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Objective: To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries.Design: Cross-sectional analysis. Multivariate regression analysis and χ 2 comparisons were used to detect differences between countries.Setting: Supermarkets in New Zealand (NZ), Australia, Canada and the UK.Subjects: Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks.Results: A total of 4157 products were analysed, including 749 from NZ, 1738 from Australia, 740 from Canada and 930 from the UK. NZ had the highest percentage of beverages with sugar added to them (52 %), while the UK had the lowest (39 %, P<0.001).Conclusions: There is substantial difference between countries in the mean energy, serving size and proportion of products eligible for fiscal sugar taxation. Current self-regulatory approaches used in these countries may not be effective to reduce the availability, marketing and consumption of sugar-sweetened beverages and subsequent intake of free sugars. [ABSTRACT FROM AUTHOR]

This study investigates the emotional content of 174 posts from 162 posters to online forums made by young (age 14–21) first‐time mothers to understand what emotions are expressed in these posts and how these emotions interact with the types of posts and the indicators of Information Poverty within the posts. Using textual analyses we provide a classification of emotions within posts across three main themes of interaction emotions, response emotions, and preoccupation emotions and show that many requests for information by young first‐time mothers are motivated by negative emotions. This has implications for how moderators of online news groups respond to online request for help and for understanding how to support vulnerable young parents. [ABSTRACT FROM AUTHOR]

Background While the consequences of body weight for physical health are well explored, the evidence for psychological well-being is less straightforward. An instrumental variable approach is used to address the endogenous relationship between body weight and well-being in the UK general population. Methods Data from the Health Survey for England (2003, 2004 and 2006) are used to fit linear and ordered probit instrument variable models for a sample of 13 862 individuals, with frequent white meat consumption instrumenting for body-weight. Non-linearities in the relationship, robustness to weak instruments and relaxation of strict exogeneity assumption are further examined. Results Accounting for endogeneity and conditional on health a protective effect on well-being is observed. A unit increase in body mass index (BMI) improves General Health Questionnaire (GHQ) by 0.17 (95% CI: 0.02–0.31) points and reduces the probability of reporting very low GHQ by 2.5% (95% CI: 0.01–0.05). Empirical testing showed that the instrument performs well, with increased meat consumption adding 0.58 points (95% CI: 0.42–0.74) to ones’ BMI. Conclusions We present support for the jolly-fat hypothesis, however, caution is recommended in drawing inferences. Further research needs to resolve the mixed findings in the literature. [ABSTRACT FROM AUTHOR]

The article analyzes the job search behavior of new graduate nurses in Italy. Topics discussed include the demographic and educational characteristics of non-employed nurses compared with their employed counterparts, the professional networking behavior of unemployed and employed nurses and the factors that influence the length of unemployment of a new graduate nurse.

This study examines the subjective experience of living with epilepsy or psychogenic nonepileptic seizures (PNES) by thematically comparing individuals' written accounts of their condition. Five key differences emerged. Theme 1: "Seizure onset" revealed differences in how individuals think about and ruminate over the possible causes of their condition. Theme 2: "Emotive tone" demonstrated that writings of those with epilepsy reflected stable emotions (no intense emotional reactions), whereas those of writers with PNES reflected anxiety and low mood. Theme 3: "Seizure symptoms" showed differences in the conceptualization of seizures. Theme 4: "Treatment" explored differences in the diagnostic journey and experiences of health care professionals. Theme 5: "Daily life" revealed that those with epilepsy perceived sequelae and seizures as something that must be fought, whereas those with PNES tended to describe their seizures as a place they enter and something that has destroyed their lives. The findings have implications for treatment and management. [ABSTRACT FROM AUTHOR]

Context: Discrimination and harassment create a hostile environment with deleterious effects on student well‐being and education. In this study, we aimed to: (i) measure prevalences and types of discrimination and harassment in one UK medical school, and (ii) understand how and why students report them. Methods: The study used a mixed‐methods design. A medical school population survey of 1318 students was carried out in March 2014. Students were asked whether they had experienced, witnessed or reported discrimination or harassment and were given space for free‐text comments. Two focus group sessions were conducted to elicit information on types of harassment and the factors that influenced reporting. Proportions were analysed using the Wilson score method and associations tested using chi‐squared and regression analyses. Qualitative data were subjected to framework analysis. Degrees of convergence between data were analysed. Results: A total of 259 (19.7%) students responded to the survey. Most participants had experienced (63.3%, 95% confidence interval [CI]: 57.3–69.0) or witnessed (56.4%, 95% CI: 50.3–62.3) at least one type of discrimination or harassment. Stereotyping was the form most commonly witnessed (43.2%, 95% CI: 37.4–49.3). In the qualitative data, reports of inappropriate joking and invasion of personal space were common. Black and minority ethnic students had witnessed and religious students had experienced a greater lack of provision (χ2 = 4.73, p = 0.03 and χ2 = 4.38, p = 0.04, respectively). Non‐heterosexual students had experienced greater joking (χ2 = 3.99, p = 0.04). Students with disabilities had experienced more stereotyping (χ2 = 13.5, p < 0.01). Female students and students in clinical years had 2.6 (95% CI: 1.3–5.3) and 3.6 (95% CI: 1.9–7.0) greater odds, respectively, of experiencing or witnessing any type of discrimination or harassment. Seven of 140 survey respondents had reported incidents (5.0%, 95% CI: 2.4–10.0). Reporting was perceived as ineffective and as potentially victimising of the reporter. Conclusions: Harassment and discrimination are prevalent in this sample and associated with gender, ethnicity, sexuality, disability and year group. Reporting is rare and perceived as ineffective. These findings have informed local developments, future strategies and the development of a national prevention policy. [ABSTRACT FROM AUTHOR]

Background: While studies have evaluated caregiver outcomes in heart failure, the burden and support needs when caring for someone with advanced heart failure at the end of life have yet to be outlined. Aim: To identify psychosocial factors associated with caregiver burden and evaluate the support needs of caregivers in advanced heart failure. Design: A sequential mixed methods study comprising two phases: (1) postal survey with advanced heart failure patients and their caregivers and (2) interviews with current and bereaved caregivers. Correlation, chi-square, t test, regression and thematic analysis were undertaken on the data. Participants: Advanced heart failure patients (n = 112) and their caregivers (n = 84) were recruited from secondary care settings across the United Kingdom and Ireland. For phase 2 interviews, current caregivers (n = 20) were purposively recruited from phase 1, and bereaved caregivers (n = 10) were purposively recruited via voluntary organisation, social media and email. Results: More than half the caregivers (53%) had levels of distress associated with depression (Zarit Burden score >24). Caregiver depression score, preparedness for caregiving and patients' depression score predicted caregiver burden. Qualitative analysis identified an overarching theme of lack of future care planning and four subthemes: (1) seeking emotional support from someone who understands, (2) want information on prognostication, (3) lack of knowledge on how to and where to get support and (4) require knowledge on what to expect at the end of life. Conclusion: Caregivers have unmet needs and feel unprepared for the future. Implementation of future care planning by clinical teams should address patient and caregiver support needs and in turn alleviate caregiver burden. [ABSTRACT FROM AUTHOR]

Aim Patient redirection can help reduce service demand by providing information about more appropriate services. There is, however, no evidence about the effect of nurse-led patient redirection in urgent care centre settings. The aim of this project was to develop and evaluate a nurse-led patient 'self-care and redirection first' intervention in an urgent care centre (UCC). Method Adopting a prospective observational design, the intervention was delivered to an opportunity sample of patients who attended a south London hospital UCC, between June and July 2014, and evaluated through patient interviews five to ten days after initial attendance. Findings 118 of the 1,710 people who attended the UCC participated in the intervention, of whom 81 (69%) were redirected to other services or home to self-care, and 37 were transferred to an emergency department. Of the 110 (93.2%) participants who completed the questionnaire, 97.2% were satisfied with the service. Only two accessed different services to those recommended, and 72.2% (n=85) said they would not reattend a UCC for a similar condition. Conclusion Treating minor ailments in a UCC is an inefficient use of resources. A nurse-led self-care and redirection intervention can help divert patients with minor ailments to more appropriate services. Further evaluation of the effect of the intervention on service demand and costs is required. [ABSTRACT FROM AUTHOR]

