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The purpose of the current study was to use the infant sibling design to explore whether proband traits of autism and ADHD could provide information about their infant sibling's temperament. This could help us to gain information about the extent to which infant temperament traits are differentially associated with autism and ADHD traits. We used parent-ratings of autistic traits and ADHD traits (CRS-3) in older siblings diagnosed with autism (age range 4 to 19 years), and their infant siblings' temperament traits (IBQ) at 9 months of age in 216 sibling pairs from two sites (BASIS, UK, and EASE, Sweden) to examine associations across siblings. We found specific, but modest, associations across siblings after controlling for sex, age, developmental level and site. Proband autistic traits were specifically related to low levels of approach in the infant siblings, with infant developmental level explaining part of the variance in infant approach. Proband ADHD traits were specifically related to high levels of infant activity even after controlling for covariates. Our findings suggest that proband traits of autism and ADHD carry information for infant sibling's temperament, indicating that inherited liability may influence early emerging behaviours in infant siblings. The impact of sex, age, developmental level and site are discussed.

Engagement with primary sources is a key feature of arts and humanities subjects, particularly classics and ancient history. Recent instructional trends emphasise integrating skills with content, particularly in the first year of higher education. We investigate how successfully first-year university students used a variety of sources in an integrated skills and content course, through analysis of 84 final essays. Most students used four to nine sources in a 1500 word essay, but only one type of ancient source. The findings express the need to move from debates about whether to integrate skills or not, to greater discuss "how" key discipline-specific skills are integrated into content-based courses. Cognitive apprenticeship theory, and a thematic approach used in museum education, are used to reflect on the findings and discuss how teachers might better support students in this key aspect of the discipline.

A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories.

Years before the term "visual literacy" came to light in 1969 (Felten, 2008; Reis, 2013), British designer and art educator, Kurt Rowland, wrote, illustrated, and meticulously designed a series of art education textbooks called "Looking and Seeing." The intent was to teach visual awareness in a way that increased the capacity for visual understanding and thinking. We explore Rowland's notion of a "grammar of vision," as an idea ahead of the times, explicating its features, and appraising the import and originality of his pedagogy. His lessons on "visual grammar" were intended to provide a way to teach students how to decipher and analyze any and all visual information. We argue that Rowland has been unduly overlooked by the academic community and is worthy of assessment and further study. Now, in an educational climate that emphasizes 21st-century skills, attention to visual literacy and critical thinking are essential. This article examines the ways in which Rowland's ideas of a visual education are relevant today, in particular with links to the National Core Arts Standards (NCAS) "responding" and "connecting."

This article reports the findings from an institutional case study into the work placement experience of undergraduate international students studying at a UK-based university. Given the centrality and importance of the employability and internationalisation agendas in higher education, little published literature considers both and how they impact upon the work placement experience of international students. With past increases in international student recruitment numbers and the drive for students, regardless of their nationality, to gain work experience, there is a need for institutions to better understand work placement from the international students' perspective. Findings revealed that challenges exist in finding and securing work placement, with critical themes emerging to include placement information, visa rules, culture differences, prior work experience, academic preparation for placement and academic writing ability. A support framework is proposed to assist institutions to consider how they could align their practices to meet international students' work placement and employability needs.

Objectives: The addition of fluoride to community drinking water supplies has been a long‐standing public health intervention to improve dental health. However, the evidence of cost‐effectiveness in the UK currently lacks a contemporary focus, being limited to a period with higher incidence of caries. A water fluoridation scheme in West Cumbria, United Kingdom, provided a unique opportunity to study the contemporary impact of water fluoridation. This study evaluates the cost‐effectiveness of water fluoridation over a 5–6 years follow‐up period in two distinct cohorts: children exposed to water fluoridation in utero and those exposed from the age of 5. Methods: Cost‐effectiveness was summarized employing incremental cost‐effectiveness ratios (ICER, cost per quality adjusted life year (QALY) gained). Costs included those from the National Health Service (NHS) and local authority perspective, encompassing capital and running costs of water fluoridation, as well as NHS dental activity. The measure of health benefit was the QALY, with utility determined using the Child Health Utility 9‐Dimension questionnaire. To account for uncertainty, estimates of net cost and outcomes were bootstrapped (10 000 bootstraps) to generate cost‐effectiveness acceptability curves and sensitivity analysis performed with alternative specifications. Results: There were 306 participants in the birth cohort (189 and 117 in the non‐fluoridated and fluoridated groups, respectively) and 271 in the older school cohort (159 and 112, respectively). In both cohorts, there was evidence of small gains in QALYs for the fluoridated group compared to the non‐fluoridated group and reductions in NHS dental service cost that exceeded the cost of fluoridation. For both cohorts and across all sensitivity analyses, there were high probabilities (>62%) of water fluoridation being cost‐effective with a willingness to pay threshold of £20 000 per QALY. Conclusions: This analysis provides current economic evidence that water fluoridation is likely to be cost‐effective. The findings contribute valuable contemporary evidence in support of the economic viability of water fluoridation scheme. [ABSTRACT FROM AUTHOR]

