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This study aimed to determine whether caffeine gum influenced perceptual-cognitive and physical performance during the extra-time period of simulated soccer match-play. Semiprofessional male soccer players (n = 12, age: 22 ± 3 years, stature: 1.78 ± 0.06 m, mass: 75 ± 9 kg) performed 120-min soccer-specific exercise on two occasions. In a triple-blind, randomized, crossover design, players chewed caffeinated (200 mg; caffeine) or control (0 mg; placebo) gum for 5 min following 90 min of soccer-specific exercise. Perceptual-cognitive skills (i.e., passing accuracy, reaction time, composure, and adaptability) were assessed using a soccer-specific virtual reality simulator, collected pre- and posttrial. Neuromuscular performance (reactive-strength index, vertical jump height, absolute and relative peak power output, and negative vertical displacement) and sprint performance (15 and 30 m) were measured at pretrial, half-time, 90 min, and posttrial. Caffeine gum attenuated declines in reaction time (pre: 90.8 ± 0.8 AU to post: 90.7 ± 0.8 AU) by a further 4.2% than placebo (pre: 92.1 ± 0.8 AU to post: 88.2 ± 0.8 AU; p <.01). Caffeine gum reduced composure by 4.7% (pre: 69.1 ± 0.8 AU to post: 65.9 ± 0.8 AU) versus placebo (pre: 68.8 ± 0.8 AU to post: 68.3 ± 0.8 AU; p <.01). Caffeine gum did not influence any other variables (p >.05). Where caffeine gum is consumed by players prior to extra-time, reaction time increases but composure may be compromised, and neuromuscular and sprint performance remain unchanged. Future work should assess caffeine gum mixes with substances like L-theanine that promote a relaxed state under stressful conditions. [ABSTRACT FROM AUTHOR]

Asynchronous video interviews (AVIs) are a form of one‐way, technology‐mediated selection interview that can help streamline and increase flexibility in the hiring process and are used to hire millions of applicants per year. Although applicant reactions to AVIs in general tend to be more negative than with traditional interview modalities, AVIs can differ widely in how they are designed. For instance, applicants can be provided with more or less preparation time, response length, rerecording options, or rely on different question formats. This study examines how AVI design features impact applicant reactions, as well as the moderating role played by applicant age and gender. Data from 27,809 real job applicant's AVI experiences were collected in 11 countries (69.3% English‐speaking) from 33 companies and relating to 72 types of positions. Data were fitted with linear mixed‐effects models to account for nesting. Results showed that allowing more preparation time and offering the opportunity to rerecord responses were related to more favorable reactions, while including more questions was related to more negative reactions. Applicants above the age of 31 reacted especially negatively to AVIs with more questions while those below the age of 30 preferred being allocated longer maximum response lengths. Women reacted more positively to increased preparation time. These findings might help both AVI vendors and hiring organizations design AVIs that facilitate a positive applicant experience. Our research also expands knowledge on applicant reactions to interviews, highlights crucial differences from traditional formats, and calls for integrating applicant characteristics into current theoretical frameworks on applicant reactions to AVIs. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the safety profile of robotic cholecystectomy performed within the United Kingdom (UK) Robotic Hepatopancreatobiliary (HPB) training programme. Methods: A retrospective evaluation of prospectively collected data from eleven centres participating in the UK Robotic HPB training programme was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters. Results: A total of 600 patients were included. The median age was 53 (IQR 65–41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600), and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR 0–1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600). Conclusion: The current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low bile leak rate, low conversion to open surgery, and low need for subtotal cholecystectomy. [ABSTRACT FROM AUTHOR]

Objectives: People with psychosis delay accessing recommended treatments, resulting in poor healthcare outcomes and increased risk of relapse. Means of improving help‐seeking and help‐acceptance could reduce duration of untreated psychosis (DUP). This study examined the role of attachment style in help‐seeking and help‐acceptance in psychosis. Design: We used an experimental design to test the effect of attachment imagery priming on help‐seeking and help‐acceptance intentions, in a sample with self‐reported psychosis. The independent variables were attachment imagery condition (secure vs. avoidant) and time (pre‐ vs. post‐prime). The dependent variables were state paranoia, help‐seeking intentions and help‐acceptance intentions. Methods: We used an online research platform to recruit people with psychosis (n = 61). Participants were randomly allocated to the secure or avoidant attachment priming condition. All completed measures of state paranoia, help‐seeking, and help‐acceptance, before and after priming. Results: In comparison with the avoidant condition, secure attachment imagery resulted in reduced paranoia and increased help‐seeking and acceptance intentions, all with large effect sizes. Conclusions: This is the first study to use an experimental design to assess the role of attachment style in help‐seeking and help‐acceptance in a clinical sample. Attachment style is causally linked to behavioural intentions that contribute to DUP. Clinicians should assess attachment and help‐seeking and acceptance, highlight these in formulation, and prioritise in treatment planning. Interventions that enhance help‐seeking and acceptance could improve access to recommended treatments and reduce DUP. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom. Aim: To explore adult intensive care nurses' decision‐making around the practice of GRV measurement to guide enteral feeding. Study Design: A cross‐sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales. Results: Two hundred and seventy‐three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4–6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision‐making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%). Conclusions: Factors affecting the nurses' decision‐making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols. Relevance to Clinical Practice: Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding. [ABSTRACT FROM AUTHOR]

Background: Patients with long term and additional needs (LEAP) in paediatric intensive care units (PICUs) are a growing and heterogenous cohort that provide unique challenges to clinicians. Currently no standard approach to define and manage this cohort exists. Aim: To analyse bed occupancy, examine current practice, and explore ideas to improve PICU care of patients with long term and additional needs. Study Design: Patients with LEAP were defined as meeting two or more of the following criteria: length of stay >14 days; life limiting condition; ≥2 failed extubations; hospital stay >1 month prior to PICU admission; likely to require long‐term ventilation. An electronic survey was then sent to all UK PICUs, via the UK Paediatric Critical Care Society, to collect quantitative and qualitative data relating to bed occupancy, length of stay, multidisciplinary and family involvement, and areas of possible improvement. Data collection were occurred between 8 February 2022 and 14 March 2022. Quantitative data were analysed using Microsoft Excel 365 and SPSS Statistics version 28.0. Raw data and descriptive statistics were reported, including percentages and median with interquartile range for non‐parametric data. Qualitative raw data were examined using thematic analysis. Analysis was undertaken independently by two authors and results assessed for concordance. Results: 70.1% (17/24) PICUs responded. 25% (67/259) of PICU beds were occupied by patients with long term and additional needs. 29% (5/17) of responding units have tailored management plans to this cohort of patient. A further 11% (2/17) have guidelines for children with generic chronic illness. 12% (2/16) of responding units had a designated area and 81% (13/16) of responding units had designated professionals. The majority (68% and 62%) of responding units engaged families and community professionals in multidisciplinary meetings. When asked how the care of long term and additional needs patients might be improved five themes were identified: consistent, streamlined care pathways; designated transitional care units; designated funding and hospital‐to‐home commissioning; development of roles to facilitate collaboration between hospital and community teams; proactive discharge planning and parallel planning. Conclusions: This survey provides a snapshot of UK practice for a cohort of patients that occupies a considerable proportion (29%) of PICU beds. While only a minority of responding PICUs offer specifically tailored management plans, the majority of units have designated professionals. Relevance to Clinical Practice: Opportunities exist to improve PICU care in LEAP patients in areas such as: streamlined care pathways, designated clinical areas, designated funding, and development of defined collaborative roles. Next steps may involve working group convention to develop a consensus definition and share good practice examples. [ABSTRACT FROM AUTHOR]

