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Background: Interventions promoting social activity may reduce behavioural psychological symptoms and improve quality of life in people living with dementia. This study aimed to identify social benefits for participants living with dementia in the context of Promoting Activity, Independence and Stability in Early Dementia (PrAISED), an exercise intervention programme promoting physical activity and independence in participants living with dementia in England. Methods: This was a multi-method realist evaluation undertaking secondary analysis of data collected during the PrAISED process evaluation, including qualitative interviews with participants with dementia, caregivers and therapists, personal notes of researchers, and video recordings of therapy sessions. The study consisted of four phases: (1) Setting operational definition of social outcomes in PrAISED; (2) Developing Context, Mechanisms, Outcome (CMO) configurations; (3) Testing and refining CMOs; and (4) Synthesising definitive CMOs into a middle range theory. Results: Two CMOs were identified. (1) When therapists were able to make therapy sessions engaging and had the caregivers' support, the participants experienced therapy sessions as an opportunity to achieve goals in areas they were interested in. They also found the sessions enjoyable. This all led to the participants being highly engaged in their social interactions with the therapists. (2) When the participants realised that they were gaining benefits and progress through the PrAISED intervention, such as increased balance, this boosted their confidence in physical ability. It might also reduce caregivers' risk-aversion/gatekeeping attitude, which in turn would lead to participants' increased participation in social activities. Conclusion: The PrAISED intervention supported social participation in participants living with dementia. Under certain circumstances, home-based therapy interventions can be beneficial for social health (regardless of physical health gains). Given the limitations of currently available outcome measures to assess social participation, qualitative methods should be used to explore social health outcomes. [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]

Background Chronic subdural haematoma (cSDH) is a common neurosurgical pathology affecting older patients with other health conditions. A significant proportion (up-to 90%) of referrals for surgery in neurosciences units (NSU) come from secondary care. However, the organisation of this care and the experience of patients repatriated to non-specialist centres are currently unclear. Objectives This study aimed to clarify patient outcome in non-specialist centres following NSU discharge for cSDH surgery and to understand key system challenges. The study was set within a representative neurosurgical care system in the east of England. Design and methods We performed a retrospective cohort analysis of patients referred for cSDH surgery. Alongside case record review, patient and staff experience were explored using surveys as well as an interactive c-design workshop. Challenges were identified from thematic analysis of survey responses and triangulated by focussed workshop discussions. Results Data on 381 patients referred for cSDH surgery from six centres was reviewed. One hundred and fifty-six (41%) patients were repatriated following surgery. Sixty-one (39%) of those repatriated suffered an inpatient complication (new infection, troponin rise or renal injury) following NSU discharge, with 58 requiring institutional discharge or new care. Surveys for staff (n = 42) and patients (n = 209) identified that resourcing, communication, and inter-hospital distance posed care challenges. This was corroborated through workshop discussions with stakeholders from two institutions. Conclusions A significant amount of perioperative care for cSDH is delivered outside of specialist centres. Future improvement initiatives must recognise the system-wide nature of delivery and the challenges such an arrangement presents. [ABSTRACT FROM AUTHOR]

Most long-term care systems (social care) for older people rely on some means testing, copayment system, private insurance, or other non-governmental funding to supplement state provision. In England, an estimated quarter of homecare delivery is funded privately. For many older people, the absence of state funding for their care is only part of the problem: they are also expected to search for care in a market characterised by complexity, plurality, and imperfect information. Surprisingly, there are few services available to support private funders to navigate the system. This paper examines willingness to pay for care navigation and seeks to classify heterogeneity of preferences for navigation support. A discrete choice experiment (DCE) survey was completed by 182 participants across England in 2020-21. The results of the random parameter logit model used to analyse preferences showed that people valued information about care options (quality, information, and finances), but they also wanted help to "think things through," as processing information could be challenging. Generally, participants valued what the navigation service provided, more than how the services were organised and delivered. The study also used latent class analysis to identify four groups with similar preferences, with almost half of participants (48%) expressing high willingness to pay for a comprehensive navigation service. The other three classes represented those with preferences focused on a narrower set of attributes: fast access to information (20%), affordable help to "think things through" (18%), and information provided by their local council (14%). The study demonstrates the potential demand and likely take-up of navigation support if made available to people who pay privately for care. Future research needs to examine the barriers to market development for social care navigation services. [ABSTRACT FROM AUTHOR]

Key content: Surgical cytoreduction and platinum‐based chemotherapy are the mainstays of ovarian cancer treatment, but 70% of patients with advanced‐stage disease will relapse after responding to first‐line chemotherapy.Recent randomised controlled trials have shown significant improvement in progression‐free survival by adding maintenance therapy including either PARP inhibitors (PARPi), bevacizumab (VEGF‐A inhibitor), or both.Homologous recombination repair is a pathway to repair DNA breaks; homologous recombination deficiency (HRD) is encountered in approximately 50% of ovarian high‐grade serous cancers (HGSC).Patients with HRD tumours demonstrate better progression‐free survival outcomes with PARPi.HRD testing is now approved for patients with high‐grade ovarian cancers including HGSC. Learning objectives: To understand available molecular testing in ovarian cancer in England and its implications for maintenance treatment strategies. Ethical issues: Patient consent is required if testing involves germline BRCA1/2 mutation (gBRCA1/2mut) assessment. A positive BRCA1/2mut result might have implications for the patient and their family. [ABSTRACT FROM AUTHOR]