Forensic mental health services play a key role in the diversion, treatment, rehabilitation, and supervision of offenders with mental health problems in Europe. Private sector providers are increasingly commissioned to provide secure care for service users. Questions have been raised about the effectiveness of the private sector providers. A sample of 229 patients from low, and medium secure psychiatric services in the United Kingdom was analyzed to determine differences in restrictive practices, adverse service user incidents, and service user characteristics between service users admitted to private sector or publicly funded hospitals. Service users with a diagnosis of a personality disorder, and those who had multiple psychiatric diagnoses were disproportionately placed in the private sector. Greater prevalence of seclusion, physical restraint, verbal aggression toward staff, physical violence toward staff and other service users, property damage, and self-harm were observed in private sector service users. Further attention is warranted around the decision-making processes that allocate people to private versus publicly funded care, potential sources of bias in admission characteristics should be taken into account when interpreting poorer clinical outcomes in the private sector. [ABSTRACT FROM AUTHOR]

This document provides an economic outlook for the UK, focusing on fiscal policy, monetary policy, prices, and wages. The forecast suggests that borrowing may exceed expectations, and the reduction in borrowing may fall short. The new government's approach to fiscal policy will play a significant role, with potential for more expansionary fiscal policy. Interest rate cuts and a gradual appreciation of the pound are predicted. Inflation is expected to rise above the Bank of England's target in late 2024. The UK economy experienced a recovery in H1 2024, with GDP rising by 0.7% in Q1 2024. Consumer spending has been weak despite growth in real household incomes. The housing market saw a strong recovery in early 2024 but has slowed down due to rising mortgage rates. Business investment has been resilient, and the labour market is loosening. The trade deficit has narrowed, but the primary and secondary income accounts moved further into deficit. Goods exports have struggled, but the data may be exaggerated and is expected to reverse soon. The current account deficit is forecasted to remain stable, and the household sector surplus has increased while the government deficit remains wide. [Extracted from the article]

The article discusses the flaws in the UK's fiscal policy and proposes reforms to improve economic growth and reduce government debt. The current fiscal rules lack credibility and allow governments to manipulate the system. The article suggests three changes to the fiscal rules: shortening the time horizon, changing the deficit target, and removing the impact of Asset Purchase Facility losses. Implementing these changes could increase GDP and lower the debt-to-GDP ratio. The article also recommends changes to the government's approach to fiscal policy and suggests focusing on public investment and funding public services. The proposed changes to the fiscal rules and policy mix could lead to stronger growth and falling debt levels. The article concludes by highlighting the importance of supply-side reforms in further improving economic outcomes. [Extracted from the article]

The UK's economic outlook is positive, with GDP growth forecasted to be 1.1% in 2024 and 2% in 2025. The new government, led by the opposition Labour party, is expected to implement the planned fiscal consolidation, which will have a significant impact on the pace of economic recovery. The Monetary Policy Committee is considering a rate cut in August, with further cuts expected in November. The housing market is expected to have a soft landing, and fiscal policy will tighten, although the impact of the new measures is smaller than the previous government's plans. The government's plans for planning system reform may provide a boost to economic growth. [Extracted from the article]

This paper discusses the provision of easy information about research to people with learning disabilities, their families and supporters. We explore some different ways we have used over the past 25 years, to make sure that research has the greatest impact both in the UK and abroad. We discuss first the process of providing easy-read versions of research at the Norah Fry Research Centre, where two of us, Goodwin and Townsley, worked on a series called Plain Facts funded by the Joseph Rowntree Foundation. We have always used different media such as audio, but more recently, have started to use video as a way of getting information out to people with learning disabilities. We aim to present the "easy information" work done at Norah Fry, to reflect on its impact, and set it within the context of the move towards accessible information more generally, questioning some of the premises about "impact" on which accessible information is based.