Objectives: Antenatal education (ANE) is part of National Health Service (NHS) care and is recommended by The National Institute for Health and Care Excellence (NICE) to increase birth preparedness and help pregnant women/birthing people develop coping strategies for labour and birth. We aimed to understand antenatal educator views about how current ANE supports preparedness for childbirth, including coping strategy development with the aim of identifying targets for improvement. Methods: A United Kingdom wide, cross-sectional online survey was conducted between October 2019 and May 2020. Antenatal educators including NHS midwives and private providers were purposively sampled. Counts and percentages were calculated for closed responses and thematic analysis used for open text responses. Results: Ninety-nine participants responded, 62% of these did not believe that ANE prepared women for labour and birth. They identified practical barriers to accessing ANE, particularly for marginalised groups, including financial and language barriers. Educators believe class content is medically focused, and teaching is of variable quality with some midwives being ill-prepared to deliver antenatal education. 55% of antenatal educators believe the opportunity to develop coping strategies varies between location and educators and only those women who can pay for non-NHS classes are able to access all the coping strategies that can support them with labour and birth. Conclusions for Practice: Antenatal educators believe current NHS ANE does not adequately prepare women for labour and birth, leading to disparities in birth preparedness for those who cannot access non-NHS classes. To reduce this healthcare inequality, NHS classes need to be standardised, with training for midwives in delivering ANE enhanced. Significance: What is Already Known on this Subject?: There is no detailed national guidance about the content or quantity of antenatal education that should be delivered by the NHS to patients and, how coping strategies are developed within these sessions is unknown. What this Study Adds?: Antenatal educators believe that quality of antenatal education needs to be improved. Access to coping strategies for labour and birth is hindered by the type of class, the educator's approach and socioeconomic status. This study can be used to support an argument for addressing the inequality in access to antenatal preparation, whilst better preparing all women through higher quality of antenatal education provision in the NHS. [ABSTRACT FROM AUTHOR]

Diet has been repeatedly shown to affect mental and sleep health outcomes. However, it is well known that there are cross‐cultural differences in dietary practices as well as the prevalence of mental and sleep health outcomes. Given that the dietary inflammatory potential of diets has been linked to mental and sleep health outcomes, in the current study we sought to assess the inflammatory status of habitual diets and examine its relationship with mental and sleep health outcomes in both the United Kingdom and Japan. Our aim was to determine if the associations between the dietary inflammation index (DII) score and these health outcomes could elucidate any potential cross‐cultural differences in health. Online survey data was collected from 602 participants (aged 18–40 years) in the United Kingdom (n = 288) and Japan (n = 314). Participants self‐reported their dietary intakes, as well as current mental health and sleep patterns. The DII score was calculated (score range − 2.79 to 3.49) We found that although participants in the United Kingdom reported better overall mental wellbeing, participants in Japan reported less severe depression, anxiety and stress and better subjective sleep quality, less sleep disturbances and daytime dysfunction, despite sleeping shorter, and a better adherence to an anti‐inflammatory diet. Moreover, across the United Kingdom and Japan, adherence to more anti‐inflammatory diets predicted higher levels of subjective sleep quality, fewer sleep disturbances, less use of sleep medicine and less daytime dysfunction. In conclusion, there are several differences between mental and sleep health outcomes in the United Kingdom and Japan, which could be attributable to the inflammatory potential of respective regional diets. Future studies are warranted to examine the mental and sleep health benefits of adhering to anti‐inflammatory traditional Japanese diets in clinical and subclinical cohorts. [ABSTRACT FROM AUTHOR]

The prevalence of mental health issues among UK undergraduate students is growing, and poor diet quality appears to be a risk factor for poor mental health although with limited research in this area. Therefore, the objective of this study was to examine the cross‐sectional associations between diet quality and common mental disorders (CMD) such as depression and anxiety in UK undergraduate students. A cross‐sectional survey consisting of demographic information and validated questionnaires (the Short‐Form Food Frequency Questionnaire [SFFFQ] and the Hospital Anxiety and Depression Scale [HADS]) was conducted to measure diet quality and anxiety and depression in young adults in 44 UK‐based universities. Multiple regression analysis adjusting for confounding factors was used to assess the associations between them. Undergraduate university students (n = 202, 67% female) with a mean age of 20.9 ± 3.6 years and a mean body mass index (n = 170) of 22.6 ± 3.2 kg/m2 took part in the study. Prevalence of anxiety was high, with 40% of the sample having an anxiety score in the severe range (≥12 points) while the prevalence of depression was lower, with 6% of the population having a depression score in the severe range (≥12 points). Diet quality was significantly higher for females than males (p = 0.034) and was poor for 38% of the sample, being more common in males compared to females, although not significantly so (43% and 36%, respectively). Diet quality was inversely associated with anxiety (β = −0.427; p = 0.029) and was more likely to be associated with anxiety in females than males (β = 0.743; p = 0.043). No significant relationship between diet quality and depression was found. Better self‐reported health, father's qualification and smoking status were also associated with less anxiety and depression. This research supports other research suggesting that UK universities should explore whether the implementation of dietary interventions and improving the food environment would be a cost‐effective option to reduce the high prevalence of anxiety among students. [ABSTRACT FROM AUTHOR]

Purpose The literature indicates that sexuality education provided in schools/colleges in the United Kingdom (UK) may not be appropriate for people with Autism Spectrum Disorder (ASD). There appears to be a lack of understanding of the subject regarding young people with Attention-Deficit/Hyperactivity Disorder (ADHD) and a dual diagnosis (ASD co-occurring with ADHD). Research also suggests that compared to neurotypical peers, young people with ASD tend to receive less support on sexuality from their parents, who often feel that they lack the appropriate skills to help their children with some sex-related issues. Some young people with ASD and ADHD also report lacking an understanding of the social nuances of dating and intimacy, which is crucial for navigating romantic relationships. Design/methodology/approach This study explored sexuality education and romantic relationships in young people based on a semi-structured interview approach to the topic. Thematic Analysis (TA) was employed to analyze the data. Findings Six themes were developed from the participants' narratives: Societal ideology about sexuality; Substandard school-based sexuality education; The role of adults in sexuality education; Pornography, as a very powerful alternative means of sexuality education; Young people and romance—a complicated world to navigate; Experience of abuse in the young neurodivergent population is a serious matter. Findings revealed that many neurodivergent and neurotypical young people received basic sex education in their schools/colleges and homes and encountered challenges navigating romantic relationships. Neurodivergent young people reported experiencing greater challenges related to their understanding of and building romantic relationships than their neurotypical peers. Originality/value To the researchers' knowledge, this is the first exploration of romantic relationships and sexuality education in neurotypical young people as well as three groups of neurodivergent young people (with ASD, ADHD, and ASD co-occurring with ADHD). [ABSTRACT FROM AUTHOR]

This article examines continuing misunderstanding about memory function especially for trauma, across three UK samples (N = 717). Delayed allegations of child sexual and physical abuse are prevalent in Western legal systems and often rely upon uncorroborated memory testimony to prove guilt. U.K. legal professionals and jurors typically assess the reliability of such memory recall via common sense, yet decades of scientific research show common sense beliefs often conflict with science. Recent international surveys show controversial notions of repression and accurate memory recovery remain strongly endorsed. In historical cases, these notions may lead to wrongful convictions. The current study surveyed the U.K. public, lawyers, and mental health professionals' beliefs about repression, dissociative amnesia and false memories. Study findings give unique data on judges' and barristers' beliefs. Overall, the study findings reinforce international scientists' concerns of a science – knowledge-gap. Repression was strongly endorsed by lay, legal and clinical participants (> 78%) as was dissociative amnesia (> 87%). Moreover, suboptimal professional legal education and juror guidance may increase misunderstanding. Correcting beliefs about memory function, and extending the contribution of memory science in the courtroom remains an important quest for cognitive scientists. [ABSTRACT FROM AUTHOR]

