnosed with an interval colorectal cancer following a negative gFOBt result. Results: Participants reported they were reassured by a negative gFOBt, interpreting their result as an “all clear”. Therefore, most did not suspect cancer as a possible cause of symptoms and many did not recall their screening result during symptom appraisal. Among those who did consider cancer, and did think about their screening test result, reassurance from a negative gFOBt led some to “downplay” the seriousness of their symptoms with some interviewees explicitly stating that their negative test result contributed to a delayed decision to seek help. Conclusion: Screening participants need to be informed of the limitations of screening and the ongoing risk of developing colorectal cancer even when in receipt of a negative result: the importance of minimizing delay in seeking medical advice for colorectal symptoms should be emphasized. [ABSTRACT FROM AUTHOR]

Abstract: Background: Stress production is important for effective communication, but this skill is frequently impaired in people with motor speech disorders. The literature reports successful treatment of these deficits in this population, thus highlighting the therapeutic potential of this area. However, no specific guidance is currently available to clinicians about whether any of the stress markers are more effective than others, to what degree they have to be manipulated, and whether strategies need to differ according to the underlying symptoms. Aims: In order to provide detailed information on how stress production problems can be addressed, the study investigated (1) the minimum amount of change in a single stress marker necessary to achieve significant improvement in stress target identification; and (2) whether stress can be signalled more effectively with a combination of stress markers. Methods & Procedures: Data were sourced from a sentence stress task performed by 10 speakers with ataxic dysarthria and 10 healthy matched control participants. Fifteen utterances perceived as having incorrect stress patterns (no stress, all words stressed or inappropriate word stressed) were selected and digitally manipulated in a stepwise fashion based on typical speaker performance. Manipulations were performed on F0, intensity and duration, either in isolation or in combination with each other. In addition, pitch contours were modified for some utterances. A total of 50 naïve listeners scored which word they perceived as being stressed. Outcomes & Results: Results showed that increases in duration and intensity at levels smaller than produced by the control participants resulted in significant improvements in listener accuracy. The effectiveness of F0 increases depended on the underlying error pattern. Overall intensity showed the most stable effects. Modifications of the pitch contour also resulted in significant improvements, but not to the same degree as amplification. Integration of two or more stress markers did not result in better results than manipulation of individual stress markers, unless they were combined with pitch contour modifications. Conclusions & Implications: The results highlight the potential for improvement of stress production in speakers with motor speech disorders. The fact that individual parameter manipulation is as effective as combining them will facilitate the therapeutic process considerably, as will the result that amplification at lower levels than seen in typical speakers is sufficient. The difference in results across utterance sets highlights the need to investigate the underlying error pattern in order to select the most effective compensatory strategy for clients. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of women in Scotland who return home to complete medical termination of pregnancy (TOP) ≤63 days of gestation, after being administered with mifepristone and misoprostol at an NHS TOP clinic.Design: Qualitative interview study.Setting: One National Health Service health board (administrative) area in Scotland.Population or Sample: Women in Scotland who had undergone medical TOP ≤63 days, and self-managed passing the pregnancy at home; recruited from three clinics in one NHS health board area between January and July 2014.Methods: In-depth, semi-structured interviews with 44 women in Scotland who had recently undergone TOP ≤63 days of gestation, and who returned home to pass the pregnancy. Data were analysed thematically using an approach informed by the Framework method.Main Outcome Measures: Women's experiences of self-management of TOP ≤63 days of gestation.Results: Key themes emerging from the analysis related to self-administration of misoprostol in clinic; reasons for choosing home self-management; facilitation of self-management and expectation-setting; experiences of getting home; self-managing and monitoring treatment progress; support for self-management (in person and remotely); and pregnancy self-testing to confirm completion.Conclusions: Participants primarily found self-administration of misoprostol and home self-management to be acceptable and/or preferable, particularly where this was experienced as a decision made jointly with health professionals. The way in which home self-management is presented to women at clinic requires ongoing attention. Women could benefit from the option of home administration of misoprostol.Tweetable Abstract: Women undergoing medical TOP 63 days found home self-management to be acceptable and/or preferable. [ABSTRACT FROM AUTHOR]

