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Accessible summary: What Is Known on the Subject?: Mental health care can be delivered remotely through video and telephone consultations.Remote consultations may be cheaper and more efficient than in person consultations. What the Paper Adds to Existing Knowledge: Accessing community mental health care through remote consultations is perceived as not possible or beneficial for all service users.Delivering remote consultations may not be practical or appropriate for all clinicians or community mental health teams. What are the Implications for Practice?: Remote consultation cannot be a 'one‐size‐fits‐all' model of community mental health care.A flexible approach is needed to offering remote consultation that considers its suitability for the service‐user, service and clinician. Introduction: Responding to COVID‐19, community mental health teams in the UK NHS abruptly adopted remote consultations. Whilst they have demonstrable effectiveness, efficiency, and economic benefits, questions remain around the acceptability, feasibility and medicolegal implications of delivering community mental health care remotely. Aim: To explore perceived advantages, challenges, and practice adaptations of delivering community mental health care remotely. Methods: Ten community mental health teams in an NHS trust participated in a service evaluation about remote consultation. Fifty team discussions about remote consultation were recorded April–December 2020. Data analysis used a framework approach with themes being coded within a matrix. Results: Three major horizontal themes of operations and team functioning, clinical pathways, and impact on staff were generated, with vertical themes of advantages, challenges, equity and adaptations. Discussion: Remote consultation is an attractive model of community mental healthcare. Clinical staff note benefits at individual (staff and service‐user), team, and service levels. However, it is not perceived as a universally beneficial or practical approach, and there are concerns relating to access equality. Implications for Practice: The suitability of remote consultation needs to be considered for each service‐user, clinical population and clinical role. This requires a flexible and hybrid approach, attuned to safeguarding equality. [ABSTRACT FROM AUTHOR]

The early medieval coin‐using economy is traditionally conceptualized as a masculine sphere with minimal female involvement. This article examines a corpus of 135 gold and pale gold coins of the later sixth and seventh centuries that underwent modification as coin‐pendants, a form of jewellery that belongs almost exclusively to feminine contexts. Analysis of this corpus reveals that these coins were valued as coins, with their attendant symbolic and economic significance, and that this transformation into jewellery did not irreversibly remove them from circulation, offering important evidence for female engagement in the seventh‐century coin‐based economy. [ABSTRACT FROM AUTHOR]

Childhood wellbeing is essential for positive outcomes in adulthood, as is academic attainment. Schools play a pivotal role in laying the foundations for children to live well. However, research investigating the relationship between wellbeing and attainment has relied on conceptualisations of wellbeing that are too broad (i.e. overall and domain-general wellbeing) or samples spanning large age ranges (thereby overlooking developmental differences). Additionally, the role of mindset, a potentially co-occurring psychological state of both wellbeing and attainment, has been neglected. This study therefore investigated the wellbeing-attainment relationship in 942 children aged 9–11 (447 male, M age = 10.5; 495 female, M age = 10.6) across 17 schools in England (UK). Structural equation models distinguished between overall wellbeing, life satisfaction, and eudaimonia, examining associations of each with children's attainment on standardised tests, accounting for mindsets, achievement goals, and sociodemographic factors. Results indicated lower life satisfaction was significantly associated with higher attainment on average, and in English and Mathematics, while eudaimonia was not significantly related to attainment. Overall wellbeing was negatively associated with Mathematics attainment only. A growth mindset was positively associated, while a fixed mindset was negatively associated, with wellbeing. In turn, a growth mindset was significantly positively associated, while a fixed mindset was negatively associated, with attainment. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to explore social isolation and loneliness in those who frequently contacted the ambulance service, what factors contributed to this and how unmet needs could be addressed. Methods: Semi‐structured interviews with staff from the ambulance service and service users who were identified as frequently contacting the ambulance service. Service users also completed the UCLA loneliness scale and personal community maps. Data were analysed thematically before triangulation with the UCLA loneliness scale and personal community maps. Results: The final analysis was drawn from 15 staff and seven service user participants. The relationship between social isolation and loneliness and contacting the ambulance service was a contributing, but not the driving, factor in contacting the ambulance service. For service users, we identified three key themes: (1) impact on activities of daily living and loneliness and/or isolation as a result of a health condition; (2) accessing appropriate health and social care services to meet needs; (3) the link between social isolation and/or loneliness and contact with the ambulance service. The analysis of staff data also highlighted three key themes: (1) social isolation and/or loneliness in their role; (2) access to other appropriate health and social care services; (3) the impact of austerity and Covid‐19 on social isolation and/or loneliness. Conclusions: Our research emphasises the complex nature of social isolation and loneliness, including the cyclic nature of poor health and social isolation and loneliness, and how this contributes to contact with the ambulance service. Patient or Public Contribution: The advisory group for the study was supported by a public and patient representative who contributed to the design of the study documentation, data analysis and authorship. [ABSTRACT FROM AUTHOR]

This piece reviews the evidence on the effect that engaging with nature has on school-age children's future attitudes and behaviour towards nature. It also looks into the impact engaging with nature has on children and young people's physical, mental and personal development and the evidence on how much time children in England are spending in natural environments. It then presents a UK Government project, the National Education Nature Park (NENP), intended to increase children in England's access to nature by developing nature spaces within the grounds of educational institutions. It concludes with suggestions for how the implementation of the NENP could be used to learn more about the effect that engaging with nature has on children alongside understanding how school-based nature projects could benefit the local environment. This article is part of the theme issue 'Bringing nature into decision-making'. [ABSTRACT FROM AUTHOR]

The core function of joint registries is to collect, collate, and present data about patients who undergo joint replacement surgery, and afford clinicians and administrators a range of analytic functions to monitor service performance. This article describes the development, evolution, and future of arthroplasty registries, drawing particularly from the experience of the Scottish Arthroplasty Project (SAP). The SAP was established in 1999 and is one of the oldest arthroplasty registries in the world. It collects information on patients undergoing hip, knee, ankle, shoulder, and elbow arthroplasty. The primary aim is to encourage continual improvement in the quality of care provided for arthroplasty patients in Scotland. It is distinct in terms of administration and methodology from the National Joint Registry (NJR) of England, Wales, and Northern Ireland as it monitors patients rather than implants. Since its inception, its work has contributed to a reduction in overall complication rates and a significant decrease in hospital length of stay for the growing number of patients undergoing arthroplasty. It continues to provide a robust database that is used to underpin national guidance through data-driven research. The research carried out by dedicated SAP fellows has enhanced the research portfolio of the SAP and raised its profile through high quality peer-reviewed publications. The SAP continues to evolve and by collaborating with other Scottish registries it will provide larger datasets containing greater diversity and granularity of information. These developments as well as ongoing analysis of existing areas ensure that the SAP continues to maintain and improve standards in arthroplasty across Scotland. [ABSTRACT FROM AUTHOR]

