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Purpose: The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons. Design/methodology/approach: In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described. Findings: The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce. Research limitations/implications: The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice. Practical implications: The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork. Originality/value: To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt. [ABSTRACT FROM AUTHOR]

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]

Official statistics tend to rely on a headcount approach to poverty measurement, distinguishing 'the poor' from the 'non-poor' on the basis of an anchored threshold. Invariably, this does little to engage with the gradations of material hardship affecting those living, to varying degrees, below the poverty line. In response, this paper interrogates an apparent flatlining in UK poverty to establish the changing profile of poverty, as well as those most affected by it. Drawing on the Family Resources survey, this paper reveals an increasing depth of poverty in the UK since 2010, with bifurcation observable in the living standards of different percentile groups below the poverty line. In addition, this paper demonstrates substantial compositional changes in the socio-demographic profile of (deep) poverty. Since 2010, the likelihood of falling into deep poverty has increased for women, children, larger families, Black people and those in full-time work. Within the context of COVID-19, I argue there is a need to re-think how we currently conceptualise poverty by better attending to internal heterogeneity within the broader analytical and methodological category of 'the poor'. Doing so raises pressing questions about the prevailing modes of poverty measurement that tend to frame and delimit the social scientific analysis of poverty, as well as the policies deemed appropriate in tackling it. [ABSTRACT FROM AUTHOR]

The top 100 most cited papers in social work journals in 2000–09 were recently listed in a British Journal of Social Work paper by Hodge, Lacasse and Benson. The citations of these 100 papers in a two-year period (2007–09) were identified and a further manual web-based search was conducted to identify some key features of the citing sources. Descriptive statistics are presented on language of publication and national location of citing authors, as well as type of citing source. Bivariate analysis was conducted of the national location of cited journal by national location of citing first author. This analysis shows a strong tendency towards within-country citation in both the UK and USA, providing some evidence of intellectual chauvinism amongst social work academics and, more specifically, evidence of a Great Atlantic Divide. [ABSTRACT FROM PUBLISHER]

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]

Purpose -- The purpose of this paper is to report findings from a formative evaluation of a suicide prevention public awareness campaign -- Choose Life, North Lanarkshire. The focus is on preventing male suicide. The paper explores how the public campaign supports a co-ordinated and community-based direction for suicide prevention work, and examines how good practice can be identified, spread, and sustained. Design/methodology/approach -- The paper draws on data collected from March to November 2011, using mixed primary research methods, including a quota survey, discussion groups with the general public, and stakeholder interviews. Findings -- The campaign effectively raised the suicide awareness of a substantial proportion of those targeted, but with regional variations. It also affected the attitudes and behaviour of those who were highly aware. However, men and women engaged somewhat differently with the campaign. The sports and leisure settings approach was effective in reaching younger men. Practical implications -- The paper discusses emerging considerations for suicide prevention, focusing on gender and approaches and materials for engaging with the public as "influencers". There are challenges to target audiences more specifically, provide a clear call to action, and engage the public in a sustained way. Originality/value -- This paper reflects on insights from a complex programme, exceptional in its focus on targeted sections of the public, especially young males. The paper indicates the importance for research and practice of intersecting dimensions of male identity, stigma and mental health, and other risk and protective factors which can inform campaigns highlighting talk about suicide among men. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper was to determine the attachment strategies of prospective adoptive parents and any correlation between attachment and the defensive strategies they used when talking about loss of fertility. The study also examined whether attachment strategy of the applicants had a bearing on the decision by the local authority to place a child. Design/methodology/approach: The sample was comprised of 48 respondents (21 couples) representing 84 per cent of all people who applied to one UK Social Services Department in a 12-month period. Placement of a child was reviewed two years following the assessment. The study used the dynamic maturational model version of the adult attachment interview (DMM-AAI), together with added questions on loss of fertility to assess the applicants' attachment strategies together with unresolved loss and trauma and the DMM modifiers. Findings: Unlike adoption studies using the Main and Goldwyn system, this study rated very few of the applicants' AAIs as secure (13 per cent), 48 per cent were in the normative low-risk range and 52 per cent of the AAIs were coded in the more complex DMM insecure strategies. There was a significant bias towards marriages where the partners deployed opposite low-risk/DMM strategies (13 (62 per cent) of couples). Compared with data on non-clinical populations the AAIs showed a high level of unresolved loss or trauma (58 per cent). Using a six-way distribution (A1-2, C1-2, B, A3-4, C3-6 and A/C) there was an 87 per cent correspondence between discourse about loss of fertility and that about attachment, thereby supporting the established proposition that reproduction is part of the attachment system. Twenty one per cent of the AAIs were coded as "disorientated" and this is discussed in terms of conflict for adoptive of parents concerning the raising of a child who carries their own genes or those of strangers. A case is made to conceptualise negative impact of infertility in terms of unresolved trauma rather than loss. Research - limitations/implications: This study adds to research showing that the DMM approach is more finely calibrated than the ABC+disorganised model with the latter likely over coding for security. The results emphasise that fertility and reproduction are legitimate subjects for attachment studies and that AAI discourse analysis is a valid methodology for future research. However coder agreement as to whether or not loss of fertility was resolved was only fair (64 per cent) κ. 0.25 (po0.33). More work is required in order to determine what constitutes unresolved loss of fertility and what impact, if any, this has on parenting an adopted child. Practical implications: The practice implications are considered in a separate paper. Social implications: The findings are contentious in that they suggest a significant number (48 per cent) of adoptive parents have needs not dissimilar to other clients of psychological services. Originality/value: This is the first DMM-AAI study with prospective adoptive parents and the findings show significant differences when compared with previous studies using the Main and Goldwyn AAI. It is also the first study to establish fertility as a legitimate area for attachment studies by using AAI discourse analysis. [ABSTRACT FROM AUTHOR]

