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In 2018, an NHS Trust (UK) implemented an innovative Nursing System Framework (NSF). The NSF formalized a two‐year strategy, which provided teams with clear aims and measurable objectives to deliver care. Failures of coordination of nursing services are well‐recognized threats to the quality, safety and sustainability of care provision. Aim: To evaluate the efficacy of introducing a NSF in an NHS Trust, using nursing sensitive indicators and pre‐selected mortality, data outcome measures. Design: A before and after implementation, observational study. Methods: 105,437 admissions were extracted at an admission record level. Data was extracted from 1st September 2018 through to the 31st August 2019. Results: Using SQUIRE guidelines to report the study, insufficient evidence was found to reject a null hypothesis with a chi‐squared test of association between in‐hospital death and the NSF intervention period, with a p‐value of.091. However, trends were seen in the data, which suggested a positive association. Conclusion: The NSF is a complex intervention, which provides direction for improvements but requires further research to understand the benefits for nurses, Midwives, Health Visitors and patients. [ABSTRACT FROM AUTHOR]

We present LDAK-GBAT, a tool for gene-based association testing using summary statistics from genome-wide association studies that is computationally efficient, produces well-calibrated p values, and is significantly more powerful than existing tools. LDAK-GBAT takes approximately 30 min to analyze imputed data (2.9M common, genic SNPs), requiring less than 10 Gb memory. It shows good control of type 1 error given an appropriate reference panel. Across 109 phenotypes (82 from the UK Biobank, 18 from the Million Veteran Program, and nine from the Psychiatric Genetics Consortium), LDAK-GBAT finds on average 19% (SE: 1%) more significant genes than the existing tool sumFREGAT-ACAT, with even greater gains in comparison with MAGMA, GCTA-fastBAT, sumFREGAT-SKAT-O, and sumFREGAT-PCA. LDAK-GBAT is a new tool for gene-based association testing using GWAS summary statistics. Applied to 109 phenotypes from large biobanks, LDAK-GBAT finds at least 20% more significant genes than popular tools such as MAGMA and GCTA-FastBAT. Further, LDAK-GBAT is computationally efficient, with good control of type 1 error in simulation studies. [ABSTRACT FROM AUTHOR]

To explore the prevalence of health anxiety in stroke survivors and its relative impact on quality of life. A cross-sectional design was used including between group comparisons of high and low health anxious stroke survivors. Stroke survivors (n = 105) were recruited via online stroke community forums. Participants completed measures of health anxiety (Short Health Anxiety Inventory), general anxiety and depression (Hospital and Anxiety and Depression Scale), disability (WHO Disability Assessment Schedule), and quality of life (Quality of Life Index). Demographics and medical histories were also assessed. Thirty percent of the sample scored above the clinical cut off for health anxiety. Stroke survivors with high health anxiety (HiHA) were found to have significantly lower quality of life (p < 0.001) and higher rates of depression (p < 0.001). Regression analysis found health anxiety to be a significant predictor of quality of life (β = –0.12; p < 0.05) in addition to levels of depression (β = –0.33; p < 0.001) and disability (β = –0.53; p < 0.001). Almost a third of stroke survivors were experiencing clinical levels of health anxiety, with HiHA significantly associated with lower quality of life. Future research should explore the use of existing evidence based psychological interventions for health anxiety in this population. Our findings suggest almost one in three stroke survivors residing in the community have clinical levels of health anxiety. High health anxiety in stroke survivors was significantly related to lower levels of quality of life. Given this finding, evidence-based treatments for health anxiety may improve quality of life and reduce distress for a significant proportion of stroke survivors. Rehabilitation approaches aimed at improving overall quality of life for stroke survivors should consider both physical and psychological interventions, with levels of physical disability, depression and anxiety all significantly associated with quality of life. [ABSTRACT FROM AUTHOR]

Associations between breastfeeding intention, duration and post‐natal depression (PND) have been shown in pre‐COVID‐19 studies. However, studies during COVID‐19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post‐natal women, taking into consideration COVID‐19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID‐19, and have important long‐term effects on women's and infant's health. A cross‐sectional internet‐based survey was conducted with 3253 post‐natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID‐19‐related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic. Key messages: This study identified independent associations of breastfeeding intention and actual breastfeeding practices with PND after adjustment for COVID‐19‐related covariates.Although women who intended to breastfeed during pregnancy were less likely to have PND, those who did not intend to breastfeed but did breastfeed were more likely to have PND than those who intended to breastfeed and breastfed.Women with shorter (vs. longer) than planned duration of breastfeeding on breast were more likely to have PND.Health care providers and policymakers should ensure tailored support is available for women's infant feeding plans and mental health. [ABSTRACT FROM AUTHOR]

There were 3,762 unaccompanied asylum-seeking children (UASC) in the UK in 2021. UASC often have significant physical and mental health needs. They suffer from conditions linked to extreme poverty, such as malnutrition and tuberculosis. The proportion of UASC with complications related to their vision, dental health, skin, sleep, and mental health is high. They are also at increased risk of sexually transmitted diseases, including blood-borne infections. UASC become 'looked after' by their local authorities and therefore should have Initial Health Assessments (IHAs) in the same way as other children also in the care of their local authorities. IHAs are comprehensive and holistic health assessments, and as such are ideal for identifying previously unrecognized or unmet health needs of UASC and for providing clear health plans on how these health needs should be managed. This article will provide an overview of the national statistics and demographics of the UASC population, describe the demographics of the local UASC population within Birmingham and highlight their health needs, and then provide advice on how to conduct IHAs in the most effective and sensitive way for this particularly vulnerable group of children in care. [ABSTRACT FROM AUTHOR]

Aims. Cardiovascular diseases (CVDs) are the leading cause of deaths globally. Mortality and incidence of CVDs are significantly higher in people with mood disorders. About 81.1% of CVD patients were reported with comorbidities in 2019, where the second most common comorbidity was due to major depressive disorder (MDD). This study, therefore, aimed to evaluate the genetic correlation between CVDs and mood disorders by using data from the UK Biobank towards understanding the influence of genetic factors on the comorbidity due to CVDs and mood disorders. Methods. The UK Biobank database provides genetic and health information from half a million adults, aged 40-69 years, recruited between 2006 and 2010. A total of 117,925 participants and 6,128,294 variants were included for analysis after applying exclusion criteria and quality control steps. This study focused on two CVD phenotypes, two mood disorders and 12 cardiometabolic-related traits to conduct association studies. Results. The results indicated a significant positive genetic correlation between CVDs and overall mood disorders and MDD specifically, showing substantial genetic overlap. Genetic correlation between CVDs and bipolar disorder was not significant. Furthermore, significant genetic correlation between mood disorders and cardiometabolic traits was also reported. Conclusions. The results of this study can be used to understand that CVDs and mood disorders share a great deal of genetic liability in individuals of European ancestry. [ABSTRACT FROM AUTHOR]

The psychoactive properties of cannabis have been known forever. Since 1987, several prospective studies have suggested an increased risk of psychosis among cannabis users, with alternative explanations failing to account for such an effect. A cause-effect relationship has thus been implied. Further evidence has indicated that there is a dose-response relationship, and high-potency cannabis varieties confer the greatest risk of psychosis. As cannabis use has become more common over the last decades, one would expect a related increase in the number of schizophrenia cases. However, evidence in this regard remains equivocal for several reasons, including relying on databases that are not primarily designed to address such question and the issue that solid information regarding the incidence of schizophrenia is a relatively recent acquisition. Recent years have seen the development of online web publications, such as Google Trends and "Our World in Data", where data are explorable and interactable for tracking and comparing trends over specific periods and world regions. By using such databases, we believe that the question whether changes in cannabis use are associated with changes in schizophrenia rates can be answered, at least partly. Therefore, we tested these tools by evaluating trends in cannabis use and both cases and prevalence of schizophrenia in the United Kingdom, one of the countries where the incident rates for psychotic disorder have been suggested to be particularly increased by cannabis consumption. Crossing data from these tools revealed that interest in cannabis has been growing at the country level for over 10 years, with a parallel overlapping raise in psychosis cases and prevalence. Following up on this example, let us think of how many public health opportunities these public resources may offer. The question now is whether public health interventions for the benefit of the general population will follow suit. [ABSTRACT FROM AUTHOR]

