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Objectives: To examine school absence and academic achievement among 7-year-old children with isolated orofacial clefts in England.Design: Analysis of educational data linked to national cleft registry and administrative hospital data.Setting: English state schools.Patients: 3523 children with isolated clefts aged 7 years between 2006 and 2014.Main Outcome Measures: Annual school absence and reaching the national 'expected level' according to teacher-assessed academic achievement.Results: Children with isolated clefts had higher mean annual school absence (10.5 days) than their peers in the national population (8.9 days). Total absence was higher in children with a cleft lip and palate (CLP; 11.3 days) or with a cleft palate only (CPO; 10.5 days) than in children with a cleft lip only (CLO; 9.5 days). The percentage reaching the expected academic level decreased with increasing school absence (from 77.4% (923/1192) with annual school absence ≤5 days to 43.4% (193/445) with annual school absence >20 days). However, differences in school absence did not explain that children with CPO (65.9% reaching expected level) or CLP (66.1% reaching expected level) had poorer levels of academic achievement than children with CLO (73.5% reaching expected level). Children with a cleft were twice as often recognised as having special education needs (40.5%) than their peers (21.6%).Conclusions: School absence and cleft type are both independently associated with school attainment at 7 years. Children with an isolated cleft, especially when the palate is involved, and those with high levels of school absence may benefit from increased support addressing their educational needs. [ABSTRACT FROM AUTHOR]

Research into experiences of social isolation and loneliness has predominantly focused on older adults, rhose post-retirement, as a significant at-risk group. Similarly, research exploring disability and loneliness has been associated with old age and conceptualised as an inevitable outcome of 'failing' health. This study seeks to conceptualise experiences of disability from a wider age group to understand if occurrences of social isolation and loneliness are commonplace. Fifteen qualitative biographical narrative interviews were completed by a Community Research Team, including 7 males and 8 females aged 32-89. A Disability Studies approach was applied to identify significant pathways from isolation into emotional loneliness, experienced by participants; fourteen of whom were affected by disability issues. Key risk factors were identified relating to disabled participants' experiences of 'loss'. Loss was associated with 'loss of ability', 'loss due to bereavement', 'loss of social connectivity' and 'loss of self-confidence'. Participants connected life events concerning loss with spending time alone, leading to feelings of emotional loneliness. The findings illustrate key risk factors in being alone during evenings and weekends, periods where disabled participants were most likely to experience subjective feelings of emotional loneliness. [ABSTRACT FROM AUTHOR]

Objective: Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index? Design: Retrospective method comparison and development study. Setting: School of Oral and Dental Science, University of Bristol. Methods: Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP. Results: The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. Conclusions: The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP. [ABSTRACT FROM AUTHOR]

Objectives: We used national data to study differences in academic achievement between 5-year-old children with an isolated oral cleft and the general population. We also assessed differences by cleft type.Methods: Children born in England with an oral cleft were identified in a national cleft registry. Their records were linked to databases of hospital admissions (to identify additional anomalies) and educational outcomes. Z-scores (signed number of SD actual score is above national average) were calculated to make outcome scores comparable across school years and across six assessed areas (personal development, communication and language, maths, knowledge of world, physical development andcreative development).Results: 2802 children without additional anomalies, 5 years old between 2006 and 2012, were included. Academic achievement was significantly below national average for all six assessed areas with z-scores ranging from -0.24 (95% CI -0.32 to -0.16) for knowledge of world to -0.31 (-0.38 to -0.23) for personal development. Differences were small with only a cleft lip but considerably larger with clefts involving the palate. 29.4% of children were documented as having special education needs (national rate 9.7%), which varied according to cleft type from 13.2% with cleft lip to 47.6% with bilateral cleft lip and palate.Conclusions: Compared with national average, 5-year-old children with an isolated oral cleft, especially those involving the palate, have significantly poorer academic achievement across all areas of learning. These outcomes reflect results of modern surgical techniques and multidisciplinary approach. Children with a cleft may benefit from extra academic support when starting school. [ABSTRACT FROM AUTHOR]

The article discusses research which assessed grommet insertion practice in the first five years of life among children with an orofacial cleft in England. Topics discussed include data analysis gathered from patients born between 1997 and 2005 who underwent surgical cleft repair, the proportion of children having repeat grommet insertions, and the absence or presence of additional anomalie, socioeconomic deprivation and region of residence.