Significant progress has been made since the 1980s in supporting adults with learning disability to live independent lives in the community. In 2012, the Department of Health in England announced the latest policy initiative to further invest in community support for people with learning disabilities,Transforming Care.Building the right community supported living setting for people does not in isolation provide for a comprehensive strategy towards achieving a paradigm shift in how people with learning disabilities experience their full right to inclusion in their communities. We undertook a practice inquiry into the quality of life experienced by people with learning disabilities. Social workers chose the focus of the inquiry to be on people’s evening routines to answer the question — were people living in the community experiencing independence or did institutional routines define their lives. The findings were that 69% of people with a learning disability were either in bed or were ready for bed. There was evidence that institutionalised routines existed in the settings with an association between an early evening meal time and the person being ready for or in bed (p = 0.0001 at Time 1 andp = 0.051 at Time 2). Implications for social work practice are discussed. [ABSTRACT FROM PUBLISHER]

Young people who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) experience higher levels of suicidality compared to heterosexual or cisgender peers, and face significant barriers accessing mental health services including prejudice from staff. In a cross-sectional survey, mental health staff who reported receiving LGBT awareness training were significantly more likely to report in relation to working with LGBT youth that they routinely discussed issues of sexuality and gender (χ2=8.782, df=2,p< 0.05); to feel that their organisation supported them to work with this group (χ2=14.401, df=2,p< 0.001); and report that they had access to adequate skills training that supported their work with suicidality and self-harm with this group (χ2=21.911, df=2,p<0.001). There is a need to enhance the mental health workforce in LGBTQ awareness, and these findings indicate that awareness training could impact positively on practice. [ABSTRACT FROM AUTHOR]

publisher‐imprint‐name Springer volume‐issue‐count 1 issue‐article‐count 0 issue‐toc‐levels 0 issue‐pricelist‐year 2017 issue‐copyright‐holder The Author(s) issue‐copyright‐year 2017 article‐contains‐esm No article‐numbering‐style Unnumbered article‐registration‐date‐year 2017 article‐registration‐date‐month 10 article‐registration‐date‐day 23 article‐toc‐levels 0 toc‐levels 0 volume‐type Regular journal‐product ArchiveJournal numbering‐style Unnumbered article‐grants‐type OpenChoice metadata‐grant OpenAccess abstract‐grant OpenAccess bodypdf‐grant OpenAccess bodyhtml‐grant OpenAccess bibliography‐grant OpenAccess esm‐grant OpenAccess online‐first false pdf‐file‐reference BodyRef/PDF/40169_2017_Article_172.pdf target‐type OnlinePDF issue‐type Regular article‐type OriginalPaper journal‐subject‐primary Medicine & Public Health journal‐subject‐secondary Medicine/Public Health, general journal‐subject‐collection SC11 --> Background: Nintedanib has been shown to slow disease progression in patients with idiopathic pulmonary fibrosis (IPF). It was approved by the National Institute for Health and Care Excellence (NICE) in January 2016 for IPF patients with a forced vital capacity (FVC) of 50–80% in the United Kingdom (UK). Aim: To report real world data about our early clinical experience using nintedanib in 187 patients with a multi‐disciplinary (MDT) diagnosis of IPF in a manufacturer funded patient in need scheme (three UK centres) prior to NICE approval. Methods: All patients with a MDT diagnosis of IPF from December 2014 to January 2016 commenced on nintedanib were included. Demographic details, adverse events (AEs) and where available lung function results were retrospectively collected from clinical letters. Results: 187 patients (76% males) with a median age of 72 years (49–89) were treated with nintedanib. The average pre‐treatment FVC was 81.1 ± 19.8% and diffusion capacity of the lungs for carbon monoxide was 43.9 ± 15% (n = 82). Fifty percent of patients started nintedanib because they were ineligible for pirfenidone due to an FVC > 80%. The median treatment course was 8 ± 4 months. The majority of patients experienced 1–3 AEs with nintedanib (52%, n = 97). The most frequent AEs were diarrhoea (50%), nausea (36%), reduced appetite (24%), tiredness (20%) and gastro‐oesophageal reflux (18%). The majority of AEs resulted in no change in treatment (64%, n = 461). 21% (n = 150) of AEs resulted in a dose reduction and 13% (n = 94) necessitated discontinuation of treatment. 1 in 5 patients discontinued treatment either temporarily or on a permanent basis during the monitoring period. In a select cohort of patients, a statistically significant greater proportion of patients remained stable or improved and a lower proportion declined, as depicted by FVC changes of > 5% after nintedanib commencement (P < 0.05 using Chi squared test). Conclusions: Nintedanib is well tolerated and has an acceptable safety profile. Only 8% of those reporting diarrhoea discontinued treatment either on a temporary or permanent basis. There were no signals with respect to increased cardiovascular morbidity or major bleeding risk. This is in keeping with the INPULSIS clinical trial findings but in a real world cohort. [ABSTRACT FROM AUTHOR]

Objective: To review the current criteria for the interpretation of positional nystagmus (PN).Design: Videonystagmography data on PN was collected for 90 patients presenting for balance testing with a history of vertigo or imbalance (excluding those diagnosed with benign paroxysmal positional vertigo). These were compared to normative data from 90 asymptomatic subjects. A literature review was carried out regarding threshold criteria for clinically significant PN. These were evaluated using the data collected.Study sample: Clinic group: 90 patients; 37 male, 53 female. Age range 15–82 years.Normative group: Ninety subjects; 31 male, 59 female. Age range 21–79 years. Results: PN was seen in 75.6% of the clinic group and in 50% of the normative group. The prevalence of nystagmus of slow phase velocity (SPV) > 3°/s was significantly higher in the clinic group than the normative group. The maximum SPV recorded in each position was greater from the clinic group than the normative group.Conclusions: This study supports the use of normative thresholds for SPV for both horizontal and vertical PN. A normative threshold of >3°/s for horizontal and >7°/s for vertical nystagmus is proposed. [ABSTRACT FROM PUBLISHER]