Background and Hypothesis It is argued that availability of diagnostic models will facilitate a more rapid identification of individuals who are at a higher risk of first episode psychosis (FEP). Therefore, we developed, evaluated, and validated a diagnostic risk estimation model to classify individual with FEP and controls across six countries. Study Design We used data from a large multi-center study encompassing 2627 phenotypically well-defined participants (aged 18–64 years) recruited from six countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions study. To build the diagnostic model and identify which of important factors for estimating an individual risk of FEP, we applied a binary logistic model with regularization by the least absolute shrinkage and selection operator. The model was validated employing the internal-external cross-validation approach. The model performance was assessed with the area under the receiver operating characteristic curve (AUROC), calibration, sensitivity, and specificity. Study Results Having included preselected 22 predictor variables, the model was able to discriminate adults with FEP and controls with high accuracy across all six countries (rangesAUROC = 0.84–0.86). Specificity (range = 73.9–78.0%) and sensitivity (range = 75.6–79.3%) were equally good, cumulatively indicating an excellent model accuracy; though, calibration slope for the diagnostic model showed a presence of some overfitting when applied specifically to participants from France, the UK, and The Netherlands. Conclusions The new FEP model achieved a good discrimination and good calibration across six countries with different ethnic contributions supporting its robustness and good generalizability. [ABSTRACT FROM AUTHOR]

Background: Nurse managers play a pivotal role in quality patient care and staff satisfaction and retention. An overwhelming amount of work tasks and responsibilities might result in their sleep problems which are expected to aggravate in the context of the COVID-19, thereby affecting their overall health and work quality. However, little attention has been paid to sleep quality among nurse managers. This study aimed to investigate the prevalence of sleep disorders among nurse managers and identify related factors of sleep quality during regular prevention and control of the COVID-19 pandemic in China. Methods: This cross-sectional online survey was conducted in 14 hospitals on a sample of 327 nurse managers in China. Participants were invited to complete the general demographic questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Simplified Coping Style Questionnaire (SCSQ). Multiple linear regression analysis was used to explore the influencing factors of sleep quality among nurse managers. Results: In this study, 43.7% of nurse managers suffered from sleep disorders. Active coping style and frequent exercise were positive factors that could influence nurse managers' sleep quality, while passive coping style and age over 41 years old were negative predictors, collectively accounting for 52.0% of the variance of sleep quality. Conclusions: The issue of sleep disorders among nurse managers during regular epidemic prevention and control period is underscored. Coping style and demographic factors including age and frequency of exercise can significantly affect nurse managers' sleep quality. Healthcare administrators should pay more attention to nurse managers' sleep disorders and implement targeted strategies based on influencing factors to ensure their sleep quality. [ABSTRACT FROM AUTHOR]

The Manchester Musculoskeletal Screening Tool (MMST) is used internationally to screen for pain, postural changes, and urinary incontinence in adults with cystic fibrosis (CF). The tool has been validated for the outcome measures of pain and incontinence but not for the thoracic movement section. The aim of this study was to assess intra (single rater) and inter-rater (between rater) reliability of the thoracic movement screen section of the MMST. This is a prospective reliability study. Digital videos of thoracic movement were taken of adults with CF during their annual musculoskeletal screening at a large UK Adult CF Center. Twelve physiotherapists independently watched the videos and scored the movements on two occasions, 2 weeks apart, using MMST. Cohen's kappa and Krippendorff alpha were used to establish intra- and inter-rater reliability. Intra-rater reliability using Cohen's kappa calculation ranged between 0.35 and 0.93. Eleven out of 12 physiotherapists had a moderate-substantial reliability score as assessed by the Landis Koch criteria. Percentage agreement for each physiotherapist ranged from 67%-97%. The inter-rater reliability was poor (Krippendorff alpha score = 0.422 (CI: 0.24–0.60)). The thoracic section of the MMST is reliable in adults with CF to highlight changes in posture and thoracic mobility that may go undetected or under-reported by the patient when repeated by the same clinician. However, the inter-rater variability is high, and it should not be considered reliable when carried out by different clinicians over time. [ABSTRACT FROM AUTHOR]

Background/Objective: Despite the increase in global research on open fractures, which continue to be a significant cause of morbidity and mortality, seriously affecting the health and quality of life of patients, there has not been any bibliometric research on this subject. The aim of this study was to make a holistic analysis of scientific articles published on the subject of open fractures using bibliometric methods. Methods: Articles published on the subject of open fractures between 1980 and 2021 were downloaded from the Web of Science (WoS) database, and were analysed using various statistical methods. Network visualisation maps were used to determine international collaborations and trend topics, and citation analyses to determine the most effective studies. Spearman's correlation coefficient was used to determine correlations, and exponential smoothing predictors to estimate the number of articles to be published in the next 5 years. Results: A total of 1742 articles were analysed. The 3 countries making the greatest contribution to literature were the USA (591, 33.9%), UK (219, 12.5%) and Germany (132, 7.5%). The most active author was Bhandari M. (n = 22). The 3 most productive institutions were determined to be the University of California System (n = 57), University of Washington (31), and Harborview Medical Center (29). The most active journal was Injury (n = 143). Conclusion: According to the analysis applied to identify trend topics, the topics most studied in recent years were determined to be surgical site infection, orthoplastics, intramedullary nail, Masquelet technique, BOAST, bone healing, closed reduction, classification, outcomes, and lower limb. [ABSTRACT FROM AUTHOR]

We investigated whether expression of social meaning operationalized as individual gender identitity and politeness moderated pitch range in the two languages of female and male Japanese-English sequential bilinguals. The bilinguals were resident in either London (UK) or Tokyo (Japan) and read sentences to imagined addressees who varied in formality and sex. Results indicated significant differences in the pitch range of the two languages of the bilinguals, and this was confirmed for female and male bilinguals in London and Tokyo, with the language differences being more extreme in the London bilinguals than in the Tokyo bilinguals. Interestingly, self-attribution of masculine gender traits patterned with within-language variation in the English pitch level of the female bilinguals, whereas self-attribution of feminine gender traits patterned with within-language variation in the English pitch level of the male bilinguals. In addition, female and male bilinguals significantly varied their pitch range in Japanese, but not in English, as a function of the imagined addressees. Findings confirmed that bilinguals produce pitch range differently in their languages and suggest that expression of social meaning may affect pitch range of the two languages of female and male bilinguals differently. [ABSTRACT FROM AUTHOR]

Understanding users' individual differences may provide clues to help identify computer users who are prone to act insecurely. We examine factors that impact home users' reported computer security behaviour. We conducted two online surveys with a total of 650 participants to investigate the relationship between self-reported security behaviour and users' knowledge, motivation, confidence, risk propensity and sex-typed characteristics. We found that all of these factors impacted security behaviour, with knowledge as the most important predictor. We further show that a user's affinity to feminine or masculine characteristics is a better determinant of security behaviour than using binary male/female descriptors. Our study enabled us to confirm earlier results in the literature in a non-organisational setting, and to extend the literature by studying additional factors and by comparing the relative importance of each factor as a predictor of security behaviour. [ABSTRACT FROM AUTHOR]

Beliefs about free will and determinism have been shown to associate with and influence behavior. The present study examined the relationship between these beliefs, key social cognitive constructs, and gambling behavior. A cross-sectional design was used with assessments taken of participants' (N = 316) past gambling behavior; beliefs in free will and determinism; and attitude, perceived behavioral control, and intention toward gambling. Four weeks after survey completion, participants (N = 218) reported their gambling behavior. A MANOVA examined differences between gambling frequency and constructs. Bivariate correlations and regressions were undertaken to understand the relationships between constructs and gambling behavior. Results showed frequent gamblers had significantly greater positive attitudes and intentions toward gambling compared to infrequent gamblers. Infrequent gamblers also had significantly stronger perceived behavioral control and beliefs in free will than frequent gamblers. Free will significantly predicted attitude and perceived behavioral control, and explained additional variance in intention above attitude and perceived behavioral control. There was no effect for determinism. Finally, gambling behavior was explained by intention and perceived behavioral control, but not beliefs in free will and determinism. The study provides evidence for the association between free will beliefs, key social cognitive constructs, and gambling behavior. Future research should confirm the causal role of these relations. [ABSTRACT FROM AUTHOR]