This article performs a site-specific and critical reading of agricultural labour in the Fen landscape in the East of England to explore lived experiences of class in this landscape. The analysis is based on fieldwork and archival research undertaken between 2017 and 2019. The article disrupts conventional division between migrant and domestic labour through employing the critical theoretical lens of the German Jewish cultural critic Walter Benjamin. The article traces previously obscured narratives of agricultural labour that glimmer in the dark light of the disruption of the distinction between migrant and domestic experiences. In doing so it follows lines of continuity and connectivity through the novel concept of the 'spectral labourer'. This concept is used to draw out the significance of tenuous and evolving chains of citizenship and state exclusion within the agricultural working classes in the Fen region. [ABSTRACT FROM AUTHOR]

Background apathy, defined as reduced goal-directed activity, interests and emotion, is highly prevalent in neurocognitive disorders (NCDs). Apathy has important consequences for the individuals who experience it and their carers, yet the lived experiences of apathy in this population are not well understood. Objective to explore how people with NCDs and their carers understand and experience apathy. Method in-depth semi-structured interviews were conducted in participants' homes. Sixteen people with NCDs (dementia or mild cognitive impairment) and 14 carers, living in four geographical areas of England, took part. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using reflexive thematic analysis. Results four themes were generated: 'Apathy is Poorly Understood'; 'Too much trouble: Mediating Effort and Outcome'; 'Preserving Identity in the Face of Loss of Capability and Autonomy' and 'Opportunity and Exclusion'. Conclusion apathy is experienced as an understandable response to the everyday struggle people with NCDs face to preserve identity in the face of threats to capability and autonomy and is exacerbated by the lack of support and opportunities. Social and environmental modifications may help reduce apathy. In line with previous qualitative research, this challenges the dominant view of apathy as a neuropsychiatric symptom that excludes the social–environmental context. [ABSTRACT FROM AUTHOR]

Background: Every Mind Matters (EMM) is a publicly funded health campaign, launched in England in 2019, to equip adults to look after their mental health, and that of others, by offering online information about common problems: anxiety, low mood, sleep, and stress. This study is one component of an independent evaluation of EMM conducted by the NIHR Mental Health Policy Research Unit. Its aim is to explore individuals' experiences of the EMM campaign and website. Methods: Four researchers, including three with lived experience of using mental health services, conducted 20, one-off, semi-structured, online interviews with a range of adult participants, including a sample of EMM users and a purposively recruited sub-sample known to have severe or long-term mental health conditions. A codebook thematic analysis was undertaken, and four main themes were identified. Findings: There was an expectation from the name Every Mind Matters that its advice would address everyone. Almost all participants had experience of mental distress and looked to EMM for help with a current problem for themselves. All participants were complimentary about the EMM website and found it to be user-friendly (theme 1) and personalised (theme 2) especially the interactive feature Your Mind Plan quiz which responds with suggested actions to improve wellbeing and follows up with reminder emails. A few participants found the website information and/or Mind Plan suggestions to be life changing. Some participants wanted EMM to better acknowledge the contexts in which they live (theme 3) such as the limitations of health conditions and health services, and difficulties of crowded housing, social policy, and climate change. Many participants would like EMM to do more (theme 4), offer more interactivity, more choice, more information about available treatments, and more stratified advice to cover more severe mental health conditions. Conclusion: EMM is available to all, including people with common or severe mental disorders. In the context of overwhelmed mental health services, people with severe mental illness expect more from EMM than advice about common problems. EMM could build on its success by extending its remit to address a wider range of needs so that everyone is included. [ABSTRACT FROM AUTHOR]

Background: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a programme of physical activity and exercise designed to maintain participation in activities of daily living, mobility, and quality of life for people living with dementia. During the COVID-19 pandemic first national lockdown in England, the PrAISED physiotherapists, occupational therapists, and rehabilitation support workers adapted to delivering the intervention remotely via telephone or video conferencing. Objective: The aim of this study was to explore therapists' experience of delivering the PrAISED intervention during the COVID-19 pandemic and derive implications for clinical practice. Methods: Qualitative semi-structured interviews were conducted with 16 therapists using purposive sampling. Thematic analysis was used to analyze the transcripts. Results: Therapists reported a change in the relationship between themselves, the person with dementia and the caregiver, with an increased reliance on the caregiver and a loss of autonomy for the person living with dementia. There was concern that this would increase the burden on the caregiver. The therapists reported using creativity to adapt to different modes of delivery. They felt their sessions were mostly focused on providing social and emotional support, and that assessing, progressing, and tailoring the intervention was difficult. Conclusion: It is possible to deliver some elements of a physical intervention using remote delivery, but a dual modal approach including remote and face-to-face delivery would optimize treatment efficacy. Educational support would be required to enable people living with dementia and their caregivers to overcome barriers relating to digital literacy. [ABSTRACT FROM AUTHOR]

In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non‐statutory home‐care providers (for‐profit, not‐for‐profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home‐care providers, the care workforce and service users. Little formal research of providers' experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi‐structured telephone interviews with 20 managers of for‐profit home‐care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home‐care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time‐consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal–steward relationships in contracting. [ABSTRACT FROM AUTHOR]