Background: Comprehensive wound assessments demonstrate better patient outcomes. Digital photography is a useful adjunct, aiding assessment and reducing the risk of overtreatment. Aim: This study compared the quality of digital photographs uploaded directly to the electronic patient record (EPR) with those uploaded via a database by non-specialist nurses as part of the development of a standard operating procedure in two cardiothoracic centres. Methods: Two specialist surveillance nurses retrospectively audited 1,837 wound photographs: 1,713 uploaded to the EPR via a database and 124 uploaded directly to the EPR. Image quality was determined by: 1) function, including clarity and documentation of appropriate clinical details alongside the image; and 2) format, including size, rotation and focus. Both function and format needed to be satisfactory to meet quality criteria. Results: Only 52% (65/124) of photos uploaded directly to the EPR were of sufficient quality versus 99% (1,702/1,713) of photos uploaded via a database. There was a significant difference in the quality of images managed using the two methods (p<0.0001). Conclusion: Findings suggest that, in practice, a database should be recommended to ensure quality control as it reduces the risk of error and facilitates reporting on wound types, care and resources. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the current practice and experience of sign-off mentors in one NHS trust. Background In the UK, sign-off mentors support nursing students in their last clinical placement and are accountable for the final assessment of fitness to practice as a registered nurse. Design Mixed-methods study. Methods The focus was on two key Nursing and Midwifery Council standards: the requirement for students to work at least 40% of their time on clinical placement with a sign-off mentor/mentor; the sign-off mentor had one-hour-per-week protected time to meet the final placement student. Data were collected through two audits of clinical and university documents and an experience survey administered to all sign-off mentors in one trust. Results The audits showed that only 22/42 (52%) of students were supervised by their sign-off mentor/mentor at least 40% of the time, whilst 10/42 (24%) students never worked a shift with their sign-off mentor. Only one student met their sign-off mentor every week. Complete data were available in 31/64 (47%) sign-off mentors, of whom 21/30 (70%) rarely/never had reduced clinical commitment to mentor final placement students. Furthermore, 19/28 (68%) met their student after their shift had ended with 24/30 (80%) reporting not getting any protected time. Conclusion Sign-off mentors have inadequate time and resources to undertake their role, yet are accountable for confirming the student has the required knowledge and skills to practise safely. The current model needs urgent review to improve mentoring standards. Relevance to clinical practice Understanding how the role of the sign-off mentor is working in practice is critical to ensuring that the Nursing and Midwifery Council standards are met, ensuring students are well supported and appropriately assessed in practice, and mentoring is given the high profile it deserves to guarantee high-quality care and protecting the public. [ABSTRACT FROM AUTHOR]

Background: The integration of patient safety into nursing curricula has been under the spotlight during recent years. Effective patient safety pedagogies and students’ sensitivity to their own role in healthcare have important roles in ensuring safe clinical performances. The patient safety content of pre-registration nursing education has previously been studied, but there is sparse evidence about how nursing students assess their own patient safety competence. Objective: To examine and compare the self-assessment of patient safety competence between British and Finnish nursing students. Methods: The Patient Safety in Nursing Education Questionnaire (PaSNEQ), in the 4-point Likert scale format, was used. We distributed 502 surveys to the final year nursing students, prior to registration in two universities of applied sciences in Finland (n = 299) and two universities in the UK (n = 203) during 2012. Of which, a total of 353 (70%) nursing students in Finland (n=195) and the UK (n=158) responded to the survey. The data were analyzed with descriptive statistics and binary logistic regression. Results: Majority of both British and Finnish participants reported that their curriculum did not include a separate module for patient safety. The overall patient safety competence of British and Finnish nursing students was high. However, the British nursing students evaluated their overall patient safety competence significantly higher than Finnish nursing students. Both groups of students ranked their competence to prevent patient safety incidents (attitude) the highest and their competence to act after errors (skill) relatively low. The predictors for having a high level of patient safety competence for nursing students were being British and detecting separate patient safety module in the curriculum. Conclusions: Nurse educators should provide students with more effective practice environment that will prepare them with the patient safety skills needed to respond to errors at work safely. [ABSTRACT FROM AUTHOR]

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

Aim To evaluate the impact of the CCSEP on care home staff in two care settings for older people in one nursing home and one residential home. Background Care homes provide personal care and accommodation for older people. The English Dementia Strategy aims to improve the quality of service provision for people with dementia. This includes specific mention of improving the quality of life in care homes and as such includes objectives related to developing the workforce knowledge and skills. The Ladder to the Moon Culture Change Studio Engagement Programme (CCSEP) is a staff training approach based on the Positive Psychology framework that uses theatre- and film-based activities. Methods This study used a wait-list controlled design. However, the data analysis plan was amended to reflect difficulties in data collection, and a quasi-experimental case study approach was consequently utilised. Outcome measures for staff attitudes and beliefs were as follows: Sense of Competence in Dementia Care Staff; Approaches to Dementia Questionnaire; Job Satisfaction Index; Brief Learning Transfer System Inventory; and Scale of Positive and Negative Experience. The Quality of Interaction Schedule (QUIS) was used to observe changes in staff-resident interaction. Results Fifty staff in two care homes completed the questionnaires and forty-one undertook formal CCSEP training. In Home A (nursing home), there was no significant change in any of the measures. In Home B (residential home), the QUIS showed an increase in positive interactions post intervention; a significant increase in the Building Relationship subscale of Sense of Competence; and a significant increase in staff sense of hopefulness towards people with dementia. The Brief Learning Transfer System Inventory showed a significant decrease post-intervention. The intervention did not significantly affect the happiness or job satisfaction of care home staff. Conclusion The results of this study provide tentative evidence about the efficacy of this staff training programme. Some significant improvement in staff attitudes to people with dementia, staff sense of competence and positive staff-resident interactions were found in one of two homes. It is likely that the organisational problems affecting the other care home limited the implementation and therefore efficacy of the intervention there. The results therefore suggest that when a supportive management structure is in place, CCSEP may be more effective in improving staff attitudes, sense of competence and interactions with residents. [ABSTRACT FROM AUTHOR]

Background While discussion continues over the future implementation of lung cancer screening, low participation from higher risk groups could limit the effectiveness of any national screening programme. Objectives To compare smokers' beliefs about lung cancer screening with those of former and never smokers within a low socioeconomic status ( SES) sample, to explore the views of lower SES smokers and ex-smokers in-depth, and to provide insights into effective engagement strategies. Design, setting and participants Using proactive, community-based recruitment methods, we surveyed 175 individuals from socioeconomically deprived communities with high smoking prevalence and subsequently interviewed 21 smokers and ex-smokers. Participants were approached in community settings or responded to a mail-out from their housing association. Results Interviewees were supportive of screening in principle, but many were doubtful about its ability to deliver long-term survival benefit for their generation of 'heavy smokers.' Lung cancer was perceived as an uncontrollable disease, and the survey data showed that fatalism, worry and perceived risk of lung cancer were particularly high among smokers compared with non-smokers. Perceived blame and stigma around lung cancer as a self-inflicted smokers' disease were implicated by interviewees as important social deterrents of screening participation. The belief that lungs are not a treatable organ appeared to be a common lay explanation for poor survival and undermined the potential value of screening. Conclusions Attitudes towards screening among this high-risk group are complex. Invitation strategies need to be carefully devised to achieve equitable participation in screening. [ABSTRACT FROM AUTHOR]

The aim of the present study was to measure the subjective well-being of a group of 225 UK registered mental health nurses (MHN) using three survey measures, and to identify whether certain demographic and workplace factors correlated with subjective well-being measure scores. An online survey incorporating the subjective well-being questions used by the Office for National Statistics, the Satisfaction with Life Scale, and the Warwick Edinburgh Mental Well-Being Scale was administered to members of two professional bodies for MHN. There was good consistency between the three subjective well-being measures, each demonstrating that UK MHN had a relatively low subjective well-being. Apart from the Office for National Statistics question, 'Overall, to what extent do you feel the things you do in your life are worthwhile?', demographic and workplace factors did not correlate with subjective well-being measure scores, although the characteristics of being male, living alone, and being aged 40-49 years were associated with lower mean scores on all three measures. The findings of the exploratory study suggest that a similar study should be undertaken with a larger representative population of MHN, and that qualitative research should explore why and how UK MHN have relatively low subjective well-being. The limitations of this study, namely the response rate and sample representativeness, mean that the results of the present study must be tested in further research on the MHN population. [ABSTRACT FROM AUTHOR]