There has been a long debate about the use of intuition in helping professions, including social work. Often viewed negatively in professional contexts, intuition is nonetheless used as a form of risk assessment. The current research examined methods of identifying child sexual abuse. A mixed methods approach was taken, with 98 participants completing an online questionnaire and 24 taking part in in-depth interviews. The participants demonstrated varied perceptions of intuition and its usefulness. Although some participants were strongly critical of its use, for others, intuition or 'gut feelings' were preferred to formal assessment tools. However, what was discussed as intuition, rather than a form of 'sixth sense', was often based on tacit knowledge; for example, abused young people's observable behaviours combined with known risk factors such as certain family characteristics. Therefore, concerns about the use of intuition may be based on incorrect assumptions. [ABSTRACT FROM AUTHOR]

Aims: To examine the impact of current age, age at diagnosis, and duration of diabetes on the incidence rate of complications among people with type 2 diabetes. Methods: Baseline data from 19,327 individuals with type 2 diabetes in the UK Biobank were analysed. Poisson regression was used to model incidence rates by current age, age at diagnosis, and duration of diabetes for the following outcomes: myocardial infarction (MI), heart failure (HF), stroke, end‐stage kidney diseases (ESKD), chronic kidney diseases (CKD), liver diseases, depression, and anxiety. Results: The mean age at baseline was 60.2 years, and median follow‐up was 13.9 years. Diabetes duration was significantly longer among those with younger‐onset type 2 diabetes (diagnosed at <40 years) compared to later‐onset type 2 diabetes (diagnosed at ≥40 years), 16.2 and 5.3 years, respectively. Incidence rates of MI, HF, stroke, and CKD had strong positive associations with age and duration of diabetes, whereas incidence rates of ESKD liver diseases, and anxiety mainly depended on duration of diabetes. The incidence rates of depression showed minor variation by age and duration of diabetes and were highest among those diagnosed at earlier ages. No clear evidence of an effect of age of onset of diabetes on risk of complications was apparent after accounting for current age and duration of diabetes. Conclusions: Our study indicates age at diagnosis of diabetes does not significantly impact the incidence of complications, independently of the duration of diabetes. Instead, complications are primarily influenced by current age and diabetes duration. [ABSTRACT FROM AUTHOR]

Background: Auditory reaction time (ART) and visual reaction time (VRT) are critical for patients with stroke, especially during balance training. According to the research, most patients with stroke are fatigued at sub-maximal levels during their stroke rehabilitation. Sub-maximal physical fatigue may affect ART and VRT and impede stroke rehabilitation. Hence, it is important to study the effect of submaximal physical fatigue on ART and VRT. A pilot study on healthy adults paves the way for further research on stroke rehabilitation. The purpose of this research is to find out if submaximal physical fatigue affects ART and VRT in healthy adults. In addition, this study also determines if ART and VRT recover to baseline after 15 min of rest post-fatigue session. Furthermore, the goal is to determine whether sub-maximal physical fatigue has a greater effect on ART or VRT. Methods: A repeated measures within-subject design was used in the study. Eighteen healthy participants (median age 24 years) completed two sessions of a sub-maximal fatigue protocol on a cycle ergometer until they reached a rating of perceived exertion (RPE) of 15 on a scale of 6–20. Two different fatigue sessions were conducted (one to study the effects of fatigue on ART and the other for VRT). ART or VRT was measured on computer software before (PRE), immediately after (POST-0), and 15 min after (POST-15) the sub-maximal physical fatigue protocol. Results: The value of median ART increased significantly from PRE to POST-0 (P = 0.002) and it decreased significantly at POST-15 (P = 0.010). Similarly, the value of mean VRT increased from PRE to POST-0 (P = 0.001) before decreasing significantly at POST-15 (P = 0.001). There was no significant difference between the effects of submaximal fatigue on ART and VRT (P = 0.156). Conclusion: Due to submaximal physical fatigue, ART and VRT were slower, but they returned to baseline after 15 min of rest. Submaximal physical fatigue had an equal impact on ART and VRT. As balance training requires quicker ART and VRT for optimal outcomes, it may be better if the physiotherapists consider a 15-min rest period between the exercise and balance training in patients with stroke. [ABSTRACT FROM AUTHOR]

Background: There are limited tools to measure the burden of disease and effectiveness of medical/surgical interventions in patients with cryptoglandular fistulas. The aim of this study was to explore concepts that are relevant and important to patients with complex cryptoglandular fistulas (CCF) and to develop a patient-centred, disease-specific, patient-reported outcome measure (PROM) to assess symptom burden and impacts of CCF. Methods: A targeted literature review was conducted, followed by one-to-one telephone interviews with five colorectal surgeons (USA, n = 3; UK, n = 1; Spain, n = 1) and 20 US adult patients with CCF to inform the development of a conceptual model and a CCF-specific PROM. The targeted literature review informed the development of the preliminary conceptual model and identified a PROM in the literature that was used as a reference to generate the draft CCF-specific PROM. The colorectal surgeon interviews provided insights on the experience of patients with CCF to refine the conceptual model, formulate probing questions for use in patient interviews, and to develop the draft CCF-specific PROM. Patients' descriptions of their experiences with symptoms and the impacts on their lives and evaluation of the draft CCF-specific PROM in concept elicitation and cognitive interviews were used to develop the final conceptual model and final CCF-specific PROM. Results: Ten symptoms (odour, pain during bowel movement, abscess, post-operative pain, discharge/drainage/leakage, anal/perianal pain, inflammation/swelling, skin irritation, bleeding and itchiness) and 11 impacts (discomfort, inability to exercise, embarrassment, difficulty sitting, worry about disease, adapted life to maintain hygiene, negatively impacted social life/isolation, inability to perform daily activities, reduced interest in sex, negatively impacted intimate relationships and negatively impacted mood) were reported as most salient by patients. The patient experience, clinician perspective, and literature review provided input to item generation. Evaluation of relevance and patient understanding through cognitive interviews with patients provided evidence for the content validity of the new patient-reported outcome measure: the 20-item Complex Cryptoglandular Fistula Questionnaire™ (CCFQ-20™). Conclusion: The CCFQ-20™ is a new clinician-guided, patient-validated, disease-specific patient-reported outcome measure that measures disease impact and quality of life in patients with CCF. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea. Objectives: The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care. Design: A cross-sectional observational design was used. Methods: Participants (N = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain. Results: The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour. Conclusion: Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain. Plain language summary: What makes people with period pain seek help? Many people experience common period pain, which can be severe and debilitating. Even though it can make daily life difficult, not many people seek medical help for period pain. The purpose of this study was to find out why people with period pain might or might not go to a doctor for help. We used a theoretical framework called the Behavioural Model of Health Services Use to try to understand this. This framework tells us that predisposing factors like age or health beliefs, enabling factors like family support and access to healthcare, and need factors like severe symptoms, can predict whether someone will go to the doctor. We wanted to test if this way of thinking could accurately predict if someone with period pain had been to see a doctor. We asked people with period pain to fill in an online survey. We asked about things like how painful their periods were, what they believed about their menstrual health, how confident they felt in managing their pain, whether they got support from others, if they thought healthcare was available, and how much the pain affected their lives. We also asked if they had ever gone to a doctor for help with their period pain. We found that these factors were not very accurate in predicting whether people sought help for period pain. The most important predictors were how much the pain affected their lives and whether they believed that healthcare appointments were available to them. If the pain was very disruptive, and if they felt there were free appointments, people were less likely to have gone to see a doctor. This study was the first to use this way of thinking to understand help-seeking for people with period pain. In the future, researchers should test different models to see if they work better for understanding help-seeking behaviour for period pain. It is important to find ways to understand this behaviour to help people seek help for their pain when they need it. [ABSTRACT FROM AUTHOR]

Background: Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes. Objective: Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice. Design: This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs' actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called 'safety netting'). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan. Participants: All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed. Approach: Data collection occurred in GP-patient consultations during 2017–2018 across 7 practices in UK during 2017–2018. Key results: GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion. Conclusions: We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty. [ABSTRACT FROM AUTHOR]