This document provides a detailed forecast for the UK economy, discussing fiscal and monetary policies. It mentions that public sector borrowing has been lower than expected, but higher interest rates and downgraded growth forecasts may lead to the government missing its fiscal rules. Government spending has increased more than anticipated due to inflation and public sector pay settlements, but this has been offset by robust growth in tax revenues. The forecast predicts a decrease in borrowing in the coming years. The document also states that interest rate hikes are unlikely until next summer and that inflation has been dropping, but strong pay growth may slow down the descent. The UK economy is expected to experience near-stagnation for the rest of 2023 and into 2024, with weak growth since early 2022. However, new GDP estimates show that the economy recovered more strongly in 2021 than previously thought. Consumer spending has been robust, supported by falling inflation and strong pay growth, but the housing market remains weak. Overall, GDP is forecasted to rise 0.7% this year, followed by 0.4% in 2024. Business investment has been stronger than expected, but it may not be sustained due to higher interest rates and a sluggish economy. The labor market is showing signs of weakening, with the unemployment rate forecasted to rise but remain relatively low. The UK's trade deficit narrowed in Q2 2023, but weak economic growth will limit rises in exports and imports. The report also provides data on sectoral [Extracted from the article]

Background: Delirium affects over 20% of all hospitalised older adults. Delirium is associated with a number of adverse outcomes following hospital admission including cognitive decline, anxiety and depression, increased mortality and care needs. Previous research has addressed prevention of delirium in hospitals and care homes, and there are guidelines on short-term treatment of delirium during admission. However, no studies have addressed the problem of longer-term recovery after delirium and it is currently unknown whether interventions to improve recovery after delirium are effective and cost-effective. The primary objective of this feasibility study is to test a new, theory-informed rehabilitation intervention (RecoverED) in older adults delivered following a hospital admission complicated by delirium to determine whether (a) the intervention is acceptable to individuals with delirium and (b) a definitive trial and parallel economic evaluation of the intervention are feasible. Methods: The study is a multi-centre, single-arm feasibility study of a rehabilitation intervention with an embedded process evaluation. Sixty participants with delirium (aged > 65 years old) and carer pairs will be recruited from six NHS acute hospitals across the UK. All pairs will be offered the intervention, with follow-up assessments conducted at 3 months and 6 months post-discharge home. The intervention will be delivered in participants' own homes by therapists and rehabilitation support workers for up to 10 intervention sessions over 12 weeks. The intervention will be tailored to individual needs, and the chosen intervention plan and goals will be discussed and agreed with participants and carers. Quantitative data on reach, retention, fidelity and dose will be collected and summarised using descriptive statistics. The feasibility outcomes that will be used to determine whether the study meets the criteria for progression to a definitive randomised controlled trial (RCT) include recruitment, delivery of the intervention, retention, data collection and acceptability of outcome measures. Acceptability of the intervention will be assessed using in-depth, semi-structured qualitative interviews with participants and healthcare professionals. Discussion: Findings will inform the design of a pragmatic multi-centre RCT of the effectiveness and cost-effectiveness of the RecoverED intervention for helping the longer-term recovery of people with delirium compared to usual care. Trial registration: The feasibility study was registered: ISRCTN15676570 [ABSTRACT FROM AUTHOR]

Student dissatisfaction with feedback is widely acknowledged in Higher Education. This has resulted in investigations that have offered suggestions for improving student satisfaction levels. This article examines one area of student concern by focusing on the feedback that students receive on examinations. The article reports the findings of student surveys and focus groups with regard to attitudes towards and experience of examinations. In addition, the article reviews the findings of an exemplar exercise that is highlighted as a particular way of enhancing feedback practices on examinations. The research findings are the product of a three-year study into student experience of feedback that paid particular attention to the case of dialogue as a means of improving the student experience. Analysis of the findings emphasise the need to tackle the feedback deficit on examinations and in turn lead to a number of recommendations for creating a model of dialogic exam feedback.