Objective: To examine the experiences of women seeking more than one termination of pregnancy (TOP) within 2 years.Design: Mixed methods study.Setting: Six TOP services across Scotland.Sample: Women presenting for TOP between July and December 2015.Methods: Descriptive and inferential analysis of quantitative survey data, thematic analysis of qualitative interview data and integrative analysis. In quantitative analysis, multinomial logistic regression was used to compare three groups: previous TOP within 2 years, previous TOP beyond 2 years and no previous TOP.Main Outcome Measures: Characteristics and experiences of women seeking TOP.Results: Of 1662 questionnaire respondents, 14.6% (n = 242) and 19.8% (n = 329) reported previous TOP within and beyond 2 years, respectively. The previous TOP within 2 years group was significantly less likely to own their accommodation than the no previous TOP group (adjusted odds ratio [aOR] 0.34, 95% CI: 0.18-0.62) and previous TOP beyond 2 years group (aOR: 0.44, 95% CI: 0.23-0.85); and more likely to report inconsistent (aOR: 1.63, 95% CI: 1.04-2.57; aOR: 1.95, 95% CI: 1.16-3.28) and consistent (aOR: 2.13, 95% CI: 1.39-3.26; aOR: 1.71, 95% CI: 1.07-2.76) contraceptive use than the no previous TOP and previous TOP within 2 years groups, respectively. Twenty-three women from the previous TOP within 2 years group were interviewed. Qualitative and integrative analyses highlight issues relating to contraceptive challenges, intimate partner violence, life aspirations and socio-economic disadvantage.Conclusions: Women undergoing more than one TOP within 2 years may experience particular challenges and vulnerabilities. Service provision should recognise this and move away from stigmatising discourses of 'repeat abortion'.Funding: Scottish Government.Tweetable Abstract: Women having two or more terminations of pregnancy in 2 years may face key challenges/vulnerabilities including intimate partner violence and socio-economic disadvantage. [ABSTRACT FROM AUTHOR]

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Objective: To determine whether human papillomavirus (HPV) immunisation has affected the prevalence of HPV genotypes and colposcopic features of cervical intraepithelial neoplasia (CIN) in young women referred for colposcopy.Design: A two-centre observational study including vaccinated and unvaccinated women.Setting: Colposcopy clinics serving two health regions in Scotland, UK.Population: A total of 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening.Methods: Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16, 18, 31, 33, and 45. Demographic data, cytology, and histology results and colposcopic features were recorded. Chi-square analysis was conducted to identify associations between vaccine status, HPV genotypes, and colposcopic features.Main Outcome Measures: Colposcopic features, HPV genotypes, mRNA expression, and cervical histology.Results: The prevalence of HPV 16 was significantly lower in the vaccinated group (8.6%) compared with the unvaccinated group (46.7%) (P = 0.001). The number of cases of CIN2+ was significantly lower in women who had been vaccinated (P = 0.006). The HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features, but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+, from 74% (unvaccinated) to 66.7% (vaccinated).Conclusions: In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in women who have been vaccinated is at the lower acceptable level of the UK national cervical screening programme guidelines.Tweetable Abstract: Reduction of hrHPV positivity and CIN in immunised women consistent with lower PPV of colposcopy for CIN2+. [ABSTRACT FROM AUTHOR]