Background Children with clefts have an increased tendency for dental anomalies and caries. Aim To determine the pattern of hospital admissions for dental treatment during primary dentition among children with clefts. Design Cohort study based on Hospital Episode Statistics, an administrative database of all admissions to National Health Service hospitals in England. Patients born alive between 1997 and 2003 who had both a cleft diagnosis and cleft repair were included. The number of hospital admissions for surgical removal of teeth, simple extraction of teeth, and restoration of teeth before the age of seven was examined. Results Eight hundred and fifty-eight hospital admissions for dental treatment among 6551 children (<7 year) with a cleft were identified. 66.4% of admissions were primarily for caries and 95.6% involved extractions. 11.4% of children had at least one admission for dental treatment. The presence of additional anomalies, having a more severe cleft type, and living in relatively deprived areas increased the risk of hospital admission. Conclusions Factors increasing the risk of hospital admission among cleft children should be taken into account when planning services. Efforts to reduce the number of hospital admissions should be focused on disease prevention, particularly among those most at risk of caries. [ABSTRACT FROM AUTHOR]

Objective To analyse hospital admissions in the first 2 years of life among children with cleft lip and/or palate in England. Design Analysis of national administrative data of hospital admissions. Setting National Health Service hospitals. Patients Patients born alive between 1997 and 2008 who underwent surgical cleft repair. Outcome measures Number of admissions, including the birth episode, and days spent in hospital were examined. Children were analysed according to cleft type and whether or not they had additional congenital anomalies. Results 10 892 children were included. In their first 2 years, children without additional anomalies (n=8482) had on average 3.2 admissions and 13.2 days in hospital, which varied from 2.6 admissions and 9.2 days with cleft lip to 4.7 admissions and 19.7 days with bilateral cleft lip and palate (BCLP). Children with additional anomalies (n=2410) had on average 6.7 admissions and 51.4 days in hospital, which varied from 6.4 admissions and 48.5 days with cleft palate to 8.8 admissions and 67.5 days with BCLP. The mean number and duration of cleft-related admissions was similar in children without (1.6 admissions and 6.4 days) and in those with additional anomalies (1.5 admissions and 8.5 days). 35.2% of children without additional anomalies had at least one emergency admission, whereas the corresponding figure was 67.3% with additional anomalies. Conclusions The burden of hospital care in the first 2 years of life varied according to cleft type and presence of additional anomalies. However, cleft-specific hospital care did not differ between children with and without additional anomalies. [ABSTRACT FROM AUTHOR]

A field and market basket study (∼1300 samples) of locally grown fruits and vegetables from historically mined regions of southwest (SW) England (Cornwall and Devon), and as reference, a market basket study of similarly locally grown produce from the northeast (NE) of Scotland (Aberdeenshire) was conducted to determine the concentration of total and inorganic arsenic present in produce from these two geogenically different areas of the U.K. On average 98.5% of the total arsenic found was present in the inorganic form. For both the market basket and the field survey, the highest total arsenic was present in open leaf structure produce (i.e., kale, chard, lettuce, greens, and spinach) being most likely to soil/dust contamination of the open leaf structure. The concentration of total arsenic in potatoes, swedes, and carrots was lower in peeled produce compared to unpeeled produce. For baked potatoes, the concentration of total arsenic in the skin was higher compared to the total arsenic concentration of the potato flesh, this difference in localization being confirmed by laser ablation inductively coupled plasma mass spectroscopy (LA-ICP-MS). For all above ground produce (e.g., apples), peeling did not have a significant effect on the concentration of total arsenic present. [ABSTRACT FROM AUTHOR]

