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This evidence synthesis applying realist concepts and behavioural science aimed to identify behavioural mechanisms and contexts that facilitate prescribers tapering opioids. We identified relevant opioid-tapering interventions and services from a 2018 international systematic review and a 2019 England-wide survey, respectively. Interventions and services were eligible if they provided information about contexts and/or behavioural mechanisms influencing opioid-tapering success. A stakeholder group (n = 23) generated draft programme theories based around the 14 domains of the Theoretical Domains Framework. We refined these using the trial and service data. From 71 articles and 21 survey responses, 56 and 16 respectively were included, representing primary care, hospital, specialist pain facilities and prison services. We identified 6 programme theories comprising 5 behavioural mechanisms: prescribers' knowledge about how to taper; build prescribers' beliefs about capabilities to initiate tapering discussions and manage psychological consequences of tapering; perceived professional role in tapering; the environmental context enabling referral to specialists; and facilitating positive social influence by aligning patient: prescriber expectations of tapering. No interventions are addressing all 6 mechanisms supportive of tapering. Work is required to operationalise programme theories according to organisational structures and resources. An example operationalisation is combining tapering guidelines with information about local excess opioid problems and endorsing these with organisational branding. Prescribers being given the skills and confidence to initiate tapering discussions by training them in cognitive-based interventions and incorporating access to psychological and physical support in the patient pathway. Patients being provided with leaflets about the tapering process and informed about the patient pathway., (© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Background: This study used national data to determine if violent child death rates fell between 1974 and 2008., Design: Using mortality data from the Office of National Statistics, categories potentially containing violent child deaths were analysed for children aged <1, 1-14 and 15-19 years. These data were compared with Home Office data on recorded homicides in children aged <1 and 1-15 years., Results: Annual rates of infant deaths registered as due to assault fell between 1974 and 2008 from 5.6 to 0.7 per 100 000 infants; those in children (1-14 years) fell from 0.6 to 0.2 per 100 000. When these deaths are combined with those registered as undetermined intent, rates are higher but still show a decline in both groups. There is a slight fall in the rates of police recorded homicides in infants, but no observable change in childhood rates. In adolescents, the rates of death from assault fell during the 1970s and have since remained static in females but have risen in males. When these deaths are combined with those registered as undetermined intent, the rates for adolescent women have remained static at 2.0 per 100 000, while for young men they increased from 3.3 to 5.7 per 100 000 before declining to 4.2 per 100 000., Conclusion: These data provide evidence that rates of violent death in infancy and middle childhood have fallen over the past 30 years. In contrast, rates in adolescence have remained static or risen over the same period.