Sexual harassment and other forms of gendered discrimination are social psychological phenomena, yet the psychological impact of sexual harassment has rarely been examined through a model which considers the role of diverse content of gender identity (i.e. norms). We used an experimental design to investigate how salient norms associated with the social identity of 'women' affect coping with sexual harassment. Participants who identified as women (N = 291) were randomly assigned to either a feminist, traditional feminine, or control norm condition, in which the salience of particular norms associated with womanhood was manipulated. Participants completed measures of personal growth (as a proxy for post-traumatic growth), and help-seeking intentions in response to a hypothetical sexual harassment scenario. Participants in the feminist condition reported significantly greater personal growth relative to those in the traditional feminine and control conditions. Participants in both the feminist and traditional feminine conditions reported significantly greater intentions to seek help from formal supports (e.g. primary care doctor), relative to those in the control condition. The findings suggest that the salience of social identities and their content may be valuable resources in promoting recovery following experiences of gendered discrimination and support the role of social identities in influencing post-trauma trajectories. [ABSTRACT FROM AUTHOR]

Humans are good at recognizing familiar faces, but are more error-prone at recognizing an unfamiliar person across different images. It has been suggested that familiar and unfamiliar faces are processed qualitatively differently. But are unfamiliar faces at least processed differently from monkey faces? Here we tested 366 volunteers on a face matching test – two images presented side-by-side with participants judging whether the images show the same identity or two different identities – comparing performance with familiar and unfamiliar human faces, and monkey faces. The results showed that performance was most accurate for familiar faces, and was above chance for monkey faces. Although accuracy was higher for unfamiliar humans than monkeys on different identity trials, there was no unfamiliar human advantage over monkeys on same identity trials. The results give new insights into unfamiliar face processing, showing that in some ways unfamiliar faces might as well be another species. [ABSTRACT FROM AUTHOR]

This paper explores the associations between different types of social capital and other measures including wellbeing, school connectedness, and pragmatic language. Seventeen adolescents who were deaf or hard of hearing (DHH) from Australia and the United Kingdom completed an online survey and their results were analysed to answer research questions relating to: social capital formation in adolescents who are DHH; associations between social capital, wellbeing, pragmatics, and school connectedness; and the role of identity in social capital formation. Statistical analyses were completed to determine: bivariate correlations between variables; significant differences between the types of social capital measured; and significant differences in social capital according to identity group. Results indicate that overall, adolescents had higher Offline social capital compared to Online social capital, and higher Family social capital in comparison to Peer and Institutional social capital. Additionally, all social capital except Online social capital had strong associations with wellbeing and school connectedness measures. Students who identified as deaf had statistically significant lower levels of social capital than those who identified as hard of hearing or hearing impaired, and bicultural; however, this result may be due to the composition of this small sample. This study indicates that social capital is associated with higher levels of wellbeing and school connectedness and demonstrates that school experiences play an important role in the formation of social capital for students who are DHH. [ABSTRACT FROM AUTHOR]

Background: Compared with the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to health care. A health check for autistic people may improve their health outcomes. Aim: To establish the views of autistic people towards a primary care health check for autistic people. Design & setting: Cross-sectional questionnaire study in England and Wales. Method: A questionnaire was sent to autistic adults with physical health conditions in England and Wales. A total of 458 people (441 autistic adults and 17 proxy responders) completed the questionnaire. Results: Most responders (73.4%, n = 336) thought a health check is needed for all autistic people. Around half of the participants thought a health check should be offered from childhood and the health check appointment should last between 15 and 30 minutes. Autistic people were positive about providing primary care staff with contextual information regarding their health and the reasonable adjustments they would like before their health check appointment. Training about autism and the health check was considered important, alongside adequate time for discussions in the health check appointment (all by over 70% of responders). The clinician's autism knowledge, seeing a familiar clinician, environmental adaptations, appropriate information, and accessible appointments were considered particularly important in making a health check accessible. Conclusion: Autistic people and relatives were supportive of a primary care health check for autistic people. Information gathered was used to support the design of a primary care health check for autistic adults. [ABSTRACT FROM AUTHOR]

Background Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental well-being after a motivational interviewing (MI) community-based PA intervention and the impact of signposting (SP) and social action (SA) (i.e. weekly group support) pathways. Methods Participants (n  = 2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental well-being data were collected at baseline (following an initial 30-min MI appointment), 12 weeks, 6 months and 12 months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models derived point estimates and 95% confidence intervals for outcomes at each time point and change scores. Results Participants increased PA and mental well-being at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12 weeks, but the SP pathway retained more participants at 6 and 12 months. Conclusions Both pathways produced similar improvements in PA and mental well-being; however, the addition of a control would have provided further insight as to the effectiveness. Due to lower resources yet similar effects, the SP pathway could be incorporated to support PA in primary care settings. [ABSTRACT FROM AUTHOR]

Measuring the physical activity of adults with progressive muscle diseases is important to inform clinical practice, for activity recommendations and for outcomes meaningful to participants in clinical trials. Despite its wide use, the measurement properties of the International Physical Activity Questionnaire (IPAQ) have not been established in a muscle disease population. The sample of 103 adults with progressive muscle diseases included independently mobile participants and wheelchair users. Their home-based activity measured by the IPAQ was compared to simultaneous weeks of accelerometer activity data collected remotely in a longitudinal, measure evaluation study. Validity, reliability, and responsiveness were evaluated for the IPAQ alone, and for the IPAQ used in conjunction with a smart activity monitor. The IPAQ did not demonstrate satisfactory criterion validity, reliability or responsiveness and it systematically overestimated moderate and vigorous physical activity time by 161 minutes per week. Measurement properties of the IPAQ were improved when it was used in combination with a smart activity monitor. The IPAQ did not have satisfactory measurement properties compared to accelerometry in adults with progressive muscle disease. Combining self-report and objective activity measures might improve the accuracy of physical activity assessment in this and other comparable populations. Physical activity is a meaningful health outcome for adults with progressive muscle diseases, for whom precise activity quantification is important because of the potential for activity-related disease exacerbation. The International Physical Activity Questionnaire (IPAQ) had unsatisfactory measurement properties compared to accelerometry; however, these were improved by adjunctive smart activity monitoring. Objective or combined physical activity measurement is recommended over self-report alone for clinical assessment of physical activity as part of rehabilitation and self-management programmes. [ABSTRACT FROM AUTHOR]

Objectives: Routinely used performance status scales, assessing patients' suitability for cancer treatment, have limited ability to account for multimorbidity, frailty and cognition. The Clinical Frailty Scale (CFS) is a suggested alternative, but research detailing its use in oncology is limited. This study aims to evaluate if CFS is associated with prognosis and care needs on discharge in oncology inpatients. Methods: We evaluated a large, single‐centre cohort study in this research. CFS was recorded for adult inpatients at a Regional Cancer Centre. The associations between CFS, age, tumour type, discharge destination and care requirements and survival were evaluated. Results and Conclusions: A total of 676 patients were included in the study. Levels of frailty were high (Median CFS 6, 81.8% scored ≥5) and CFS correlated with performance status (R = 0.13: P = 0.047). Patients who were frail (CFS ≥ 5) were less likely to be discharged home (62.9%) compared with those who were not classed as frail (86.1%) (OR 3.6 [95%CI 2.1 to 6.3]: P < 0.001). Higher CFS was significantly associated with poorer prognosis in all ages. Solid organ malignancy (hazard ratio [HR] 2.60 [95%CI 2.05–3.32]) and CFS (HR 1.43 [95%CI 1.29–1.59]; P < 0.001) were independently associated with poorer survival. This study demonstrated that CFS may help predict prognosis in adult oncology inpatients of any age. This may aid informed shared decision‐making in this setting. Future work should establish if routine CFS measurement can aid the appropriate prescription of systemic therapy and enable early conversations about discharge planning. [ABSTRACT FROM AUTHOR]