Background: Restrictions introduced in response to the COVID-19 pandemic led to increased risk of deconditioning in the general population. No empirical evidence of this effect however has been gathered in people living with dementia. This study aims to identify the causes and effects of COVID-19-related deconditioning in people living with dementia.Methods: This is a longitudinal phenomenological qualitative study. Participants living with dementia, their caregivers and therapists involved in the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation during the COVID-19 pandemic were qualitatively interviewed at two time points: the baseline 2 months after the national lockdown was imposed in England (i.e., May 2020), the follow up 2 months after the first set (i.e. July 2020). The data were analysed through deductive thematic analysis.Results: Twenty-four participants living with dementia, 19 caregivers and 15 therapists took part in the study. Two themes were identified: Causes of deconditioning in people living with dementia during the COVID-19 pandemic and effects of deconditioning in people living with dementia during the COVID-19 pandemic. A self-reinforcing pattern was common, whereby lockdown made the person apathetic, demotivated, socially disengaged, and frailer. This reduced activity levels, which in turn reinforced the effects of deconditioning over time. Without external supporters, most participants lacked the motivation / cognitive abilities to keep active. Provided the proper infrastructure and support, some participants could use tele-rehabilitation to combat deconditioning.Conclusion: The added risks and effects of deconditioning on people with dementia require considerable efforts from policy makers and clinicians to ensure that they initiate and maintain physical activity in prolonged periods of social distancing. Delivering rehabilitation in the same way as before the pandemic might not be feasible or sustainable and innovative approaches must be found. Digital support for this population has shown promising results but remains a challenge.Trial Registration: The PrAISED trial and process evaluation have received ethical approval number 18/YH/0059 from the Bradford/Leeds Ethics Committee. The ISRCTN Registration Number for PrAISED is  15320670 . [ABSTRACT FROM AUTHOR]

Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves 'managing' and 'shaping' the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than 'time and task' objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning. [ABSTRACT FROM AUTHOR]

Background In 2013, the English National Health Service launched the policy of 7- day services to improve care quality and outcomes for weekend emergency admissions. Aims To determine whether the quality of care of emergency medical admissions is worse at weekends, and whether this has changed during implementation of 7- day services. Methods Using data from 20 acute hospital Trusts in England, we performed randomly selected structured case record reviews of patients admitted to hospital as emergencies at weekends and on weekdays between financial years 2012--2013 and 2016--2017. Senior doctor ('specialist') involvement was determined from annual point prevalence surveys. The primary outcome was the rate of clinical errors. Secondary outcomes included error- related adverse event rates, global quality of care and four indicators of good practice. Results Seventy- nine clinical reviewers reviewed 4000 admissions, 800 in duplicate. Errors, adverse events and care quality were not significantly different between weekend and weekday admissions, but all improved significantly between epochs, particularly errors most likely influenced by doctors (clinical assessment, diagnosis, treatment, prescribing and communication): error rate OR 0.78; 95% CI 0.70 to 0.87; adverse event OR 0.48, 95% CI 0.33 to 0.69; care quality OR 0.78, 95% CI 0.70 to 0.87; all adjusted for age, sex and ethnicity. Postadmission in- hospital care processes improved between epochs and were better for weekend admissions (vital signs with National Early Warning Score and timely specialist review). Preadmission processes in the community were suboptimal at weekends and deteriorated between epochs (fewer family doctor referrals, more patients with chronic disease or palliative care designation). Conclusions and implications Hospital care quality of emergency medical admissions is not worse at weekends and has improved during implementation of the 7- day services policy. Causal pathways for the weekend effect may extend into the prehospital setting. [ABSTRACT FROM AUTHOR]

Background: Up to 70% of patients report ongoing symptoms 4 weeks after hospitalisation for pneumonia; the impact on primary care is poorly understood.Aim: To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation.Design and Setting: A population-based cohort study in England using a UK primary care database of anonymised medical records (Clinical Practice Research Datalink [CPRD]) linked to Hospital Episode Statistics (HES).Method: Adults with the first International Classification of Diseases, 10th Revision (ICD-10) code for pneumonia (J12-J18) recorded in HES between July 2002 and June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined.Results: Of 56 396 adults, 55.9% (n = 31 542) consulted primary care within 30 days of hospital discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year before index admission (adjusted subhazard ratio [sHR] 8.98, 95% confidence interval [CI] = 6.42 to 12.55). The most common reason for consultation was for a respiratory disorder (40.7%, n = 12 840), 11.8% for pneumonia specifically. At consultation, 31.1% (n = 9823) received further antibiotics. Penicillins (41.6%, n = 5753/13 829) and macrolides (21.9%, n = 3029/13 829) were the most common antibiotics prescribed.Conclusion: Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia. [ABSTRACT FROM AUTHOR]

Purpose: To describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19. Methods: Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017–2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports. Results: 10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a PaO2/FiO2 ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting. Conclusion: Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services. [ABSTRACT FROM AUTHOR]