Background: Previous studies based on death certificates have found professional soccer players were more likely to die with neurodegenerative diseases, including dementia. Therefore, this study aimed to investigate whether retired professional male soccer players would perform worse on cognitive tests and be more likely to self-report dementia diagnosis than general population control men. Methods: A cross-sectional comparative study was conducted between August 2020 and October 2021 in the United Kingdom (UK). Professional soccer players were recruited through different soccer clubs in England, and general population control men were recruited from the East Midlands in the UK. We obtained self-reported postal questionnaire data on dementia and other neurodegenerative diseases, comorbidities and risk factors from 468 soccer players and 619 general population controls. Of these, 326 soccer players and 395 general population controls underwent telephone assessment for cognitive function. Results: Retired soccer players were approximately twice as likely to score below established dementia screening cut-off scores on the Hopkins Verbal Learning Test (OR 2.06, 95%CI 1.11–3.83) and Verbal Fluency (OR 1.78, 95% CI 1.18–2.68), but not the Test Your Memory, modified Telephone Interview for Cognitive Status, and Instrumental Activities of Daily Living. Analyses were adjusted for age, education, hearing loss, body mass index, stroke, circulatory problems in the legs and concussion. While retired soccer players were younger, had fewer cardiovascular diseases and other morbidities and reported healthier lifestyles, 2.8% of retired soccer players reported medically diagnosed dementia and other neurodegenerative disease compared to 0.9% of controls (OR = 3.46, 95% CI 1.25–9.63) after adjustment for age and possible confounders. Conclusions: UK male retired soccer players had a higher risk of performing below established cut-off scores of dementia screening tests and were more likely to self-report medically diagnosed dementia and neurodegenerative diseases, despite having better overall physical health and fewer dementia risk factors. Further study is needed to determine specific soccer-related risk factors. [ABSTRACT FROM AUTHOR]

Background Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. Aims The aim of this work was to develop recommendations to guide all research relevant to older people. Methods A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. Results A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. Conclusion Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research. [ABSTRACT FROM AUTHOR]

In this research, we examine the relationship between customer satisfaction with water and wastewater services, demographic factors, communication with the utility, and perceived trustworthiness. Through a survey of the UK public (n = 7 6 0), we found that 77% of the respondents stated they were satisfied with their water and wastewater services. Statistical analysis highlighted significant demographic differences in the level of satisfaction, particularly by age, with higher satisfaction in older respondents. We found that the degree to which respondents think their water utility can be trusted to provide accurate information predicted satisfaction, as did more frequent engagement with a water utility's social media. More frequently contacting a water utility or discussing water services with friends and family both negatively predicted satisfaction. Meeting the public's expectations for accurate and timely information is coupled with their perceptions of a water utility's trustworthiness and their satisfaction with water and wastewater services. Water utilities may increase the satisfaction of their customers through strategies and initiatives that are attentive to the credibility of the information they provide and the means through which they provide it. In summary, our research indicates that the water sector's ambition to develop more diverse (and inclusive) customer engagement experiences, including through online platforms and social media, may deliver benefits (particularly with the less engaged and younger age groups across varying regional water governance contexts) that complement the overall efforts to build trust and satisfaction, but we acknowledge that these are complex long-term processes. [ABSTRACT FROM AUTHOR]

This study examined sex differences in reading skill and reading motivation, investigating whether these differences could be better accounted for by sex, or by gender identity. One hundred and eighty-two primary school children (98 males) aged 8-11 completed a reading comprehension assessment, reading motivation questionnaire and a gender role questionnaire. While there were no sex differences in reading skill or extrinsic reading motivation, girls had significantly higher intrinsic reading motivation. However, responses to intrinsic motivation were better explained by gender identity than sex. In addition, a feminine identity was more closely associated with many different aspects of reading motivation than a masculine identity. Implications for our understanding of sex differences in reading are discussed. (Contains 3 tables.)

Purpose: The purpose of this paper is to introduce the key themes in the area of the impact of demographic change on young workers and older workers in relation to education, skills and employment, as discussed in the papers included in this section. The authors have also drawn upon data from their project "From Young Workers to Older Workers" as a context for the papers. Design/methodology/approach: This paper draws out the main themes from the papers contained within this section and presents original data from interviews with 97 older workers who were interviewed at two points in time--labour market entry and labour market exit. Findings: The selection of papers in this section is outlined, as well as offering some findings from the authors' research on older workers. Originality/value: The papers in this section, including this paper, offer an overview of some of the key debates in relation to the impact of demographic change on both young workers and older workers. (Contains 1 table.)

Bioethics is an increasingly important part of the biosciences curriculum at school and in higher education, but few science teachers have much experience of teaching the subject in an engaging or interactive manner. This article sets out a session that allows students to practise the skills of ethical thinking and ethical debate in a relevant context as members of an "ethics committee". They can then compare their decision with the opinions of the group as a whole as well as explore the resolution of the issue in the real world. The session can be easily adapted to a range of audiences, and has been trialled with primary and secondary school children, undergraduates in medicine and the biosciences, and adults as part of university outreach events. (Contains 2 tables.)

There is a notable absence in contemporary rural studies--of both a theoretical and empirical nature--concerning the changing nature of rural local government. Despite the scale and significance of successive rounds of local government reorganisation in the UK, very little has been written on this topic from a rural perspective. Instead research on local political change has tended to concentrate on local governance and local partnerships--on the extra-governmental aspects of the governance system--rather than on local government itself. In contrast, this paper draws upon strategic-relational state theory to explore the changing structures and institutions of rural local government, and analyse how these can be related to the changing state strategies of those groups which are politically powerful in rural areas. In this respect, the paper draws on current and previous rounds of local government reorganisation to illustrate how new objects of governance, new state strategies and new hegemonic projects are emerging as a consequence of such restructuring processes. (Contains 3 figures.)