Objective: The Covid‐19 pandemic led to challenging discussions between oncology clinicians and patients regarding additional risks posed by SARS‐CoV‐2 infection whilst receiving systemic anti‐cancer therapies (SACT). We assess the potential factors affecting discontinuation of adjuvant early breast cancer treatment during the pandemic. Methods: Data were collected on all patients with early breast cancer undergoing adjuvant SACT, between 16 March and 17 April 2020 at a single UK cancer centre. Univariate binary logistic regression analysis was performed on variables including age, recurrence risk, Index of Multiple Deprivation decile, presence of physical comorbidities, modality of treatment (neoadjuvant or adjuvant), type of treatment (cytotoxic chemotherapy or monoclonal antibodies), percentage of cycles completed and availability of alternative treatments, with a binary dependent variable on treatment discontinuation. Results: Sixty‐two patients with early breast cancer were identified: 18 receiving neoadjuvant and 44 adjuvant therapies. Median age was 57.5 years (range 31–75 years). Age (P = 0.02), percentage of treatment cycles completed (P = 0.014) and presence of alternative treatment options (P = 0.019) were significant factors for SACT discontinuation during the height of the Covid‐19 pandemic. Conclusion: Factors affecting patients' decisions to discontinue SACT for early breast cancer during the Covid‐19 pandemic were elucidated, which may help identify patients requiring additional support. [ABSTRACT FROM AUTHOR]

Objective: Evidence suggests that cervical screening intervals can be extended and lifetime cervical screening for human papillomavirus (HPV)‐vaccinated women could be reduced. This study examines UK women's attitudes to extending screening intervals and assesses associations between knowledge, risk perception and HPV vaccination status, and acceptability of changes. Methods: Using a convenience sampling strategy, an anonymous mixed‐methods online survey was used and data recorded from 647 women (mean age = 28.63, SD = 8.69). Results: Across the full sample, 46.1% of women indicated they would wait 5 years for their next cervical screening, while 60.2% of HPV‐vaccinated women would be unwilling to have as few as three cervical screens in a lifetime. Multivariate analysis revealed those who are regular screened, those who intend to attend when invited, and those who perceive greater personal risk of cervical cancer are less likely to accept a 5‐year screening interval. Qualitative findings relating to benefits of extending intervals included convenience of less tests, less physical discomfort, and psychological distress. Concerns identified included the likelihood of developing illness, increased psychological distress relating to what may be happening in the body, and worries about increased risk of cervical cancer. Conclusion: Women need clear and specific information about HPV timelines, their relationship with cancer risk, and the rationale for extending screening intervals. [ABSTRACT FROM AUTHOR]

Aim: To analyse the current scientific knowledge and research lines focused on environmentally sustainable health systems, including the role of nurses. Background: There seem to be differences between creating interventions focused on environmentally sustainable health systems, including nurses, and the scarcity of research on this topic, framed on the Sustainable Development Goals. Methods: A bibliometric analysis was carried out, via three databases (Web of Science, Scopus and Pubmed), and the guideline recommendations were followed to select bibliometric data. Results: The search resulted in 159 publications, significantly increasing the trends from 2017 to 2021 (p =.028). The most relevant countries in this area were the United States, the United Kingdom and Sweden. Also, the top articles were from relevant journals, indexed in Journal Citation Report, and the first and the second quartiles linked to the nursing field and citations (p <.001). Conclusion: Education is key to achieving environmentally sustainable health systems via institutions and policies. Implications for Nursing Management: There is a lack of experimental data and policies on achieving or maintaining environmentally sustainable health care systems, indicating that nurses have an important role and should be consulted and included in decision‐making policies regarding sustainability in the health care systems. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that anterolateral procedures can reduce the risk of rerupture in high-risk recreational athletes undergoing primary anterior cruciate ligament (ACL) reconstruction (ACLR). However, this effectiveness has never been evaluated in elite athletes. Purpose: The purpose of this study was to evaluate the effectiveness of lateral extra-articular tenodesis (LET) in reducing revision rates in primary ACLR in elite athletes. Additionally, this study evaluated whether LET had a greater effect when combined with ACLR utilizing a hamstring or patellar tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive cohort of elite athletes with an isolated ACL tear undergoing autograft patellar or hamstring tendon reconstruction with or without Lemaire LET were analyzed between 2005 and 2018. A minimum 2-year follow-up was required. The association between the use of LET and ACL graft failure as defined by revision ACLR was evaluated with univariate and multivariate logistic regression models. Results: A total of 455 elite athletes (83% men and overall age 22.5 ± 4.7 years) underwent primary ACLR with (n = 117) or without (n = 338) a LET procedure. Overall, 36 athletes (7.9%) experienced ACL graft failure, including 32 (9.5%) reconstructions without a LET and 4 (3.4%) with a LET. Utilization of LET during primary ACLR reduced the risk of graft failure by 2.8 times, with 16.5 athletes needing LET to prevent a single ACL graft failure. Multivariate models showed that LET significantly reduced the risk of graft rupture (relative risk = 0.325; P =.029) as compared with ACLR alone after controlling for sex and age at ACLR. Including graft type in the model did not significantly change the risk profile, and although a patellar tendon graft had a slightly lower risk of failure, this was not statistically significant (P =.466). Conclusion: The addition of LET reduced the risk of undergoing revision by 2.8 times in elite athletes undergoing primary ACLR. This risk reduction did not differ significantly between the patellar tendon and hamstring tendon autografts. With these results, status as an elite athlete should be included in the indications for a LET, as they are at increased risk for ACL graft failure. [ABSTRACT FROM AUTHOR]

Introduction: The introduction of the COVID-19 lockdown and social distancing policy has the potential to restrict access to physical activity, change exercise behavior, and to increase sedentary behavior. This study was conducted with the support of British Blind Sport and evaluates the effect of the lockdown policy on adults with visual impairments in the United Kingdom (UK). Methods: An online survey based on the World Health Organization's Global Physical Activity Questionnaire was completed by 73 participants (median age 35–44 years, 59% female) to gain information on how the implementation of the lockdown policy by the UK government has affected physical activity and sedentary behavior in adults that are visually impaired. Paired sample t-tests and Wilcoxon signed rank tests were used to analyze continuous and Likert scale data, respectively. Results: The majority of participants continued to exercise during lockdown, but the nature of this activity altered with a significant change to exercising in a private indoor space (+190% (always), z = −3.871, p < 0.001), and those exercising alone (+118% (always), z = −2.595, p = 0.009). The volume of activity reduced in all cases, between −11% and −52%, with significant changes in duration of vigorous day-to-day activity, moderate day-to-day activity, travel by foot or cycle, and vigorous recreational activity. Sedentary behavior increased on average by 21% (t (59) = −2.050, p = 0.045), with a greater effect seen in females (+36%, t (35) = −2.525, p = 0.016). Discussion: Reductions in physical activity volume and increases in sedentary behavior are consequences of the UK lockdown for those with visual impairments. The health and well-being implications of these data to this specific population are of particular concern. Implications for Practitioners: Lockdown measures should be designed with consideration of the needs of people with disabilities. Innovative ways to engage these populations in physical activity are strongly encouraged. [ABSTRACT FROM AUTHOR]

Background: Developmental language disorder (DLD) has clear functional ramifications in the areas of social competency, emotion recognition, emotional well‐being and literacy skill, which have been found to persist from childhood to adolescence. These domains are important factors during the transition from primary to secondary school in typical development (TD). Nevertheless, there is a paucity of research on the transition from primary to secondary school for adolescents with DLD and low language (LL) ability. Aims: To investigate the association between psychosocial domains, literacy skill and concerns about school during the transition to secondary school for adolescents with DLD, LL and their TD peers. The first research question examined whether levels of social competency, emotion recognition, emotional well‐being and literacy skill predicted school concern for the three groups. The second research question explored the longitudinal relationship between school concern and psychosocial and literacy indicators over the transition. Methods & Procedures: Participants (aged 10–11 years) with DLD (n = 30), LL ((n = 29) and TD (n = 42) were recruited for this longitudinal study from eight UK primary schools. Standardized language and psychosocial assessments were administered in the spring and summer terms of the final year of primary school, and the autumn and summer terms of the first year in secondary school. Outcomes & Results: Regression analyses showed pre‐transition school concern to be predicted by emotion recognition for the DLD group, by social competence and emotional well‐being for the LL group, and by social competence for the TD group. Post‐transition concern was predicted by emotional well‐being for the LL group; with no significant predictors for the DLD/TD groups. Path analyses revealed an association between literacy skill and emotion recognition for the DLD group. A developmental cascade illustrated a relationship between social competence and emotional well‐being for the TD group. Conclusions & Implications: This study concludes that transition interventions must be differentiated according to language ability; support for DLD adolescents should focus on emotion recognition skill, provision for LL adolescents should centre on emotional well‐being, and TD participants should be particularly supported in the domain of social competence in advance of the move to secondary school. Additionally, this study emphasizes the importance of the inclusion of a LL group, as their outcomes cannot be predicted using DLD/TD research. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited research exploring the transition from primary school to secondary for adolescents with DLD or LL ability. Research on TD has highlighted vulnerable domains at this time. As these key areas are evidenced spheres of difficulty in DLD and LL, there was a strong impetus for this study. What this paper adds to existing knowledge: This study reveals differences between language ability groups in the predictors of school concern both pre‐ and post‐transition. Concerns of adolescents with DLD were predicted by emotion recognition, those of adolescents with LL were predicted by emotional well‐being, and a longitudinal link between social competence and emotional well‐being was evidenced for TD adolescents. What are the potential or actual clinical implications of this work?: This study has implications for researchers and clinicians, as a need has been identified for a new clinical group. It also has practical implications for transition support planning for educational practitioners, families and adolescents. [ABSTRACT FROM AUTHOR]