Complex and enduring mental health problems require greater treatment resources, usually in the form of multidisciplinary support, including providing psychological therapies. This paper reports on an NHS, tertiary-level specialist psychotherapy service offering Psychodynamic therapies with longer-term, exploratory transdiagnostic approaches to support complexity and sustained personality functioning. This paper adopts a naturalistic study design evaluating the effectiveness of Psychodynamic therapy using pre- and post-outcomes across a 10-year period. A total of n = 474 participants self-report pre- and post-outcome measures were used as the marker of effectiveness along with therapist assessments during intake and engagement. The findings showed that Psychodynamic therapy was effective in reducing psychological distress based on service-user self-report and therapist assessments. While intake scores varied by socio-demographic factors, the rate of change across most groups was similar. There were several limitations relating to data quality and completeness which reflect the naturalistic design. Despite the limits of a naturalistic design, this study provides evidence of support for the place of Psychodynamic therapies within NHS mental health care, catering to those with complex and enduring mental health problems. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to estimate the impact of introducing a draught alcohol‐free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England. Design: Randomised crossover field trial. Setting: England. Participants: Fourteen venues that did not previously sell draught alcohol‐free beer. Intervention and comparator: Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol‐free beer. Control periods operated business as usual. Measurements The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness. Findings The adjusted mean difference in weekly sales of draught alcoholic beer was −20 L [95% confidence interval (CI) = −41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol‐free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of −29 L per week (95% CI = −53 to −5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = −328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol‐free beer was available. Conclusions: Introducing a draught alcohol‐free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD)-related mortality has declined substantially in the United Kingdom (UK) in recent decades, but the continued relevance of conventional risk factors for prediction of CVD mortality throughout the life-course is uncertain. We compared the 10-year risks and lifetime risks of CVD mortality associated with conventional risk factors recorded in middle and old age. The Whitehall study was a prospective study of 19,019 male London civil servants (mean age 52 years) when enrolled in 1967–1970 and followed-up for 50 years for cause-specific mortality. In 1997, 7044 (83%) survivors (mean age 77 years) were re-surveyed. The 10-year and lifetime risks of CVD mortality were estimated by levels of CVD risk factors recorded in middle-age and old-age, respectively. By July 2020, 97% had died (22%, 51% and 80% before age 70, 80 and 90 years, respectively) and 7944 of 17,673 deaths (45%) were from CVD. The 10-year and lifetime risks of CVD death increased linearly with higher levels of CVD risk factors recorded in middle-age and in old-age. Individuals in the top versus bottom 5% of CVD risk scores in middle age had a 10.3% (95% CI:7.2–13.4) vs 0.6% (0.1–1.2) 10-year risk of CVD mortality, a 61.4% (59.4–65.3) vs 31.3% (24.1–34.5) lifetime risk of CVD mortality and a 12-year difference in life expectancy from age 50 years. The corresponding differences using a CVD risk score in old-age were 11.0% (4.4–17.5) vs 0.8% (0.0–2.2) for 10-year risk and 42.1% (28.2–50.0) vs 30.3% (6.0–38.0) for lifetime risk of CVD mortality and a 6-year difference in life expectancy from age 70 years. Conventional risk factors remained highly predictive of CVD mortality and life expectancy through the life-course. The findings highlight the relevance of estimation of both lifetime risks of CVD and 10-year risks of CVD for primary prevention of CVD. [ABSTRACT FROM AUTHOR]

Background: Identifying clusters of co-occurring diseases may help characterise distinct phenotypes of Multiple Long-Term Conditions (MLTC). Understanding the associations of disease clusters with health-related outcomes requires a strategy to assign clusters to people, but it is unclear how the performance of strategies compare. Aims: First, to compare the performance of methods of assigning disease clusters to people at explaining mortality, emergency department attendances and hospital admissions over one year. Second, to identify the extent of variation in the associations with each outcome between and within clusters. Methods: We conducted a cohort study of primary care electronic health records in England, including adults with MLTC. Seven strategies were tested to assign patients to fifteen disease clusters representing 212 LTCs, identified from our previous work. We tested the performance of each strategy at explaining associations with the three outcomes over 1 year using logistic regression and compared to a strategy using the individual LTCs. Results: 6,286,233 patients with MLTC were included. Of the seven strategies tested, a strategy assigning the count of conditions within each cluster performed best at explaining all three outcomes but was inferior to using information on the individual LTCs. There was a larger range of effect sizes for the individual LTCs within the same cluster than there was between the clusters. Conclusion: Strategies of assigning clusters of co-occurring diseases to people were less effective at explaining health-related outcomes than a person's individual diseases. Furthermore, clusters did not represent consistent relationships of the LTCs within them, which might limit their application in clinical research. [ABSTRACT FROM AUTHOR]

Background and Aim: Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. Methods: An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE‐ICP Collaboration. Findings: Twenty‐three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self‐doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. Conclusion: We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. Patient or Public Contribution: This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders. [ABSTRACT FROM AUTHOR]

Objectives: Despite significant investment in social prescribing in England over the last decade, we still do not know if it works, or how models of social prescribing fit within wider health and care policy and practice. This study explores current service delivery structures and assesses the feasibility of a national evaluation of the link worker model. Methods: Semi-structured interviews were conducted between May and September 2020, with 25 key informants from across social prescribing services in England. Participants included link workers, voluntary, community and social enterprise staff, and those involved in policy and decision-making for social prescribing services. Interview and workshop transcripts were analysed thematically, adopting a framework approach. Results: We found differences in how services are provided, including by individual link workers, and between organisations and regions. Standards, referral pathways, reporting, and monitoring structures differ or are lacking in voluntary services as compared to clinical services. People can self-refer to a link worker or be referred by a third party, but the lack of standardised processes generated confusion in both public and professional perceptions of the link worker model. We identified challenges in determining the appropriate outcomes and outcome measures needed to assess the impact of the link worker model. Conclusions: The current varied service delivery structures in England poses major challenges for a national impact evaluation. Any future rigorous evaluation needs to be underpinned with national standardised outcomes and process measures which promote uniform data collection. [ABSTRACT FROM AUTHOR]

Background: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people's homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness. Methods: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners' experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is 'successful rehabilitation' defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. Discussion: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services. Trial registration: ISRCTN17381762 retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: The Genomic Medicine Service (GMS) was launched in 2018 in England to create a step-change in the use of genomics in the NHS, including offering whole genome sequencing (WGS) as part of routine care. In this qualitative study on pediatric rare disease diagnosis, we used an implementation science framework to identify enablers and barriers which have influenced rollout. Methods: Semi-structured interviews were conducted with seven participants tasked with designing the GMS and 14 tasked with leading the implementation across the seven Genomic Medicine Service Alliances (GMSAs) and/or Genomic Laboratory Hubs (GLHs) between October 2021 and February 2022. Results: Overall, those involved in delivering the service strongly support its aims and ambitions. Challenges include: 1) concerns around the lack of trained and available workforce (clinicians and scientists) to seek consent from patients, interpret findings and communicate results; 2) the lack of a digital, coordinated infrastructure in place to support and standardize delivery with knock-on effects including onerous administrative aspects required to consent patients and order WGS tests; 3) that the “mainstreaming agenda”, whilst considered important, encountered reluctance to become engaged from those who did not see it as a priority or viewed it as being politically rather than clinically driven; 4) the timelines and targets set for the GMS were perceived by some as too ambitious. Interviewees discussed local adaptations and strategies employed to address the various challenges they had encountered, including 1) capacity-building, 2) employing genomic associates and other support staff to support the consent and test ordering process, 3) having “genomic champions” embedded in mainstream services to impart knowledge and best practice, 4) enhancing collaboration between genetic and mainstream specialties, 5) building evaluation into the service and 6) co-creating services with patients and the public. Conclusion: Our findings highlight the challenges of implementing system-wide change within a complex healthcare system. Local as well as national solutions can undoubtedly address many of these barriers over time. [ABSTRACT FROM AUTHOR]