Background: There is uncertainty about the associations of angiotensive enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) drugs with COVID-19 disease. We studied whether patients prescribed these drugs had altered risks of contracting severe COVID-19 disease and receiving associated intensive care unit (ICU) admission.Methods: This was a prospective cohort study using routinely collected data from 1205 general practices in England with 8.28 million participants aged 20-99 years. We used Cox proportional hazards models to derive adjusted HRs for exposure to ACE inhibitor and ARB drugs adjusted for sociodemographic factors, concurrent medications and geographical region. The primary outcomes were: (a) COVID-19 RT-PCR diagnosed disease and (b) COVID-19 disease resulting in ICU care.Findings: Of 19 486 patients who had COVID-19 disease, 1286 received ICU care. ACE inhibitors were associated with a significantly reduced risk of COVID-19 disease (adjusted HR 0.71, 95% CI 0.67 to 0.74) but no increased risk of ICU care (adjusted HR 0.89, 95% CI 0.75 to 1.06) after adjusting for a wide range of confounders. Adjusted HRs for ARBs were 0.63 (95% CI 0.59 to 0.67) for COVID-19 disease and 1.02 (95% CI 0.83 to 1.25) for ICU care.There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 disease. The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean (adjusted HR 1.05, 95% CI 0.87 to 1.28) and Black African (adjusted HR 1.31, 95% CI 1.08 to 1.59) groups than the white group (adjusted HR 0.66, 95% CI 0.63 to 0.70). A higher risk of COVID-19 with ARBs was seen for Black African (adjusted HR 1.24, 95% CI 0.99 to 1.58) than the white (adjusted HR 0.56, 95% CI 0.52 to 0.62) group.Interpretation: ACE inhibitors and ARBs are associated with reduced risks of COVID-19 disease after adjusting for a wide range of variables. Neither ACE inhibitors nor ARBs are associated with significantly increased risks of receiving ICU care. Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine changes in the nature, form and range of commissioning arrangements for home care. Design/methodology/approach: Data from two discrete national surveys of English local authorities with social service responsibilities were used. In the first, undertaken in 2007, responses from 111 of the 151 local authorities (74%) were received; in the second, undertaken in 2017, responses from 109 local authorities (72%) were received. A combined data set of 79 complete cases, 52% of local authorities, was created. Percentage point differences across the two time periods were calculated and tested to identify significant changes and a systematic analysis of the free-text responses regarding intended changes to the commissioning process in each data set was undertaken. Findings: Findings identified substantial changes in some aspects of the commissioning of home care in the 2007-2017 decade. Collaboration between stakeholders had increased, particularly regarding the identification of future needs. Improved conditions of service and remuneration for home care workers were evident within the commissioning process. Standardised charges for home care (regardless of time and day) had also become more widespread. Initiatives to prompt providers to deliver more personalised care were more evident. Originality/value: This paper describes the evolution of commissioning arrangements for home care in localities in response to national policy initiatives. It provides guidance to commissioners in meeting the needs of current service users and emphasises the importance of collaboration with stakeholders, particularly providers, in securing future capacity. [ABSTRACT FROM AUTHOR]

Summary: Policy and practice developments in adult social care in England and elsewhere recognise the increasing role of the non-statutory sector. Care coordination services are central to the delivery of tailored support. This qualitative study focuses on support for older people and reports an analysis of 13 non-statutory sector services providing care coordination, grouped into four service types. Semi-structured interviews explored the influence of service context on the nature of practice. Findings: Particular elements of care coordination (e.g. assessment) were found to be shaped by the specific aims and purpose of each service type, such as extent to which they had a commissioning or provider role and the nature of their target group. Aspects of a range of case and care management approaches were in use throughout the sample, varying in relation to the distinct features of the service type. A set of overarching standards was found to be relevant to all services considered. Non-statutory sector services were found to provide innovative support which both complemented and sometimes substituted for the statutory sector. Applications: Findings point to the continued importance of social work values and methods to the work of non-statutory sector services providing care coordination and to current limitations in relation to what the sector can provide. These are issues which employers and service commissioners need to address to ensure that non-statutory sector services have the capacity and standards of practice to meet the demands made of them. Further areas of research are identified. [ABSTRACT FROM AUTHOR]

Summary As a result of national policy in respect of social care of adults in England, the non-statutory sector is increasingly more evident in the provision of care services previously undertaken by local government, including the delivery of care coordination for older people. However, little is currently known about the scope, content, or quality of services providing care coordination within this sector. This article reports the findings from a postal survey undertaken in January 2014 of non-statutory organisations in England providing care coordination services and investigates variations in their key attributes. Organisations providing care coordination services were identified using various strategies to create a database of services. Questionnaires encompassing several areas of enquiry were mailed to managers of care coordination services identified from the database. Findings There was similarity in the operation of the care coordination services sampled. Many were small-scale services, contract-funded, and providing short-term support. Volunteer staff were a feature of most services. All services worked to written protocols and standards and almost all levied no charge. Many shared information with healthcare or local authority staff with user consent. Service user satisfaction was measured and used for service improvement. Application This is one of the first studies undertaken in England to investigate the provision of care coordination by the non-statutory sector and to identify patterns of variation in key service attributes. Implications for commissioners, service providers, workforce, and social workers are further discussed. The findings provide baseline data against which future developments can be measured. [ABSTRACT FROM AUTHOR]

Background: death certification data are routinely collected in most developed countries. Coded causes of death are a readily accessible source and have the potential advantage of providing complete follow-up, but with limitations. Objective: to investigate the reliability of using death certificates for surveillance of dementia, the time trend of recording dementia on death certificates and predictive factors of recording of dementia. Subjects: individuals aged 65 and over in six areas across England and Wales were randomly selected for the Medical Research Council Cognitive Function and Ageing Study (CFAS) and CFAS II with mortality follow-up. Methods: prevalence of dementia recorded on death certificates were calculated by year. Reporting of dementia on death certificates compared with the study diagnosis of dementia, with sensitivity, specificity and Cohen's x were estimated. Multivariable logistic regression models explored the impact of potential factors on the reporting of dementia on the death certificate. Results: the overall unadjusted prevalence of dementia on death certificates rose from 5.3% to 25.9% over the last 26 years. Dementia reported on death certificates was poor with sensitivity 21.0% in earlier cohort CFAS, but it had increased to 45.2% in CFAS II. Dementia was more likely to be recorded on death certificates in individuals with severe dementia, or those living in an institution, yet less likely reported if individuals died in hospital. Conclusion: recording dementia on death certificate has improved significantly in the England and Wales. However, such information is still an underestimate and should be used alongside epidemiological estimations. [ABSTRACT FROM AUTHOR]