Purpose In most European countries there is a range of quality control system mechanisms, however, poor quality and institutional violence can be found in the residential sector. Taking Portugal as an example of a country that uses an inspection-only approach, this paper focuses on the monitoring system for controlling the quality of care in nursing homes. The purpose of this paper is to analyse how mistreatment of older people is identified and dealt with by the national social security services. In particular it looks at what the indicators are with which to assess poor quality care and mistreatment (how it is perceived and defined), which factors affect mistreatment of older people and intervention outputs (i.e. what are the sanctions to prevent and combat this).Design/methodology/approach An exploratory approach was based on a mixed method, using a database of 3,685 complaints reported to the social security inspection services. To understand the context of the complaints and the assessment of institutional violence, focus groups were carried out with inspectors from the National Inspection Service.Findings The focus groups identified severe situations of poor care, mistreatment of older people and loss of human rights and dignity. Some indicators were found in key areas of care and the factors associated with this were based on Kamavarapu's typology (2017): physical conditions of facilities; closed organisational models; difficult working conditions; and perceived concerns of residents. Monitoring and inspection systems are still based on minimum standards focusing on structural and process quality, devoting little attention to the human rights situation of older persons and clinical issues.Research limitations/implications The number of participants in the focus groups was limited in size but the uniqueness of this exploratory method draws a dark picture of non-licensed nursing homes in Portugal.Originality/value An exploratory analysis was useful to identify institutional violence and discuss potential implications, in terms of effectiveness of quality care control, which calls for special attention by policy makers and researchers when monitoring the human rights of older persons. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known about this topic?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates.No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. What this paper adds to existing knowledge?: It appears feasible to use the HIP to profile and compare physical health‐related risks in people with SMI across different international settings.The HIP tool identified significant differences in areas of risk across the four countries. What are the implications for practice?: The HIP could be used to identify unique clusters of health promotion needs in different countries.Use of HIP health checks may support implementation of individualized interventions. Introduction: To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim: To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method: An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results: Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion: This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi‐national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice: It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources. [ABSTRACT FROM AUTHOR]

This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs' experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises. [ABSTRACT FROM AUTHOR]

Purpose: In previous research, personality and exposure to psychiatry were independently shown to shape medical students attitudes towards psychiatry (ATP). This paper aims to investigate the role of psychiatry placements and personality types on medical student attitudes towards psychiatry (ATP). Design/methodology/approach: All medical students from four consecutive years at Cambridge University, UK were invited to take part in an online questionnaire including the ATP-30 Questionnaire and The Big Five Factor personality Inventory (BFI). Findings: Students who had completed their psychiatry placement had more positive ATP than students who had not (t = −3.24, adjusted p = 0.004). However, this was not reflected in an increased self-reported likelihood of choosing psychiatry as a career (t = 0.28, adjusted p = 0.78). Higher agreeable personality scores were associated with both a higher willingness to take up psychiatry as a career (linear model estimate 0.06; p = 0.03), and more positive ATP (linear model estimate 0.14; p < 0.0001). Originality/value: This work seems to confirm that exposure to psychiatry improves attitudes towards psychiatry. Agreeable personality traits were also associated with a higher willingness to take up psychiatry postgraduate training. These findings might help shape future campaigns to improve the profile of psychiatry training. Future research on this topic is needed to address whether improved ATP among medical students can longitudinally improve recruitment into post-graduate psychiatry training. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To analyse published ranking tables on academics’ h‐index scores to establish whether male nursing academics are disproportionately represented in these tables compared with their representation across the whole profession. Background: Previous studies have identified a disproportionate representation of UK male nursing academics in publishing in comparison with their US counterparts. Design: Secondary statistical analysis, which involved comparative correlation of proportions. Methods: Four papers from the UK, Canada, and Australia containing h‐index ranking tables and published between 2010–2017, were reanalysed in June 2017 to identify authors’ sex. Pearson's chi‐squared test was applied to ascertain whether the number of men included in the tables was statistically proportionate to the number of men on the pertinent national professional register. Findings: There was a disproportionate number of men with high h‐index scores in the UK and Canadian data sets, compared with the proportion of men on the pertinent national registers. The number of men in the Australian data set was proportionate with the number of men on the nursing register. There were a disproportionate number of male professors in UK universities. Conclusion: The influence of men over nursing publishing in the UK and Canada outweighs their representation across the whole profession. Similarly, in the UK, men's representation in the professoriate is disproportionately great. However, the Australian results suggest that gender inequality is not inevitable and that it is possible to create more egalitarian nursing cultures. [ABSTRACT FROM AUTHOR]

Purpose People with learning disabilities may experience discrimination which prevents them from exercising choice and control over their right to participate in democratic processes. The paper aims to discuss this issue.Design/methodology/approach Taking data collected by social workers during a campaign from the 2015 UK General Election, this paper analyses the variables associated with higher rates of democratic participation by people with learning disabilities.Findings The present authors undertook secondary analysis on data collected by social workers supporting adults with learning disabilities who were living in community housing units. In total, 1,019 people with learning disabilities who were living in 124 community housing units in one English county gave consent to participate. In total, 84 per cent were registered to vote and 26 per cent cast a vote on polling day. People were significantly more likely to cast a vote if they lived in a housing unit where they understood their rights (Wald χ2 =4.896, p=0.027).Practical implications The analyses are consistent with the hypothesis that supporting people with learning disabilities to understand their right to participate in elections increases the likelihood they will cast a vote on a polling day. There are practical implications from this finding for commissioning practices, support planning, and education of health and social care practitioners.Originality/value This is the first study of this size which examines data from people with learning disabilities on their experience of democratic participation and the role of social work. [ABSTRACT FROM AUTHOR]