Aims: To estimate the impact on selection and actual purchasing of (a) health warning labels (text‐only and image‐and‐text) on alcoholic drinks and (b) calorie labels on alcoholic and non‐alcoholic drinks. Design: Parallel‐groups randomised controlled trial. Setting: Drinks were selected in a simulated online supermarket, before being purchased in an actual online supermarket. Participants: Adults in England and Wales who regularly consumed and purchased beer or wine online (n = 651). Six hundred and eight participants completed the study and were included in the primary analysis. Interventions: Participants were randomized to one of six groups in a between‐subjects three [health warning labels (HWLs) (i): image‐and‐text HWL; (ii) text‐only HWL; (iii) no HWL] × 2 (calorie labels: present versus absent) factorial design (n per group 103–113). Measurements: The primary outcome measure was the number of alcohol units selected (with intention to purchase); secondary outcomes included alcohol units purchased and calories selected and purchased. There was no time limit for selection. For purchasing, participants were directed to purchase their drinks immediately (although they were allowed up to 2 weeks to do so). Findings There was no evidence of main effects for either (a) HWLs or (b) calorie labels on the number of alcohol units selected (HWLs: F(2,599) = 0.406, P = 0.666; calorie labels: F(1,599) = 0.002, P = 0.961). There was also no evidence of an interaction between HWLs and calorie labels, and no evidence of an overall difference on any secondary outcomes. In pre‐specified subgroup analyses comparing the 'calorie label only' group (n = 101) with the 'no label' group (n = 104) there was no evidence that calorie labels reduced the number of calories selected (unadjusted means: 1913 calories versus 2203, P = 0.643). Among the 75% of participants who went on to purchase drinks, those in the 'calorie label only' group (n = 74) purchased fewer calories than those in the 'no label' group (n = 79) (unadjusted means: 1532 versus 2090, P = 0.028). Conclusions: There was no evidence that health warning labels reduced the number of alcohol units selected or purchased in an online retail context. There was some evidence suggesting that calorie labels on alcoholic and non‐alcoholic drinks may reduce calories purchased from both types of drinks. [ABSTRACT FROM AUTHOR]

This paper reports original evidence about the experiences of 109 girls and women criminalised in England and Wales under the controversial legal doctrine of joint enterprise (JE). Over three-quarters of the women were convicted of murder or manslaughter. Yet, in no cases was evidence presented that the girl or woman used a deadly weapon. In 90% of the cases, the defendants engaged in no violence at all, and in nearly half of the cases, they were not present at the scene of the violent incident. In seeking to make sense of these findings, JE becomes a lens through which we can conceptualise gendered processes of criminalisation. Decisions to charge women that reflect strategic approaches to policing and prosecuting some forms of violence and harm, alongside prosecution and defence strategies used in the courtroom that reproduce patriarchy, class stigma and racism, will be explored. Simultaneously, the criminalising processes actively obscure and silence the wider context and personal histories of the lives of girls and women, which once surfaced, expose wider tensions in addressing all harms to deliver justice for women. [ABSTRACT FROM AUTHOR]

Gay, bisexual, and other men who have sex with men (GBMSM) experience a high prevalence of psychosocial health problems, such as harmful substance use and depression, as well as being disproportionately affected by HIV. HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users' wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP's psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines. [ABSTRACT FROM AUTHOR]

Progression to higher education in England varies markedly by region, with lower rates of participation outside of London. While some previous studies have explored challenges in accessing higher education in rural and coastal areas, there is a lack of research which considers both individual-level and geographic effects in relation to regional variations in HE progression. In this study, using multivariate regression analysis, we examine whether regional differences in transition to higher education can be explained by the rural/coastal nature of the geographic area in which young people grow up, by area-level deprivation, or by the characteristics of young people living within these regions. The analysis uses the Longitudinal Study of Young People in England, a representative cohort study. These data have been linked to information on the proximity to the coast. Consistent with other work, we find that individual differences and area-level deprivation predict HE aspirations and progression. The newly introduced coastal/rural indicator also predicts HE aspirations and progression, but this is mitigated by the inclusion of individual differences and area-level deprivation. However, we find that unexplained regional differences persist. In particular, the South West of England emerges as a regional cold spot for HE. Consequently, policy makers should consider the role that regional dynamics may have in influencing the choices and constraints faced by young people. The approach may also be applicable to understanding inequalities in progression to HE in other countries. [ABSTRACT FROM AUTHOR]

Objective: To report the 5‐year failure‐free survival (FFS) following high‐intensity focused ultrasound (HIFU). Patients and Methods: This observational cohort study used linked National Cancer Registry data, radiotherapy data, administrative hospital data and mortality records of 1381 men treated with HIFU for clinically localised prostate cancer in England. The primary outcome, FFS, was defined as freedom from local salvage treatment and cancer‐specific mortality. Secondary outcomes were freedom from repeat HIFU, prostate cancer‐specific survival (CSS) and overall survival (OS). Cox regression was used to determine whether baseline characteristics, including age, treatment year, T stage and International Society of Urological Pathology (ISUP) Grade Group were associated with FFS. Results: The median (interquartile range [IQR]) follow‐up was 37 (20–62) months. The median (IQR) age was 65 (59–70) years and 81% had an ISUP Grade Group of 1–2. The FFS was 96.5% (95% confidence interval [CI] 95.4%–97.4%) at 1 year, 86.0% (95% CI 83.7%–87.9%) at 3 years and 77.5% (95% CI 74.4%–80.3%) at 5 years. The 5‐year FFS for ISUP Grade Groups 1–5 was 82.9%, 76.6%, 72.2%, 52.3% and 30.8%, respectively (P < 0.001). Freedom from repeat HIFU was 79.1% (95% CI 75.7%–82.1%), CSS was 98.8% (95% CI 97.7%–99.4%) and OS was 95.9% (95% CI 94.2%–97.1%) at 5 years. Conclusion: Four in five men were free from local salvage treatment at 5 years but treatment failure varied significantly according to ISUP Grade Group. Patients should be appropriately informed with respect to salvage radical treatment following HIFU. [ABSTRACT FROM AUTHOR]

The quality of romantic relationships is associated with mental health and wellbeing throughout the life course. A number of programmes have been developed to support young people in navigating healthy relationships, and a larger role for relationship education was recently formalised in statutory guidance in England. This study aimed to systematically review the evidence base for relationship education programmes. Evaluations of relationship education programmes for young people, including charting of outcome domains and measures, were reviewed, followed by a focussed synthesis of data from studies that included outcome domains of relevance to healthy relationships. Thirty-six studies of seven programmes were found that focussed on one or more outcomes relating to healthy relationship skills, knowledge and attitudes, none of which were assessed as high quality. All evaluated programmes were developed in the US, and only one evaluation was conducted in the UK. The evaluations had a diverse set of outcome domains and outcome measures, few had longitudinal measures. No evidence was found for young people's involvement in programme or evaluation development. High-quality longitudinal evaluations and a core set of validated outcome measures are needed. This research also highlights the need to co-create programmes with young people, teachers and relationship experts that are feasible, acceptable and integrated into a mental health-informed curriculum [ABSTRACT FROM AUTHOR]

