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Background: There is consensus about the importance of 'recovery' in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched.Aims: To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England.Method: In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR).Results: Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31-0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians.Conclusions: Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery. [ABSTRACT FROM AUTHOR]

The article focuses on the subject of educational opportunity in its relation to ability. The chances for a child of talent but of little wealth to rise through the universities to a position of leadership in the nation are still small, in relation to the numbers of such children and to the chances of the wealthier. Since 1870 , England has assumed to some extent, the position in education which the Church held in the Middle Ages. The attitude of individual endeavor in the nineteenth century towards educational` opportunity can best be judged by an examination of what it did to increase the numbers of secondary schools and to fit their character to the needs of the time. Nineteenth century witnessed the building up of two educational systems in England. On one hand, the secondary day-schools, seemed to have been aiming at a system based upon social class, in which the prospects of the children would be determined largely by the position of the parents. On other hand, there was the State's system, which took over the elementary schools and nearly freed them from the stigma of charity, while reforming and extending the secondary day schools.

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'.

Objective: To determine characteristics associated with COVID-19 vaccine coverage among individuals aged 50 years and above in England since the beginning of the programme., Design: Observational cross-sectional study assessed by logistic regression and mean prevalence margins., Setting: COVID-19 vaccinations delivered in England from 8 December 2020 to 17 May 2021., Participants: 30 624 257/61 967 781 (49.4%) and 17 360 045/61 967 781 (28.1%) individuals in England were recorded as vaccinated in the National Immunisation Management System with a first dose and a second dose of a COVID-19 vaccine, respectively., Interventions: Vaccination status with COVID-19 vaccinations., Main Outcome Measures: Proportion, adjusted ORs and mean prevalence margins for individuals not vaccinated with dose 1 among those aged 50-69 years and dose 1 and 2 among those aged 70 years and above., Results: Of individuals aged 50 years and above, black/African/Caribbean ethnic group was the least likely of all ethnic groups to be vaccinated with dose 1 of the COVID-19 vaccine. However, of those aged 70 years and above, the odds of not having dose 2 was 5.53 (95% CI 5.42 to 5.63) and 5.36 (95% CI 5.29 to 5.43) greater among Pakistani and black/African/Caribbean compared with white British ethnicity, respectively. The odds of not receiving dose 2 was 1.18 (95% CI 1.16 to 1.20) higher among individuals who lived in a care home compared with those who did not. This was the opposite to that observed for dose 1, where the odds of being unvaccinated was significantly higher among those not living in a care home (0.89 (95% CI 0.87 to 0.91))., Conclusions: We found that there are characteristics associated with low COVID-19 vaccine coverage. Inequalities, such as ethnicity are a major contributor to suboptimal coverage and tailored interventions are required to improve coverage and protect the population from SARS-CoV-2., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

National guidelines give advice on topics which should be covered when counselling patients with a new diagnosis of genital herpes (HSV) with the aim of reducing transmissions. This three-site UK audit of documentation of counselling for patients with a new diagnosis of genital herpes reviewed the records of 284 patients. Documentation in all areas of counselling was limited and this may result in adverse medico-legal consequences for patients and clinicians.

In April 2013, local authorities gained responsibility for commissioning sexual health services in England. With many services going out to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. The aim of this study was to evaluate the impact of tendering on GUM trainees. An electronic survey designed by the British Association for Sexual Health and HIV Trainees' Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Eighty-two individuals responded (74% GUM trainees, 25% newly appointed consultants, 1% locum appointed for service). Sixty-three per cent (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered during the tendering process and 20% (8/41) felt that it was. Forty-four per cent (18/41) felt adequately supported. Thirty per cent (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated: other than management experience the overall impact on all parameters was negative, namely morale, senior support and education. In conclusion, this survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering.