This study aimed to understand how psychological factors affect regular exercise in older adults, hypothesising that trait self-control mediates the relationship between motivation types (intrinsic, extrinsic, and amotivation) and exercise time. In this cross-sectional study, 430 older adults (mean age = 68.8 ± 6.72) completed questionnaires regarding their perceived trait self-control, motivation towards leisure activities, and level of physical activity. A Bayesian mediation analysis was performed, controlling for demographics. We documented positive direct (c′ = 0.021, 95%CI [0.001, 0.043]) and indirect (ab = 0.028, 95%CI [0.014, 0.043]) effects of intrinsic motivation on exercise, a fully mediated indirect effect of extrinsic motivation on exercise (ab = 0.027, 95%CI [0.011, 0.046]), and negative direct (c′ = −0.281, 95%CI [−0.368, −0.194]) and indirect (ab = −0.161, 95%CI [−0.221, −0.105]) effects of amotivation on exercise. There was no direct association between extrinsic motivation and exercise (c′ = 0.013, 95% CI [−0.013, 0.037]). In conclusion, trait self-control mediates motivation to influence exercise behaviour in older adults. Intrinsically motivated individuals resist sedentary living and show higher self-control, while extrinsically motivated ones rely on self-control and are more susceptible to non-adherence during mental fatigue. High amotivation is linked to less exercise and reduced self-control, suggesting potential non-compliance with structured exercise interventions. [ABSTRACT FROM AUTHOR]

Against the backdrop of the COVID‐19 pandemic, workplace wellbeing is a key priority for employers. Severe market and health conditions continue to bring inevitable problems that could be reduced with the application of psychological interventions to prevent mental and physical health issues, making this study a highly pertinent and valuable contribution to the field. This paper reports the effects of a rational emotive behaviour therapy (REBT) programme on the irrational beliefs and emotional reactivity of 56 office‐based sales professionals located in the northwest region of the UK. A pre‐test, post‐test experimental design was utilised, and a mixed model ANOVA (repeated measures) was adopted to assess changes in mean differences concerning irrational beliefs and emotional reactivity at pre and post‐test stages for the intervention group, in comparison to a control group. Results indicate that those in the REBT group reported significant reductions in irrational beliefs and emotional reactivity, whilst those in the control group reported no such changes. It is recommended that future research studies consider utilizing a mixed methods design and focus on a strategic collaboration of organisational and individual level interventions for improving the psychological wellbeing and performance of sales personnel. [ABSTRACT FROM AUTHOR]

Background: Oral language skills provide the foundation for formal education, yet many children enter school with language weaknesses. This study evaluated the efficacy of a new language enrichment programme, the Nuffield Early Language Intervention—Preschool (NELI Preschool), delivered to children in the year before they enter formal education. Methods: We conducted a preregistered cluster randomised controlled trial in 65 nursery schools in England (https://doi.org/10.1186/ISRCTN29838552). NELI Preschool consists of a 20‐week whole‐class language enrichment programme delivered by a teacher each day for 20 min. In addition, children with the weakest language skills in each class are allocated to receive additional targeted support delivered by classroom assistants (whole‐class + targeted). The language skills of all children (n = 1,586) in participating classrooms were assessed using the LanguageScreen automated app (https://oxedandassessment.com/languagescreen/). Settings were then randomly allocated to an intervention or control group. The children with the weakest language in each class (whole‐class + targeted children n = 438), along with four randomly selected children in each class allocated to the whole‐class only programme (n = 288) were individually tested on a range of language measures. Results: Children receiving NELI Preschool made larger gains than children in the control group on an oral language latent variable (whole‐class children d =.26; whole‐class + targeted children d =.16). Conclusions: This study provides good evidence that whole‐class intervention delivered in preschool can produce educationally significant improvements in children's language skills. The intervention is scaleable and relatively low cost. These findings have important implications for educational and social policy. [ABSTRACT FROM AUTHOR]

Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing. [ABSTRACT FROM AUTHOR]

Background: Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI). Methods: Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. Results: Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy‐specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content. Conclusions: Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in‐person sessions using a hybrid structure to enable the development of a support network. Highlights: Thirteen online focus group discussions were conducted across the UK and Ireland.Five themes were generated around cooking during pregnancy and the content and structure of a cooking and food skills programme.There was support for an inclusive cooking programme that included a wide range of food‐related skills.Participants believed the programme should be supported by the health services.There was support for the use of digital technologies, potentially combined with in‐person sessions using a hybrid structure. [ABSTRACT FROM AUTHOR]

Background: With the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied. Methods: We conducted an extensive review of COSECSA general surgery trainees' operative case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization. Results: Among 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001). Conclusions: The study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques. [ABSTRACT FROM AUTHOR]

Objectives To evaluate a strategy designed to optimize care and increase uptake of urate-lowering therapy (ULT) during hospitalizations for gout flares. Methods We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment and re-hospitalization rates, were compared between patients hospitalized for flares in the 12 months post-implementation and a retrospective cohort of hospitalized patients from 12 months pre-implementation. Results One hundred and nineteen and 108 patients, respectively, were hospitalized for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n  = 94 and n  = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio [aOR] 11.5; 95% CI 4.36, 30.5; P  < 0.001). After implementation, more patients achieved a serum urate ≤360 μmol/l within 6 months of discharge (10.6% pre-implementation vs 26.8% post-implementation; aOR 3.04; 95% CI 1.36, 6.78; P  = 0.007). The proportion of patients re-hospitalized for flares was 14.9% pre-implementation vs 9.3% post-implementation (aOR 0.53; 95% CI 0.22, 1.32; P  = 0.18). Conclusion Over 90% of patients were initiated on ULT after implementing a strategy to optimize hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalizations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalized gout patients to achieve urate targets, closer primary–secondary care integration is still needed. [ABSTRACT FROM AUTHOR]

Research shows that, in mental healthcare, empathy and active listening skills play a fundamental role in the therapeutic relationship. Despite this, clinicians receive little training in cultivating these qualities, and there is a dearth of training in therapeutic relationships and relational care in this field more generally. In response to this paucity of training, a new intensive three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). The CARE training programme has recently been delivered to a number of mental health teams in different boroughs of an NHS Trust and has undergone several rounds of redevelopment. This paper outlines the CARE training programme's objectives and mode of delivery, and subsequently presents questionnaire results from recent CARE trainees regarding their experience of the nature and utility of the training. Four main themes emerged from responses to the question of the utility of the training, these were 'A shift towards more person-centred care', 'Strengthens the therapeutic relationship', 'Facilitates more collaborative care with patients and their families' and 'Development of new skills and therapeutic techniques'. The paper concludes by discussing the potential of this training to help forge a substantial shift in the culture of mental health services in a systemic way. [ABSTRACT FROM AUTHOR]