This paper considers the support networks of older people in populations with a preponderance of multigenerational households and examines the most vulnerable network types in terms of loneliness and isolation. Current common typologies of support networks may not be sensitive to differences within and between different cultures. This paper uses cross-sectional data drawn from 590 elders (Gujaratis, Punjabis and Sylhetis) living in the United Kingdom and South Asia. Six variables were used in K-means cluster analysis to establish a new network typology. Two logistic regression models using loneliness and isolation as dependent variables assessed the contribution of the new network type to wellbeing. Four support networks were identified: ‘Multigenerational Households: Older Integrated Networks’, ‘Multigenerational Households: Younger Family Networks’, ‘Family and Friends Integrated Networks’ and ‘Non-kin Restricted Networks’. Older South Asians with ‘Non-kin Restricted Networks’ were more likely to be lonely and isolated compared to others. Using network typologies developed with individualistically oriented cultures, distributions are skewed towards more robust network types and could underestimate the support needs of older people from familistic cultures, who may be isolated and lonely and with limited informal sources of help. The new typology identifies different network types within multigenerational households, identifies a greater proportion of older people with vulnerable networks and could positively contribute to service planning. [ABSTRACT FROM PUBLISHER]

Purpose – An innovative training initiative to raise the awareness of personality disorder and enable more effective working with people with personality disorder who come into contact with the wider multi-agency system has been developed. For the purpose of the training initiative the nationally recognised Knowledge and Understanding Framework (KUF, awareness-level programme) has been employed. An overview of the comprehensive multi-agency training initiative will be outlined with reporting and discussion of the outcome data provided within this paper. The paper aims to discuss these issues. Design/methodology/approach – This paper outlines the development and outcomes of a service evaluation study. The utilised outcome measures were carried out at pre-, post- and three-month follow-up measures. The Personality Disorder-Knowledge Attitude and Skills Questionnaire was utilised on the recommendation of the central team. Additionally a Visual Analogue Scale was developed for the purpose of this study was also employed. Findings – Data findings are positive particularly when comparing pre- and post-results and the pre- and follow-up results. There appears to be an apparent peak in results post-training which could be attributed to the fact that knowledge and understanding is recent and fresh in the delegates mind, however positive results are still reported at follow-up there does appear to be decline in results and durability of the effect when three-month follow-up is compared against the post-training results. Research limitations/implications – Follow-up was at three months, which is a relatively short-time span post-training it would be of great interest to see in the future if the decline in the three areas continues. If this was followed up and if this pattern continued this could provide us with evidence to support the development of refresher courses. In the future, due to the multi-agency design of this service evaluation, comparisons of the different sectors, agencies and occupations involved, could also be explored further to establish what multi-agency areas the training has had the most effect and impact. Practical implications – High levels of demand from multi-agencies to receive training in personality disorder is reported. Our findings and experience provide evidence that multi-agencies partners from a variety of professional backgrounds can effectively work in partnership with people with lived experience to effectively deliver the KUF training. Social implications – This innovative roll-out of KUF training provides evidence that with a little investment, a comprehensive multi-agency roll-out of KUF is achievable and can provide statistically significant positive results displaying the effectiveness and change brought about via the KUF training. Originality/value – The originality of this sustainable and low-cost approach to educating the wider system is reported in this paper. This has lead to the strategy receiving national recognition winning a nursing times award in 2011 and a model of innovative practice nationally. [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]

The notion that you don't have to go to church to be a good Christian is accepted as an indicator of the form of implicit religiosity espoused by those who (in Bailey's analysis) say that they “believe in Christianity.” The present paper builds on the findings of a recently published survey of rural Anglican churchgoers celebrating harvest which suggested that de-institutionalised implicit religion may be superseding commitment to conventional explicit religious attendance. The responses of 1081 people who attended Christmas carol services in two English cathedrals in 2009 and 2010 are analysed. The findings of the previous paper that implicit religiosity is more prevalent among younger people and among those who attend church less frequently are replicated. Evidence is also found that women are more inclined to this view than men and that those who have a loose historical connection through baptism are more likely to endorse it than those with either no historical connections or stronger ones. Suggestions are made for further research. [ABSTRACT FROM AUTHOR]

Objective. To compare the clinical and functional outcomes of US-guided (USG) vs landmark-guided (LMG) injection for the treatment of adults with shoulder pathology.Method. MEDLINE, AMED and Embase in addition to unpublished literature databases were searched from 1950 to August 2011. Studies were included if they were randomized or non-randomized controlled trials comparing USG vs LSG injections for the treatment of adults with shoulder pathology. Two reviewers independently performed data extraction and appraisal of the studies. Meta-analyses were performed where possible and when inappropriate a narrative review of the data was presented.Results. Six papers including 307 patients were reviewed; 142 received LMG injections and 165 received USG injections. There was a statistically significant difference in favour of USG for pain at 6 weeks (standardized mean difference 1.03; 95% CI 0.12, 1.93; P = 0.03). There was no statistically significant difference between the injection methods with respect to shoulder function (standardized mean difference 0.33; 95% CI −0.59, 1.25; P = 0.48). There was a significant difference between interventions for shoulder abduction at 6 weeks in favour of the USG method (mean difference 2.81; 95% CI 0.67, 4.95; P = 0.01). No other movements showed a statistically significant difference.Conclusion. There is a statistically significant difference in pain and abduction between LMG and USG steroid injections for adults with shoulder pathology. However, these differences are small and may not represent clinically useful differences. The current evidence base is limited by a number of important methodological weaknesses, which should be considered when interpreting these findings. The cost-effectiveness of the intervention should be considered in the design of future studies. [ABSTRACT FROM PUBLISHER]