Background:Alcohol is one of the least intervened risk factors in the management of hypertension at the primary care level. In order to improve alcohol interventions, a better understanding of knowledge, attitudes and clinical practice of lifestyle interventions in the management of hypertension is needed. Method:As a part of a European study (France, Germany, Italy, Spain, UK), 211 German general practitioners (GPs) were recruited in Bavaria and Hamburg and surveyed via an Internet-based questionnaire. Results were compared with the European sample (n = 2870). Results:One-third of the patients seen by German GPs had hypertension (36.2%, standard deviation (SD): 14.6) and among cases with hypertension, less than half were ever screened for alcohol (4.5 out of 10 patients). The foremost reasons for not screening for alcohol were that alcohol was not considered a major risk factor for hypertension plus the lack of knowledge of appropriate alcohol screening instruments. The majority of German GPs managed patients with hazardous drinking levels themselves or in their practice (71.3%, 95% confidence interval (CI): 64.6–77.2%), but only 42.0% (95% CI: 35.2–49.0%) managed alcohol dependent patients. German screening rates were slightly lower but interventions of screened positive patients higher than the European average. Conclusions:Rates of alcohol screening in patients with hypertension in primary health care may be increased by improving GPs knowledge of alcohol as a major risk factor for hypertension, increasing GPs education on alcohol and screening instruments, and providing reimbursement. This may increase treatment of alcohol problems in patients with hypertension and reduce hypertension. [ABSTRACT FROM PUBLISHER]

Aims The aim of this study was to investigate the relationships between depressive symptoms, burnout and perceptions of patient safety. A mediation model was proposed whereby the association between symptoms of depression and patient safety perceptions was mediated by burnout. Background There is growing interest in the relationships between depressive symptoms and burnout in healthcare staff and the safety of patient care. Depressive symptoms are higher in healthcare staff than the general population and overlap conceptually with burnout. However, minimal research has investigated these variables in nurses. Given the conceptual overlap between depressive symptoms and burnout, there is also a need for an explanatory model outlining the relative contributions of these factors to patient safety. Design A cross-sectional questionnaire was distributed at three acute NHS Trusts. Method Three-hundred and twenty-three hospital nursing staff completed measures of depressive symptoms, burnout and patient safety perceptions (including measures at the level of the individual and the work area/unit) between December 2015 - February 2016. Results When tested in separate analyses, depressive symptoms and burnout facets were each associated with both patient safety measures. Furthermore, the proposed mediation model was supported, with associations between depressive symptoms and patient safety perceptions fully mediated by burnout. Conclusion These results suggest that symptoms of depression and burnout in hospital nurses may have implications for patient safety. However, interventions to improve patient safety may be best targeted at improving burnout in particular, with burnout interventions known to be most effective when focused at both the individual and the organisational level. [ABSTRACT FROM AUTHOR]

This article aims to investigate associations between perceived control and health-related quality of life ( HRQOL) with dietary changes after prostate cancer diagnosis and to explore General Practitioners' ( GPs) perceptions on the role of diet in prostate cancer post-diagnosis. Ninety-five prostate cancer patients completed measures of dietary change, one for after diagnosis and another for after therapy. They also scored their HRQOL and perceived control. There were discrepancies in dietary changes reported between a general question (28.4% no dietary changes) and a specific (42.1%-51.5% range of no change for various food items). Most patients initiated healthy changes. Patients who changed their diet after diagnosis had lower cognitive functioning and external locus of control (doctors). Patients who changed their diet after therapy had lower cognitive and emotional functioning, quality of life and external locus of control (doctors). Then, fourty-four GPs responded to an online survey. Their open-ended responses were analysed using Content Analysis. They reported interest in the role of diet in cancer but also lack of relevant knowledge. They were skeptical on providing information. Clinical interventions should consider patients' cognitive ability, their relationship with their health professional and their wellbeing. Also, GPs' confidence to provide dietary advice needs to be addressed. [ABSTRACT FROM AUTHOR]

Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (1) a lack of patient-centred care and involvement in decision-making, (2) a need for health professional training and revision of information resources to negate the effects of heteronormativity and (3) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration. [ABSTRACT FROM AUTHOR]

Accessible summary Most physical activity (PA) studies exclude individuals with severe and profound intellectual disabilities, and the reasons for these exclusions are unclear. Therefore, this study explored the practicalities of recruiting and measuring adults with intellectual disabilities, including those with severe and profound intellectual disabilities., Each individual and their carer or family filled in a questionnaire where they were asked about their PA over the previous 7 days; thereafter, they were given an accelerometer for 7 days to measure their physical activities., Four things were found to be important for this type of study: (i) where participants lived; (ii) what was used in measuring their PA; (iii) their reported PA was similar to what their family/carer reported; and (iv) it was also similar to what was measured., The study showed that it is possible to measure PA irrespective of the intellectual disability severity and that adults with intellectual disabilities can tell you about their PA and so can their relatives/carers without the need for expensive equipment., Abstract Background Few studies have measured physical activity ( PA) levels of adults with intellectual disabilities using both objective and subjective methods, but none included individuals with profound intellectual disabilities. To inform effective measurement of PA across the disability spectrum, this study explored: the feasibility of measuring PA levels using the International Physical Activity Questionnaire-short version ( IPAQ-s) and a wrist-worn 7-day accelerometer; examined the level of agreement between instruments/raters; and established the recruitment rate. From the literature reviewed, no study has investigated these issues. Materials and Methods Two-hundred adults with intellectual disabilities from a local authority lists in UK were invited to participate. Participants were administered an accelerometer for seven days and the IPAQ-s (self and carer-reported). Results Twenty participants with mild to profound intellectual disabilities (20-70 years) were recruited. The response rate was significantly different between home (16%) and residential homes (4%): χ2(1) = 7.7, p < .05. All participants completed the IPAQ-s but only 15 completed 7-day accelerometer. Self and carer-reported PA had perfect agreement on IPAQ-s, and agreements between instruments using PA guidelines was substantial ( k = 0.6, p < .05). However, mean moderate-vigorous PA min/week differed between measures at 145 and 207 from IPAQ-s and accelerometer respectively. Conclusions Recruitment demonstrated a need for better engagement with residential homes. While both the IPAQ-s and accelerometers can be used to evaluate PA levels, the IPAQ-s was more acceptable and carer report was accurate, but it underestimated absolute moderate-vigorous PA levels. These findings indicate that IPAQ-s can be used to measure PA levels, including in those with profound intellectual disabilities. [ABSTRACT FROM AUTHOR]

This article presents a profile of intimate partner homicides (IPH) committed within London incorporating a gendered comparison of the perpetrators’ relationships. Data was sourced from the original police files for offenses committed in the capital between 1998 and 2009 (N = 207; 173 male and 34 female perpetrators). In common with other international descriptive studies, the results indicate comparative differences between partners according to perpetrator gender in terms of age profiles, employment status, experience of mental health issues, intoxication at time of killing, and possession of criminal convictions. Gender-based IPH descriptive studies have tended to focus on a collation of either victim or perpetrator or relationship characteristics, often in isolation from one another. Assessments of how parties interact within fatal relationships are invariably absent, and yet, it is the relationship that forms the backdrop against which the fatal acts are perpetrated. This study, therefore, not only provides an insight into the profile of IPH committed within London where none had previously existed but also demonstrates the advantages of incorporating relationship concordance measures. The inclusion of such measures when researching IPH assists homicide investigators in understanding the dynamics taking place within the cohort of fatal relationships they police. It also provides researchers a useful platform to enhance understanding of this crucial aspect, for it is the relationship itself which is what defines IPH and distinguishes as a unique subset of homicide. [ABSTRACT FROM AUTHOR]

There has been growing interest in religion and spirituality within social work literature. However, little empirical research has explored Islamic welfare organisations and especially their significance for service users. This article presents findings from an evaluation of a British Islamic social work organisation (Ihsaan Social Support Association (ISSA) Wales), drawing on qualitative interviews with Muslim service users (n = 8) and quantitative findings from the service user database (n = 495), a quality-of-life assessment (n = 42) and a satisfaction survey (n = 36). In discussing the qualitative findings, religious authority, authenticity, culture, gender and the role of mosques are considered in analysing why the organisation's services were perceived as beneficial to their Muslim service users. Over three-quarters of those responding to a satisfaction survey reported that the help from the organisation had improved their well-being, but quantitative data from assessment and review showed no evidence of either improvement or deterioration in quality of life over time, with the exception of social life, where there was a significant improvement. Overall, in exploring the experiences of these service users, the findings highlight the diversity within the category of the 'Muslim service user' and the potential contribution that Islamic social welfare organisations may make in meeting the needs of British Muslims. [ABSTRACT FROM AUTHOR]