Using previously unanalysed data from Norbert Elias's lost study of young workers in Leicester--the "Adjustment of Young Workers to Work Situations and Adult Roles" (1962-1964), and data from a subsequent restudy of the same respondents in 2003-2005, this paper focuses on three main themes. First, we critically examine the concept of transition as it is currently used in education and youth research. We argue that the vast majority of what is written about the transition process focuses upon how the process has changed over time. However such approaches, whilst clearly documenting important aspects of social change, ignore and underestimate continuities and similarities in the young people's experiences of transition, regardless of their spatial and temporal location. For example, despite significant labour market changes in the UK, young people still have to make the transition from full-time education to whatever follows next, be it employment, unemployment or further and higher education. Second, we examine the young workers' experiences and perceptions of the transition process in the 1960s. Building upon analyses offered elsewhere the data suggests that the young person's experiences of school to work transitions in the 1960s had many similarities to the transitional experience today--namely that, as now, the transition process was characterised by complexity, uncertainty and risk. Finally, the impact of these early transition experiences on subsequent careers are also examined as revealed in the life history interviews of the restudy. Despite a drastically changing local labour market, and the fact that most of the workers were no longer working in the industries of their youth, the analysis reveals the sample retained a strong sense of occupational identity based on their initial transition experiences. The paper concludes by highlighting the significance of the findings of this particular data set. The data is unique because it provides a rare insight of the outcomes of decisions made by school leavers some forty years ago on their experiences of the labour market. As such it provides an invaluable glimpse of the lasting impact of the school to work transition on individual working lives. (Contains 1 table and 2 notes.)

Purpose: The paper alerts small business employers to new dictates of the Disability Discrimination Act (2005) as it applies to learning disabilities. Then the "Learning to Work" project featured in the paper offers small business employers a set of approaches and methods for the identification of a learning-disabled young adult candidate's training needs. Design/methodology/approach: Interviews were carried out with 12 of the 52 companies in which the Breakaway-supported employment service, operating from the Southdown Housing Association, has so far secured employment for people with learning disabilities. Findings: Comments from employers in the survey represented predominantly very favourable experiences with the learning-disabled individuals, mixed with some reservations about their need for additional training time, and their relative inflexibility in response to change of work routines. Research limitations/implications: The investigation was confined to SMEs in Sussex. As they stand, the methods could be used in different business sectors, but further research is planned on elicitation of candidates' personal constructs, resource modelling, and continuous training cycles. Originality/value: Recognised supported employment models were used but significantly adapted. Some methods used in the paper were new. (Contains 5 figures. Questionnaire A: a short questionnaire on learning disability and supported employment is appended.)

The United Kingdom National Data Centre, on behalf of the UK government, is responsible for handling the analysis and assessment of radionuclide data from the International Monitoring System—the verification system operated and maintained by the Comprehensive Nuclear-Test-Ban Treaty Organisation. A series of custom-developed software packages have been implemented for the analysis of both Noble Gas and Particulate sampling data and the subsequent source parameter estimation of radionuclide detection events. These include a radionuclide pipeline for the download, analysis, sorting and archiving of radionuclide data, as well as an atmospheric transport modelling pipeline for performing simulations at varying degrees of fidelity. A new software package, CARVE, provides the capability to interrogate radionuclide detection events and assess their relevance in the context of the Treaty using interactive mapping. [ABSTRACT FROM AUTHOR]