This paper concerns a study exploring the salience of a 'job description' for the effective self-management of a long-term condition to the experiences of a group of women living with difficult asthma. This is a life-threatening disease. It has been claimed that sufferers are a marginalised, misunderstood, mistreated and vulnerable group. The method involved secondary analysis of focus group data. The job description has been developed as a tool to enable nurses to facilitate and support effective self-management. This study was designed to examine the application of this tool to a particular case. Long-term conditions are a growing feature of the developed world and are strongly implicated in health inequalities. They are more prevalent in socially and economically disadvantaged populations and therefore add further burden to already vulnerable people. Effective self-management is critical to adapting and adjusting to the experience of a long-term condition and nurses have a responsibility to promote this process. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the in vivo bond failure rates of orthodontic brackets bonded using Orthosolo universal bond enhancer and compared it with the conventional bonding primer, Transbond XT. Design: This was a single centre randomized controlled clinical study. Setting: Department of Child Dental Health, Bristol Dental Hospital, Bristol, UK. Materials and methods: Thirty-three consecutive patients undergoing fixed orthodontic appliance therapy were included in this study. Using split-mouth design, diagonally opposite quadrants were randomly allocated a primer, either Orthosolo universal bond enhancer (Ormco, Orange, CA, USA) or Transbond XT primer (3M Unitek, Monrovia, CA, USA). A total of 555 teeth were bonded using a conventional acid-etch technique. 277 received Orthosolo as their primer and 278 received the Transbond XT primer. Bond failures and their positions were recorded at six months. Results: There was an overall bond failure rate of 1.26%. Four brackets failed in the Orthosolo group (0.72%) and three failed in the Transbond XT group (0.54%). Conclusion: There was no clinical or statistically significant difference in the in vivo bond failure rates between orthodontic brackets bonded using either Orthosolo universal bond enhancer or the conventional Transbond XT primer. [ABSTRACT FROM AUTHOR]

This is a report on the use of a regional database of patients undergoing orthognathic treatment in the South West of England. The benefits and difficulties of using a regional database are discussed. [ABSTRACT FROM AUTHOR]

Taking its cue from Pooley and Turnbull's (1998) claim that there is no evidence of any difference in the propensity to migrate by region or settlement size, this article investigates the appropriate scale for migration research. It presents some preliminary findings from a micro-level study of three occupationally contrasting communities in Cornwall in the second half of the 19th century. Reconstructing the migration histories of a cohort of children from the 1851 census enumerators' books and making use of local and online census and civil registration index databases, the study identifies some clear differences in migration patterns and propensity at the community level. Moving from patterns to processes it argues that labour markets and occupational structures remain the most important explanatory variables structuring migration, but that these were mediated at the individual level by the influence of the family which played a key role in facilitating or deterring movement. [ABSTRACT FROM AUTHOR]

The curtain has come down on the first year of the new social work degree in England. This paper presents the findings of a survey of social work educators in academic and practice settings to find out how practice learning in this year has been experienced and the shape of plans for the rest of the new degree. The paper reflects on the enormous diversity of arrangements for practice learning, in terms of patterns of delivery, assessment, funding, and service user and carer involvement. One pattern that is emerging strongly is a more experimental flavour to this first year, with new practice learning sites being developed, and the use of group arrangements to supervise and support students. However, there is also the potential for inconsistency in standards, especially in the ways that students are judged as 'fit for practice learning'. There are concerns that the new partnerships are increasingly driven by universities and colleges, with some agency partners unclear about what is happening and why. There are also indications that the postgraduate programmes will have less room for experimentation than the three-year undergraduate courses and this may become a source of divergence between the two routes. [ABSTRACT FROM AUTHOR]

New regionalist writings display a growing tendency to turn towards the role of institutions and culture in the formation of regions. However, the way these are articulated is less than clear. This article calls for a re-combination of culture and institutions in order to analyse the process of regional formation at a micro-level. To do this it employs the concepts of discourse and the everyday to investigate the cultural reproduction of the region in the peak institutions of the new regionalization in the South West of England. In the absence of widespread regional identities in England, such institutions play a major role in constructing and policing the meaning of `region'. Interview data help to unpack an evolving regional discourse in south-west England, one that involves the everyday reproduction of representations of the region in the new regional institutions. Underlying this discourse of the region lie some traditional and stereotypical images of the South West. Furthermore, the implications of this reconfiguration of scale are explored in relation to another territorial identity at a lower scale, with reference to the campaign for a Cornish Assembly. The article concludes that the power of regional elites to create regions is overstated by the new regionalism. [ABSTRACT FROM AUTHOR]