Simple Summary: Healthcare professionals recognise the importance of fertility preservation and their responsibility to initiate discussions. However, despite advanced training within respective fields, discrepancies in knowledge remain regarding techniques of fertility preservation, referral pathways and existing educational resources available to patients, preventing efficient implementation of services. Further education and training regarding the methods of fertility preservation and how to refer patients to specialist services are required. Many of the personal barriers faced by healthcare professionals could be overcome through regular teaching on communication skills used for breaking bad news. (1) Background: This study aims to establish the knowledge, attitudes and current behaviours towards female fertility preservation (FP) services amongst healthcare professionals (HCPs) in the UK. (2) Methods: An online survey was advertised publicly on the social media platform Instagram between 25 February 2021 and 11 March 2021. (3) Results: In total, 415 participants fulfilled the inclusion criteria and completed the survey. The majority of HCPs discussed FP techniques either never 39.5% (n = 164), once a year 20.7% (n = 86) or once a month 17.8% (n = 74). The majority rated their knowledge of each type of FP method as 'very poor' or 'poor' and strongly disagreed 14.2% (n = 59) or disagreed 42.2% (n = 175) with the statement they 'felt confident to counsel a patient on FP'. The majority either agreed 37.8% (n = 157) or strongly agreed 22.2% (n = 92) that it was their responsibility to discuss FP and 38.1% (n = 158) agreed or strongly agreed 19.5% (n = 81) they considered the desire for future fertility when planning treatment. The majority 87.2% (n = 362) had not experienced formal training on FP. (4) Conclusions: Discrepancies in knowledge remain regarding techniques of FP, referral pathways, awareness of facilities offering services and existing educational resources. Many HCPs recognise the importance of FP and their responsibility to initiate discussions. The knowledge that FP may not delay the treatment of cancer has also improved; however, training in FP is scarce. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is subject to extensive risk reduction approaches. A central strategy is reducing the unnecessary use of antimicrobials across agriculture and human and animal health care without jeopardising health outcomes for all species concerned. A prominent framework is antimicrobial stewardship which seeks to balance access to effective infection treatments with ensuring that effective antimicrobials are available for future generations. Balancing these goals has proven challenging and the consumption of antimicrobials and AMR both continue to grow. To shed light on this situation, we examined the risk reasoning that underpins AMR reduction in interviews with 51 practitioners, scientists and policy-makers working on AMR in Australia and the UK. Important themes in our analysis were that action to reduce infection risks clashed with AMR reduction rationalities. Participants were often not able to explain how treating an infection for an individual patient could harmonise with the longer-term goal of AMR reduction. Due to the potential for patient harm, making decisions to use antimicrobials was narrated as individualised and moralised. We argue that more effective AMR reduction depends on addressing this fundamental tension in AMR risk, and its individualising and moralising effects, as the starting point – not the outcome – of policy and practice for AMR reduction. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy and the postpartum period is a difficult time for women living with HIV (WLWH) and postpartum engagement with HIV care is often reduced, with implications for health and well-being. We aimed to explore the postpartum health experiences of WLWH in relation to engagement in HIV care. Methods: The NESTOR (iNvESTigating the pregnancy and pOst-paRtum health experience of women living with HIV) study was a UK based qualitative semi-structured interview study. 61 eligible women were identified. We used a purposive sampling technique to recruit women with differing levels of engagement in HIV care. Interviews were conducted via telephone or video call. Interviews were audio recorded and fully transcribed. We used a thematic approach for data analysis, and two researchers independently coded the data and established the key themes. Results: 11 of 61 (18%) eligible women participated in the interviews, and the three main themes were 'infant feeding decisions', 'managing the risk of mother to child transmission', and 'managing the knowledge of their HIV status'. These themes offer detailed insights into the significant psychological and emotional challenges these women had experienced, and the practical support from healthcare professionals in both HIV and maternity services that had enabled them to navigate those challenges. Discussion: There have been life-changing developments in the treatment and care for people living with HIV. However, even in the U = U (undetectable = untransmittable) era, traditional concerns about breastfeeding, risk of transmission to the infant and stigma continue to shape the postpartum experience of WLWH. As these impact on their emotional and psychological wellbeing, support in these areas needs to be prioritised. Significance: Studies report that postpartum retention in HIV care and viral load suppression are suboptimal for women living with HIV, where an important reason is the financial cost and access to healthcare. However, there is a relative scarcity of evidence describing the problems faced by women accessing HIV and maternity services within socialised healthcare systems, such as those in the UK. Women living with HIV face unanticipated challenges when becoming new mothers relating to disclosure of their HIV status, fears of vertical transmission and perceived perceptions of others deeming them inadequate mothers. Importantly, our analysis illustrates potential opportunities where intervention might mitigate the emotional and physical impact of these issues on their wellbeing throughout pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

Child safeguarding services intervene when a child is at risk of serious emotional or physical harm. Oxfordshire County Council is implementing a new approach to child safeguarding (Family Solutions Plus [FSP]) with a greater focus on whole family support and reducing the need for foster care. We sampled two cohorts of children closed within 1 year and examined the time spent in services. The sample included 474 children entering services before the new model's implementation and 561 children after. A greater proportion of children receiving FSP required a single care plan before their case was closed (85.9%; 69.4%, p < 0.001) and only experienced the lowest level plan (74.5%; 61.8%, p < 0.001). On average, this group spent less time in services for the period being observed (MD = 17.58, 95% confidence interval = 6.19, 28.96). At this early stage, no significant reduction in the number of children requiring foster care was seen (5.5%; 3.9%, p = 0.23). These initial findings suggest a potential association of FSP with a reduced number and level of care plans as well as length of time. Local authorities in England may investigate further whether FSP is a potentially useful model in improving safeguarding services. [ABSTRACT FROM AUTHOR]

There is emerging evidence that post-traumatic growth is a relevant concept in addiction recovery. However, existing measures, such as the post-traumatic growth inventory, were designed to measure post-traumatic growth in general trauma populations. It is unclear if the post-traumatic growth inventory is suitable for individuals in recovery from substance-related addiction. The current study aimed to qualitatively assess the content validity of the post-traumatic growth inventory for individuals in addiction recovery. The think-aloud method was applied, and semi-structured interviews utilized, to collect data from 20 individuals in recovery from unhealthy alcohol and/or drug use. Reflexive thematic analysis was used to analyze data in relation to item interpretation and experience of post-traumatic growth. Qualitative assessment supported three out of five subscales on the post-traumatic growth inventory (new possibilities, personal strength and appreciation of life). Modifications were suggested on some items from the relating to others domain and responses to the spiritual change domain possibly reflected a cultural influence. There was an identified need to include items that account for positive changes in health behavior. The current study highlights domains of post-traumatic growth for those in addiction recovery and how the post-traumatic growth inventory may understate some forms of positive life change. Future research should focus on validating a revised version of the post-traumatic growth inventory for this population. [ABSTRACT FROM AUTHOR]

Open research practices seek to enhance the transparency and reproducibility of research. While there is evidence of increased uptake in these practices, such as study preregistration and open data, facilitated by new infrastructure and policies, little research has assessed general uptake of such practices across psychology university researchers. The current study estimates psychologists' level of engagement in open research practices across universities in the United Kingdom and Ireland, while also assessing possible explanatory factors that may impact their engagement. Data were collected from 602 psychology researchers in the United Kingdom and Ireland on the extent to which they have implemented various practices (e.g., use of preprints, preregistration, open data, open materials). Here we present the summarized descriptive results, as well as considering differences between various categories of researcher (e.g., career stage, subdiscipline, methodology), and examining the relationship between researcher's practices and their self‐reported capability, opportunity, and motivation (COM‐B) to engage in open research practices. Results show that while there is considerable variability in engagement of open research practices, differences across career stage and subdiscipline of psychology are small by comparison. We observed consistent differences according to respondent's research methodology and based on the presence of institutional support for open research. COM‐B dimensions were collectively significant predictors of engagement in open research, with automatic motivation emerging as a consistently strong predictor. We discuss these findings, outline some of the challenges experienced in this study, and offer suggestions and recommendations for future research. Estimating the prevalence of responsible research practices is important to assess sustained behaviour change in research reform, tailor educational training initiatives, and to understand potential factors that might impact engagement. [ABSTRACT FROM AUTHOR]

Dropout from psychotherapy among adolescents is a common occurrence. Adolescents' need for independence can be in direct conflict with therapeutic relationships, particularly in open-ended psychotherapy where endings need to be negotiated. The present study was a service evaluation, which aimed to identify how open-ended once-weekly psychoanalytic psychotherapy ends with adolescents, and whether dropout could be predicted from a range of adolescent and treatment factors. The sample comprised 443 adolescents, aged 14–24, who had received psychoanalytic psychotherapy in a community-based clinic. Logistic regression was used to estimate the effects of predictors on the odds of dropout. Adolescents were categorised based on how treatment ended: adolescents' unilateral decision (43%), mutually agreed between adolescent and therapist (27%), initiated by changed external circumstances such as relocation (23%) or a referral to another service (6%). Younger adolescents and those from more disadvantaged backgrounds were most at risk of dropout. Missed sessions early in treatment were also predictive of dropout. Neither therapist change nor the number of services was significantly associated with dropout. This study shows that dropout is a frequent occurrence in open-ended psychoanalytic psychotherapy. Further research is needed to explore how young people at risk of dropout can be better supported to attend treatment to ensure they receive the maximum benefits. Moreover, research is required to identify how therapists can optimally respond to missed sessions, to avoid subsequent dropout and to facilitate positive and appropriate treatment endings. [ABSTRACT FROM AUTHOR]