Background: Mental health acute crisis episodes are associated with high inpatient costs. Self-management interventions may reduce readmission by enabling individuals to manage their condition. Delivery of such interventions by Peer Support Workers (PSWs) may be cost-effective. CORE, a randomized control trial of a PSW self-management intervention compared to usual care, found a significant reduction in admissions to acute mental healthcare for participants receiving the intervention. This paper aims to evaluate the cost-effectiveness of the intervention over 12 months from a mental health service perspective. Analysis methods of increasing complexity were used to account for data missingness and distribution. Methods: Participants were recruited from six crisis resolution teams in England from 12 March 2014 to 3 July 2015 (trial registration ISRCTN: 01027104). Resource use was collected from patient records at baseline and 12 months. The EQ-5D-3L was collected at baseline and 4 and 18 months, and linear interpolation was used to calculate 12-month values for quality-adjusted life-years (QALYs). The primary analysis of adjusted mean incremental costs and QALYs for complete cases are calculated separately using OLS regression. Secondly, a complete-case non-parametric two-stage bootstrap (TSB) was performed. The impacts of missing data and skewed cost data were explored using multiple imputation using chained equations and general linear models, respectively. Results: Four hundred and forty-one participants were recruited to CORE; 221 randomized to the PSW intervention and 220 to usual care plus workbook. The probability that the PSW intervention was cost-effective compared with the workbook plus usual care control at 12 months varied with the method used, and ranged from 57% to 96% at a cost-effectiveness threshold of £20,000 per QALY gained. Discussion: There was a minimum 57% chance that the intervention was cost-effective compared to the control using 12-month costs and QALYs. The probability varied by 40% when methods were employed to account for the relationship between costs and QALYs, but which restricted the sample to those who provided both complete cost and utility data. Caution should therefore be applied when selecting methods for the evaluation of healthcare interventions that aim to increase precision but may introduce bias if missing data are heavily unbalanced between costs and outcomes. [ABSTRACT FROM AUTHOR]

Background: Women considering immediate breast reconstruction require high-quality information about the likely need for secondary reconstruction and the long-term risk of revisional surgery to make fully informed decisions about different reconstructive options. Such data are currently lacking. This study aimed to explore the impact of reconstruction type on the number of revisions and secondary reconstructions performed 3, 5, and 8 years after immediate breast reconstruction in a large population-based cohort. Methods: Women undergoing unilateral mastectomy and immediate breast reconstruction for breast cancer or ductal carcinoma in situ in England between 1 April 2009 and 31 March 2015 were identified from National Health Service Hospital Episode Statistics. Numbers of revisions and secondary reconstructions in women undergoing primary definitive immediate breast reconstruction were compared by procedure type at 3, 5, and 8 years after index surgery. Results: Some 16 897 women underwent immediate breast reconstruction with at least 3 years' follow-up. Of these, 14 069 had a definitive reconstruction with an implant only (5193), latissimus dorsi flap with (3110) or without (2373) an implant, or abdominal free flap (3393). Women undergoing implant-only reconstruction were more likely to require revision, with 69.5 per cent (747 of 1075) undergoing at least one revision by 8 years compared with 49.3 per cent (1568 of 3180) in other reconstruction groups. They were also more likely to undergo secondary reconstruction, with the proportion of women having further reconstructive procedures increasing over time: 12.8 per cent (663 of 5193) at 3 years, 14.3 per cent (535 of 3752) at 5 years, and 17.6 per cent (189 of 1075) at 8 years. Conclusion: Long-term rates of revisions and secondary reconstructions were considerably higher after primary implant-based reconstruction than autologous procedures. These results should be shared with patients to support informed decision-making. [ABSTRACT FROM AUTHOR]

Background: Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. Aims: To assess changes to service use following a service user's first visit to a unit, characterise the population accessing these units and examine equality of access to the units. Methods: A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. Results: The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5–13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%–82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. Conclusions: Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge. [ABSTRACT FROM AUTHOR]

Background: Reducing portion sizes of commercially available foods could be an effective public health strategy to reduce population energy intake, but recent research suggests that the effect portion size has on energy intake may differ based on socioeconomic position (SEP). Objective: We tested whether the effect of reducing food portion sizes on daily energy intake differed based on SEP. Methods: Participants were served either smaller or larger portions of food at lunch and evening meals (N = 50; Study 1) and breakfast, lunch and evening meals (N = 46; Study 2) in the laboratory on two separate days, in repeated-measures designs. The primary outcome was total daily energy intake (kcal). Participant recruitment was stratified by primary indicators of SEP; highest educational qualification (Study 1) and subjective social status (Study 2), and randomisation to the order portion sizes were served was stratified by SEP. Secondary indicators of SEP in both studies included household income, self-reported childhood financial hardship and a measure accounting for total years in education. Results: In both studies, smaller (vs larger) meal portions led to a reduction in daily energy intake (ps <.02). Smaller portions resulted in a reduction of 235 kcal per day (95% CI: 134, 336) in Study 1 and 143 kcal per day (95% CI: 24, 263) in Study 2. There was no evidence in either study that effects of portion size on energy intake differed by SEP. Results were consistent when examining effects on portion-manipulated meal (as opposed to daily) energy intake. Conclusions: Reducing meal portion sizes could be an effective way to reduce overall daily energy intake and contrary to other suggestions it may be a socioeconomically equitable approach to improving diet. Trial registration: These trials were registered at www.clinicaltrials.gov as NCT05173376 and NCT05399836. [ABSTRACT FROM AUTHOR]

Background: Social distancing restrictions to manage the COVID-19 pandemic were put in place from March 2020 in the United Kingdom (UK), with those classed as "highly clinically vulnerable" advised to shield entirely and remain at home. However, personal risk perception has been shown to comprise of various elements beyond those outlined in the national pandemic guidance. It is unclear whether those deemed COVID-19 vulnerable identified as high-risk to COVID-19 and thus complied with the relevant advice. The aim of this research is to explore the perception of risk in catching and spreading COVID-19, amongst individuals from individual households, and vulnerable groups in a region of the UK. Methods: Two individual, semi-structured interviews were conducted, four-weeks apart, with adults living in households in the Liverpool City Region. At the follow-up interview, participants were given the option of using photo-elicitation to guide the discussion. Reflexive thematic analysis was employed to conceptualise themes. The qualitative analysis was underpinned with symbolic interactionism. Results: Twenty-seven participants (13:14 males:females, and 20 with a vulnerable risk factor to COVID-19) completed a baseline interview, and 15 of these completed a follow-up interview four-weeks later. Following thematic analysis, two overarching themes were conceptualised, with subthemes discussed: theme 1) Confusion and trust in the risk prevention guidance; and theme 2) Navigating risk: compliance and non-compliance with public health guidance. Conclusion: Participants developed their own understanding of COVID-19 risk perception through personal experience and comparison with others around them, irrespective of vulnerability status. COVID-19 guidance was not complied with as intended by the government, and at times even rejected due to lack of trust. The format in which future pandemic guidance is conveyed must be carefully considered, and take into account individuals' experiences that may lead to non-compliance. The findings from our study can inform future public health policy and interventions for COVID-19 and future pandemics. [ABSTRACT FROM AUTHOR]