Objectives: There is a strong association between stress and psychotic symptoms, and this study examined the bidirectional nature of this relationship in parents with psychosis, with negative affect as a mediator and a range of other psychosocial factors included as covariates. It also examined whether stress from parenting had a larger impact on psychosis than non-parenting stress. Design: The study used a within-participants repeated measures design, using experience sampling methodology (ESM). ESM is a self-report surveying technique completed over an intensive longitudinal period. Participants completed six surveys a day, for 10days. Methods: Thirty-five participants with psychosis who were a parent to a child between the ages of 2 and 16 took part. Study phones alerted participants to complete surveys by beeping at semi-random intervals over 10days. Multi-level modelling was used with surveys at Level-1 and participants at Level-2. Predictor variables were time-lagged in order to infer directionality. Results: Parenting stress was found to predict psychotic symptoms, and this relationship was mediated by negative affect. The reverse direction was also confirmed. Few of the additional psychosocial factors were found to have a significant impact on the models' estimations. Parenting stress was not found to have a larger impact on psychosis than other sources of stress. Conclusions: This study provides further evidence of the bidirectional relationship between stress and psychosis in the context of parenting. Further research should explore if parenting stress plays a unique role in predicting psychotic symptoms by comparing parents and non-parents with psychosis. [ABSTRACT FROM AUTHOR]

Background There is a need to reduce antimicrobial uses in humans. Previous studies have found variations in antibiotic (AB) prescribing between practices in primary care. This study assessed variability of AB prescribing between clinicians. Methods Clinical Practice Research Datalink, which collects electronic health records in primary care, was used to select anonymised clinicians providing 500+ consultations during 2012--2017. Eight measures of AB prescribing were assessed, such as overall and incidental AB prescribing, repeat AB courses and extent of risk- based prescribing. Poisson regression models with random effect for clinicians were fitted. Results 6111 clinicians from 466 general practices were included. Considerable variability between individual clinicians was found for most AB measures. For example, the rate of AB prescribing varied between 77.4 and 350.3 per 1000 consultations; percentage of repeat AB courses within 30 days ranged from 13.1% to 34.3%; predicted patient risk of hospital admission for infection- related complications in those prescribed AB ranged from 0.03% to 0.32% (5th and 95th percentiles). The adjusted relative rate between clinicians in rates of AB prescribing was 5.23. Weak correlation coefficients (<0.5) were found between most AB measures. There was considerable variability in case mix seen by clinicians. The largest potential impact to reduce AB prescribing could be around encouraging risk- based prescribing and addressing repeat issues of ABs. Reduction of repeat AB courses to prescribing habit of median clinician would save 21 813 AB prescriptions per 1000 clinicians per year. Conclusions The wide variation seen in all measures of AB prescribing and weak correlation between them suggests that a single AB measure, such as prescribing rate, is not sufficient to underpin the optimisation of AB prescribing. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the use of an innovative resilience-building training programme delivered to NHS Safeguarding Leads and other participating professionals over a five-month period concluding in March 2019. The developers used knowledge and expertise in both the fields of psychology and drama-based learning to promote comprehension, retention and a capacity for using and conveying these strategies to other health-care workers. Design/methodology/approach: Attendees were given pre- and post-questionnaires to examine the effectiveness of the training in terms of understanding the stages of burnout, developing an awareness of personal risk factors that may be associated with potential burnout and their perceptions of the confidence they have in both evaluating their personal resilience and using acquired skills and coping techniques that they may apply to their personal and professional lives. A Wilcoxon Signed Ranks test was administered, to assess the significance of the difference between pre- and post-training scores. Findings: Following the training, participants reported statistically significant improvements relating to their understanding of terms, including "burnout". They also reported an increased awareness of their personal risk factors associated with burnout and felt more resilient having completed the training. Statistically significant changes were reported in all of these areas, with the drama element of the training being commended on about one third of all feedback forms where, with the post-test results, a narrative (unscored) opportunity for feedback was sought. Research limitations/implications: The authors note that a long-term follow-up of retention and use of this training was not undertaken, though they consider that, post-pandemic, this necessary training can be reinitiated and that, as with other professional initiatives, video-engagement technology may be, through innovative efforts, merged with these effective training techniques as an option for future training applications. Practical implications: To the best of the authors' knowledge, this training programme was the first of its kind to use a psychologically underpinned drama-based didactic approach to build resilience and protect against burnout. The results of this paper show that this training used an effective and efficient medium for successfully meeting these primary objectives. Social implications: It is considered that using a similar training approach would be effective in building resilience and preventing burnout in health-care professionals. Originality/value: This paper evaluates the effectiveness of an innovative resilience-building training programme drawing upon the field of psychology and drama-based learning to support safeguarding professionals within the NHS. [ABSTRACT FROM AUTHOR]

National and international recommendations for thermal care at preterm birth include recommendations to avoid hypothermia and hyperthermia. There is limited evidence demonstrating harm resulting from admission hyperthermia. Our aim was to assess the relationships between admission temperature and outcomes in very low birth weight (VLBW) babies in a unit with low rates of hypothermia and a higher rate of hyperthermia. This was an observational study based on routinely collected data including demographics, admission temperature, survival and major morbidity outcomes. Subjects were 1104 consecutive inborn VLBW babies admitted to a Neonatal Intensive Care Unit in United Kingdom between 2010 and 2017. Results: 155 (14%) of babies were hypothermic (<36.5 °C) with only 21 (1.9%) < 36 °C, and 254 (23%) of babies were hyperthermic (>37.5 °C). The rate of major abnormality on cranial ultrasound scan was increased in the hyperthermic babies compared to the normothermic babies (37/239 (15.5%) vs. 54/601 (9%), relative risk (95% CI) 1.723 (1.166 to 2.546), p = 0.006). There was no difference in survival or other major morbidity in the hyperthermic babies compared to the normothermic babies. There was no association between hypothermia and survival or any major morbidity, although this probably reflects the low power of the study given the low rates of significant hypothermia. Higher admission temperature was associated with an increase in the risk of major cranial ultrasound abnormality using multiple logistic regression analysis (p = 0.007) with an increased odds ratio (95% CI) of 1.48 (1.11 to 1.97) for each degree of increase. We conclude that admission hyperthermia is independently associated with an increased risk of preterm brain injury. It is not possible to state whether this is a causative association, or whether the association is a consequence of a shared aetiology of perinatal infection. [ABSTRACT FROM AUTHOR]