Introduction: Within 10 years of multiple sclerosis (MS) progression, nearly all women will have experienced symptoms associated with bladder, bowel and/or sexual health. Yet despite the impact these symptoms have on physical, psychological and social well‐being, it remains an underserved area within the UK healthcare system. Study Aim: This research employs a participatory research approach framed within the principles of intersectional feminism to collaboratively investigate the lived experiences of pelvic floor dysfunction (PFD) and healthcare interactions among UK‐based women with MS. Setting and Participants: Women residing in the United Kingdom with MS were invited to participate in online interviews facilitated by the primary author. Analysis: A thematic framework analysis offering a structured yet adaptable approach to data collection and interpretation. Results: One focus group involving four women with MS and seven individual, one‐to‐one interviews with women with MS provided insights into the challenges associated with navigating both MS and PFD. Four main themes included: Navigating MS and PFD; Cycles of Control; Mind, Mobility and Bladder Embodiment; Silenced Voices: The Impact of Taboos/Stigma/Dismissal on Preventing Access and Resistance through Collective Community. Six subthemes were also identified. Taken together, these themes cumulatively reflect PFD as an unmet healthcare need. Conclusion: Our findings underscore negative healthcare experiences, inadequate information provision and unmet needs related to PFD, emphasising the compounding effects of gender and disability biases. Impact: We hope that these insights can lay the groundwork for developing tailored therapeutic interventions and improved PFD healthcare for women with MS. Potential solutions include using existing MS support communities. Public Contributions: Women with MS were actively involved in co‐producing interview scripts for one‐to‐one interviews. The primary author shared study findings at an MS group event, engaging in discussions with over 30 individuals, including people with MS and their loved ones. MS advocates played a pivotal role in contextualising the study within the broader lived experience of MS. [ABSTRACT FROM AUTHOR]

Introduction: The impact of multiple health conditions on bowel cancer screening is currently unknown. We explored the impact of multiple health conditions on bowel cancer screening perceptions, experience and clinical management decisions following a positive stool test. Methods: Semi‐structured qualitative interviews were conducted remotely with Bowel Screening Wales staff (n = 16) stratified by regional location and role and with screening participants (n = 19) stratified by age, gender and comorbidity. Interview topics were guided by the Common‐Sense Model. Results: Screening participants, regardless of comorbidity status, placed great emphasis on the importance of early detection of cancer and completing the bowel screening process. Screening staff emphasised comorbidities in the clinical decision‐making process; however, screening participants had low awareness of the impact that comorbidities can have on bowel screening. Participants describe how the presence of multiple health conditions can mask potential bowel symptoms and influence beliefs about follow‐up. Conclusion: Bowel screening staff try to individualise the service to meet participant needs. The potential mismatch in screening staff and participant awareness and expectations of the bowel screening and diagnostic process needs to be addressed. Clearer and more regular communication with screening participants could support the screening process, particularly for those with significant coexisting health conditions or facing time delays. The possible masking effects and misattribution of symptoms because of comorbidities highlight an opportunity for education and raising awareness for screening participants and a potential area of focus for discussions in clinical consultations and staff training. Patient and Public Contribution: Project funding included costs for patients and public contributors to be compensated for their contributions to the project, in line with current standards. A patient and public contributor was involved in the design of the study, including protocol development, and the interpretation of key findings and implications for patients, which are subsequently reflected within the manuscript. [ABSTRACT FROM AUTHOR]

Aims: The DAFNEplus programme incorporates behaviour change techniques into a modified educational intervention and was developed to help address the glycaemic drift observed amongst graduates of standard DAFNE programmes. As the programme's success will be contingent on staff buy‐in, we explored healthcare professionals' experiences of, and views about, delivering DAFNEplus during a clinical trial to help inform decision making about rollout post‐trial. Methods: We interviewed n = 18 nurses and dieticians who delivered DAFNEplus during the trial. Data were analysed thematically. Results: While many shared initial reservations, all described how their experiences of DAFNEplus programme delivery had had a positive, transformative impact upon their perceptions and working practices. This transformation was enabled by initial training and supervision sessions, the confidence gained from using scripts to support novel programme content delivery, and experiences of delivering the programme and observing DAFNEplus principles being well received by, and having a positive impact on, attendees. Due to these positive experiences, interviewees described a strongly felt ethical mandate to use some DAFNEplus techniques and curriculum content in routine clinical care. While being supportive of a national rollout, they anticipated a variety of attitudinal and logistical (e.g. workload) challenges. Conclusions: This study provides a vital dimension to the evaluation of the DAFNEplus programme. Interviewees found the intervention to be acceptable and expressed high levels of buy‐in. As well as offering potential endorsement for a national rollout, our findings offer insights which could help inform development and rollout of future behaviour change interventions to support diabetes self‐management. [ABSTRACT FROM AUTHOR]

This study explores the mediating role of self-regulation in the relationship between bullying victimization and depressive symptoms among adolescents, considering the moderating effects of gender and region. A cross-sectional analysis was conducted with 3984 adolescents aged 12–18 from the United Kingdom, Hong Kong, Taiwan, and the Netherlands. Data were collected via an online survey administered through Qualtrics. The survey included validated measures such as the Illinois Bullying Scale (IBS) to measure bullying victimization, the Adolescent Self-Regulatory Inventory (ASRI) to measure self-regulation, and the Patient Health Questionnaire (PHQ) to measure depression. The SPSS macro PROCESS was employed for data analysis, with model 4 used for testing the mediating effects of self-regulation and model 1 for assessing the moderating effects of gender and region. The results demonstrated significant associations between bullying victimization, self-regulation, and depressive symptoms. Self-regulation mediated the positive association between bullying victimization and depression, with notable variations across genders and regions. Specifically, male students in Hong Kong exhibited an increased susceptibility to depression when subjected to bullying. These findings underscore the protective role of self-regulation in mitigating the adverse effects of bullying victimization on adolescent mental health. Implications for interventions and prevention strategies targeting adolescent depression are discussed. [ABSTRACT FROM AUTHOR]

Aims With an ageing population, the presence of asymptomatic valvular heart disease (VHD) in the community remains unknown. The aim of this study is to determine the prevalence and associated factors of asymptomatic VHD in individuals ≥60 years old and to evaluate the feasibility of echocardiographic screening for VHD in this population. Methods and results This was a prospective cohort study conducted between 2007 and 2016 in the UK. Asymptomatic patients with no prior indication for echocardiography were invited to participate and evaluated with a health questionnaire, clinical examination, and transthoracic echocardiography. A total of 10,000 individuals were invited through their general practices. A total of 5429 volunteered to participate, of whom 4237 were eligible for inclusion. VHD was diagnosed in more than a quarter of patients (28.2%). The most common types of VHD were regurgitation of the tricuspid (13.8%), mitral (12.8%), and aortic (8.3%) valves (trivial regurgitation was not included). The rate of prevalence of clinically significant VHD was 2.4% (2.2% moderate and 0.2% severe), with mitral and aortic regurgitation being the most common. The only parameter associated with significant VHD was age (odds ratio 1.07 per 1 year increment, 95% confidence interval 1.05–1.09, P < 0.001). The number needed to scan to diagnose one clinically significant case of VHD is 42 for individuals ≥60 and 15 for those ≥75 years old. Conclusion Asymptomatic VHD is present in a significant proportion of otherwise healthy individuals without known VHD over 60 years old. Age is strongly associated with an increased incidence of significant VHD. [ABSTRACT FROM AUTHOR]