Rationale Given the high number of young adults caring for a family member, and the potential for adverse psychosocial outcomes, there is a need for a screening tool, with clinical utility, to identify those most vulnerable to poor outcomes and to aid targeted interventions. Objectives (i) To determine whether current knowledge from cancer literature regarding young carers is generalisable to chronic conditions and, therefore, whether an existing screening tool could be adapted for this population. (ii) To develop a measure of unmet needs in this population and conduct initial psychometric analysis. Design This was mixed method; interviews in study one informed measure development in study two. Inclusion criteria were as follows: having a parent with a chronic condition and being aged 16-24 years. In study 1, an interpretative phenomenological analysis was conducted on interviews from seven young adults (age range 17-19 years). Study 2 explored factor structure, reliability and validity of the Offspring Chronic Illness Needs Inventory ( OCINI). Participants were 73 females and 34 males (mean ages 18.22, SD = 1.16; 18.65, SD = 1.25). Main outcome measures OCINI, Depression Anxiety and Stress Scale, and the Adult Carers Quality of Life Scale. Results Interviews communicated that the impact of their parent's condition went unacknowledged and resulted in psychosocial, support and informational needs. An exploratory principal axis analysis of the OCINI yielded five factors. Significant and positive correlations were found between unmet needs and stress, anxiety, and depression, and inversely with quality of life. Conclusions The scale has applications in clinical settings where these young people, who are at risk of negative psychological outcomes, may be assessed and unmet needs targeted appropriately. [ABSTRACT FROM AUTHOR]

Background and Aims Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin injection have a high risk of drug-related death soon after release from prison. The NALoxone InVEstigation (N-ALIVE) pilot trial (ISRCTN34044390) tested feasibility measures for randomized provision of naloxone-on-release (NOR) to eligible prisoners in England. Design. Parallel-group randomized controlled pilot trial. Setting English prisons. Participants A total of 1685 adult heroin injectors, incarcerated for at least 7 days pre-randomization, release due within 3 months and more than 6 months since previous N-ALIVE release. Intervention Using 1 : 1 minimization, prisoners were randomized to receive on release a pack containing either a single 'rescue' injection of naloxone or a control pack with no syringe. Measurements Key feasibility outcomes were tested against prior expectations: on participation (14 English prisons; 2800 prisoners), consent (75% for randomization), returned prisoner self-questionnaires (RPSQs: 207), NOR-carriage (75% in first 4 weeks) and overdose presence (80%). Findings Prisons (16) and prisoners (1685) were willing to participate [consent rate, 95% confidence interval (CI) = 70-74%]; 218 RPSQs were received; NOR-carriage (95% CI = 63-79%) and overdose presence (95% CI = 75-84%) were as expected. We randomized 842 to NOR and 843 to control during 30 months but stopped early, because only one-third of NOR administrations were to the ex-prisoner. Nine deaths within 12 weeks of release were registered for 1557 randomized participants released before 9 December 2014. Conclusions Large randomized trials are feasible with prison populations. Provision of take-home emergency naloxone prior to prison release may be a life-saving interim measure to prevent heroin overdose deaths among ex-prisoners and the wider population. [ABSTRACT FROM AUTHOR]

Self-injury is common in autism spectrum disorder (ASD); however few studies have investigated correlates of self-injury or the putative associations with self-restraint. Questionnaire data on self-injury, self-restraint, health conditions, overactivity/impulsivity and repetitive/restricted behavior were collected on 208 children and 216 adults with ASD (mean age = 24.10, range 6-61). Self-injury and self-restraint were frequent and significantly associated in both children (45.7% and 40.9%, p < 0.001) and adults (49.1, and 42.6%, p < 0.001). Severe self-injury was predicted by lower ability, health conditions and overactivity/impulsivity in children (p < 0.001) and repetitive/restricted behavior and overactivity/impulsivity in adults (p < 0.001). These data provide preliminary support for a developmental model of self-injury and self-restraint in which painful health conditions and compromised behavioral control influence the presence and trajectory of self-injury in ASD. [ABSTRACT FROM AUTHOR]

Objective: To determine the short-term cognitive and symptomatic outcome following mild traumatic brain injury. Methods: Setting: Emergency Departments of two UK tertiary referral hospitals. Participants: Adult patients presenting to the Emergency Departments of the Royal London Hospital and Salford Royal Hospital with suspected traumatic brain injury within 24 hours and Glasgow Coma Score > 8. A non-TBI comparison group included adult patients with no head or neck injury. Design: Prospective multi-centre cohort study. Main measures: The Standardized Assessment of Concussion (SAC), the Concussion Symptom Inventory (CSI) and total number of symptoms, measured at baseline and 72 hours. Results: This study enrolled 189 patients with and 51 patients without TBI. Patients with TBI had marked cognitive impairment which persisted at 72 hours (SAC score at baseline = 25 [23-27] vs 72 hours = 25 [22-27]; p = 0.1). Patients with TBI had persistent high symptom severity, although this had decreased at 72 hours (CSI score at baseline = 9 [4-22] vs 72 hours = 5 [1-19], p = 0.002). A similar pattern was observed with the total number of symptoms (baseline = 4 [2-8] vs 72 hours = 0 [0-4]; p < 0.001). Patients with TBI had worse neurocognitive function, higher overall symptom severity and higher total number of symptoms compared with patients without TBI. Patients without TBI' neurocognitive function and symptom severity remained constant, but the number of symptoms reduced between baseline and 72 hours. Conclusion: There is a cognitive deficit and symptom burden in patients with mild TBI presenting to the Emergency Department which persists at 72 hours. [ABSTRACT FROM AUTHOR]

Background: Reductions in whole brain and grey matter volumes are robust features of schizophrenia, yet their etiological influences are unclear. Methods: We investigated the association between the genetic and environmental risk for schizophrenia and brain volumes. Whole brain, grey matter and white matter volumes were established from structural MRIs from twins varying in their zygosity and concordance for schizophrenia. Hippocampal volumes were measured manually. We conducted between-group testing and full genetic modelling. Results: We included 168 twins in our study. Whole brain, grey matter, white matter and right hippocampal volumes were smaller in twins with schizophrenia. Twin correlations were larger for whole brain, grey matter and white matter volumes in monozygotic than dizygotic twins and were significantly heritable, whereas hippocampal volume was the most environmentally sensitive. There was a significant phenotypic correlation between schizophrenia and reductions in all the brain volumes except for that of the left hippocampus. For whole brain, grey matter and the right hippocampus the etiological links with schizophrenia were principally associated with the shared familial environment. Lower birth weight and perinatal hypoxia were both associated with lower whole brain volume and with lower white matter and grey matter volumes, respectively. Limitations: Scan data were collected across 2 sites, and some groups were modest in size. Conclusion: Whole brain, grey matter and right hippocampal volume reductions are linked to schizophrenia through correlated familial risk (i.e., the shared familial environment). The degree of influence of etiological factors varies between brain structures, leading to the possibility of a neuroanatomically specific etiological imprint. [ABSTRACT FROM AUTHOR]