Background: Although free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis. Methods: Secondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London. Results: Almost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001). Conclusions: Self-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye testing in those with self-reported vision loss. Further exploration is needed to identify these factors and lead towards effective case finding. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: To date, improvements on U.K. acute mental health wards have been difficult to sustain. The barriers to change may be context dependent. Mental health wards are volatile workplaces with service user violence/aggression, frequent staff and patient changes, and ongoing service improvements.The evidence suggests that burnout affects staff perceptions of barriers to change, and ward climate affects burnout. As two potentially important, independent predictors of staff perceptions of barriers to change, the impact of ward climate and burnout on how staff regard changes should be considered. What the paper adds to existing knowledge?: Elements of ward climate such as high numbers of incidents and temporary staff independently worsened mental health staff perceptions of barriers to change, in addition to negative impacts from burnout and occupational status.How staff perceived ward climate was also linked their perceptions of barriers to change; however, burnout was no longer a significant consideration with these variables.Staff with low job satisfaction and high interaction anxiety also had low confidence regarding changes. Staff with low job satisfaction were also demotivated towards changes. What are the implications for practice?: Ward climate is clearly an important factor in how nurses view organizational changes. In this study, nurses' perceptions of barriers to change were worse if they viewed ward climate negatively, or if temporary staff and incident numbers were high.Staff perceptions of ward climate and barriers to change should be assessed, ahead of service changes.Developing change strategies based on such information is likely to produce better implementation outcomes. Specifically, targeting staff confidence and motivation (which are barriers to change) may improve how staff regard their ward climate. Introduction: To create successful change programmes for mental health wards, it is necessary to understand which aspects of ward climate prevent change. Question: Does ward climate influence mental health nurse's perceptions of barriers to change? Method: Random‐effects models were used to test whether the following ward climate variables influenced the outcome measure "staff perceptions of barriers to change" (VOCALISE) and its subscales (powerlessness/confidence/demotivation): (a) Perceptions of ward climate (VOTE: subscales included work intensity/job satisfaction/interaction anxiety). (b) Ward climate indicators (incidents/detention under the Mental Health Act (2007)/staffing/bed pressure). As known predictors of VOCALISE, burnout (Maslach Burnout Inventory) and occupational status were included in the models. Results: Perceptions of ward climate (VOTE), incidents, temporary staff, occupational status and burnout significantly and negatively affected perceptions of barriers to change (VOCALISE). Staff with low job satisfaction (VOTE) and high interaction anxiety (VOTE) also had low confidence (VOCALISE). Staff with low job satisfaction (VOTE) were also demotivated (VOCALISE). Discussion: Ward climate is an important predictor of how staff regard service changes in mental health wards. Implications for practice: Staff perceptions of ward climate and barriers to change should be assessed ahead of service changes to identify pressures that impede progress and lower morale. [ABSTRACT FROM AUTHOR]

Purpose: Drawing on survey data (N = 7,826) collected in the United Kingdom, Australia, and the United States, this paper examines whether sexual orientation is a differentiating factor in explaining relationship quality and maintenance. Previous research suggests that sexual orientation is not significant in determining relationship satisfaction; however, these analyses have used traditional variable driven approaches, which do not provide an holistic view of the relationship by considering the unique combination of characteristics. Method: In this study, latent profile analyses were used, which is a person-centered approach that allows for identification of different types of long-term relationships. Results: Data suggested that LGB individuals had marginally higher levels of relationship quality compared to their heterosexual counterparts, and sexual orientation was also associated with differing types of long-term relationships. Discussion: These findings are interrogated in more detail, in particular, how sexual orientation is associated with types of long-term relationships and how everyday practices are associated with relationship quality. [ABSTRACT FROM AUTHOR]

Foot ulceration in people with diabetes is a global problem (Boulton, 2004). The human and financial costs within the UK are significant and increasing with a calculation of £900m for the year 2014-15 (Kerr, 2019). On average, an episode of ulceration costs the NHS £14,600 to treat (Kerr, 2017). Ulcerations increase 5-year morbidity by almost 2.5 times (Walsh, 2016). The presence of callus and neuropathy occur commonly and are a recognised high predicator of foot ulceration (International Working Group on the Diabetic Foot, 2019; NICE, 2019). National and international guidelines recommend the use of emollients and the reduction of callus as important preventative actions. Most people with diabetes are likely to have their first interaction with professional advice on ulcer prevention within the community in a primary care setting. Patients with callus and neuropathy are most likely to be prescribed non-keratolytic emollients or, on rare occasions, low-concentration urea creams by their GP to treat callus. This paper assesses the effectiveness of these creams in treating callus in patients referred to diabetic foot clinics, and compares their efficacy to that of a high-concentration keratolytic (25% urea) cream prescribed or recommended by podiatrists. [ABSTRACT FROM AUTHOR]

Defensive practice has received attention through the Munro review of child protection, which has identified that current organisational cultures increase the likelihood of defensive practice. Whilst the wider socio-political climate that gives rise to defensive practice has been explored within the literature, little attention has been paid to the everyday realities of defensive practice. This paper reports the findings of a study into final year social work students' attitudes towards defensive practice within social work. Three focus groups were completed with a total of ninety final-year students that collected qualitative and quantitative data using interactive software. This paper examines how participants perceived defensive practice, both in general and when faced with real-life vignettes. Participants distinguished between pro-active behaviour (sins of commission) and passive behaviour (sins of omission), generally regarding the latter as less serious because it was less tangible and easier to attribute to more positive motives. Whilst the literature identifies defensive practice as deliberate behaviour, the focus group discussions suggest that it is a subtler and less conscious process. Whilst there was there was a general consensus about the nature of defensive practice, there was considerable disagreement about specific vignettes and several competing explanations are explored. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis has many risk factors; however, the effect of anti-tumour necrosis factor therapy has not been investigated in depth. Our experience points to a detrimental clinical effect in overall prevalence of chronic rhinosinusitis, despite its benefit in certain subtypes. Method: A telephone survey was performed to parallel the findings of the Global Allergy and Asthma European Network chronic rhinosinusitis screening survey. This was itself based on the widely recognised European Position Paper on Rhinosinusitis and Nasal Polyps criteria. Results: A total of 120 patients responded to the survey. The prevalence of chronic rhinosinusitis in the anti-tumour necrosis factor therapy population was 20 per cent (95 per cent confidence interval = 12.84-27.16). When compared using a chi-square test, for a two-by-two contingency table, this finding was significant against the prevalence recorded in the normal population. Conclusion: This is the first observational study indicating increased prevalence of chronic rhinosinusitis in patients treated with anti-tumour necrosis factor therapy. These clinical findings require investigation in greater depth to clarify the nature of pathologies currently diagnosed and treated as chronic rhinosinusitis. [ABSTRACT FROM AUTHOR]