Many people living with dementia have difficulties at mealtimes, which can result in serious complications for physical and mental health, leading to hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to explore current practice in mealtime care for this population, identify good practice, and understand the factors influencing mealtime care. Approximately 28 h of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care staff and residents living with dementia. Twenty-five semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. A constant comparative approach was taken, to probe emergent findings and explore topics in greater depth. Key thematic categories were identified, including: tensions in mealtime care; the symbolic nature of mealtime care; navigating tensions via a person-centred approach; contextual constraints on mealtime care; and teamwork in mealtime care. The findings indicated that a person-centred approach helps carers to find the right balance between apparently competing priorities, and teamwork is instrumental in overcoming contextual constraints. This evidence has contributed to development of a training intervention for care home staff. Future research should investigate the feasibility of mealtime care training in care homes. [ABSTRACT FROM AUTHOR]

The last few years have seen the rapid emergence of synthetic drug derivatives known as new psychoactive substances (NPS) among the homeless population. Previous research has focused on understanding the issues from homeless or stakeholder perspectives but not the public's. The purpose of this research is to understand the perspectives of the public and service providers regarding NPS use among the homeless population using thematic analysis of Twitter data. Tweets from Twitter were extracted and imported into NVivo 12 for thematic analysis. Tweets were included if they were written and related to NPS among the homeless. Excluded tweets were those related to interventional studies or with personalized information. The findings showed that two NPS were discussed on Twitter being novel synthetic opioids (NSOs) and synthetic cannabinoid receptor agonists (SCRAs). Thematic analysis of Twitter discussions revealed that individuals held a negative attitude toward the government and the services provided to the homeless NPS users, for both NSOs and SCRAs. In summary, NSOs were more frequently discussed on the Twitter platform than SCRAs. NSOs were consumed by homeless population in the United States and Canada, and SCRA by the homeless in the United Kingdom. [ABSTRACT FROM AUTHOR]

Introduction: Patient-reported outcomes measures (PROMs) are valuable tools for assessing health-related quality of life and treatment effectiveness in individuals with traumatic brain injuries (TBIs). Understanding the experiences of individuals with TBIs in completing PROMs is crucial for improving their utility and relevance in clinical practice. Methods: Sixteen semi-structured interviews were conducted with a sample of individuals with TBIs. The interviews were transcribed verbatim and analysed using Thematic Analysis (TA) and Natural Language Processing (NLP) techniques to identify themes and emotional connotations related to the experiences of completing PROMs. Results: The TA of the data revealed six key themes regarding the experiences of individuals with TBIs in completing PROMs. Participants expressed varying levels of understanding and engagement with PROMs, with factors such as cognitive impairments and communication difficulties influencing their experiences. Additionally, insightful suggestions emerged on the barriers to the completion of PROMs, the factors facilitating it, and the suggestions for improving their contents and delivery methods. The sentiment analyses performed using NLP techniques allowed for the retrieval of the general sentimental and emotional "tones" in the participants' narratives of their experiences with PROMs, which were mainly characterised by low positive sentiment connotations. Although mostly neutral, participants' narratives also revealed the presence of emotions such as fear and, to a lesser extent, anger. The combination of a semantic and sentiment analysis of the experiences of people with TBIs rendered valuable information on the views and emotional responses to different aspects of the PROMs. Discussion: The findings highlighted the complexities involved in administering PROMs to individuals with TBIs and underscored the need for tailored approaches to accommodate their unique challenges. Integrating TA-based and NLP techniques can offer valuable insights into the experiences of individuals with TBIs and enhance the interpretation of qualitative data in this population. [ABSTRACT FROM AUTHOR]

Background: The Social Motivation Theory proposes that social reward processing differences underlie autism. However, low social motivation has also been linked to higher anxiety. Given the co‐occurrence between autism and anxiety, it is possible that anxiety drives the association between social motivation and autistic characteristics. This study tests the mechanisms underlying the association between social motivation and autistic traits. Methods: Participants were 165 adolescents (71 male), aged 10–16 years, from the Mapping profiles of cognition, motivation and attention in childhood (C‐MAPS) study, enriched for autistic traits (70 participants with an autism diagnosis, 37 male). Participants completed a battery of online experimental tasks, including a Choose‐a‐Movie social motivation task and social cognition measures (theory of mind; emotion recognition), alongside parent‐reported child anxiety and autistic traits. Results: Higher social motivation was significantly associated with lower autistic traits (β = −.26, p <.001). Controlling for social cognition did not change the association between social motivation and autistic traits. Controlling for anxiety did significantly reduce the strength of the association (unstandardized coefficient change: p =.003), although social motivation remained associated with autistic traits (β = −.16, p =.004). Post hoc analyses demonstrated differential sex‐effects: The association between social motivation and autistic traits was significant only in the females (β = −.38, p <.001), as was the attenuation by anxiety (unstandardized coefficient change: p <.001). Conclusions: The association between social motivation and autistic traits could be partially attributed to co‐occurring anxiety. Sex‐specific effects found in females may be due to environmental factors such as increased social demands in adolescent female relationships. Results are consistent with self‐report by autistic individuals who do not identify as having reduced social motivation. [ABSTRACT FROM AUTHOR]

Background/Aims: Molar pregnancy is a rare complication of pregnancy. Patients face surgery, human chorionic gonadotropin monitoring and potentially systemic treatment, resulting in unique support needs. This study's aim was to explore the impacts of gestational trophoblastic disease on embodied and emotional experience. Methods: This qualitative study considered stories of molar pregnancy from 20 women in the UK, US, Canada and Australia. These were drawn from 18 publicly available online blogs and eight semi-structured interviews, and analysed thematically. Results: Three themes were developed: 'loss', describing women's responses to their pregnancy ending; 'isolation', comprising 'rarity', 'lack of awareness' and support seeking; and 'alienation', capturing the unfamiliarity of diagnosis, 'failure' and barriers to 'moving forward'. Conclusions: Experiences are shaped by wider narratives of 'typical' pregnancy. Patient care requires an individualised and responsive approach, and non-specialist practitioners should feel confident in discussing molar pregnancy and have access to up-to-date guidance. [ABSTRACT FROM AUTHOR]

There is an urgent need to develop an international competency and capability framework to support standardization of education and roles in advanced practice physiotherapy (APP). This need arose due to the rapid growth of the APP model of care, implemented out of necessity in the absence of agreement as to the competencies and capabilities or formal education required for the roles. This study explores the views and perceptions of practitioners and key stakeholders on a draft competency and capability framework for advanced practice physiotherapists. The purpose of this study was to: 1) gather feedback from key stakeholders (advanced practice physiotherapists, researchers, and leaders) on a draft competency and capability framework and 2) use that feedback to revise and improve the draft framework. Qualitative study using a series of four multi-national online focus groups. Thematic analysis was conducted according to Braun and Clarke. Sixteen participants from the United Kingdom, Ireland, Canada, Australia, and New Zealand participated in the study. Five themes were generated after data analysis: clinical expert, experienced communicator, strong leader, collaborator, and knowledge creator). A modified competency and capability framework was developed based on feedback from the focus groups and input from subject matter experts (SMEs). This study provides a modified core competency and capability framework comprising 24 competencies grouped under six domains. This study is a step toward international standardization of advanced practice physiotherapy based on a commonly agreed framework for the education and training of advanced practice physiotherapists. [ABSTRACT FROM AUTHOR]