Objective: To compare the original synthetic control (OSC) method with alternative approaches (Generalized [GSC], Micro [MSC], and Bayesian [BSC] synthetic control methods) and re‐evaluate the impact of a significant restructuring of urgent and emergency care in Northeast England, which included the opening of the UK's first purpose‐built specialist emergency care hospital. Data Sources: Simulations and data from Secondary Uses Service data, a single comprehensive repository for patient‐level health care data in England. Study Design: Hospital use of individuals exposed and unexposed to the restructuring is compared. We estimate the impact using OSC, MSC, BSC, and GSC applied at the general practice level. We contrast the estimation methods' performance in a Monte Carlo simulation study. Data Collection/Extraction Methods: Hospital activity data from Secondary Uses Service for patients aged over 18 years registered at a general practice in England from April 2011 to March 2019. Principal Findings: None of the methods dominated all simulation scenarios. GSC was generally preferred. In contrast to an earlier evaluation that used OSC, GSC reported a smaller impact of the opening of the hospital on Accident and Emergency (A&E) department (also known as emergency department or casualty) visits and no evidence for any impact on the proportion of A&E patients seen within 4 h. Conclusions: The simulation study highlights cases where the considered methods may lead to biased estimates in health policy evaluations. GSC was found to be the most reliable method of those considered. Considering more disaggregated data over a longer time span and applying GSC indicates that the specialist emergency care hospitals in Northumbria had less impact on A&E visits and waiting times than suggested by the original evaluation which applied OSC to more aggregated data. [ABSTRACT FROM AUTHOR]

Objective: To explore the views of female genital mutilation (FGM) survivors, men and healthcare professionals (HCPs) on the timing of deinfibulation surgery and NHS service provision. Design: Qualitative study informed by the sound of silence framework. Setting: Survivors and men were recruited from three FGM prevalent areas of England. HCPs and stakeholders were from across the UK. Sample Forty‐four survivors, 13 men and 44 HCPs. Ten participants at two community workshops and 30 stakeholders at a national workshop. Methods: Hybrid framework analysis of 101 interviews and three workshops. Results: There was no consensus across groups on the optimal timing of deinfibulation for survivors who wished to be deinfibulated. Within group, survivors expressed a preference for deinfibulation pre‐pregnancy and HCPs antenatal deinfibulation. There was no consensus for men. Participants reported that deinfibulation should take place in a hospital setting and be undertaken by a suitable HCP. Decision making around deinfibulation was complex but for those who underwent surgery it helped to mitigate FGM impacts. Although there were examples of good practice, in general, FGM service provision was suboptimal. Conclusion: Deinfibulation services need to be widely advertised. Information should highlight that the procedure can be carried out at different time points, according to preference, and in a hospital by suitable HCPs. Future services should ideally be developed with survivors, to ensure that they are clinically and culturally appropriate. Guidelines would benefit from being updated to reflect the needs of survivors and to ensure consistency in provision. [ABSTRACT FROM AUTHOR]

Research exploring the educational relevance of wellbeing only tentatively confronts the 'tension' of expecting educators to nurture pupils' wellbeing while school effectiveness is evaluated by metrics of academic performance. Complete wellbeing includes hedonia (feeling) and eudaimonia (doing) well. Accordingly, school 'happiness agendas' overlook the latter, despite psychologists suggesting eudaimonia ('welldoing') is foundational for wellbeing, particularly in adolescence. Rooted in Aristotlean ideas of 'living and doing well', philosophers underline eudaimonia's educational significance. However, high‐stakes testing undermines eudaimonia, with England's performativity culture representing a barrier. Recently scholars have called for 'stronger evidence' documenting links between adolescent mental illness and academic pressures. The present study therefore explored 18 adolescents' (14–15 years' old) lived experiences of wellbeing in one English state school. Although existing studies document adolescents' conceptualisations of 'wellbeing', adolescents' lived experiences, particularly of eudaimonia and specifically in school, are comparatively absent. Interviews adopting a phenomenological approach therefore investigated (1) how adolescents experience wellbeing, and (2) what 'doing well' at school means to adolescents. Adolescents' welldoing experiences did not resemble eudaimonia, which involves individuals connecting with personal purpose through cultivation of their unique abilities. Instead, welldoing at school was instrumentalised as obtaining good grades. Although hedonia was reflected in adolescents' experiences, hedonia was intrinsically connected to welldoing, with mental health attributed to achieving 'good' or 'bad' grades, respectively. Recommendations include the need for wholescale integration of wellbeing into education in England, which requires (1) overhauling educational aims to focus on supporting individual flourishing as opposed to academic standards, and (2) de‐emphasising harmful performativity culture. [ABSTRACT FROM AUTHOR]