Introduction: Antivirals, such as molnupiravir, and SARS-CoV-2 neutralising monoclonal antibodies (nMAbs), such as sotrovimab, reduced the risk of hospitalisation and death in clinical trials of high-risk non-hospitalised patients with Covid-19. However, the real-world benefits of these drugs are unclear. Aims: To evaluate the characteristics and outcomes of high-risk patients referred for outpatient antiviral or nMAb treatment for symptomatic Covid-19. Methods: The records of patients referred to a large UK Covid Medicines Delivery Unit (CMDU) over nine weeks (December 2021-February 2022) were reviewed. Data were collected on demographics, referral indications, vaccination, deprivation, treatment, complications, hospital admission, and mortality. Results: 1820 patients were referred to the CMDU, with 604 (33.2%) suitable for further assessment. 169 patients received sotrovimab, 80 patients received molnupiravir, 70 patients declined treatment, and 266 were ineligible for treatment because of resolving symptoms. There were trends towards higher proportions of female and white patients, lower deprivation scores, and malignancy- or transplant-related indications in the groups receiving treatment compared with untreated patients. Covid-19-related hospitalisations occurred in 1.2% of the treated group and 3.0% of the untreated group indicating a potential treatment effect, however Covid-related hospitalisations were lower than reported in the original clinical trials (2.2% compared with 7–10%). Conclusion: The referral pathways for outpatient treatment of Covid-19 are inefficient, and the UK system may not be serving all groups equitably. Hospitalisation with Covid-19 was rare regardless of treatment. Ongoing service evaluation is required to ensure efficient use of resources for the outpatient management of Covid-19. [ABSTRACT FROM AUTHOR]

Data from 1960s British research on school-to-work transition (n=882) revealed young people's reflections on education, their expectations of employment, and perceptions of a good job. Data show some similarities with the concerns of today's youth. Using historical data such as these allows retesting or reexamination of debates. (Contains 32 references.) (SK)

Investigated the relationship between support offered (to friends and strangers) and individualism among government workers and teachers in Indonesia and the United Kingdom. Survey data indicated that Indonesian respondents were more wiling to offer support to strangers than their British counterparts. Individualism was a significant predictor of (lesser) support in Britain only. British females and older Indonesian people offered the highest levels of support. (SM)

The article discusses the economic outlook for the UK, highlighting that while historical data has been revised upwards, the overall outlook remains weak. The GDP growth forecast for 2023 has been raised to 0.7% due to revisions in historical data, but the near-term outlook is challenging. Factors such as sticky inflation and the impact of tighter monetary policy are expected to hinder economic growth. The article also mentions that the Bank of England is likely to keep interest rates at 5.25% until next summer. [Extracted from the article]

The UK Economic Outlook report states that while historical data has been revised upwards, the overall economic outlook remains weak. GDP growth for 2023 has been raised to 0.7% due to stronger data, but inflation and tighter monetary policy are expected to hinder economic activity. The report also highlights that the Bank of England is likely to keep interest rates at 5.25% until next summer, and rate cuts may occur after the US and European central banks loosen their monetary policies. The report includes forecasts for various economic indicators, such as GDP growth, inflation, unemployment rate, and government balance. [Extracted from the article]

Depicts the following aspects of training and development in the United Kingdom: public-policy strategy and infrastructure, corporate policies and strategies, organization and delivery of training, the training and development profession, and trends in the use of training. (SK)

Background: Suicide prevention is a national priority for the UK government. Autistic people are at greater risk of experiencing self-harm and suicidal thoughts and behaviours than the general population. Safety plans are widely used in suicide prevention but have not yet been designed with and for autistic people. We developed the first safety plan specifically targeting suicidality in autistic adults: the Autism Adapted Safety Plan (AASP). It consists of a prioritised list of hierarchical steps that can be used prior to or during a crisis to mitigate risk of self-harm and suicidal behaviour. This is a pilot study that aims to assess the feasibility and acceptability of the AASPs and the research processes, including the response rates, potential barriers and reach of AASPs, methods of recruitment, what comprises usual care, and economic evaluation methods/tools. Methods: This is an external pilot randomised controlled trial of a suicide prevention tool aimed at mitigating the risk of self-harm and suicidal behaviour in autistic adults: AASPs. Participants will be assessed at baseline and followed up 1 month and 6 months later. Assessments include questions about self-harm, suicidality, service use, and their experience of the AASP/taking part in the study. Autistic adults who have a clinical autism diagnosis and self-reported history of self-harm, suicidal thoughts, or suicidal behaviours within the last 6 months will be invited to take part in the study. Informed consent will be obtained. Participants will be recruited via community and third sector services (including community settings, autism charities, and mental health charities). They may also "self-refer" into the study through social media recruitment and word of mouth. Ninety participants will be randomised to either develop an AASP or receive their usual care in a 1:1 ratio. Discussion: The present study will provide an evaluation of the suitability of the processes that would be undertaken in a larger definitive study, including recruitment, randomisation, methods, questionnaires, outcome measures, treatment, and follow-up assessments. Trial registration: ISRCTN70594445, Protocol v4: 8/2/22. [ABSTRACT FROM AUTHOR]