There is a prevalent view in England that family-based care is the preferred placement option for children placed in out-of-home care. Nonetheless, it is acknowledged that for some young people residential group care can offer the best chance of positive outcomes, transition, and in some cases a route to permanence. With an emphasis on innovation, there has been a recent governmental focus on the role and purpose of these placements. This conceptual paper explores how the political and legislative context has influenced the current opinion and use of residential care, as well as examining the importance of factors such as attachment and relationships, parenting/intervention, the notion of home, a sense of belonging, and adolescent development. Evidence exploring associated risk and resilience factors is also discussed. We question whether adopting a child development perspective and moving the discourse away from placement type to placement purpose would better support children and young people to fulfill their life chances. Residential care undoubtedly offers a different experience to that of family-based care, although, further research assessing a wider range of attributable outcomes is necessary to understand how policy and practice can intervene to best support development and opportunity for children placed in out-of-home care. [ABSTRACT FROM AUTHOR]

Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice. Further, though it is recognised that patients play a fundamental role in quality improvement, there are few examples of where they learn together with professionals. To contribute to addressing this gap, we review a collaborative fellowship in Northwest London, designed to build capacity to improve healthcare, which enabled patients and professionals to learn together. Using the lens of collaborative learning, we conducted an exploratory study of six cohorts of the year long programme (71 participants). Data were collected using open text responses from an online survey (n = 31) and semi-structured interviews (n = 34) and analysed using an inductive open coding approach. The collaborative design of the Fellowship, which included bringing multiple perspectives to discussions of real world problems, was valued by participants who reflected on the safe, egalitarian space created by the programme. Participants (healthcare professionals and patients) found this way of learning initially challenging yet ultimately productive. Despite the pedagogical and practical challenges of developing a collaborative programme, this study indicates that opening up previously restricted learning opportunities as widely as possible, to include patients and carers, is an effective mechanism to develop collaborative skills for quality improvement. [ABSTRACT FROM AUTHOR]

Gastric confirmation by pH is only achievable in approximately 50% of placements and X-rays are expensive and may be misinterpreted. Bedside electromagnetic (EM) guidance offers real-time confirmation. The authors determined the accuracy of guidance in predicting gastric body position from the EM trace using official Cortrak guidance (the EM trace reaches the bottom left quadrant of the anterior screen) compared with local guidance (detailed anterior-depth description of the GI flexures). X-ray, pH or an EM trace beyond the gastric body were used to independently confirm gastric position. Of 496 EM traces, 49% of tubes were in the oesophagus on entry to the lower left quadrant whereas 12% had already reached the gastric body in the upper left quadrant. Overall, predicting position by quadrant was 70% accurate whereas differentiating the pre-gastro-oesophageal junction (pre-GOJ) from the gastric body flexure was 100% accurate. Confirming gastric position by the anterior trace quadrant appears to be unsafe whereas expert differentiation of the pre-GOJ and gastric body flexures was reliable. The authors invite Corpak Medsystems (now owned by Halyard Health) to update its guidance in view of these findings. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the support worker functions in community mental health teams for older adults in relation to roles, boundaries, supervision and training. Background Support workers in community mental health teams provide important help to older people with complex mental and physical health needs in their own homes. Their numbers have grown substantially in recent years, but without professional registration there is concern that boundaries with qualified practitioners are insufficiently clear and that they do not receive the support they require. Design Qualitative research using interview data and thematic framework analysis investigated support workers' and registered practitioners' perspectives on roles, boundaries, supervision and training. Methods Semi-structured face-to-face interviews were undertaken in 2011, with 42 members of nine teams spread across England, including support workers and community mental health nurses. Coding of transcribed audio-recordings and subsequent analysis was undertaken by four researchers. Results Support workers undertook diverse roles and had considerable autonomy over their duties. Participants agreed about what tasks support workers should not undertake, yet there was evidence of 'negotiated' boundaries and examples of these being breached. Lines of authority were complex, yet support workers were supported through open communication with the wider team. Training was problematic, with few courses tailored for support workers and efforts towards formal qualification hindered by low pay and time pressures. Conclusion Local and national attention is needed to prevent 'drift' into activities that both support workers and registered practitioners consider outside their remit. Barriers to training and further qualification need to be addressed. [ABSTRACT FROM AUTHOR]

Purpose The provision of information and advice for older people arranging their own care is a policy objective. The purpose of this paper is to explore the range and scope of web-based information about care coordination activities for older people in the non-statutory sector in England.Design/methodology/approach Non-statutory organisations were identified through a structured internet search. Services were screened to identify those providing at least one care coordination activity. A postal survey of services was conducted in 2014 and results compared with the initial findings of the web search.Findings Almost 300 services were identified, most of which were provided by three organisations: Age UK; Alzheimer’s Society; and the British Red Cross. Brokerage was the most frequently reported care coordination activity; the majority of services focussed on help to stay at home; and carers and older people (including those with dementia) were the target groups most often identified. Comparison of the two information sources revealed a significant agreement between two care coordination’s activities: compiling support plans and monitoring and review.Research limitations/implications Findings are based on a purposive sample of organisations and therefore care must be exercised in generalising from them.Originality/value This study is one of the first to systematically explore the nature and extent of information about care coordination activities provided by the non-statutory sector in England. It was conducted when policy advocated both an increased role for the non-statutory sector and an increase in self-directed support. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.Methods: An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission.Results: Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types.Conclusions: Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide new insights into the contribution and experiences of non-statutory sector (voluntary) services delivering care coordination.Design/methodology/approach This qualitative study, based on face-to-face semi-structured interviews with 17 managers from a range of non-statutory sector services, used thematic data analysis supported by a framework approach.Findings Four themes emerged: commissioning arrangements undermined non-statutory sector development; working relationships between statutory and non-statutory services required time and energy to navigate and sustain; the establishment of a niche role in the larger network of provision; and tensions relating to future developments. The non-statutory sector was found to provide a mix of services, including specialist provision targeting specific communities that complemented or substituted for those provided by the state. Managers wanted their services to be recognised by the statutory sector as equal partners in the delivery of care coordination and were also keen to retain their independence.Practical implications Findings provide information for service commissioners and managers from statutory and non-statutory sectors indicating a complex set of experiences and views regarding the role of the latter. This is particularly salient in a political landscape which has increasing expectations of their involvement in the provision of care coordination.Originality/value This study considers the work of the non-statutory sector in the delivery of care coordination to adults and older people, an area under-reported to date. It suggests that there are opportunities available for these services to become embedded within a wider social care system and to excel by retaining or developing specialist roles and services. [ABSTRACT FROM AUTHOR]