Background: Increasing the availability of non-alcoholic options is a promising population-level intervention to reduce alcohol consumption, currently unassessed in naturalistic settings. This study in an online retail context aimed to estimate the impact of increasing the proportion of non-alcoholic (relative to alcoholic) drinks, on selection and purchasing of alcohol. Methods and results: Adults (n = 737) residing in England and Wales who regularly purchased alcohol online were recruited between March and July 2021. Participants were randomly assigned to one of 3 groups: "25% non-alcoholic/75% alcoholic"; "50% non-alcoholic/50% alcoholic"; and "75% non-alcoholic/25% alcoholic," then selected drinks in a simulated online supermarket, before purchasing them in an actual online supermarket. The primary outcome was the number of alcohol units selected (with intention to purchase); secondary outcomes included actual purchasing. A total of 607 participants (60% female, mean age = 38 years [range: 18 to 76]) completed the study and were included in the primary analysis. In the first part of a hurdle model, a greater proportion of participants in the "75% non-alcoholic" group did not select any alcohol (13.1%) compared to the "25% non-alcoholic" group (3.4%; 95% confidence interval [CI] −2.09, −0.63; p < 0.001). There was no evidence of a difference between the "75% non-alcoholic" and the "50% non-alcoholic" (7.2%) groups (95% CI 0.10, 1.34; p = 0.022) or between the "50% non-alcoholic" and the "25% non-alcoholic" groups (95% CI −1.44, 0.17; p = 0.121). In the second part of a hurdle model in participants (559/607) selecting any drinks containing alcohol, the "75% non-alcoholic" group selected fewer alcohol units compared to the "50% non-alcoholic" (95% CI −0.44, −0.14; p < 0.001) and "25% non-alcoholic" (95% CI −0.54, −0.24; p < 0.001) groups, with no evidence of a difference between the "50% non-alcoholic" and "25% non-alcoholic" groups (95% CI −0.24, 0.05; p = 0.178). Overall, across all participants, 17.46 units (95% CI 15.24, 19.68) were selected in the "75% non-alcoholic" group; 25.51 units (95% CI 22.60, 28.43) in the "50% non-alcoholic" group; and 29.40 units (95% CI 26.39, 32.42) in the "25% non-alcoholic" group. This corresponds to 8.1 fewer units (a 32% reduction) in the "75% non-alcoholic" compared to the "50% non-alcoholic" group, and 11.9 fewer alcohol units (41% reduction) compared to the "25% non-alcoholic" group; 3.9 fewer units (13% reduction) were selected in the "50% non-alcoholic" group than in the "25% non-alcoholic" group. For all other outcomes, alcohol selection and purchasing were consistently lowest in the "75% non-alcoholic" group. Study limitations include the setting not being entirely naturalistic due to using a simulated online supermarket as well as an actual online supermarket, and that there was substantial dropout between selection and purchasing. Conclusions: This study provides evidence that substantially increasing the proportion of non-alcoholic drinks—from 25% to 50% or 75%—meaningfully reduces alcohol selection and purchasing. Further studies are warranted to assess whether these effects are realised in a range of real-world settings. Trial registration: ISRCTN: 11004483; OSF: https://osf.io/qfupw. In a randomised controlled trial, Natasha Clarke and colleagues explore the impact of changing the proportion of available non-alcoholic versus alcoholic drinks on alcohol selection and online purchasing. Author summary: Why was this study done?: Excessive alcohol consumption contributes to the global burden of non-communicable diseases, including cancer, heart disease, and stroke. Interventions that change physical and economic environments have the potential to reduce alcohol consumption. Interventions targeting physical environments include availability interventions that involve changing the proportion of healthier options that are available, relative to less healthy options. A previous online study found that increasing the availability of non-alcoholic compared to alcoholic drinks reduced the hypothetical selection of alcoholic drinks, but there is an absence of evidence from naturalistic settings. What did the researchers do and find?: This study evaluated the impact of increasing the proportion of non-alcoholic (relative to alcoholic) drinks, on selection and actual purchasing of alcohol. In a randomised controlled trial, 737 participants were randomly assigned to one of 3 groups with varying proportions of alcoholic versus non-alcoholic drinks ("25% non-alcoholic/75% alcoholic"; "50% non-alcoholic/50% alcoholic"; and "75% non-alcoholic/25% alcoholic"). Participants selected drinks from 64 options in a simulated online supermarket that was designed to look and function similarly to an online supermarket. Participants were then required to immediately purchase the same drinks in an actual online supermarket. It was found that increasing the proportion of non-alcoholic drinks—from 25% to 50% or 75%—reduced the amount of alcohol selected and bought, in this online supermarket setting. What do these findings mean?: This study provides evidence that increasing the proportion of non-alcoholic drinks could reduce alcohol selection and purchasing, highlighting the potential for availability interventions to reduce alcohol sales at the population level. Further studies are warranted to assess whether these effects are realised in a range of real-world settings. [ABSTRACT FROM AUTHOR]

Background: Many children and adolescents with Type 1 Diabetes Mellitus (T1DM) don't meet the recommended levels of physical activity. Healthcare professionals (HCPs) have a key role in supporting and encouraging children and adolescents with T1DM to be physically active. This study aims to understand the perspectives of HCPs in relation to supporting physical activity and implementing guidelines relating to physical activity. Methods: An online mixed methods survey was circulated to HCPs in pediatric diabetes units in England and Wales. Participants were asked about how they support physical activity in their clinic and their perceptions of barriers/enablers of providing physical activity support to children and adolescents with T1DM. Quantitative data were analysed descriptively. An deductive thematic approach was applied to the free text responses using the Capability Opportunity Motivation model of Behaviour (COM-B) as a framework. Results: Responses were received from 114 individuals at 77 different pediatric diabetes units (45% of pediatric diabetes units in England and Wales). HCPs surveyed felt that the promotion of physical activity is important (90%) and advised patients to increase levels of physical activity (88%). 19% of the respondents felt they did not have sufficient knowledge to provide support. HCPs reported limited knowledge and confidence, time and resources as barriers to providing support. They also felt the current guidance was too complicated with few practical solutions. Conclusion: Pediatric HCPs need training and support to be able to encourage and support children and adolescents with T1D to be a physical activity. In addition, resources that provide simple and practical advice to manage glucose around exercise are needed. [ABSTRACT FROM AUTHOR]

Background: Primary Care Networks (PCNs) were established in England in 2019 and will play a key role in providing care at a neighbourhood level within integrated care systems (ICSs). Aim: To identify PCN 'catchment' areas and compare the overlap between registered and resident populations of PCNs. Design & setting: Observational study using publicly available data on the number of people within each Lower layer Super Output Area (LSOA) registered to each general practice in England in April 2021. Method: LSOAs were assigned to the PCN to which the majority of residents were registered. The PCN catchment population was defined as the total number of people resident in all LSOAs assigned to that PCN. The PCN catchment populations were compared with the population of people registered to a GP practice in each PCN. Results: In April 2021, 6506 GP practices were part of 1251 PCNs, with 56.1% of PCNs having 30 000-50 000 registered patients. There was a strong correlation (0.91) between the total registered population size and catchment population size. Significant variation was found in the percentage of residents in each LSOA registered to a GP practice within the same PCN catchment, and strong associations were found with both urban and rural status, and socioeconomic deprivation. Conclusion: There exists significant variation across England in the overlap between registered and resident (catchment) populations in PCNs, which may impact on integration of care in some areas. There was less overlap in urban and more deprived areas, which could exacerbate existing health inequalities. [ABSTRACT FROM AUTHOR]

Background: The reconfiguration of specialist hospital services, with service provision concentrated in a reduced number of sites, is one example of major system change (MSC) for which there is evidence of improved patient outcomes. This paper explores the reconfiguration of specialist oesophago-gastric (OG) cancer surgery services in a large urban area of England (Greater Manchester, GM), with a focus on the role of history in this change process and how reconfiguration was achieved after previous failed attempts. Methods: This study draws on qualitative research from a mixed-methods evaluation of the reconfiguration of specialist cancer surgery services in GM. Forty-six interviews with relevant stakeholders were carried out, along with ~160 hours of observations at meetings and the acquisition of ~300 pertinent documents. Thematic analysis using deductive and inductive approaches was undertaken, guided by a framework of 'simple rules' for MSC. Results: Through an awareness of, and attention to, history, leaders developed a change process which took into account previous unsuccessful reconfiguration attempts, enabling them to reduce the impact of potentially challenging issues. Interviewees described attending to issues involving competition between provider sites, change leadership, engagement with stakeholders, and the need for a process of change resilient to challenge. Conclusion: Recognition of, and response to, history, using a range of perspectives, enabled this reconfiguration. Particularly important was the way in which history influenced and informed other aspects of the change process and the influence of stakeholder power. This study provides further learning about MSC and the need for a range of perspectives to enable understanding. It shows how learning from history can be used to enable successful change. [ABSTRACT FROM AUTHOR]