Pasteurised donor human milk is recommended for very low birthweight infants who do not have access to their mother's milk. Although the use of donor milk continues to increase, little is known about the donation experiences of milk bank donors. We aimed to describe and compare enablers, barriers and patterns of human milk donation and identify factors predicting donation volume in a convenience sample of approved milk bank donors in the United Kingdom and the United States. A cross‐sectional online survey was conducted from August 2022 to December 2022. Approved milk bank donors (n = 556) from three milk banks in the United States (n = 369, Mothers' Milk Bank of Florida, Mother's Milk Bank of North Texas and Northwest Mothers Milk Bank) and one milk bank in the United Kingdom (n = 187, Hearts Milk Bank) completed the survey. A substantial portion of donors in both settings reported participating in other forms of milk exchange (51% of U.S. donors vs. 39% of UK donors, p = 0.009). Top donation barriers reported in both settings were completing the serological screening and having enough space to store collected milk. Most donors started donating when their infant was 3 months old or older and reported donating mature milk. The most common source of information related to milk banking in each setting was the internet (United Kingdom–70% vs. United States ‐ 63%, p = 0.112). Variables that predicted lifetime donation volume differed between the United States and the United Kingdom, highlighting the importance of setting‐specific milk banking research. Key messages: Milk bank donors in the United Kingdom and the United States reported primarily receiving milk banking information from the internet and not their health care provider.A substantial portion of human milk bank donors in the United Kingdom and the United States participate in other forms of milk exchange, including sharing with a peer.Participating in other forms of milk exchange did not predict lower milk bank donation volumes.Barriers to donation and predictors of donation volume differed between donors in the United Kingdom and the United States, suggesting setting‐specific research is warranted to improve the donation process globally. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the effectiveness of a highly individualized morphosyntactic intervention using the SHAPE CODING™ system delivered at different dosages. Method: Eight children with developmental language disorder aged 8;0–10;10 (years;months) received 10 hr of explicit individualized intervention for morphosyntax delivered in 30-min individual sessions once per week for 20 weeks. Following at least four baseline probe tests, two grammatical targets per session received explicit instruction until they reached criterion (90%), when the next target was introduced. To control for session length and teaching episode density, either both targets received 20 teaching episodes per session or one target received 10 teaching episodes and the other 30. Maintenance testing of completed targets was also carried out. Results: Scores on probe tests post-intervention were significantly higher than during the baseline phase (d = 1.6) with no change during the baseline or maintenance phases. However, progress during the intervention phase was highly significant. One participant showed significantly faster progress with intervention, while one (with the lowest attention score) made little progress. When considering progress relative to cumulative intervention sessions, progress was faster with 30 teaching episodes per session and slower with 10. However, when cumulative teaching episodes were used as the predictor, all three within-session dosages showed very similar rates of progress, with the odds of a correct response increasing by 3.9% for each teaching episode. The targets that were achieved required an average of 40–60 teaching episodes. Conclusions: With the exception of one participant, the individualized intervention was highly effective and efficient. Thus, the individualized target identification process and intervention method merit further research in a larger group of children. The cumulative number of teaching episodes per target provided across sessions appeared to be key. Thus, clinicians should aim for high teaching episode rates, particularly if the number of sessions is constrained. Otherwise, intervention scheduling can be flexible. [ABSTRACT FROM AUTHOR]

Background: Global challenges arise from infectious diseases which represent significant challenges to the provision of healthcare, requiring efficient management procedures to limit transmission. Evaluating current outbreak management processes within UK healthcare services is essential for identifying strengths, weaknesses, and potential improvements. Objectives: This study aimed to assess infection prevention and control (IPC) practitioners' access to outbreak management (OM) data. Secondary objectives involved determining IPC practitioners' perceptions of outbreak management processes and the state of digitalisation of OM in the UK. Methods: National cross-sectional survey data were collected to evaluate current outbreak management approaches. To supplement this, information requests were sent to the 10 largest teaching and research NHS hospital trusts in England. Findings: The survey received 55 responses with 53 considered for analysis. Out of 10 NHS trusts, nine provided completed FOI responses, while one was unable to provide data. Discussion: The study offers unique insights into prevailing outbreak management practices within UK health services. Although positive perceptions surround key outbreak management stages, concerns arise, including varying confidence levels in surveillance processes' robustness, efficacy of management interventions, and communication effectiveness. Conclusions: The study highlights challenges with OM processes in the UK, including issues like poor surveillance and delayed outbreak detection. Positive practitioner perceptions contrast with concerns over data collection, follow-up, and limited digitalisation, relying on basic tools like Excel and Word, hindering retrospective learning. [ABSTRACT FROM AUTHOR]

Background: There are limited practical advanced life support algorithms to aid teams in the management of cardiac arrest in patients on extracorporeal membrane oxygenation (ECMO). Methods: In our specialist tertiary referral centre we developed, by iteration, a novel resuscitation algorithm for ECMO emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to resolve gas line disconnection) and a multiple choice question (MCQ) examination. Results: Following this intervention the median confidence scores increased from 2 (Interquartile range IQR 2, 3) to 4 (IQR 4, 4) out of maximum 5 (n = 53, p < 0.0001). Theoretical knowledge assessed by median MCQ score increased from 8 (6, 9) to 9 (7, 10) out of maximum 11 (n = 53, p0.0001). The use of the ECMO algorithm reduced the time taken by teams in a simulated emergency to identify a gas line disconnection and resolve the problem from median 128 s (65, 180) to 44 s (31, 59) (n = 36, p 0.001) and by a mean of 81.5 s (CI 34, 116, p = 0.001). Conclusions: We present an evidence based practical ECMO resuscitation algorithm that provides guidance to clinical teams responding to cardiac arrest in ECMO patients covering both patient and ECMO troubleshooting. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that often persists into adulthood. Underlying alterations in brain connectivity have been identified but some relevant connections, such as the middle, superior, and inferior cerebellar peduncles (MCP, SCP, and ICP, respectively), have remained largely unexplored; thus, we sought to investigate whether the cerebellar peduncles contribute to ADHD pathophysiology among adults. Methods: We applied diffusion-weighted spherical deconvolution tractography to dissect the cerebellar peduncles of male adults with ADHD (including those who did or did not respond to methylphenidate, based on at least 30% symptom improvement at 2 months) and controls. We investigated differences in tract metrics between controls and the whole ADHD sample and between controls and treatment-response groups using sensitivity analyses. Finally, we analyzed the association between the tract metrics and cliniconeuropsychological profiles. Results: We included 60 participants with ADHD (including 42 treatment responders and 18 nonresponders) and 20 control participants. In the whole ADHD sample, MCP fractional anisotropy (FA; t 78 = 3.24, p = 0.002) and hindrance modulated orientational anisotropy (HMOA; t 78 = 3.01, p = 0.004) were reduced, and radial diffusivity (RD) in the right ICP was increased (t 78 = −2.84, p = 0.006), compared with controls. Although case–control differences in MCP FA and HMOA, which reflect white-matter microstructural organization, were driven by both treatment response groups, only responders significantly differed from controls in right ICP RD, which relates to myelination (t 60 = 3.14, p = 0.003). Hindrance modulated orientational anisotropy of the MCP was significantly positively associated with hyperactivity measures. Limitations: This study included only male adults with ADHD. Further research needs to investigate potential sex- and development-related differences. Conclusion: These results support the role of the cerebellar networks, especially of the MCP, in adult ADHD pathophysiology and should encourage further investigation. Clinical trial registration: NCT 03709940 [ABSTRACT FROM AUTHOR]

Cognitive control is a predictor of later‐life outcomes and may underpin higher order executive processes. The present study examines the development of early cognitive control during the first 24‐month. We evaluated a tablet‐based assessment of cognitive control among infants aged 18‐ and 24‐month. We also examined concurrent and longitudinal associations between attentional disengagement, general cognitive skills and cognitive control. Participants (N = 60, 30 female) completed the tablet‐task at 18‐ and 24‐month of age. Attentional disengagement and general cognitive development were assessed at 5‐, 8‐, 12‐, 18‐ and 24‐month using an eye‐tracking measure and the Mullen Scales of Early Learning (MSEL), respectively. The cognitive control task demonstrated good internal consistency, sensitivity to age‐related change in performance and stable individual differences. No associations were found between infant cognitive control and MSEL scores longitudinally or concurrently. The eye‐tracking task revealed that slower attentional disengagement at 8‐month, but faster disengagement at 18‐month, predicted higher cognitive control scores at 24‐month. This task may represent a useful tool for measuring emergent cognitive control. The multifaceted relationship between attention and infant cognitive control suggests that the rapid development of the attentional system in infancy results in distinct attentional skills, at different ages, being relevant for cognitive control development. [ABSTRACT FROM AUTHOR]