When operating in multiteam settings, it is important that goals are cohesive between team members, especially in high-stakes, risky, and uncertain environments. This study explored goal consistency during a multiteam emergency response simulation. A total of n = 50 commanders from the UK Police Services, Fire and Rescue Services, and Ambulance Services took part in a simulated terrorism exercise, who were split into n = 13 teams. Each team responded to the same simulated terrorist event, which was based on a 'Marauding Terrorist Firearms Attack' ( MTFA) at a city centre train station. Data were collected using electronically time-stamped 'decision logs' and post-incident questionnaires that measured team members' self-reported goals. Goals that were 'attack' focussed (e.g., 'treat patients') were coded as 'approach' (i.e., focussed on achieving positive outcomes) and goals that were 'defence' focussed (e.g., protect emergency responders) were coded as 'avoid' (i.e., focussed on avoiding negative outcomes). It emerged that different agencies prioritized different goal types; Fire commanders initially prioritized avoid goals but then increased approach orientations, Ambulance commanders were consistently approach oriented, and Police commanders showed goal conflict (tensions between adopting approach and avoid goals). Despite goal differences, participants rated that their interagency goals were consistent in a post-scenario questionnaire, suggesting that commanders were unaware of the nuanced differences between their agency-specific objectives. At the multiteam level, teams who predominantly held attack/approach goals were significantly faster at decision logging early in the incident, yet defend/avoid teams were faster at decision logging later into the incident. Implications for multiteam coordination are discussed. Practitioner points The 'save life' goal in multiteam emergency response settings is vague and open to interpretation. This can impede coordination when agencies assume that they are working towards the same 'save life' goal, but are actually focussed on different and role-specific objectives with regard to how they will achieve it., A joint decision model that helps to clarify agency-specific tactical priorities may be more useful in multiteam contexts than one that uses ambiguous and abstract (i.e., 'save life') interagency goals., A focus on achieving positive outcomes (attack/approach goal; e.g., 'treat patients') can speed up decision-making during the early stages of an incident, but when the situation becomes more complex and dynamic, then a focus on avoiding negative outcomes (defend/avoid goal; e.g., protect emergency responders from harm) might lead to faster action., When responding to complex emergencies, practitioners should focus on satisficing to achieve 'least-worst' outcomes rather trying to maximize gains. [ABSTRACT FROM AUTHOR]

Background Well-documented associations exist between socio-economic background and language ability in early childhood, and between educational attainment and language ability in children with clinically referred language impairment. However, very little research has looked at the associations between language ability, educational attainment and socio-economic background during adolescence, particularly in populations without language impairment. Aims To investigate: (1) whether adolescents with higher educational outcomes overall had higher language abilities; and (2) associations between adolescent language ability, socio-economic background and educational outcomes, specifically in relation to Mathematics, English Language and English Literature GCSE grade. Method & Procedures A total of 151 participants completed five standardized language assessments measuring vocabulary, comprehension of sentences and spoken paragraphs, and narrative skills and one nonverbal assessment when between 13 and 14 years old. These data were compared with the participants' educational achievement obtained upon leaving secondary education (16 years old). Univariate logistic regressions were employed to identify those language assessments and demographic factors that were associated with achieving a targeted A*-C grade in English Language, English Literature and Mathematics General Certificate of Secondary Education (GCSE) at 16 years. Further logistic regressions were then conducted to examine further the contribution of socio-economic background and spoken language skills in the multivariate models. Results & Outcomes Vocabulary, comprehension of sentences and spoken paragraphs, and mean length utterance in a narrative task along with socio-economic background contributed to whether participants achieved an A*-C grade in GCSE Mathematics and English Language and English Literature. Nonverbal ability contributed to English Language and Mathematics. The results of multivariate logistic regressions then found that vocabulary skills were particularly relevant to all three GCSE outcomes. Socio-economic background only remained important for English Language, once language assessment scores and demographic information were considered. Conclusions & Implications Language ability, and in particular vocabulary, plays an important role for educational achievement. Results confirm a need for ongoing support for spoken language ability throughout secondary education and a potential role for speech and language therapy provision in the continuing drive to reduce the gap in educational attainment between groups from differing socio-economic backgrounds. [ABSTRACT FROM AUTHOR]

Background: Nurses report inadequacies in health promotion practices. This study investigated attitudes toward being role models for healthy eating, and examined predictors of health promotion attitudes in preregistered nurses. Method: A questionnaire was completed by 493 preregistered nurses. Measures included health promotion attitudes, healthy lifestyle index, self-esteem, and body satisfaction. Results: Preregistered nurses (89.5%) felt that nurses should be role models for health. However, 37% had a negative health promotion attitude and were more likely to be dissatisfied with their body and lead less healthy lifestyles. Most preregistered nurses (96%) felt that delivering health promotion would be a key element of their job and held positive health promotion attitudes. Healthy lifestyle was the most consistent significant predictor of health promotion attitude. Conclusion: Preregistered nurses with an unhealthy lifestyle and lower self-esteem held a more negative health promotion attitude. Intervention is needed to support preregistered nurses in making healthy lifestyle choices, improving their self-perception and health promotion attitude. [ABSTRACT FROM AUTHOR]

Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks’ follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0–10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in–walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required. [ABSTRACT FROM AUTHOR]

Background People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in mental health may reflect between-group differences in rates of exposure to common social determinants of poorer health. Materials and Methods The present authors undertook secondary analysis of confidentialized unit records collected in Wave 3 of Understanding Society. Results British adults with intellectual impairments living in general households are at significantly increased risk of potential mental health problems than their non-disabled peers (e.g. GHQ Caseness OR = 1.77, 95% CI (1.25-2.52), P < 0.001). Adjusting for between-group differences in age, gender and indicators of socio-economic position eliminated this increased risk [ GHQ Caseness adjusted OR = 1.06, 95% CI (0.73-1.52), n.s]. Conclusions Our analyses are consistent with the hypothesis that the increased risk of poor mental health among people with intellectual impairments may be attributable to their poorer living conditions rather than their intellectual impairments per se. Greater attention should be given to understanding and addressing the impact of exposure to common social determinants of mental health among marginalized or vulnerable groups. [ABSTRACT FROM AUTHOR]

This article contributes to the growing body of research that explores the significance of context in health information behavior. Specifically, through the lens of trust judgments, it demonstrates that gender is a determinant of the information evaluation process. A questionnaire-based survey collected data from adults regarding the factors that influence their judgment of the trustworthiness of online health information. Both men and women identified credibility, recommendation, ease of use, and brand as being of importance in their trust judgments. However, women also take into account style, while men eschew this for familiarity. In addition, men appear to be more concerned with the comprehensiveness and accuracy of the information, the ease with which they can access it, and its familiarity, whereas women demonstrate greater interest in cognition, such as the ease with which they can read and understand the information. These gender differences are consistent with the demographic data, which suggest that: women consult more types of sources than men; men are more likely to be searching with respect to a long-standing health complaint; and, women are more likely than men to use tablets in their health information seeking. Recommendations for further research to better inform practice are offered. [ABSTRACT FROM AUTHOR]