This retrospective pilot study conducted on a community-based cohort of both men and women of various ages and underlying clinical presentations examined the durability and reproducibility of HR-ARM findings influencing their potential impact on clinical decision-making at the point of care (Jameson et al. in Br J Surg 81:1689-1692, 1994). The key finding of our study was that only a minority of patients who underwent repeat anorectal manometry as analyzed by the London Classification had stable manometric findings, raising questions regarding the validity of a single manometric measurement, as currently analyzed, for clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: During COVID‐19 restrictions in England in spring 2020, early years settings for young children were closed to all but a small percentage of families, social contact was limited and play areas in parks were closed. Concerns were raised about the impact of these restrictions on young children's emotional well‐being. The aim of this study was to explore parents' perceptions of young children's emotional well‐being during these COVID‐19 restrictions. Methods: We interviewed 20 parents of children 3–4 years due to begin school in England in September 2020. Interviews were conducted via telephone (n = 18) and video call (n = 2), audio‐recorded and transcribed verbatim. Interviews focused on childcare arrangements, children's behaviour and transition to school. A sample of transcripts were coded line by line to create a coding framework, which was subsequently applied to the remaining transcripts. Coded data were then analysed using a nurture lens to develop themes and further understanding. Results: Participants were predominantly mothers (n = 16), White British (n = 10) and educated to degree level (n = 13), with half the sample living in the highest deprivation quintile in England (n = 10). Five were single parents. Three themes developed from nurturing principles were identified: creating age‐appropriate explanations, understanding children's behaviour and concerns about school transition. Parents reported that their children's emotional well‐being was impacted and described attempts to support their young children while looking ahead to their transition to primary school. Conclusions: This study is one of the first to examine in‐depth perceptions of COVID‐19 restrictions on young children's emotional well‐being. The longer term impacts are not yet understood. Although young children may be unable to understand in detail what the virus is, they undoubtedly experience the disruption it brings to their lives. The well‐being of families and children needs to be nurtured as they recover from the effects of the pandemic to allow them to thrive. [ABSTRACT FROM AUTHOR]

Care home residents with stroke have higher levels of disability and poorer access to health services than those living in their own homes. We undertook observations and semi‐structured interviews (n = 28 participants) with managers, staff, residents who had experienced a stroke and their relatives in four homes in London, England, in 2018/2019. Thematic analysis revealed that residents' needs regarding valued activity and stroke‐specific care and rehabilitation were not always being met. This resulted from an interplay of factors: staff's lack of recognition of stroke and its effects; gaps in skills; time pressures; and the prioritisation of residents' safety. To improve residential care provision and residents' quality of life, care commissioners, regulators and providers may need to re‐examine how care homes balance safety and limits on staff time against residents' valued activity, alongside improving access to specialist healthcare treatment and support. [ABSTRACT FROM AUTHOR]

Background: The implementation of change in health and care services is often complicated by organisational micropolitics. There are calls for those leading change to develop and utilise political skills and behaviours to understand and mediate such politics, but to date only limited research offers a developed empirical conceptualisation of the political skills and behaviours for leading health services change. Methods: A qualitative interview study was undertaken with 66 healthcare leaders from the English National Health Service (NHS). Participants were sampled on the basis of their variable involvement in leading change processes, taking into account anticipated differences in career stage, leadership level and role, care sector, and professional backgrounds. Interpretative data analysis led to the development of five themes. Results: Participants' accounts highlighted five overarching sets of political skills and behaviours: personal and interpersonal qualities relating to self-belief, resilience and the ability to adapt to different audiences; strategic thinking relating to the ability to understand the wider and local political landscape from which to develop realistic plans for change; communication skills for engaging and influencing stakeholders, especially for understanding and mediating stakeholders' competing interests; networks and networking in terms of access to resources, and building connections between stakeholders; and relational tactics for dealing with difficult individuals through more direct forms of negotiation and persuasion. Conclusion: The study offers further empirical insight the existing literature on healthcare organisational politics by describing and conceptualising the political skills and behaviours of implementing health services change. [ABSTRACT FROM AUTHOR]

Simple Summary: NHS-Galleri is a randomised controlled trial that will assess how well a blood test can reduce the number of late-stage cancers by helping to find cancers early. The test looks at patterns in blood samples to detect a cancer signal. NHS-Galleri has enrolled over 140,000 people, invited from the general population of England aged 50–77 years who did not have or were not being investigated for cancer. Blood is being collected up to three times: first when people join the study and again 12 and 24 months later. Half the participants (chosen at random) will have their blood tested and half will have their blood stored. Participants will not be told whether their blood will be tested or stored. Participants with a cancer signal detected result will be sent for further diagnostic testing in the NHS. The trial will help the NHS decide whether to introduce screening using this test. We report the design of the NHS-Galleri trial (ISRCTN91431511), aiming to establish whether a multi-cancer early detection (MCED) test that screens asymptomatic individuals for cancer can reduce late-stage cancer incidence. This randomised controlled trial has invited approximately 1.5 million persons and enrolled over 140,000 from the general population of England (50–77 years; ≥3 years without cancer diagnosis or treatment; not undergoing investigation for suspected cancer). Blood is being collected at up to three annual visits. Following baseline blood collection, participants are randomised 1:1 to the intervention (blood tested by MCED test) or control (blood stored) arm. Only participants in the intervention arm with a cancer signal detected have results returned and are referred for urgent investigations and potential treatment. Remaining participants in both arms stay blinded and return for their next visit. Participants are encouraged to continue other NHS cancer screening programmes and seek help for new or unusual symptoms. The primary objective is to demonstrate a statistically significant reduction in the incidence rate of stage III and IV cancers diagnosed in the intervention versus control arm 3–4 years after randomisation. NHS-Galleri will help determine the clinical utility of population screening with an MCED test. [ABSTRACT FROM AUTHOR]

Objective: Major system change can be stressful for staff involved and can result in 'subtractive change' – that is, when a part of the work environment is removed or ceases to exist. Little is known about the response to loss of activity resulting from such changes. Our aim was to understand perceptions of loss in response to centralization of cancer services in England, where 12 sites offering specialist surgery were reduced to four, and to understand the impact of leadership and management on enabling or hampering coping strategies associated with that loss. Methods: We analysed 115 interviews with clinical, nursing and managerial staff from oesophago-gastric, prostate/bladder and renal cancer services in London and West Essex. In addition, we used 134 hours of observational data and analysis from over 100 documents to contextualize and to interpret the interview data. We performed a thematic analysis drawing on stress-coping theory and organizational change. Results: Staff perceived that, during centralization, sites were devalued as the sites lost surgical activity, skills and experienced teams. Staff members believed that there were long-term implications for this loss, such as in retaining high-calibre staff, attracting trainees and maintaining autonomy. Emotional repercussions for staff included perceived loss of status and motivation. To mitigate these losses, leaders in the centralization process put in place some instrumental measures, such as joint contracting, surgical skill development opportunities and trainee rotation. However, these measures were undermined by patchy implementation and negative impacts on some individuals (e.g. increased workload or travel time). Relatively little emotional support was perceived to be offered. Leaders sometimes characterized adverse emotional reactions to the centralization as resistance, to be overcome through persuasion and appeals to the success of the new system. Conclusions: Large-scale reorganizations are likely to provoke a high degree of emotion and perceptions of loss. Resources to foster coping and resilience should be made available to all organizations within the system as they go through major change. [ABSTRACT FROM AUTHOR]