A major concern with COVID‐19 was the impact it would have on individual health, the routine use of healthcare services, and physical activities, especially for older adults with comorbidities. To address this, we studied the association between these variables for older adults during the pandemic. To explore what policy instruments might be effective in mitigating the negative impacts, we investigated the effects of a shielding notice for those identified as vulnerable by the government and social media given it has been an important source for disseminating information of COVID‐19. We employed a UK sample with 3,807 participants aged ≥50 from an online survey administered during May and June 2020. Based on numbers of comorbidities, we separated the sample into a higher comorbidity group with those in the upper quartile of the sample (n = 829) and a lower comorbidity group with the remainder (n = 2,978). Statistical methods include chi‐squared analyses and cross‐sectional regressions. We found that individuals with higher comorbidities were more likely to have poorer self‐reported health and mental health and to receive a shielding notice from the government compared to those without (p < 0.05). Decreases in physical activities were associated with poorer self‐reported health and the increases were associated with better self‐reported health; on the other hand, the decreases were associated with poorer mental health, but the increases did not link to better mental health. Examination of the effects of policy instruments shows that a shielding notice was positively associated with primary care use. The notice generated greater reliance on telephone/video consultations compared to in‐person consultations, but the impacts were less strong for people with higher comorbidities. Frequent use of social media raised the probability of increasing physical activities and reduced that of decreasing physical activities, implying social media being an effective tool in promoting physical activities during the lockdown and subsequent restrictions. [ABSTRACT FROM AUTHOR]

This study explores the impact of mental capacity in relation to breast screening for women with intellectual disabilities in the UK. Participation in breast screening is considerably lower for women with intellectual disabilities compared to the general population. Barriers to screening include poor mobility and behavioural difficulties. There is currently no research which primarily explores the relationship between mental capacity and breast screening for this group of individuals. This paper presents the results of a cross‐sectional survey of 131 women with intellectual disabilities supported by eight Social Care Providers within England and Wales. The data were collected between January 2017 and July 2017. The current research explores the decision‐making process surrounding breast screening, considering the impact of associated risk factors during this process. Participants completed a specifically created survey addressing the aforementioned issues. The results indicated that women who lacked capacity, were less likely to engage in breast screening. It was also demonstrated that the process outlined in the Mental Capacity Act (MCA; 2005) was not always followed; women were not routinely assessed if there were doubts regarding their decision‐making ability around breast screening and best interest meetings (BIM) were not always held if the person lacked capacity. In order to be able to generalise the current findings, further research is needed to gain a broader understanding of how professionals make decisions around breast screening for women with intellectual disabilities in case the individuals are unable to decide this independently. [ABSTRACT FROM AUTHOR]

Purpose: Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary's Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues. Design/methodology/approach: To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori. Findings: A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence. Practical implications: Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery. Originality/value: This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics. [ABSTRACT FROM AUTHOR]

Positive outcomes of social networking use in both informal and non-educational settings have attracted significant research attention. These benefits include social capital formation, higher job performance and satisfaction, an increased sense of belonging, improved knowledge management skills, and enabling of life-long learning opportunities. Compulsive use of social networking, however, remains a major issue among the younger users, potentially leaving a long-lasting impact on the younger population. Concerns have been raised regarding links between the compulsive use of social media and individual academic, social and physical performance. This study explores the motivations for social networking use, their relations to compulsive use, and implications for academic, physical and social performance, in an effort to inform strategies for the appropriate adoption and utilisation of social networking technologies. The study employs a finite mixture approach to segmenting the sample, and results show that two distinct groups motivated by utilitarian and social objectives respectively drive compulsive use by British students. Unlike previous studies, the UK sample does not display differences in terms of age or gender. This finding highlights the trend of gender agnostic views of social platforms by developers. The paper concludes with a discussion of the implications for practice and future research. [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]

The promotion of choice and control for older people is a policy priority for social care services in the United Kingdom and is at the heart of recent drives to personalise services. Increasingly, we are seeing a move away from institutionalised care (e.g. in care homes) towards enablement, with more services being delivered in community-based settings. Extra care housing has been promoted as a purpose-built, community-based alternative to residential care for older people. However, whilst accounts of users' experiences in particular service types are plentiful, the use of different instrumentation and measures makes comparison between settings difficult. We combined data from four studies where participants were older people either living in care homes or extra care housing or receiving care at home. All of these studies asked participants to rate their control over daily life, using the Adult Social Care Outcomes Toolkit (ASCOT). This paper presents the results of an ordinal logistic regression analysis indicating that, after controlling for differences in age, ability to perform activities of daily living and self-rated health, setting had a significant effect on older people's sense of control. Residents in care homes and extra care housing report similar levels of control over daily life but consistently report feeling more in control than older people receiving care at home. Implications for policy and practice are discussed. [ABSTRACT FROM PUBLISHER]

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure - the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [ SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs ( AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care ( N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department ( OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [ OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up ( AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. [ABSTRACT FROM AUTHOR]

Research applying rational-emotive behavior therapy (REBT) with athletes is sparse and findings are equivocal. REBT can be applied using education workshops, but previous studies in sport have not assessed changes in irrational beliefs following REBT. This paper reports the effects of a single REBT education workshop on irrational beliefs in elite soccer academy athletes from pretest to posttest. Statistical analyses indicate temporary reductions in irrational beliefs following the workshop. Results are discussed with reference to mechanisms of change, study limitations, workshop reflections, and recommendations for developing REBT workshops. [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]