Understanding the developmental course of all health issues associated with preterm birth is important from an individual, clinical and public health point-of-view. Both the number of preterm births and proportion of survivors have increased steadily in recent years. The UK Millennium Cohort Study ( n = 18,818) was used to examine the association of gestational age with maternal ratings of general health and behavior problems at ages 5 and 11 years using binary and multinomial logistic regression analyses. The association between mothers' ratings of general health and behavior problems was relatively weak at each time point. Children rated as being in poor general health remained constant over time (4.0 % at age 5, 3.8 % at age 11), but children rated as having behavioral problems increased by almost 100 % (5.6 % at 5; 10.5 % at 11). A gradient of increasing risk with decreasing gestational age was observed for a composite health measure (general health problems and/or behavior problems) at age 5, amplified at age 11 and was strongest for those with chronic problems (poor health at both age 5 and age 11). This association was found to be compounded by child sex, maternal characteristics at birth (education, employment, marital status) and duration of breast feeding. Integrated support to at-risk families initiated during, or soon after pregnancy, may prevent chronic problems and might potentially reduce long term health costs for both the individual and health services. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine selection and delivery of preoperative verbal information deemed important by nurses to relay to patients immediately prior to day surgery. Background Elective day-case surgery is expanding, patient turnover is high and nurse-patient contact limited. In the brief time-frame available, nurses must select and precisely deliver information to patients, provide answers to questions and gain compliance to ensure a sustained, co-ordinated patient throughput. Concise information selection is therefore necessary especially given continued day surgery expansion. Study design Electronic questionnaire. Methods A survey investigating nurses' choice of patient information prior to surgery was distributed throughout the UK via email addresses listed on the British Association of Day Surgery member's website (January 2015-April 2015). Results Participants were requested to undertake the survey within 2-3 weeks, with 137 participants completing the survey giving a 44% response rate. Verbal information deemed most important by nurses preoperatively was checking fasting time, information about procedure/operation, checking medication, ensuring presence of medical records/test results and concluding medical investigations checks. To a lesser extent was theatre environment information, procedure/operation start time and possible time to discharge. Significant differences were established between perceived importance of information and information delivery concerning the procedure/operation and anaesthesia details. Conclusion Nurses working with competing demands and frequent interruptions, prioritised patient safety information. Although providing technical details during time-limited encounters, efforts were made to individualise provision. A more formal plan of verbal information provision could help ease nurses' cognitive workload and enhance patient satisfaction. Relevance to clinical practice This study provides evidence that verbal information provided immediately prior to day surgery may vary with experience. Nurse educators and managers may need to provide greater guidance for such complex care settings as delivery of increasingly technical details during brief encounters is gaining increasing priority. [ABSTRACT FROM AUTHOR]

Objectives: To prospectively investigate the impact of transitions in informal caregiving on emotional well-being over two years in a large population study of older people. Methods: Information on provision of unpaid care in 2004/2005 and 2006/2007 was available for 6571 participants in the English Longitudinal Study of Ageing. Three well-being domains were also assessed on each occasion: life satisfaction (measured with the Satisfaction with Life Scale); quality of life (assessed with the CASP-19 scale); and depression symptoms (measured using the Centers for Epidemiologic Studies Depression Scale). Multivariable analyses of the impact on well-being of two-year caregiving transitions (caregiving entry and caregiving exit, or continued caring) were conducted separately for spousal/child carers and carers of other family/non-relatives. Results: Compared to non-caregiving, entry into spousal/child caregiving was associated with decline in quality of life (B = −1.60, p <.01) whereas entry into caregiving involving other kin relations increased life satisfaction (B = 1.02, p <.01) and lowered depression symptoms (B = −0.26, p <.05). Contrary to expectations, caregiving exit was related to increased depression in both spousal/child (B = 0.44, p <.01) and non-spousal/child (B = 0.25, p <.05) carers. Continued spousal/child caregiving was also related to decline in quality of life (B = −1.24, p <.05). Other associations were suggestive but non-significant. Conclusion: The emotional impact of different caregiving transitions in later life differs across kin relationships; notably, spousal and child carers' well-being was consistently compromised at every stage of their caregiving career over the two-year study period. [ABSTRACT FROM AUTHOR]

Background: Conduct problems (CP) and attention deficit hyperactivity disorder (ADHD) are often comorbid and have each been linked to 'unhealthy diet'. Early-life diet also associates with DNA methylation of the insulin-like growth factor 2 gene (IGF2), involved in fetal and neural development. We investigated the degree to which prenatal high-fat and -sugar diet might relate to ADHD symptoms via IGF2 DNA methylation for early-onset persistent (EOP) versus low CP youth. Methods: Participants were 164 youth with EOP (n = 83) versus low (n = 81) CP drawn from the Avon Longitudinal Study of Parents and Children. We assessed if the interrelationships between high-fat and -sugar diet (prenatal, postnatal), IGF2 methylation (birth and age 7, collected from blood), and ADHD symptoms (age 7-13) differed for EOP versus low CP youth. Results: Prenatal 'unhealthy diet' was positively associated with IGF2 methylation at birth for both the EOP and low CP youth. For EOP only: (a) higher IGF2 methylation predicted ADHD symptoms; and (b) prenatal 'unhealthy diet' was associated with higher ADHD symptoms indirectly via higher IGF2 methylation. Conclusions: Preventing 'unhealthy diet' in pregnancy might reduce the risk of ADHD symptoms in EOP youth via lower offspring IGF2 methylation. [ABSTRACT FROM AUTHOR]

Background Non-prescription medicines (NPMs) can be misused, abused or lead to dependence, but the prevalence of these problems within the UK general population was unknown. The aim of this study was to estimate the prevalence of self-reported misuse, abuse and dependence to NPMs. Methods A cross-sectional postal survey was sent to 1000 individuals aged ≥18 randomly drawn from the UK Edited Electoral Register. Results A response rate of 43.4% was achieved. The lifetime prevalence of NPM misuse was 19.3%. Lifetime prevalence of abuse was 4.1%. Younger age, having a long-standing illness requiring regular NPM use and ever having used illicit drugs or legal highs were predictive of misuse/ abuse of NPMs. In terms of dependence, lifetime prevalence was 2% with 0.8% currently dependent and 1.3% dependent in the past. Dependence was reported with analgesics (with and without codeine), sleep aids and nicotine products. Conclusion Given the increasing emphasis on self-care and empowering the public to manage their health with NPMs, the findings highlight the need for improved pharmacovigilance of these medicines to maximize benefits with minimal risk. Healthcare providers need to be aware of the potential for misuse, abuse and dependence, particularly in patients with long-term illness. [ABSTRACT FROM AUTHOR]

Background Population levels of physical activity are far below recommendations limiting its public health benefits. Utility cycling (i.e. cycling for transport purposes) may be a means of increasing this activity. Empirical evidence quantifying the contribution of utility cycling to the population levels of physical activity is sparse. Methods The English Active People Survey (APS) was analysed to assess the likelihood of meeting UK physical activity guidelines in those who reported utility cycling compared with those who did not. Odds ratios were adjusted for important socioeconomic confounders using a logistic regression model. Results In the full sample, unadjusted odds ratio for meeting physical activity guidelines in favour of utility cyclists was 5.21 (95% confidence interval (CI) 4.96-5.47) and adjusted odds ratio was 4.08 (95% CI 3.88-4.29). The odds were even higher for utility cyclists in inner London [adjusted OR: 6.08 (4.07-7.86)]. The pattern was consistent regardless of the number of activities through which people met the physical activity guideline. Conclusion Utility cycling can make a significant contribution to levels of physical activity As an activity that can easily integrate into everyday life, utility cycling appears to be a pragmatic policy option for public health decision-makers. [ABSTRACT FROM AUTHOR]

Background Data-driven student drinking norms interventions are based on reported normative overestimation of the extent and approval of an average student's drinking. Self-reported differences between personal and perceived normative drinking behaviors and attitudes are taken at face value as evidence of actual levels of overestimation. This study investigates whether commonly used data collection methods and socially desirable responding (SDR) may inadvertently impede establishing 'objective' drinking norms. Methods U.K. students ( N = 421; 69% female; mean age 20.22 years [ SD = 2.5]) were randomly assigned to 1 of 3 versions of a drinking norms questionnaire: The standard multi-target questionnaire assessed respondents' drinking attitudes and behaviors (frequency of consumption, heavy drinking, units on a typical occasion) as well as drinking attitudes and behaviors for an 'average student.' Two deconstructed versions of this questionnaire assessed identical behaviors and attitudes for participants themselves or an 'average student.' The Balanced Inventory of Desirable Responding was also administered. Results Students who answered questions about themselves and peers reported more extreme perceived drinking attitudes for the average student compared with those reporting solely on the 'average student.' Personal and perceived reports of drinking behaviors did not differ between multitarget and single-target versions of the questionnaire. Among those who completed the multitarget questionnaire, after controlling for demographics and weekly drinking, SDR was related positively with the magnitude of difference between students' own reported behaviors/attitudes and those perceived for the average student. Conclusions Standard methodological practices and socially desirable responding may be sources of bias in peer norm overestimation research. [ABSTRACT FROM AUTHOR]