Objectives: The UK National Institute for Health and Care Excellence (NICE) indicate that palliative care patients are at high risk of delirium and should be screened for it using the short confusion assessment method (short CAM). This study aimed to assess the perceptions of the short CAM for delirium screening amongst health-care workers in specialist palliative care inpatient units (SPCUs) and to investigate its use as a screening instrument. Methods: Patients in 5 SPCUs in the North East of England were screened for delirium using the short CAM and a staff survey assessed the acceptability of the short-CAM in this setting. Results: Of the 63 staff surveyed, 79.4% felt screening for delirium was important and 59.3% found the short CAM 'not at all' burdensome to complete. However, only 40.7% felt that the short-CAM often accurately reflected patients' conditions and none felt it always accurately reflected patients' condition. Of 298 patients screened, 20% screened positive on the short CAM. Malignant and intra-cerebral diseases were significant independent predictors of a positive screen. Hospice length of stay and in-hospice mortality were higher in those with a positive result (66.7%) than in those without (38.2%). Conclusions: Health professionals deem delirium screening to be important in SPCUs, but may not support routine use of the short CAM. This could reflect a limited perceived impact on care and lack of confidence in this tool to reflect a complex patient group. [ABSTRACT FROM AUTHOR]

Many people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the association between multi-agency working and psychosocial characteristics of work, practitioner time-use and job satisfaction. Design/methodology/approach – A comparison of practitioners working in multi-agency (health and social care) and single-agency (social care-only) teams, using data from the 2008 evaluation of individual budgets pilots in England. Participants worked in care manager roles supporting adult social care service users, and comprised social workers and a smaller number of health professionals. Data were collected using a self-completed questionnaire. Findings – Data were returned from 249 respondents (a 29 per cent response rate), with two-thirds working in single-agency teams. No significant differences were found between team type and job satisfaction. Respondents in multi-agency teams reported greater decision authority but poorer supervisory support than those in single-agency teams. The latter finding was robust to further exploration using regression to control for confounding factors. Research limitations/implications – These data were not specifically collected for the study and response rates were relatively low due to organisational upheaval at the time of data collection, which may affect interpretation. Practical implications – Government policy is dedicated to extending integrated forms of working, including multi-agency teamwork. This research suggests that such structures need careful planning for them to work effectively, with particular attention to supervision arrangements. Originality/value – This research gives a systematic and objective exploration of the relationship between job characteristics, time-use and satisfaction of practitioners in single as compared to multi-agency teams. [ABSTRACT FROM AUTHOR]

This article examines the public attitudes of various religious commentators in Britain towards emigrants and emigration in the mid-Victorian decades. These figures include bishops, Anglican clergy (but also those of some other denominations), those directly involved in ministry to emigrants, and lay proponents of emigration. It also contrasts their views with those of more secular commentators influenced by political economy. The article argues that while religious commentary proposed emigration to be a good thing, for emigrants and for the expansion of Christianity and the British empire, this contrasted with a more sceptical attitude towards steerage immigrants by Thomas Malthus. It also contrasted with a focus on amelioration of conditions for emigrants by those in emigration ministry, who saw emigrants as assisting the extension of the Church rather than the empire. [ABSTRACT FROM AUTHOR]

Objectives To identify patient and caregiver characteristics associated with caregiver dissatisfaction with hospital care of cognitively impaired elderly adults. Design Secondary analysis of data from a randomized controlled trial. Setting An 1,800-bed general hospital in England providing the only emergency medical services in its area. Participants Cognitively impaired individuals aged 65 and older randomly assigned to a specialist unit or standard geriatric or internal medical wards (N = 600) and related caregivers (N = 488). Measurements Patient and caregiver health status was measured at baseline, including delirium, cognitive impairment, behavioral and psychological symptoms, activities of daily living, and caregiver strain. Caregiver satisfaction with quality of care was ascertained after hospital discharge or death. Results Four hundred sixty-two caregivers completed satisfaction questionnaires. Regardless of assignment, 54% of caregivers were dissatisfied with some aspects of care, but overall 87% were satisfied with care. The main areas of dissatisfaction were communication, discharge planning, and medical management. Dissatisfaction was associated with high levels of patient behavioral and psychological symptoms on admission, caregiver strain and poor psychological well-being at admission, a diagnosis of delirium, and the relationship between the caregiver and the patient. There was less dissatisfaction from caregivers of patients managed on the specialist Medical and Mental Health Unit than those on standard wards, after controlling for multiple factors. Conclusion Dissatisfaction was associated with patient behavioral and psychological symptoms and caregiver strain but was not immutable to efforts to improve care. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change. Design/methodology/approach: Content analysis was used to analyse "free text" responses to open questions from a national survey about CMHTs' organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions. Findings: Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integration with social care services typically detailed desired changes. Practical implications: Four key issues emerged comprising a high level of support from managers to develop integrated practices; a need to define the focus of CMHTs for older people and to be fully resourced; and the importance of a nurturing and supportive team environment. Originality/value: The methodology provides a bridge between qualitative and quantitative research, exploring the volume of statements on particular topics and their meaning. [ABSTRACT FROM AUTHOR]