Background: The British Police Service and Armed Forces are male-dominated occupations, characterised by frequent trauma exposure and intensive demands. Female police employees and military personnel may have unique experiences and face additional strains to their male counterparts. This analysis compared the levels of post-traumatic stress disorder (PTSD), hazardous/harmful alcohol consumption, and comorbidity in female police employees and military personnel. Methods: Police data were obtained from the Airwave Health Monitoring Study (N = 14,145; 2007–2015) and military data from the Health and Wellbeing Cohort Study (N = 928; phase 2: 2007–2009 and phase 3: 2014–2016). Multinomial/logistic regressions analysed sample differences in probable PTSD, hazardous (14–35 units per week) and harmful (35 + units per week) alcohol consumption, and comorbid problems. We compared covariate adjustment and entropy balancing (reweighting method controlling for the same covariates) approaches. Results: There were no significant differences in probable PTSD (police: 3.74% vs military: 4.47%) or hazardous drinking (police: 19.20% vs military: 16.32%). Female military personnel showed significantly higher levels of harmful drinking (4.71%) than police employees (2.42%; Adjusted Odds Ratios [AOR] = 2.26, 95% Confidence Intervals [CIs] = 1.60–3.21), and comorbidity (1.87%) than police employees (1.00%, AOR = 2.07, 95% CI = 1.21–3.54). Entropy balancing and covariate-adjustments obtained the same results. Conclusions: Comparable levels of probable PTSD were observed, which are slightly lower than estimates observed in the female general population. Future research should explore the reasons for this. However, female military personnel showed higher levels of harmful drinking than police employees, emphasising the need for alcohol interventions in military settings. [ABSTRACT FROM AUTHOR]

Purpose: Despite the higher prevalence of problem drinking in the UK military compared to the general population, problem recognition appears to be low, and little is known about which groups are more likely to recognise a problem. This study examined prevalence of problem drinking recognition and its associations. Methods: We analysed data from 6400 regular serving and ex-serving personnel, collected in phase 3 (2014–2016) of the King's Centre for Military Health Research cohort study. Measurements: Participants provided sociodemographic, military, health and impairment, life experiences, problem drinking, and problem recognition information. Problem drinking was categorised as scores ≥ 16 in the AUDIT questionnaire. Associations with problem recognition were examined with weighted logistic regressions. Findings: Among personnel meeting criteria for problem drinking, 49% recognised the problem. Recognition was most strongly associated (ORs ≥ 2.50) with experiencing probable PTSD (AOR = 2.86, 95% CI = 1.64–5.07), social impairment due to physical or mental health problems (AOR = 2.69, 95% CI = 1.51–4.79), adverse life events (AOR = 2.84, 95% CI = 1.70–4.75), ever being arrested (AOR = 2.99, CI = 1.43–6.25) and reporting symptoms of alcohol dependence (AOR = 3.68, 95% CI = 2.33–5.82). To a lesser extent, recognition was also statistically significantly associated with experiencing psychosomatic symptoms, feeling less healthy, probable common mental health disorders, and increased scores on the AUDIT. Conclusion: Half of UK military personnel experiencing problem drinking does not self-report their drinking behaviour as problematic. Greater problem drinking severity, poorer mental or physical health, and negative life experiences facilitate problem recognition. [ABSTRACT FROM AUTHOR]

Purpose: Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. Methods: Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. Results: Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05–1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16–1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09–1.35) following adjustment for demographic, military and health characteristics. Conclusions: The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours. [ABSTRACT FROM AUTHOR]