Objectives:This paper reports two related analyses of verbal material from sevenLiving Well with Dementiagroups: the first examines changes in the verbal behaviours of participants across the course of the sessions in all seven groups; while the second contrasts therapist behaviour in two groups. Methods:In the first analysis, recordings of three sessions from each group were transcribed and participant descriptions of dementia were analysed using the Markers of Assimilation of Problematic Experiences of Dementia (MAPED) rating procedure. In the second analysis, therapist behaviour in weeks 2 and 8 from two groups (F and G) was analysed using the Hill Counsellor Verbal response rating scale. Inter-rater reliabilities for the two sets of ratings were ‘good’ and ‘very good’, respectively. Results:For the MAPED ratings, a five by four contingency table was analysed using chi-squared, which indicated a highly significant change in assimilation. There were significant higher levels of level 1 and 2 markers in the first two sessions and level 4 for sessions 5 and 6. Facilitators used significantly more direct guidance and information giving behaviour in the second session at Location F compared to Location G. Conclusions:The results suggest that important changes occurred in the way that dementia was described across the seven LivDem groups: this includes both reductions in the avoidance of direct references to dementia after the first two sessions, as well as an increase in ‘insight’ statements. Directive facilitator behaviour may be associated with poorer outcomes. [ABSTRACT FROM PUBLISHER]

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

(1) Background: Preterm premature rupture of membranes (PPROM) has been associated with increased perinatal morbidity, but the effect of PPROM on respiratory disease has not been previously quantified. We hypothesised that PPROM would be associated with a higher incidence of invasive ventilation. (2) Methods: A retrospective cohort study at the Neonatal Unit at King's College Hospital NHS Foundation Trust, London, UK, was conducted on infants born before 37 weeks of gestation. PPROM was defined as the rupture of membranes for >48 h. (3) Results: We reviewed 1901 infants (434 with PPROM) with a median (IQR) gestational age of 32.4 (28.7–35.0) weeks. The median (IQR) duration of rupture of membranes in the infants with PPROM was 129 (78–293) h. The incidence of invasive ventilation was 56% in the infants with PPROM and 46% in the infants without PPROM (p < 0.001). Following regression analysis, PPROM was significantly related to a higher incidence of invasive ventilation (odds ratio: 1.48; 95% CI: 1.13–1.92, adjusted p = 0.004) after adjusting for birth weight [odds ratio = 0.34; 95% CI: 0.33–0.43, adjusted p < 0.001], Apgar score at 10 min [odds ratio =0.61; 95% CI: 0.56–0.66, adjusted p < 0.001] and antenatal corticosteroid use (adjusted p = 0.939). (4) Conclusions: PPROM was associated with a 1.48-fold higher risk of needing invasive ventilation. [ABSTRACT FROM AUTHOR]

Introduction: Parent/carers of disabled children want timely and personalized support. Research suggests that technology may address some limitations associated with traditional methods of communication with therapists (e.g. letter, telephone). This exploratory study examined United Kingdom (UK) parents and carers views on the use of digital technology (i.e. computers/phones) in supporting their child and the potential for its greater use in the care of children with complex needs. Methods: An online survey was distributed via special schools and support forums/networks. Questions explored use of and attitudes to digital technology in the care of children with complex needs. Descriptive statistical analyses and content analyses were undertaken on the data. Results: Respondents were 43 parents/carers whose children used rehabilitation services prior to the COVID-19 pandemic. The majority used digital technology frequently to support their child and saw the potential for greater use in rehabilitation services – provided this was not at the expense of in-person therapist contact. Conclusion: Parents and carers held positive views of digital technology as a tool to support their child and enhance rehabilitation services. Recommendations include regular service consultation on parental/child attitudes to digital service delivery and longitudinal studies to assess related health outcomes. [ABSTRACT FROM AUTHOR]

Although reduced working time and furlough policy initiatives are widely regarded as important for economic and business reasons, little is known about their impacts on workers' mental health at the onset of COVID-19 pandemic. Using data from the UK Household Longitudinal Panel Study data from 2018 to February 2020 and April 2020 and change score analysis, this study aims to compare mental health changes between those who worked reduced hours, were furloughed and left/lost paid work. The results suggest that at the onset of COVID-19 reduced working time and furlough can protect workers' mental health, but only for men not for women. The gender differences remain significant even after controlling for housework and childcare responsibilities at the onset of COVID-19. These results highlight the importance of distributing paid work more equitably and formulating gender-sensitive labour market policies in protection of workers' mental health. [ABSTRACT FROM AUTHOR]

Background: Experiencing childbirth as traumatic is common and can have long-lasting negative consequences for women's mental health. However, fostering a sense of social identity has been shown to protect psychological wellbeing and mental health during life transitions, such as entering parenthood. This study therefore investigated the relationship between traumatic childbirth and first-time mothers' social identity and their psychological wellbeing, and more specifically whether strength of identity as a first-time mother protected psychological wellbeing following traumatic childbirth. Method: Women over the age of 18 who were living in the UK and had given birth to their first child in the past nine months were recruited to the study from clinical and community settings. They completed digital self-report questionnaires about their birth experience, social identity, mental health, and psychological wellbeing. Women who perceived themselves to have had a traumatic birth (the trauma group; N = 84) were compared to women who did not perceive themselves to have had a traumatic birth (the control group, N = 39). T-tests and chi square tests assessed preliminary group differences before multivariate analyses of covariance controlled for covariates. Post-hoc tests identified the direction of differences. Multiple regression and moderation analyses analysed interaction effects. Results: The trauma group had significantly lower psychological wellbeing (mean = 41.5, 95% CI [39.4–43.7], p =.008, partial η2 = 0.059), compared to the control group (mean = 48.4, 95% CI [45.3–51.5]), but the two groups did not differ in the strength of their first-time mother identity, which was high across both groups. Strength of identity did not moderate the relationship between traumatic childbirth and psychological wellbeing. Giving birth by caesarean section independently reduced the strength of the first-time mother identity (p =.017, partial η2 = 0.049). All analyses controlled for emotional and practical support, perceptions of healthcare staff, and mode of birth. Conclusions: Having a traumatic birth was associated with lower psychological wellbeing, and the strength of first-time mother identity does not appear to moderate this relationship. Factors such as mode of birth may be more important. Further research, including longitudinal designs, is needed to understand the relationship between these constructs and identify more effective ways of protecting first-time mothers' mental health. [ABSTRACT FROM AUTHOR]