Background: The rate of renal transplantation is limited by the number of donor organs available. A valuable source of organs is currently supplied by donation after cardiac death (DCD). At the Richard Bright Renal Unit, we have expanded our criteria for DCD, increasing the upper age limit for donation from 65 to 70., Method: We performed a retrospective analysis of all DCD recipients between 2003 and 2009. We compared outcomes for patients age<60 versus >60 as measured by delayed graft function and estimated glomerular filtration rate (eGFR) and incidence of graft failure., Results: One hundred thirty-six DCD transplantations took place. Our early data showed excellent results for non-heart-beating donation. Over the last 7 years, the average age of DCD donors has increased from 43 in 2003 to 50 in 2009. The increase in age has been correlated with a decrease in average recipient eGFR from 59 in 2003 to 32 in 2009. Recipients of kidneys from older DCD donors (>60) have significantly lower eGFRs at 1 month and 1 year compared to kidneys from donors aged <60. The incidence of delayed graft function in recipients of kidneys from donors aged>60 was 71% compared to 40% for <60 age group. Despite this, we have not found any evidence of higher graft failure rates in the recipients of grafts from the >60 donor age group., Conclusions: Expanding the age limits of our DCD donor program has led to an increased average donor age, reduced average eGFR, and increased delayed graft function. There is no evidence of reduced graft survival., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Children with language impairments have difficulty in reporting verbal inferences, but it is unclear whether the source of this problem lies in limitations of language comprehension, an inability to access world knowledge, or the integration of information in discourse. Children with pragmatic language impairments (CwPLI) are often described as having disproportionate difficulty with verbal inference, although there is little empirical support for this view., Aims: To examine the performance of children with specific language impairment (CwSLI), CwPLI and a control group with typical language development (CwTLD) on a verbal inferential comprehension task; to explore whether CwPLI's verbal inferential comprehension performance are disproportionate to their sentence comprehension difficulties; and to analyse inferential error types made by the three groups., Methods & Procedures: Sixty-four children with language impairments (CwLI), aged between 6 and 11 years, participated in an inference comprehension task (IC) and a task of sentence comprehension (SC). For the purpose of analysis, the LI group was then split into two subgroups: CwPLI and CwSLI, using a checklist of pragmatic features. A group of CwTLD were matched to LI children on SC ability and gender; a separate group of CwTLD (CA) was matched to CwLI by age and gender., Outcomes & Results: CwLI had lower raw scores on the IC task than CA-matched CwTLD, but similar scores to SC-matched CwTLD. CwPLI produced lower raw IC scores than CwSLI, and this was the same when age and SC performance were controlled for. CwSLI performed similarly to their SC-matched and CA-matched control subjects on the IC task. CwPLI scored significantly less on the IC task than both their SC-matched and CA-matched control subjects. A regression analysis showed that age and SC ability account for 36% of the variance on the IC task, but group (SLI versus PLI) status accounts for just 5%. A detailed analysis of error types and item performance on the IC task showed a trend for CwPLI to perform more poorly on developmentally more complex inference items, but there was no evidence for a unique pattern of inference errors in CwPLI., Conclusions & Implications: Children with language impairments tend to perform like younger children with matched level of sentence comprehension ability on a verbal inference comprehension task. CwPLI have more difficulty with this task than CwSLI, but the distribution of scores shows considerable overlap exists between clinical groups. Sentence comprehension ability, age and, to a lesser extent, group status contribute to verbal inferencing ability in children with language impairments, but other factors may be important. The implications for assessment and intervention are discussed.

Patients waiting more than 3 years for a renal transplant were ranked according to our novel Bristol and Region Allocation by Non-heart beating Donor Score (BRANDS). One kidney from 40 non-heart beating donors was allocated to the highest BRANDS long-waiter and the other kidney allocated according to the UK National Allocation Scheme (NAS). The scheme reduced the number of patients waiting more than 3 years by 20%. Despite longer dialysis time, greater sensitization and more human leukocyte antigen mismatches, BRANDS patients had equivalent 3-year graft survival (BRANDS 91%, NAS 97%, P=0.264) and patient survival (BRANDS 94%, NAS 92%, P=0.99). Results were similar to 242 synchronous recipients from heart-beating donors. Renal function was significantly lower in BRANDS recipients (40 vs. 62 mL/min/1.73 m2, P<0.0001). Transplanting long-waiting patients with kidneys from non-heart beating donors has reduced waiting times without compromising early outcomes. It is unclear if equivalent survival will be sustained in the long term.

Eleven population-based cancer registries tabulated second cancers among 133,411 patients diagnosed with testicular cancer, ovarian cancer or Hodgkin's disease between 1945 and 1984. Overall, 3,157 second cancers were observed, as compared with 2,420 expected at least one year after the first cancer. Survivors of testicular and ovarian cancer experienced 30% and 20% more cancers respectively than the general population comparison group, and patients previously diagnosed with Hodgkin's disease had an 80% excess of cancer. No information was available either on treatment for the first cancer, or other risk factors. However, temporal patterns in the risk of specific second cancers were analysed, with particular reference to the possible role of therapy for the first cancer. Leukaemia of the acute or non-lymphatic type, which has been previously linked to alkylating agent therapy, occurred in excess following all 3 first cancers, as did non-Hodgkin's lymphoma (overall relative risks of 6.1 and 1.8 respectively, with considerably higher relative risks following Hodgkin's disease). Other cancers for which important and plausibly therapy-induced excesses occurred were lung cancer following Hodgkin's disease (relative risk 1.9), breast cancer following Hodgkin's disease (relative risk 1.4) and bladder cancer following ovarian cancer and Hodgkin's disease (relative risks 1.7 and 2.2 in women, respectively). Rarer sites at which striking excesses occurred were the salivary gland, thyroid, bone and connective tissue. There were smaller, but clear excesses for cancers of the rectum and colon following ovarian cancer and testicular cancer, skin cancer following Hodgkin's disease, and kidney cancer following ovarian cancer. Overdiagnosis, misclassification of metastases and confounding by other risk factors were all considered as explanations of observed excesses. Nonetheless, it appeared that there are clear excess risks for cancers other than acute leukaemia which must be ascribed to therapy for the first cancer, especially in view of the possible under-reporting in registry material. Case-control studies are under way to provide information on the role of specific aspects of therapy.