A correction to this paper has been published: https://doi.org/10.1007/s00134-021-06413-2 [ABSTRACT FROM AUTHOR]

Social workers in adult social care are at particular risk of job-related stress, although the contribution of different organisational and policy changes to this phenomenon is subject to debate. This paper explores a theoretical framework from the occupational psychology literature (the Job Demand/Control Model) to identify the characteristics of those most at risk of stress, in a sample of 249 social workers and other care managers working in English adult social services from the Individual Budget (IB) pilots. It finds that it is the particular combination of high work pressures, with a lack of control over decision making and resources needed to do the work, that are detrimental to job satisfaction. The study also finds that staff involved in delivering IBs were over twice as likely to be at risk of stress compared to those without any IB holders on their caseload. In-depth interviews with forty-eight care managers identified widespread complaints of additional pressures relating to IBs, but also the possibility that these may lessen as the policy evolves. The paper concludes that the Job Demand/Control Model is a helpful framework for evaluating the job-related impact of social work changes, particularly when part of a multi-methods approach. [ABSTRACT FROM AUTHOR]

Purpose: Despite centralisation of paediatric intensive care units (PICU) in the UK, children continue to be admitted to adult intensive care units (AICU). We aimed to analyse trends in the admission of children to AICUs over a 16-year period from 1996, and describe their case mix, outcome and resource use in a recent cohort (2009-2011). Methods: We extracted data from consecutive admissions of children (1996-2011) to AICUs from the Intensive Care National Audit and Research Centre Case Mix Programme Database. We studied case mix, outcome and resource use as well as regional, seasonal and temporal variations in admissions of children to AICU. Results: A total of 13,430 children were admitted to AICUs between 1996 and 2011 (representing 1.3 % of all admissions). This proportion decreased from 2.8 % in 1996 to 0.6 % in 2011. Crude mortality fell from 6.7 to 2.8 %, and the proportion transferred out to a PICU rose from 18.9 to 51.4 %. In recent years (2009-2011), half of the 2,320 admissions of children occurred in just three English Strategic Health Authorities. The median length of unit stay was 7.7 h (IQR 3.8-19.7) for survivors and 11.5 h (IQR 5.0-36.2) for non-survivors. Conclusions: The number of children admitted to AICUs in England, Wales and Northern Ireland has been steadily declining since 1996. In recent years, half of all children admitted to AICUs are transferred to PICU, usually following a short stay. The reasons for regional variation in paediatric admissions to AICUs, and the cause of death in the small number of children who die in AICUs, are unclear. [ABSTRACT FROM AUTHOR]

Abstract: Bridging the gap between policy aspirations and the ability of regulators to deliver robust evidence-based tools within affordable and realistic time-scales presents major challenges to the science community. Lake-MImAS (Morphological Impact Assessment System) is a hydromorphological classification and decision-support tool adaptable to any setting, developed in response to the EC Water Framework Directive (WFD) requirement to classify all surface waters in the European Union and achieve at least good ecological status by 2015. Lake-MImAS provides a transparent and consistent risk-assessment framework to assess the impact of hydromorphological pressures on ecologically relevant lake features and associated processes. Underpinned by expert-judgement, the tool quantifies lost ‘system capacity’ (%) relative to pristine, or un-impacted condition and does so on a type-specific basis. Morphological condition limits (MCLs) separate ‘lost capacity’ into five condition classes ranging from near natural to severely altered. Near natural (<5% capacity loss) corresponds directly with high ecological status of the WFD and provides the basis to define reference conditions. The calibrated tool was tested against independent judgement made by expert practitioners from UK environment and conservation agencies. The same condition class was assigned in 84% of Scottish lochs (n =40), in 58% of lakes in England and Wales (n =28) and in 57% of loughs in Northern Ireland (n =27). The overall agreement was 68% and 98% of all comparisons lay within one condition class. In most cases where different classes were assigned the explanation lay in local experts underestimating the extent of water level regulation. Whilst further work is required to strengthen the evidence base linking hydromorphological alteration and ecological response, Lake-MImAS provides the foundation for a pragmatic risk-assessment scheme to support WFD classification and related regulatory activity. The modular nature of the tool means it adaptive to new locations, lake type and pressure combinations and it has wider applications including physical condition monitoring for conservation sites, impact assessment arising from new developments and supporting remediation programmes. [Copyright &y& Elsevier]

The article provides a comparison between France and England laws in terms of fault and breach of contract. It is said that in England, the concept of fault as part of contractual liability have not been given much discussion. On the other hand, fault has reportedly been part of thinking about liability for breach of contract in French law. Differences in legal techniques as well as similarities and differences in practical results of both laws are also explored in the article.

The article offers the author's insights on the Lambeth Conference to celebrate the bicentenary of the birth of G. A. Selwyn, first bishop of New Zealand in England. The author argues on the effort by Selwyn and his contemporaries in the nineteenth century in preserving the provincial autonomy in the Anglican Communion. He discusses the Christian authority of the bishop and its representation in synodal government. He also remarks on doctor Colin Podmore on archbishop's role in the Communion.