Background and Aims People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. In Scotland, national survey data indicate lower HCV incidence in prison than the community (4.3 versus 7.3 per 100 person-years), but a 2.3-fold elevated transmission risk among recently released (< 6 months) PWID. We evaluated the contribution of incarceration to HCV transmission among PWID and the impact of prison-related prevention interventions, including scaling-up direct-acting antivirals (DAAs) in prison. Design Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration. Setting Scotland, UK. Participants A simulated population of PWID. Measurements Population-attributable fraction (PAF) of incarceration to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment, as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison release. Findings Incarceration contributes 27.7% [PAF; 95% credible interval (CrI) -3.1 to 51.1%] of HCV transmission among PWID in Scotland. During the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95% CrI = 8.4-13.3%) and 9.7% (95% CrI = 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95% CrI = -28.5 to 18.0%) and 4.7% (95% CrI = -11.3 to 14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95% CrI = 19.7-57.5%) and 33.3% (95% CrI = 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95% CrI = 38.0-51.3%) and 45.5% (95% CrI = 39.3-51.0%), respectively. Conclusions Incarceration and the elevated transmission risk following prison release can contribute significantly to hepatitis C virus transmission among people who inject drugs. Scaling-up hepatitis C virus treatment in prison can provide important prevention benefits. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Research highlights the need to better understand the impact of alcohol-related harm on families and communities. Scottish policy initiatives to reduce alcohol consumption and alcohol-related harm include the planned introduction of a minimum unit price for alcohol. We aimed to explore existing and proposed changes in alcohol policy, from the standpoint of heavy drinkers, through accounts of their involvement and repercussions for family and friends.Design and Methods: Interviews were conducted with 20 heavy drinkers, recruited from hospital alcohol treatment centres in Scotland's two largest cities. Participants were part of a larger longitudinal mixed methods study. Interviews explored experiences of alcohol-related harm and the impact, or potential impact, of alcohol policy changes on drinking patterns, risk-taking, consumption and wellbeing. Data coded for 'family and friends' were thematically analysed using a constant comparison method.Results: Family and friends were portrayed as important for aiding moderation and abstinence, but more often for sustaining continued heavy drinking. Heavy drinkers with complex needs and those living in deprived communities suggested that increased alcohol prices could exacerbate the detrimental effect on their health and social circumstances, and that of their family, should their consumption remain excessive.Discussion and Conclusions: Population level policy initiatives to reduce alcohol consumption, such as minimum unit pricing, will impact on the families and social networks of heavy drinkers in addition to the drinker. The most vulnerable may be affected disproportionately. Alcohol policy changes and evaluations need to consider consequences for drinkers, families and communities. [O'May F, Whittaker A, Black H, Gill J. The families and friends of heavy drinkers: Caught in the cross-fire of policy change? Drug Alcohol Rev 2017;36:192-199]. [ABSTRACT FROM AUTHOR]

Background and Aims It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call-outs to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue; and is there evidence of an association between ambulance call-outs to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas? Design Controlled time-series analysis. Setting Scotland, UK, 2008-15. Participants Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week). Intervention Scotland's NNP; formally implemented on 1 April 2011. Measurements Primary outcome measure was weekly incidence (counts) of call-outs to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call-outs to heroin-related overdose in the London Borough area acquired from the London Ambulance Service. Findings There was no significant association between SAS call-outs to opioid-related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = −0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call-outs did not differ significantly between pilot and non-pilot regions (interaction test, P = 0.62). Conclusions The supply of take-home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid-related overdose incidents in the 4-year period after it was implemented in April 2011. [ABSTRACT FROM AUTHOR]

Authors have generally reported that mental health nurses (MHNs) have positive attitudes to providing physical health care to service users with severe mental illness. In the present study, we aimed to explore if this positive attitude translates to enhanced clinical practice by interviewing MHNs and the service users they work with. Semistructured interviews were completed with 15 service users and 18 MHNs from acute, rehabilitation, and community services. These were then transcribed and analysed using thematic analysis. Six themes emerged: (i) not the work of MHNs; (ii) the physical effects of psychiatric drugs are ignored; (iii) the need to upskill; (iv) keeping busy; (v) horrible hospital food/living on takeaways; and (vi) motivation to change. Our overarching meta-theme was of unmet physical health need among service users. [ABSTRACT FROM AUTHOR]