Purpose: To examine factors associated with being re-admitted in the year after discharge from acute postpartum psychiatric treatment. Methods: Secondary data analysis of information collected from mothers who were admitted to acute psychiatric services in the year after childbirth between 2013 and 2017. We carried out univariable analyses and multivariable hierarchical logistic regression to examine risk factors for women's re-admission to acute psychiatric care (inpatient or community crisis care) in the year following discharge. Results: Sixty-seven (24.1%) of 278 women were re-admitted in the year after discharge from acute care; the median number of days to re-admission was 86 (IQR 35–214), and women who were re-admitted accessed a median of two further acute services (IQR 1–3). In adjusted analyses, reporting a history of childhood trauma (aOR 1.02; 95% CI 1.00- 1.03, p = 0.036), a higher level of difficulties in the mother–infant bond (aOR 1.03; 95% CI 1.01–1.06, p = 0.009) and younger age (aOR 0.95; 95% CI 0.90–1.00, p = 0.066) were associated with re-admission. Conclusion: This study confirms that the role of childhood adverse experiences on mental health is relevant for outcomes in women experiencing acute postpartum psychiatric episodes. Ongoing parent–infant bonding difficulties are also independently associated with re-admission. Perinatal mental health services therefore need to offer evidence-based interventions to address histories of trauma and to support parent–infant bonding to optimise mental health in women following discharge from acute psychiatric services. However, further research is needed to explore what other factors, not measured in our study, are also influential to re-admission. [ABSTRACT FROM AUTHOR]

It has long been proposed that perceptions of threat contribute to greater outgroup negativity. Much of the existing evidence on the threat–prejudice association in the real world, however, is cross‐sectional in nature. Such designs do not adequately capture individual‐level changes in constructs, and how changes in constructs relate to changes in other theoretically relevant constructs. The current research exploited the unique opportunity afforded by the mass COVID‐19 vaccination programme in the United Kingdom to explore whether reductions in pathogen threat coincide with reductions in outgroup prejudice and avoidance. A two‐wave longitudinal study (N1 = 912, N2 = 738) measured British adult's perceptions of COVID‐19 threat and anti‐immigrant bias before and during mass vaccine rollout in the United Kingdom. Tests of latent change models demonstrated that perceived COVID‐19 threat significantly declined as the vaccine programme progressed, as did measures of outgroup avoidance tendencies, but not prejudiced attitudes. Critically, change in threat was systematically correlated with change in outgroup avoidance: those with greater reductions in perceived COVID‐19 threat were, on average, those with greater reductions in outgroup avoidance. Findings provide important and novel insights into the implications of disease protection strategies for intergroup relations during an actual pandemic context, as it unfolds over time. [ABSTRACT FROM AUTHOR]

Background: Anterior capsular contraction syndrome (ACCS) describes the progressive fibrotic phimosis of the anterior capsular bag that usually occurs a few months after cataract surgery. YAG laser anterior capsulotomy (YAGAC) is the most common treatment option due to the low-risk profile of this intervention. Purpose: In this series, we evaluated the outcomes of an advanced nurse practitioner (ANP) in conducting this laser intervention, comparing the results with those of ophthalmologists. Methodology: Our study represents a single-centre, retrospective, continuous case series of 108 eyes that underwent YAGAC due to ACCS between January 2017 and July 2020 at the Birmingham and Midland Eye Centre, the second largest tertiary referral centre in the United Kingdom. Results: The groups treated by ANPs and ophthalmologists were similar in respect to age, gender, and laterality of the laser procedure. Eyes treated by ophthalmologists had significantly more ocular comorbidities (p < .001), the most common of which was glaucoma. Although the complication rate was higher in the ophthalmologist group, it did not reach statistical significance. However, there was a trend toward significance in the retreatment rate, with 8.6% (7/81) of eyes lasered by ophthalmologists requiring further YAGAC, and no repeat procedure was needed in the ANP group. Conclusions: YAGAC leads to good visual outcomes and a low complication rate inbothophthalmologist andANPgroups. Implications: Advanced nurse practitioners can deliver results that are comparable with those of experienced ophthalmologists. [ABSTRACT FROM AUTHOR]

Introduction: Model of Human and Occupational Screening Tool (MOHOST) is a scale used to assess occupational functioning in mental health inpatients which can inform suitable post-discharge placements. However, there is little research on the relationship between scores on Motivation for Occupation (MO) and Pattern of Occupation (PO) subscales of the MOHOST and types of discharge placement. Method: The records of all patients discharged over a 2-year period from a male psychiatric rehabilitation unit were examined. All patients had undergone MOHOST assessments; however, these scores were not a factor in their discharge placement selection. Analyses were done on types of discharge placements (transfer to another psychiatric unit or community discharge) versus predischarge scores in MO and PO of MOHOST. Results: N = 20 and average length of stay was 23 months. There was positive correlation between MO and PO scores and discharge placements (rs = 0.66, p = 0.002; rs = 0.67 and p = 0.001, respectively). Using ordinal logistic regression, for each unit increase of negative score in PO, there was 0.68 increase in the log odds of more restrictive discharge placements, p = 0.008. Conclusion: The study suggests that MOHOST is a useful tool in determining suitable placements for patients being discharged or transferred from psychiatric rehabilitation units. [ABSTRACT FROM AUTHOR]

Background: Relatives of people with psychosis or bipolar disorder experience high levels of distress but are typically not offered the support they need. Online peer forums may offer a solution, but knowledge about who uses them, how, and why is limited. This study reported on online forum use during the Relatives Education and Coping Toolkit (REACT) trial. Objective: We aimed to report who used the forum and why; how sociodemographic factors are associated with participation; the relationship among frequency, type of use, and outcomes; and how the forum was used. Methods: The relationships between key sociodemographic characteristics, levels of forum use, and distress were statistically analyzed. We used thematic and semantic analyses to understand the reasons for relatives joining the forum and the key topics initiated by them. We also used the University Centre for Computer Corpus Research on Language Semantic Analysis System to compare how relatives and REACT supporters (moderators) used the forum. Results: A total of 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59.4% (207/348) of the relatives across the entire age range, with no significant associations between sociodemographic factors and forum participation, or between level or type of use and relatives' distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns, and talk about stressful events. Relatives were most concerned about recent events, negative emotions linked to caring, experiences of conflict or threat, and concerns about suicide. These posts underscored both the challenges the relatives were facing and the fact that they felt safe sharing them in this context. Conclusions: Although only a proportion of REACT participants engaged actively with its forum, they were widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support, and guidance and to offer detailed information about their experiences. The topics raised highlighted the burden carried by relatives and the potential value of easy-access, moderated, peer-supported forums in helping relatives to manage the challenges they faced. [ABSTRACT FROM AUTHOR]

This study aimed to compare characteristics of nurse educators, factors related to teaching global nursing, contents of global education and support and the level of burden of global education and factors related to the burden between nurse educators among top nursing universities in Japan and four English-speaking countries. Intercultural sensitivity is the active desire to motivate oneself to understand, appreciate and accept different cultures. Nurse educators need to be culturally sensitive to teach cultural care to nursing students. This is a cross-sectional exploratory international comparative study using an online survey. Participants were nurse educators with a nurse license in the top 20 in Japan and the top 10 universitiesin the United States, Canada, United Kingdom and Australia (hereafter "English-speaking countries"), respectively. The questions in Google form selected participants by the inclusion criteria. Intercultural sensitivity was measured by the Intercultural Sensitivity Scale. Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and Spearman's correlation coefficients were used for the analyses. Data were collected from October 2023 to January 2024. A total of 144 in Japan (response rate=29.0 %) and 106 educators in English-speaking countries (response rate=2.4 %) were included in the analysis. Nurse educators in Japan had less work experience in foreign countries, had fewer opportunities to take part in cross-cultural interactions and had significantly lower intercultural sensitivity. In both groups, those who had more experience in foreign countries with higher intercultural sensitivity taught global nursing. While in Japan nurse educators who had higher proficiency in non-native languages and those who had more frequently taken part in cross-cultural interactions taught global nursing, in English-speaking countries full-time workers who had attended international academic conferences taught. In Japan, global nursing was a more optional course and the number of contents taught was lower. While participants in Japan had international seminars at universities as support for global nursing education, those in English-speaking countries had faculty members with different cultural backgrounds. Participants in Japan felt more burden for global nursing education. In Japan, more proficient non-native language, more frequent cross-cultural interaction and higher intercultural sensitivities were associated with a lower burden, while teaching other than in their native language, contents taught and performance evaluation were associated with a higher burden in English-speaking countries. Higher intercultural sensitivity, performance evaluation and proficiency in non-native language may be important for nurse educators to teach global nursing and support is necessary to enhance them. [ABSTRACT FROM AUTHOR]