Assessed reflective writing is increasingly common in UK higher education. Students writing in this mode are typically required to narrate their experiences, evaluate their performance, investigate associated emotions, and comment on what has been learned. In this paper I focus on assessed reflective writing by students on an MA TESOL course who are required to write individual reflections on a process of working in a group to produce teaching materials. This task places particular demands on the writer. Like other students writing reflectively, they need to manage complex self presentation: to appear honest about relative successes and failures, to show evidence of appropriate reflection, and to indicate desirable learning. Because they are reflecting on a group experience, they also need to differentiate themselves from their work group in their account, and to reflect critically on others as well as on themselves. My focus in this paper is on the ways they manage these additional demands. I first examine the relative frequency with which writers refer to themselves and their work group, and then examine the content of self-referential and group-referential statements. Finally, I examine semantic patterns in the data and draw conclusions regarding possible reasons behind student writers’ choices about how to represent themselves and others. [ABSTRACT FROM PUBLISHER]

Purpose – The first NHS forensic low secure unit for adolescents, the Westwood centre, opened in 2004. This paper seeks to focus on service utilisation and initial outcomes for the young people admitted in the first 45 months compared with young people accessing a neighbouring open adolescent unit. Design/methodology/approach – In order to understand service utilisation and initial outcomes, the clinical profiles of young people admitted in the first 45 months were evaluated. This included demographics, locality, admission status, length of stay, medication use, presenting problem, diagnosis, previous and discharge destination. The profiles of young people accessing the low secure unit were then compared with young people accessing a neighbouring open adolescent unit. Clinical profiles were ascertained from available healthcare records and service data. These were inspected and analysed using descriptive statistics.Findings – Thirty (54 per cent) of the 56 Westwood young people were male, the mean age at admission was 16.3 years and mean length of stay was 202 days. Twenty-five (44 per cent) young people had a discharge diagnosis related to psychosis, the remainder having primary problems relating to emotional and/or conduct problems. 26 (47 per cent) were discharged to another hospital setting and 20 (35 per cent) returned to their home of origin. Young people accessing the low secure unit were significantly older at admission and there was a trend for a higher proportion of females to be admitted to the open setting. In addition, the low secure unit had a greater proportion of young people with psychotic disorders and longer lengths of stay. Case examples illustrate a pilot of initial outcomes. Research limitations/implications – There were time differences in comparison of low secure and open unit and retrospective use of health care records. Practical implications – Clinical profiling is useful as a basis to consider clinical outcomes, pathways, utilization of a service, service/training needs and development. Comparisons between inpatient units provide further evidence to the areas above and help dispel myths that may otherwise guide decisions, e.g. about which diagnoses or gender affecting length of stay. Most young people progress positively from the low secure service onto open or community settings. Improving future outcomes for young people include such as through diversion from custody, length of admission, reduced symptoms/risks and planned progress to suitable community placements or home. Originality/value – The paper provides a clinical profile of young people accessing a low secure setting in comparison to an open unit. This has relevance to other secure and inpatient adolescent units and is important in considering pathways and outcomes. [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]

The study reported in this paper aimed at exploring the views of staff and patients of a potential emergency nurse practitioner service in an acute trust in the UK. The role of the nurse in emergency care has changed considerably in recent years, and the evolution of the emergency nurse practitioner role has changed emergency service provision dramatically. The emergency nurse practitioner role is not uniformly defined across emergency care in the UK, and the resulting blurring of the role of emergency nurse practitioners with that of emergency department medical staff is not helpful to hospital staff or patients. A quantitative and qualitative mixed method design was used that enabled exploration of an individual's viewpoint within their own practice or natural surroundings. Self-completed questionnaires were used to determine health professionals' opinions, and semi-structured interviews were employed to explore patients' views. A total of 144 health professionals responded to the questionnaire survey giving a response rate of 28·5%, and 10 patients participated in qualitative interviews. Health professionals and patients alike were generally supportive of an emergency nurse practitioner service, but there were some concerns in relation to the role and functions of the emergency nurse practitioner and associated accountability issues. This paper contributes further data that demonstrate the inter-professional and patient support of the advanced role of the emergency nurse practitioner and highlights potential conflictual issues and barriers to implementation that can and must be resolved successfully through proper consultation prior to the service being introduced. This paper provides important information to health professionals and service providers that should help to facilitate the introduction and maintenance of a successful and effective emergency nurse practitioner service in any trust. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine parent/caregiver perspectives and experiences of speech-language pathology provision during the COVID-19 pandemic for children born with cleft palate. Method: An online questionnaire to parents of children born with cleft palate asked about delays and changes to speech-language pathology provision during the first U.K. national lockdown. Parents were also asked their views on the effectiveness of online speech-language pathology provision. Analysis considered variation in speech-language pathology provision by region. Chi-square and Mann-- Whitney U tests examined associations between speech-language pathology provision and socioeconomic status and child age. Free text responses were analyzed using qualitative content analysis. Results: Three hundred fifty-six (39.3%) children were receiving speechlanguage pathology intervention before the first national lockdown. A further 49 (9.0%) were due to start speech-language pathology intervention during the lockdown. Speech-language pathology provision varied both nationally and within smaller geographical regions. Overall, 146 (42.6%) children continued to receive speech-language pathology and 197 (57.4%) had intervention delayed. There was no association between delayed speech-language pathology and socioeconomic status. Older children were more likely to experience delayed speech-language pathology provision (p = .004). Qualitative analysis revealed concerns about access to speech-language pathology, challenges with adequate devices to access online provision, technological problems, and child engagement in online provision. Parents reported online provision as being "better than nothing." Conclusions: Parents/caregivers reported delays to speech-language pathology provision during the first lockdown, but this varied geographically and was more prevalent for older children. Concerns about access to speech-language pathology provision were raised, including challenges regarding online provision. Follow-on work will consider the impact of the delays experienced on longer term outcomes. [ABSTRACT FROM AUTHOR]