Sedentary behaviour (SB) is associated with negative health outcomes and is prevalent post-stroke. This study explored SB after stroke from the perspective of stroke service staff. Qualitative mixed-methods study. Non-participant observations in two stroke services (England/Scotland) and semi-structured interviews with staff underpinned by the COM-B model of behaviour change. Observations were analysed thematically; interviews were analysed using the Framework approach. One hundred and thirty-two observation hours (October - December 2017), and 31 staff interviewed (January –June 2018). Four themes were identified: (1) Opportunities for staff to support stroke survivors to reduce SB; (2) Physical and psychological capability of staff to support stroke survivors to reduce SB; (3) Motivating factors influencing staff behaviour to support stroke survivors to reduce SB; (4) Staff suggestions for a future intervention to support stroke survivors to reduce SB. Staff are aware of the consequences of prolonged sitting but did not relate to SB. Explicit knowledge of SB was limited. Staff need training to support stroke survivors to reduce SB. Sedentary behaviour in the community was not reported to change markedly, highlighting the need to engage stroke survivors in movement from when capable in hospital, following through to home. Stroke survivor sedentary behaviour is influenced, directly and indirectly, by the actions and instructions of stroke service staff in the inpatient and community setting. The built and social environment, both in the inpatient and community settings, may limit opportunities for safe movement and can result in stroke survivors spending more time sedentary. Stroke service staff appreciate the benefit of encouraging stroke survivors to stand and move more, if it is safe for them to do so. Staff would be amenable to encourage stroke survivors to reduce sedentary behaviour, provided they have the knowledge and resources to equip them to support this. [ABSTRACT FROM AUTHOR]

PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of the COVID‐19 pandemic on diagnostic and treatment activity in 2020 across hospital providers of prostate cancer (PCa) care in the English National Health Service. Methods: Diagnostic and treatment activity between 23 March (start of first national lockdown in England) and 31 December 2020 was compared with the same calendar period in 2019. Patients newly diagnosed with PCa were identified from national rapid cancer registration data linked to other electronic healthcare datasets. Results: There was a 30.8% reduction (22 419 vs 32 409) in the number of men with newly diagnosed PCa in 2020 after the start of the first lockdown, compared with the corresponding period in 2019. Men diagnosed in 2020 were typically at a more advanced stage (Stage IV: 21.2% vs 17.4%) and slightly older (57.9% vs 55.9% ≥ 70 years; P < 0.001). Prostate biopsies in 2020 were more often performed using transperineal (TP) routes (64.0% vs 38.2%). The number of radical prostatectomies in 2020 was reduced by 26.9% (3896 vs 5331) and the number treated by external beam radiotherapy (EBRT) by 14.1% (9719 vs 11 309). Other changes included an increased use of EBRT with hypofractionation and reduced use of docetaxel chemotherapy in men with hormone‐sensitive metastatic PCa (413 vs 1519) with related increase in the use of enzalutamide. Conclusion: We found substantial deficits in the number of diagnostic and treatment procedures for men with newly diagnosed PCa after the start of the first lockdown in 2020. The number of men diagnosed with PCa decreased by about one‐third and those diagnosed had more advanced disease. Treatment patterns shifted towards those that limit the risk of COVID‐19 exposure including increased use of TP biopsy, hypofractionated radiation, and enzalutamide. Urgent concerted action is required to address the COVID‐19‐related deficits in PCa services to mitigate their impact on long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background and aim: Despite the significant mental health challenges the COVID-19 pandemic and its associated government measures have presented, research has shown that the majority of people have adapted and coped well. The aim of this study was i) to determine the proportion of people with mental stability and volatility during the pandemic in a North West England city region sample and ii) to establish group differences in psychosocial variables. Mental stability and volatility refer to the extent to which individuals reported change in levels of common mental health symptoms over the course of 12 weeks. No change in mental health over the 12 weeks reflected mental stability whilst change in mental health reflected mental volatility. Method: A two-wave-online survey (N = 163) was used to explore the psychological and social impact of the pandemic on relatively disadvantaged neighbourhoods within the region. The data collected represents 12 weeks of individual pandemic experience between mid-June and mid-December 2020. A three-level composite common mental health change variable was created combining self-reported anxiety and depression to group stable, volatile, and very volatile individuals in terms of the changeability of their mental health. Kruskal-Wallis with post-hoc tests were used to determine how people with mental stability and volatility differed on factors categorised within an ecological framework of resilience (individual, community, societal, and COVID-19 specific). Results: Individuals categorised as 'stable' in terms of mental health symptoms (63.6%) had better mental and physical health; were more tolerant of uncertainty; and reported higher levels of resilience and wellbeing compared to 'very volatile' people (19.8%). These individuals also reported feeling less socially isolated, experienced a greater sense of belonging to their community which was more likely to fulfil their needs, and were more likely to have access to green space nearby for their recommended daily exercise. 'Stable' individuals did not report worrying any more during the pandemic than usual and tolerated uncertainty better compared to those in the 'volatile' group. Implications: The majority of participants in this sample were mentally stable and coping well with the challenges presented by the pandemic. The resilience of these individuals was related to key place-based factors such as a strong sense of community and useable local assets. The data showcase the role of place-based social determinants in supporting resilience and thereby highlight key preventative measures for public mental health during times of international crisis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether patient‐reported urinary incontinence (UI) and bother scores after radical prostatectomy (RP) result in subsequent intervention with UI surgery. Patients and Methods: Men diagnosed with prostate cancer in the English National Health Service between April 2014 and January 2016 were identified. Administrative data were used to identify men who had undergone a RP and those who subsequently underwent a UI procedure. The National Prostate Cancer Audit database was used to identify men who had also completed a post‐treatment survey. These surveys included the Expanded Prostate Cancer Composite Index (EPIC‐26). The frequency of subsequent UI procedures, within 6 months of the survey, was explored according to EPIC‐26 UI scores. The relationship between 'good' (≥75) or 'bad' (≤25) EPIC‐26 UI scores and perceptions of urinary bother was also explored (responses ranging from 'no problem' to 'big problem' with respect to their urinary function). Results: We identified 11 290 men who had undergone a RP. The 3‐year cumulative incidence of UI surgery was 2.5%. After exclusions, we identified 5165 men who had also completed a post‐treatment survey after a median time of 19 months (response rate 74%). A total of 481 men (9.3%) reported a 'bad' UI score and 207 men (4.0%) also reported that they had a big problem with their urinary function. In all, 47 men went on to have UI surgery within 6 months of survey completion (0.9%), of whom 93.6% had a bad UI score. Of the 71 men with the worst UI score (zero), only 11 men (15.5%) subsequently had UI surgery. Conclusion: In England, there is a significant number of men living with severe, bothersome UI after RP, and an unmet clinical need for UI surgery. The systematic collection of patient‐reported outcomes could be used to identify men who may benefit from UI surgery. [ABSTRACT FROM AUTHOR]

This study presents a qualitative exploration of individuals identifying as 'mixed white and Black Caribbean' (MWBC) in Britain. The focus of this research aimed to answer the question, 'how do mixed white and Black Caribbean millennials in Britain experience their identity?' Six participants, aged 22–31 years, were interviewed about their family, relationships and personal values. The results were analysed using interpretative phenomenological analysis and highlighted three main themes: 'Public Perception', 'Caribbean Heritage' and 'Conversations'. Each theme was analysed from an integrative psychotherapeutic viewpoint, before concluding with suggestions for counsellors and psychotherapists working with this client group in clinical practice. [ABSTRACT FROM AUTHOR]