Context: In sprint events, the first 2 steps are used to accelerate the center of mass horizontally and vertically. Amputee athletes cannot actively generate energy with their running-specific prosthesis. It is likely that sprint acceleration mechanics, including step asymmetry, are altered compared with able-bodied athletes. Purpose: To investigate spatiotemporal and kinetic variables of amputee compared with able-bodied sprinters. Methods: Kinematic and kinetic data of the first and second stance were collected from 15 able-bodied and 7 amputee sprinters (2 unilateral transfemoral, 4 unilateral transtibial, and 1 bilateral transtibial) with a motion-capture system (250 Hz) and 2 force plates (1000 Hz). In addition, bilateral asymmetry was quantified and compared between groups. Results: Compared with able-bodied athletes, amputee athletes demonstrated significantly lower performance values for 5- and 10-m times. Step length, step velocity, and step frequency were decreased and contact times increased. Peak horizontal force and relative change of horizontal velocity were decreased in both stances. Peak vertical force and relative change of vertical velocity were lower for the amputee than the able-bodied group during the first stance but significantly higher during the second stance. During the first stance, able-bodied and amputee sprinters displayed a similar orientation of the ground-reaction-force vector, which became more vertically orientated in the amputee group during second stance. Amputee sprinters showed significantly greater asymmetry magnitudes for vertical force kinetics compared with able-bodietd athletes. Conclusion: A running-specific prosthesis does not replicate the function of the biological limb well in the early acceleration phase. [ABSTRACT FROM AUTHOR]

Aims: Complementary medicine therapists such as traditional acupuncturists are a large resource for supporting public health targets to improve health behaviours. Our objectives were to determine the prevalence and patterns of UK acupuncturists' provision of lifestyle change support, test theory-based hypotheses about facilitators and barriers to supporting lifestyle changes and to explore associated characteristics and attitudes. Methods: A mixed methods design in which British Acupuncture Council members (Sept 2019-April 2020) completed an online questionnaire assessing prevalence of lifestyle change support, typical patterns across patients and behaviours, Theory of Planned Behaviour constructs, practitioner characteristics and open-text responses regarding additional behaviours and clinical decisions to introduce lifestyle change. Results: Three hundred fifty-two traditional acupuncturists participated (Mean age = 51.5 years, SD 9.9; 81.8% (n = 288) female). 57.7% (n = 203) reported offering support for lifestyle change during their most recent consultation. 91.7% (n = 323) reported supporting lifestyle change 'always or most of the time' for patients with chronic conditions and 67.9% (n = 239) reported this for patients with acute conditions. The pattern of typical support for different health behaviours ranged from 44.6% (n = 157) for smoking reduction (acute conditions) to 95.2% (n = 335) for diet support (chronic conditions). A linear regression model found that frequency of support for lifestyle change in acute patients was predicted by acupuncturists' attitudes to both clinical role and importance of health behaviours, confidence in their ability to provide lifestyle change support and use of fewer behaviour change techniques. The decision to first offer lifestyle change support was guided by perceived patient receptiveness, whether presenting condition/diagnosis were likely to improve with lifestyle change and whether a strong therapeutic relationship was established. Conclusions: Traditional acupuncturists' reports suggest their work supports key public health targets for promoting healthy behaviours. Less frequent support for alcohol/smoking may reflect user characteristics but may suggest training needs for acupuncturists. Increase could be made for support in acute presentations, however the importance of patient receptiveness, linking advice to condition, and therapeutic alliance should be explored further. There may be important differences between acupuncture practice and mainstream healthcare (e.g. high level of contact, longer visits, holistic approach) which impact mechanisms of action of behaviour change. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Eating disorders (ED), disordered eating (DE) and low energy availability (LEA) can be detrimental to health and performance. Previous studies have independently investigated the prevalence of ED, DE or LEA; however, few combined methods have identified risk within female athletes. The aim of this study was to identify the prevalence of ED, DE and LEA in UK-based female athletes and investigate whether associations exist between age, competition level and primary sport. The Female Athlete Screening Tool (FAST) and Low Energy Availability in Females Questionnaire (LEAF-Q) were used in a cross-sectional study design. A total of 112 responses eligible for analysis were received. A total of 16%, 44% and 53% of female athletes were at risk of ED (FAST: >94), DE and LEA, respectively. Competition level (recreational, competitive or professional athletes; fishers, p ≤ 0.05) influenced and was a predictor of FAST (R2 = 0.076, F(1,110) = 10.067, p ≤ 0.05, variance inflation value; VIF = 1.0) whereas age influenced (age: H(2) = 13.128, p ≤ 0.05), and was a predictor (R2 = 0.144, F(2,109) = 9.170, p ≤ 0.05, VIF = 1.0) of LEAF-Q. A positive correlation was observed between FAST and LEAF-Q scores (R = 0.496, p ≤ 0.05). Age and competition level may be predicting risk factors of ED/DE and LEA within female athletes; however, further research is required to support the findings of this present study. [ABSTRACT FROM AUTHOR]

Background: Increased demand for nurse practitioners emphasizes the importance of consistent and ongoing collection of data to provide a better understanding of the NNP workforce and to promote retention and recruitment of NNPs. Purpose: To understand how work environment and work hours influence job or career satisfaction. Methodology: The National Association of Neonatal Nurse Practitioners in collaboration with the National Certification Corporation emailed an online survey to all 6,558 certified neonatal nurse practitioners (NNPs) in 2020 with 845 (12.8%) responding. Subjects included those with responsibilities in direct patient care, transport NPs, faculty/directors, and advanced practice registered nurse coordinators/managers/administrators. Results: Satisfaction with career choice as an NNP was reported as very satisfied by 58% (n = 493) and mostly satisfied by 37% (n = 310). Satisfaction with current job as an NNP was reported as very satisfied for 30% (n = 252), with 51% being mostly satisfied (n = 435). Age influenced satisfaction scores, with NNPs aged 61 years or older having a higher mean score than NNPs aged 31-40 years (p =.041). The majority of NNPs did not use all of their available paid time off (72%; n = 609) and respondents worked an additional 248 extra hours per year. NNPs experience bullying (58%) and/or lateral violence (32%). Seventeen percent have called in sick for mental health reasons (n = 147). Conclusions: Neonatal nurse practitioners' satisfaction is multifactorial. Those who reported taking time off for self-prescribed mental health indicated less job satisfaction, more work hours, poor work/life balance, and a less-than-optimum work environment. Implications: Overall, NNPs are satisfied with their career choice but are less satisfied with their job choice. Understanding factors that influence mental well-being and job satisfaction will improve recruitment and retention of nurse practitioners. [ABSTRACT FROM AUTHOR]

Intimate partner homicides are often situated within the context of domestic abuse, and although less prevalent than domestic abuse, there have been several multi‐agency approaches to understanding the risk for these fatal crimes. Domestic Homicide Reviews (DHRs) were introduced in 2011 to provide information to help with assessing such risk. This paper aims to analyse DHRs in England and Wales to investigate/determine risk factors for domestic homicide following intimate partner abuse. All publicly available DHRs published between July 2011 and November 2020 where the victim and perpetrator were or had been intimate partners (N = 263) were retrieved from Community Safety Partnership websites in England and Wales. A quantitative design was used to extract data from DHRs, and descriptive and inferential statistics were generated by SPSS 26. Findings identified risk factors relating to domestic abuse, including stalking, separation, and the victim being in a new relationship. Sociodemographic risk factors included higher levels of deprivation, lower income and higher barriers to housing and services. This highlights the role of both individual and sociodemographic factors in domestic homicides, and particularly the need for greater socioeconomic security for victims of domestic abuse. In conclusion, though much of the data is in line with previous research, our analysis highlights the pivotal role of regional poverty, with comfortable socioeconomic conditions offering protection against intimate partner homicides. This research suggests important directions for future research and makes a valuable contribution to a more in‐depth understanding of the relationship between domestic abuse and intimate partner homicide. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties of the Ego Resiliency Scale-Revised (ER89-R). Though support exists for a multidimensional conceptualisation using classical test theory approaches (i.e., a higher-order model comprising Openness to Life Experiences and Optimal Regulation factors), this measure has not been subjected to Rasch analysis. Accordingly, this paper evaluated the higher-order model via confirmatory factor analysis (CFA) before assessing Openness to Life Experiences and Optimal Regulation components using Rasch analysis. CFA, using a general population sample (N = 2009), supported the higher-order factor structure. Openness to Life Experiences and Optimal Regulation scales met Rasch model assumptions. Specifically, good item/person fit and item/person reliability, and evidence of unidimensionality. Moreover, most items displayed gender invariance. Overall, findings supported the higher-order conceptualisation of the ER89-R, and indicated that the Openness to Life Experiences and Optimal Regulation scales are relatively useful measures of ego resiliency components in a general population sample. [ABSTRACT FROM AUTHOR]