Background: Children with language impairment (LI) show heterogeneity in development. We tracked children from pre-school to middle childhood to characterize three developmental trajectories: resolving, persisting and emerging LI. Methods: We analyzed data from children identified as having preschool LI, or being at family risk of dyslexia, together with typically developing controls at three time points: t1 (age 3;09), t3 (5;08) and t5 (8;01). Language measures are reported at t1, t3 and t5, and literacy abilities at t3 and t5. A research diagnosis of LI (irrespective of recruitment group) was validated at t1 by a composite language score derived from measures of receptive and expressive grammar and vocabulary; a score falling 1SD below the mean of the typical language group on comparable measures at t3 and t5 was used to determine whether a child had LI at later time points and then to classify LIs as resolving, persisting or emerging. Results: Persisting preschool LIs were more severe and pervasive than resolving LIs. Language and literacy outcomes were relatively poor for those with persisting LI, and relatively good for those with resolving LI. A significant proportion of children with average language abilities in preschool had LIs that emerged in middle childhood -a high proportion of these children were at family risk of dyslexia. There were more boys in the persisting and resolving LI groups. Children with early LIs which resolved by the start of formal literacy instruction tended to have good literacy outcomes; children with late-emerging difficulties that persisted developed reading difficulties. Conclusions: Children with late-emerging LI are relatively common and are hard to detect in the preschool years. Our findings show that children whose LIs persist to the point of formal literacy instruction frequently experience reading difficulties. [ABSTRACT FROM AUTHOR]

Background: Obesity-related lifestyle behaviors usually co-exist but few studies have examined their simultaneous relation with body weight. This study aimed to identify the hierarchy of lifestyle-related behaviors associated with being overweight in adults, and to examine subgroups so identified. Methods: Data were obtained from a cross-sectional survey conducted across 60 urban neighborhoods in 5 European urban regions between February and September 2014. Data on socio-demographics, physical activity, sedentary behaviors, eating habits, smoking, alcohol consumption, and sleep duration were collected by questionnaire. Participants also reported their weight and height. A recursive partitioning tree approach (CART) was applied to identify both main correlates of overweight and lifestyle subgroups. Results: In 5295 adults, mean (SD) body mass index (BMI) was 25.2 (4.5) kg/m², and 46.0 % were overweight (BMI ≥25 kg/m²). CART analysis showed that among all lifestyle-related behaviors examined, the first identified correlate was sitting time while watching television, followed by smoking status. Different combinations of lifestyle-related behaviors (prolonged daily television viewing, former smoking, short sleep, lower vegetable consumption, and lower physical activity) were associated with a higher likelihood of being overweight, revealing 10 subgroups. Members of four subgroups with overweight prevalence >50 % were mainly males, older adults, with lower education, and living in greener neighborhoods with low residential density. Conclusion: Sedentary behavior while watching television was identified as the most important correlate of being overweight. Delineating the hierarchy of correlates provides a better understanding of lifestyle-related behavior combinations which may assist in targeting preventative strategies aimed at tackling obesity. [ABSTRACT FROM AUTHOR]

Background:Evidence suggests that college students are often unclear about how much alcohol is present in different drinks.Objectives:To evaluate the abilities of students to estimate the alcohol contents of drinks, both in relative and absolute terms, and to examine how alcohol strength informs behavior.Methods:For 10 popular drinks that varied by alcohol content, beverage and volume, 209 UK university students rank-ordered the drinks according to total alcohol content and then estimated, for each drink, the number of UK “units” of alcohol contained and its percentage alcohol-by-volume (% ABV). Participants also reported the importance of drink strength as a factor in drink choice, and its influence in different scenarios.Results:There was low but significant concordance between participants’ rank-orderings of drinks by strength, and the correlation of mean ranks with correct ranks was also significant. However, their explicit estimates of the numbers of “units” in the drinks, and their % ABV values, often diverged dramatically from actual values. Participants tended to overestimate the unit contents of spirit-based drinks but underestimated the unit contents of beers and wine; women were consistently less accurate than men, typically making greater underestimates for commonly-consumed drinks. Over one-third of the sample reported that strength influenced drink choice, but its importance ranked below flavor and cost; drink strength might contribute to drink choice depending on the drinking situation.Conclusion/Importance:Young drinkers (women especially) have a poor awareness of the alcohol contents of different drinks, particularly wines and beers, but they make better judgments of relative strength. [ABSTRACT FROM PUBLISHER]

There are limited comparisons between the experience of disabled students in higher education and their non-disabled peers, particularly on practice placements. This article presents the results of such a comparison, across six professional disciplines in one UK university. The results revealed that both disabled and non-disabled students reported positive placement experiences and also similar difficulties. Such difficulties were exacerbated for some disabled students, however, including as a consequence of the attitudes of others to disability. Recommendations for practice are identified that aim to enhance the placement experience of all students and to remove barriers to access. [ABSTRACT FROM PUBLISHER]

Baby‐led weaning, where infants self‐feed family foods in place of traditional spoon‐feeding of purees, is continuing to grow in popularity. Evidence is emerging which suggests that the method may promote healthier eating behaviour and weight gain in children, but the research is in its infancy. One issue is the self‐selecting nature of participants to the approach. Although those who follow a baby‐led approach are known to have a higher education and more professional occupation, little is known about wider maternal characteristics, which might affect either adoption of or outcomes of the method. The aim of this study was to explore differences in maternal characteristics between those adopting a baby‐led or traditional approach. Six hundred four mothers with an infant aged 6–12 months completed a questionnaire including a copy of the Dutch Eating Behaviour Questionnaire (DEBQ), Brief Symptom Inventory (BSI) (anxiety, obsessive–compulsive and depression scales) and Ten Item Personality Questionnaire (TIPQ) alongside details of weaning approach (baby‐led vs. traditional). Mothers who adopted a baby‐led weaning style scored significantly lower on restrained eating (DEBQ), anxiety and introversion (TIPQ) and anxiety and obsessive–compulsive symptoms (BSI). Mothers who currently adopt a baby‐led approach are therefore significantly different in personality, eating behaviour and well‐being characteristics compared with those adopting a traditional approach. These characteristics may affect likelihood of choosing a baby‐led approach or indirectly affect outcomes for infants weaned using the approach. Further research exploring baby‐led weaning in a wider population sample is needed. [ABSTRACT FROM AUTHOR]

Background:Engaging and inspiring the next generation of physician-scientists at an early stage is recognised as key to ensure the future of medical research. However, little is known about medical student perceptions of research. Objectives:We attempted to ascertain perceptions of research and research-orientated careers from medical students studying in different countries. Methods:An online questionnaire was developed, piloted, and promoted to medical students in various countries. Results:1625 responses were collected from 38 countries. Analysis was restricted to data collected from countries with >100 responses (n = 890). Less than half the respondents felt their medical school provided adequate research training. Key perceived barriers to research participation as a student included lack of time and difficulty finding mentors or projects. A significant gender disparity existed in research ambitions of students with females desiring less research involvement. The importance of barriers and satisfaction with research training differed significantly between countries. Conclusions:Students perceive a number of key barriers to research involvement and pursuit of research-orientated careers. Programmes designed to engage students with research should focus on overcoming identified barriers. Greater effort is needed to engage female students who report more significant barriers and less desire to follow research-orientated careers. [ABSTRACT FROM PUBLISHER]