Shared Lives (adult placement) is a model of community-based support where an adult who needs support and/or accommodation moves into or regularly visits the home of an approved Shared Lives carer, after they have been matched for compatibility. It is an established but small service which has been used mainly by people with learning disabilities but which has the potential to offer an alternative to traditional services for some older people. However, there is little research on the outcomes for older users of Shared Lives. This paper presents findings from a survey of 150 older people using Shared Lives support across 10 Shared Lives schemes in England, which took place between June 2013 and January 2014. The aim was to identify outcomes for older users of Shared Lives and compare these to outcomes for older users of other social care services. In the absence of an ideal study design involving randomised allocation, statistical matching was used to generate a comparison group from the Adult Social Care Survey from 2011/12, with 121 cases matched to 121 Shared Lives cases. The main outcome measures were Social Care-Related Quality of Life (measured by the ASCOT) and overall quality of life. Findings indicated that Shared Lives can deliver good outcomes for older people, particularly for overall quality of life. In comparison to the matched group of older people using other forms of support, there was some evidence that Shared Lives may deliver better outcomes in some aspects of quality of life. Limitations to the research mean, however, that more work is needed to fully understand the role Shared Lives could play in supporting older people. [ABSTRACT FROM AUTHOR]

Background: Adverse Drug Reactions (ADRs) are a major public health problem. Prompt reporting of suspected ADRs is fundamental in the post-marketing surveillance of medicines and helps in ensuring medicine safety. However, fewer ADRs are reported in general and in particular by community pharmacists. There is limited knowledge about the factors which are preventing community pharmacists in the UK from reporting an ADR. Objectives: To identify the barriers to ADR reporting among community pharmacists practicing in the UK. Methods: A cross sectional study using a 25-items questionnaire (both online and paper based) including 10 barriers to ADR reporting was conducted from 1st April 2012 to September 2012. Community pharmacists practicing in the West Midlands, UK, were approached for the participation in this study. Chi-Square and regression were applied to identify covariates for the barriers to ADR reporting. A significant value of 0.05 was assigned for analysis. Results: Of the 230 invited community pharmacists, 138 pharmacists responded (response rate 60%). The median age of respondents was 31 years. All pharmacists reported that they would report both serious and mild ADRs from drugs with black triangle among children as well as adults. About 95% (n=131) of the pharmacists were familiar with the paper based ADR reporting system. Storebased pharmacists were more likely to be more confident about which ADRs to report [0.680, 95% Confidence Interval 0.43-3.59]. Lack of time 46.4% (n=64), and pharmacists perception that ADR is not serious enough to report (65.2%; n=90) were identified as barriers to ADR reporting. Majority 63.0% (n=87) of the pharmacists identified training and information about what to report and access to Information Technology (IT) (For example access to internet connection) 61.6% (n=85) as facilitators to ADR reporting process. Conclusion: Lack of time and ADRs considered not serious enough by pharmacists to report were barriers to ADR reporting. Further training and education about the types of ADRs to be reported can help to improve the reporting of ADRs. [ABSTRACT FROM AUTHOR]

Background: Lifestyle advice is widely considered as an integral component of acupuncture treatment. However, it is unclear whether lifestyle advice and related self-care are important for sustaining benefit over the longer term. In a novel secondary analysis of trial data, this paper explores the nature and impact of acupuncture-related diagnosis, and associated lifestyle advice and self-care, in patients with chronic neck pain. Design: In a three-arm, randomized, controlled multicenter trial with 12 months of follow-up, a total of 517 patients with chronic neck pain were randomized in equal proportions to acupuncture, Alexander technique, or usual care alone. Methods: For each acupuncture patient, practitioners reported treatment components that included an acupuncture-related diagnosis and provision of associated lifestyle advice. Patients reported at baseline, 3, 6, and 12 months on variables related to treatment, which included aspects of self-care, self-efficacy, and lifestyle advice acted upon, as well as pain and disability scores. Congruence between practitioner advice and patient take-up was assessed using chi-squared test. Impact of lifestyle advice and self-efficacy on outcome was evaluated using regression models. Results: Among patients randomized to acupuncture, the most common diagnostic framework involved the Zang-Fu syndromes for 139/160 (87%) patients. Lifestyle advice was provided by practitioners to 134/160 (84%) of patients, most commonly related to exercise, relaxation, diet, rest, and work. Significant congruence with patient take-up was found for diet, rest, and work. Moreover, patients in the acupuncture group improved their ability to use what they had learnt and increased their self-efficacy. In turn, these characteristics were associated with significant reductions in pain and disability scores at 12 months. Conclusion: Acupuncture-related lifestyle advice helped patients improve the way they live and care for themselves and enhanced self-efficacy and ability to use what they had learnt. These changes were associated with reductions in pain and disability at 12 months. [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 and Purpose The aim of this study was to assess whether the severity of tinnitus, as measured using ratings of tinnitus loudness, annoyance, and effect on life, was influenced by the lockdown related to the coronavirus disease 2019 (COVID-19) pandemic. Research Design This was a retrospective study. Study Sample The data for 105 consecutive patients who were seen at a tinnitus clinic in an audiology department in the United Kingdom during the COVID-19 lockdown between April and June 2020 and 123 patients seen in the same period of the previous year, prior to the COVID-19 pandemic were included. Data Collection Demographic data for the patients, results of their pure-tone audiometry, and their score on visual analog scale (VAS) of tinnitus loudness, annoyance, and effect on life were imported from their records held at the audiology department. This was a retrospective survey comparing ratings on the VAS of tinnitus loudness, annoyance, and effect on life for consecutive patients seen during the COVID-19 lockdown and consecutive patients seen in the same period of the previous year, prior to the COVID-19 pandemic. Patients seen prior to lockdown used a pen and paper version of the VAS, while the patients who were assessed during the COVID-19 lockdown used an adapted version of the VAS, via telephone. All patients were seeking help for their tinnitus for the first time. Results The mean scores for tinnitus loudness, annoyance, and effect on life did not differ significantly for the groups seen prior to and during lockdown. Conclusion Any changes in psychological well-being or stress produced by the lockdown did not significantly affect ratings of the severity of tinnitus. [ABSTRACT FROM AUTHOR]