Background: Preventing the decline in physical activity which occurs around 10-11 years of age is a public health priority. Physically active play can make unique contributions to children's development which cannot be obtained from more structured forms of physical activity. Encouraging active play in children's leisure time has potential to increase physical activity levels while promoting optimal child development. Aspired wisdom states that contemporary British children no longer play outdoors, but systematic evidence for this is lacking. We need to build a more informed picture of contemporary children's play before we consider interventions to increase it. Methods: Eleven focus groups were conducted with 77, 10-11 year old children from four primary schools in Bristol, UK. Focus groups examined: 1) children's perceptions of 'play'; 2) how much of their play is active play; and 3) contexts of children's active play. All focus groups were audio-taped and transcribed verbatim. Data were analysed using a thematic approach. Results: Children's perceptions of play were broad and included both physically active and sedentary behaviours. Children reported that they frequently engaged in active play and valued both the physical and social benefits it provided. Whereas boys frequently reported having a 'kick about' or riding bikes as their preferred forms of active play, girls were less likely to report a specific activity. Additionally, boys reported greater independent mobility in their active play compared to girls. Finally, boys were more likely to report playing with neighbourhood friends but girls more frequently reported playing with family members. Conclusions: Promoting active play in children's leisure time may increase the physical activity of children, but interventions may need to be tailored according to gender. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have investigated the association between level of social deprivation and acute hospital outcome for admissions to adult general critical care units. It is important to be aware if an association exists because risk prediction models do not adjust for deprivation. Materials and Methods: Deprivation was measured using the Index of Multiple Deprivation (IMD) 2004, developed using 2001 census data in England. Eighty-four thousand four hundred twenty-three admissions to 138 adult general critical care units in England were selected from the Case Mix Programme Database from 1 year before to 1 year after the census date and linked to the IMD using postcodes. Logistic regression analysis was used to investigate a possible association between quintile of IMD and acute hospital mortality. Results: As deprivation increased, acute hospital mortality also increased (P < .001). This association remained after adjusting for age, sex, acute severity, medial history, source of admission, and reason for admission to critical care (adjusted odds ratio for most vs least deprived quintile, 1.19; 95% confidence interval, 1.10-1.28). Conclusions: There is an association between increasing deprivation and increasing risk of mortality for admissions to adult general critical care unit units in England. Further research is required to identify other unmeasured potential confounders (eg, smoking, alcohol consumption) as possible explanations for this association. [Copyright &y& Elsevier]

Abstract: Objective: To examine associations between active play and the physical activity of 10- to 11-year-old children. Method: Cross-sectional study of 747, 10- tot11-year-olds, conducted between February 2008 and March 2009 in Bristol, UK. Mean minutes of moderate to vigorous physical activity (MVPA) and mean activity levels (counts per minute, CPM) were assessed by accelerometer. Frequency of active play was self-reported. Results: Regression models indicated that frequent active play (5 or more days per week) was associated with mean daily activity levels (CPM) (girls: p =<0.01; boys: p =<0.01), but was only associated with mean daily MVPA for girls (p =<0.01). For leisure-time physical activity, active play was associated with children''s CPM (girls: p =0.02; boys: p =<0.01) and MVPA (girls: p =<0.01; boys: p =0.03) on weekdays after school, but was only associated with weekend day CPM for boys (p =<0.01). Conclusion: Active play is associated with children''s physical activity with after-school potentially being a critical period. Strategies to promote active play may prove to be a successful means of increasing children''s physical activity. [Copyright &y& Elsevier]

Rowan Clemente, Specialised Dietitian, and Stephen Taylor, Research Dietitian, North Bristol NHS Trust, consider the current UK pH stick threshold and whether it might be putting vulnerable patients at risk [ABSTRACT FROM AUTHOR]

Abstract: Client functioning and treatment engagement were examined in relation to staff attributes and organizational climate across a diverse sample of drug treatment and outreach programs in England. Self-rating assessments were obtained from 1,539 clients and 439 counselors representing 44 programs, and results were interpreted using comparable data from studies of treatment programs in the United States. Client scores on treatment participation and counseling rapport in England were directly related to their higher levels of motivation and psychosocial functioning, as well as to staff ratings of professional attributes and program atmosphere. By linking records from English clients with their counselors in each program, findings also indicate these relationships are rooted in the personal interactions between clients and their counselor. Standardized assessments of treatment structure, process, and performance used across therapeutic settings and national boundaries show there is generalizability in the pattern of clinical dynamics, including the relationships between organizational functioning and quality of services. [Copyright &y& Elsevier]

The article reviews the exhibition "The Railway: Art in the Age of Steam," at the Walker Art Gallery in Liverpool, England from April 18-August 10, 2008.

The article explores the prevalence of cancer among teenagers and young adults in England from 1979 to 2003. It notes that environmental changes and personal behavior stimulate the development of cancer among individuals. It mentions that age, sex, and location trigger cancer changes. Moreover, public health campaigns encourage lifestyle choices to teenagers.

Cancer is the leading cause of disease-related death in teenagers and young adults aged 13-24 years (TYAs) in England. We have analysed national 5-year relative survival among more than 30,000 incident cancer cases in TYAs. For cancer overall, 5-year survival improved from 63% in 1979-84 to 74% during 1996-2001 (P<0.001). However, there were no sustained improvements in survival over time among high-grade brain tumours and bone and soft tissue sarcomas. Survival patterns varied by age group (13-16, 17-20, 21-24 years), sex and diagnosis. Survival from leukaemia and brain tumours was better in the youngest age group but in the oldest from germ-cell tumours (GCTs). For lymphomas, bone and soft tissue sarcomas, melanoma and carcinomas, survival was not significantly associated with age. Females had a better survival than males except for GCTs. Most groups showed no association between survival and socioeconomic deprivation, but for leukaemias, head and neck carcinoma and colorectal carcinoma, survival was significantly poorer with increasing deprivation. These results will aid the development of national specialised service provision for this age group and identify areas of clinical need that present the greatest challenges. [ABSTRACT FROM AUTHOR]