Background Unintentional carbon monoxide (CO) poisoning poses a public health challenge. The UK National Poisons Information Service (NPIS) provides advice to healthcare professionals via the online database, TOXBASE®, and a 24-hour telephone line. Our aim was to analyse all CO-related enquiries to the NPIS. Methods We analysed enquiries regarding unintentional CO exposure (1st July 2015-30th June 2019). Information on patient demographics, CO source and location, clinical features and poisoning severity was collected from telephone enquiries and TOXBASE accesses. Results 2970 unintentional non-fire-related CO exposures were reported. Exposures occurred commonly in the home (60%) with faulty boilers frequently implicated (27.4%). Although five fatalities were reported, 68.7% of patients experienced no or minor symptoms only (headache most frequently reported). Despite being the gold standard measurement, blood carboxyhaemoglobin concentration was only recorded in 25.6% patients, with no statistically significant correlation with severity. Conclusions Unintentional CO exposures in the UK commonly occur in domestic settings and although are generally of low severity, fatalities continue to occur. Carboxyhaemoglobin measurement is important to confirm exposure but further work is required to assess its validity as a prognostic indicator in CO exposure. Public health policy should continue to focus on raising awareness of the dangers of CO. [ABSTRACT FROM AUTHOR]

Background Measurement of UK food insecurity has historically been inconsistent, making it difficult to understand trends. This study contributes by reporting and analysing data from a national survey conducted in line with UN Food and Agriculture Organization (FAO) recommendations and standard methods, providing an internationally comparable pre-coronavirus disease 2019 (COVID-19) snapshot of food insecurity. Methods Data came from a nationally representative 2019 UK sample (N  = 2000) surveyed by Ipsos-Mori. Prevalence of food insecurity was assessed using the UN FAO Food Insecurity Experience Scale. Logistic regression was used to model food insecurity in relation to geographic and socio-demographic variables. Results Severe food insecurity was reported by 3% of the sample, an increase of 66.7% over the last directly comparable UK analysis (Gallup World Poll data from 2016 to 2018). Indication of some degree of food insecurity was reported by 14.2% of the sample and tended to be higher amongst younger age groups, those on lower incomes, and home renters (as opposed to owners). No geographic variables were significantly associated with food insecurity prevalence. Conclusions The finding that prevalence of severe food insecurity was already increasing before the COVID-19 pandemic, across all areas of the UK, is cause for concern. Our results provide an important benchmark for assessing the impact of COVID-19 on food insecurity. [ABSTRACT FROM AUTHOR]

At the Open University in the UK, students taking undergraduate degree qualifications in areas such as Data Science and Economics are now the largest cohort of students on a second-year undergraduate statistics module, originally written for specialist mathematics and statistics students. This paper outlines an ongoing project to identify how more targeted support could be provided to students who are studying non-mathematics and statistics qualifications. This has involved engaging all the tutors who provided support in the project to create a new way of adapting their teaching styles and tutorial content. By grouping students who had similar qualification goals together and linking these groups to individual tutors, the new way of working created an atmosphere where students feel able to share their own misunderstandings and see how statistics is useful within their chosen qualifications. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to co-design a falls prevention education programme with aged care home residents and staff and evaluate its feasibility. The intention of providing the education programme was to assist residents to stay safe and mobile whilst reducing their risk of falling. Design/methodology/approach: A two-phase mixed methods participatory design using a resident (n = 6) and care staff (n = 5) consumer engagement panel, pre- and post-programme resident (n = 35) survey and semi-structured care staff interviews (n = 8) was undertaken in two countries. Findings: A poster, brochure, video and staff education guide featuring 12 safety messages depicting fall prevention behaviours were co-designed. Residents, supported by staff, perceived the falls prevention education programme as enjoyable and informative, but there were no significant differences in capability, opportunity or motivation. However, several residents were observed enacting fall prevention behaviours such as "If I feel unwell, I'll ring the bell" and waiting for staff assistance. Challenges to programme demand, acceptability and implementation which may have impacted residents' exposure and engagement with the programme were identified, along with recommendations to improve feasibility. Practical implications: When developing falls prevention education programmes partnering with residents and staff, providing choices to meet personal and aesthetic preferences along with frequent, shorter duration learning opportunities are important for translating education messages into actions. Originality/value: The use of bespoke resources, novel rhymes, positive messages emphasising safety and co-designing with residents themselves was a welcomed point of programme difference. [ABSTRACT FROM AUTHOR]

Motivation It has become routine in neuroscience studies to measure brain networks for different individuals using neuroimaging. These networks are typically expressed as adjacency matrices, with each cell containing a summary of connectivity between a pair of brain regions. There is an emerging statistical literature describing methods for the analysis of such multi-network data in which nodes are common across networks but the edges vary. However, there has been essentially no consideration of the important problem of outlier detection. In particular, for certain subjects, the neuroimaging data are so poor quality that the network cannot be reliably reconstructed. For such subjects, the resulting adjacency matrix may be mostly zero or exhibit a bizarre pattern not consistent with a functioning brain. These outlying networks may serve as influential points, contaminating subsequent statistical analyses. We propose a simple Outlier DetectIon for Networks (ODIN) method relying on an influence measure under a hierarchical generalized linear model for the adjacency matrices. An efficient computational algorithm is described, and ODIN is illustrated through simulations and an application to data from the UK Biobank. Results ODIN was successful in identifying moderate to extreme outliers. Removing such outliers can significantly change inferences in downstream applications. Availability and implementation ODIN has been implemented in both Python and R and these implementations along with other code are publicly available at github.com/pritamdey/ODIN-python and github.com/pritamdey/ODIN-r, respectively. Supplementary information Supplementary data are available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

Background: Women with COVID-19 experienced numerous concerns and doubts about the safety of breastfeeding their babies, and lack of support may have impacted breastfeeding practices. This study aims to compare breastfeeding beliefs, practices, and contact with healthcare professionals regarding the level of postnatal feeding support provided during the COVID-19 pandemic in Brazil, South Korea, Taiwan, Thailand, and the United Kingdom. Methods: A multi-country cross-sectional study was conducted with postnatal women in five countries. Women up to six months postpartum were invited to complete an online survey concerning the transmission of preventative measures, beliefs toward breastfeeding, infant feeding practices in the last 24 hours and experiences of postnatal infant feeding support between July to November 2021. Bivariate and multivariate analyses were performed to identify the association. Results: Of the 3,253 eligible responses received, 39.5% of children were aged between one and two months, but in Taiwan (36%) and South Korea (42.8%) they were between three and four months. The mean of the belief score was significantly different among countries (p < 0.0001). Women in Brazil and the UK had a higher rate of breastfeeding at the breast (90.7% and 85.4%, respectively) compared to the three Asian countries (p < 0.0001) while feeding with expressed breastmilk in Thailand (59.9%), Taiwan (52.6%), and South Korea (50.4%) was higher than the others (p < 0.0001). Brazil and UK mothers (mean = 16.0 and 14.5 respectively) had a higher mean score for belief toward breastfeeding during the COVID-19 than the others. These results are inversely associated with breastfeeding but positively related to formula feeding practice. Postnatal feeding support during the COVID-19 pandemic was mainly provided by healthcare professionals (67.1%) and peers / family through face-to-face personal contact (51.6%) in all countries. Conclusion: Some differences were found in breastfeeding beliefs during the COVID-19 pandemic in Asian countries. A positive breastfeeding belief was associated with the practice of breastfeeding at the breast. Women from all countries received postpartum infant feeding support from health professionals and peers / family through personal contacts. Governments need to emphasize and disseminate the importance of breastfeeding safety, especially in Asian countries. [ABSTRACT FROM AUTHOR]