Presents letters to the editor concerning medical issues. Question whether the National Health Service in England is guilty of ageism by not giving free personal care for some older people; Chemotherapy treatments given at a patients' workplace; Helicobacter pylori testing and endoscopy for dyspepsia; Others.

Discusses homelessness among single people in England. Closure of Alvaston Resettlement Unit, near Derby, England; Reactions to resettlement; Diversity in lifestyle among single homeless white men.

Abstract Objectives The aim of this study was to discover whether lower socio-economic status is associated with increased experiences of loneliness and isolation. The research subsequently determined whether this relationship impacted health inequalities. Study design The study used a cross-sectional, self-reported survey collecting information on loneliness, isolation and poor health (n = 680). The survey was administered through Sunderland District Council in 2016–2017, and data were analysed at The University of Sunderland. Methods The study used a quantitative approach, and data were analysed using descriptive statistics, engaging in univariate, bivariate and multivariate levels of analysis. Results A number of significant findings emerged from the data analysis, linking lower socio-economic status to experiences of loneliness (P = 0.000) and social isolation (P = 0.000). When determining if social isolation and socio-economics had a detrimental impact on a person's health, no statistical association was discovered (P = 0.098). Yet, there was a significant relationship concerning socio-economic status, loneliness and poor health (P = 0.026). Conclusions The authors have identified a number of associations within the data with reference to isolation, loneliness and poor health. Therefore, participants from a lower socio-economic group experienced disproportionately high levels of social isolation and emotional loneliness when compared with other socio-economic groups. The data also demonstrate that participants who experienced loneliness, and who were from a lower socio-economic background, were consistently more likely to report poor health than those from other socio-economic backgrounds. Highlights • This article examines the impact of loneliness and isolation on communities within the North East of England. • People with a household annual income of below £10,000 experienced disproportionately high levels of loneliness. • The findings present evidence that socio-economics and loneliness have a detrimental impact on a person's health. [ABSTRACT FROM AUTHOR]

England's 10 national parks are renowned for their landscapes, wildlife, and recreational value. However, surface waters in the national parks may be vulnerable to pollution from human-use chemicals, such as active pharmaceutical ingredients (APIs), because of factors like ineffective wastewater treatment, seasonal tourism, a high proportion of elderly residents, and the presence of low-flow water bodies that limit dilution. The present study determined the extent of API contamination in the English national parks by monitoring 54 APIs in 37 rivers across all national parks over two seasons. Results were compared to existing data sets for UK cities and to concentration thresholds for ecological impacts and antimicrobial resistance selection. Results revealed widespread contamination of the national parks, with APIs detected at 52 out of 54 sites and in both seasons. Thirty-one APIs were detected, with metformin, caffeine, and paracetamol showing the highest mean concentrations and cetirizine, metformin, and fexofenadine being the most frequently detected. While total API concentrations were generally lower than seen previously in UK cities, locations in the Peak District and Exmoor had higher concentrations than most city rivers. Fourteen locations had concentrations of either amitriptyline, carbamazepine, clarithromycin, diltiazem, metformin, paracetamol, or propranolol above levels of concern for fish, invertebrates, and algae or for selection for antimicrobial resistance. Therefore, API pollution of the English national parks appears to pose risks to ecological health and potentially human health through recreational water use. Given that these parks are biodiversity hotspots with protected ecosystems, there is an urgent need for improved monitoring and management of pharmaceutical pollution and pollution more generally not only in national parks in England but also in similar environments across the world. Environ Toxicol Chem 2024;43:2422-2435. © 2024 The Author(s). Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC., (© 2024 The Author(s). Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.)