Context: Care homes in the UK were hit badly by the COVID-19 pandemic, with numerous outbreaks and deaths of residents and staff. Objectives: To capture the impact of the pandemic on care home staff well-being and share insights and learning about how to optimise support for the workforce. Methods: Fifteen senior care staff from care homes looking after older people in England were interviewed between December 2020 and March 2021, when the sector was still under strict restriction measures. The topic guide was developed in consultation with care home staff. Interviews were transcribed and analysed using a reflexive thematic analysis approach to identify themes and sub-themes of the impact on staff well-being. Findings: The impact of the pandemic was overwhelmingly negative, with those interviewed reporting both mental and physical health implications. We identified three themes: emotional exhaustion (upset and trauma, increased responsibility and workload, feelings of guilt); frustration (feeling misunderstood, undervalued, unrecognised, abandoned); and relationships (the importance of supportive working relationships within the care home and with external agencies). Limitations: Staff interviewed were managers or in other senior roles; it would be beneficial to synthesise this research with studies involving other care home staff and residents and their relatives. Given the disparate nature of the care home sector, a larger sample may have identified additional insights. Implications: This study provides insight into the resilience of care home staff during the pandemic and challenges to this; this could help to inform future efforts as to support of the workforce and sector. [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: The majority of older people (> 65 years) in hospital have frailty and are at increased risk of readmission or death following discharge home. In the UK, following acute hospitalisation, around one third of older people with frailty are referred on for rehabilitation, termed 'intermediate care' services. Although this rehabilitation can reduce early readmission to hospital (< 30 days), recipients often do not feel ready to leave the service on discharge, suggesting possible incomplete recovery. Limited evidence suggests extended rehabilitation is of benefit in several conditions and there is preliminary evidence that progressive physical exercise can improve mobility and function for older people with frailty, and slow progression to disability. Our aim is to evaluate the effectiveness of the Home-based Older People's Exercise (HOPE) programme as extended rehabilitation for older people with frailty discharged home from hospital or intermediate care services after acute illness or injury.Methods: A multi-centre individually randomised controlled trial, to evaluate the clinical and cost-effectiveness of the HOPE programme. This individualised, graded and progressive 24-week exercise programme is delivered by NHS physiotherapy teams to people aged 65 and older with frailty, identified using the Clinical Frailty Scale, following discharge from acute hospitalisation and linked intermediate care rehabilitation pathways. The primary outcome is physical health-related quality of life, measured using the physical component summary score of the modified Short Form 36- item health questionnaire (SF36) at 12 months. Secondary outcomes include self-reported physical and mental health, functional independence, death, hospitalisations, care home admissions. Plans include health economic analyses and an embedded process evaluation.Discussion: This trial seeks to determine if extended rehabilitation, via the HOPE programme, can improve physical health-related quality of life for older people with frailty following acute hospitalisation. Results will improve awareness of the rehabilitation needs of older people with frailty, and provide evidence on the clinical and cost-effectiveness of the targeted exercise intervention. There is potential for considerable benefit for health and social care services through widespread implementation of trial findings if clinical and cost-effectiveness is demonstrated.Trial Registration: ISRCTN 13927531 . Registered on April 19, 2017. [ABSTRACT FROM AUTHOR]

For improving human health, reformulation can be a tool as it allows individuals to consume products of choice while reducing intake of less desirable nutrients, such as sugars and fats, and potentially increasing intake of beneficial nutrients such as fibre. The potential effects of reformulating foods with increased fibre on diet and health need to be better understood. The objective of this statistical modelling study was to understand how fibre enrichment can affect the diet and health of consumers. The UK National Diet and Nutrition Survey datasets from 2014 to 2015 and 2015 to 2016 were utilised to evaluate intakes of fibre and kilocalories with a dietary intake model. Foods and beverages eligible for fibre enrichment were identified (n 915) based on EU legislation for fibre content claims. Those people who meet dietary reference values and fibre enrichment health outcomes such as weight, CVD and type 2 diabetes risk reductions were quantified pre- and post-fibre reformulation via Reynolds et al., D'Agostino et al. and QDiabetes algorithms, respectively. The fibre enrichment intervention showed a mean fibre intake of 19·9 g/d in the UK, signifying a 2·2 g/d increase from baseline. Modelling suggested that 5·9 % of subjects could achieve a weight reduction, 72·2 % a reduction in cardiovascular risk and 71·7 % a reduced risk of type 2 diabetes with fibre fortification (all Ps ≤ 0·05). This study gives a good overview of the potential public health benefits of reformulating food products using a straightforward enrichment scenario. [ABSTRACT FROM AUTHOR]

Background: Spinal assessment and immobilisation has been a topic of debate for many years where, despite an emerging evidence base and the delivery of new guidance overseas, little has changed within UK pre-hospital practice. Since 2018, South East Coast Ambulance Service NHS Foundation Trust has spent time working with local trauma networks and expertise from within the region and international colleagues to develop a set of C-spine assessment and immobilisation guidelines that reflect the current best available international evidence and significant changes in international pre-hospital practice from settings such as Scandinavia and Australasia. Methods: A specialist group was commissioned to review the topic of pre-hospital spinal immobilisation and explore potential for evidence-based improvement. In conjunction with local trauma networks, subject matter experts and a thorough review of recent literature, a series of recommendations were made in order to improve spinal care within the authoring trust. Results: Seven recommendations were made, and an updated set of guidelines produced. These included the removal of semi-rigid collars from pre-hospital spinal immobilisation; the creation of two tiers of patients to ensure that the high-risk and low-risk populations are considered separately and an accompanying decision tool to safeguard both cohorts; an increased emphasis on the risk of spinal injury in the frail and older patient; an emphasis on spinal motion restriction rather than rigid immobilisation; an increased emphasis on self-extrication; and the use of a marker for emergency departments. Summary: An updated set of guidance has been produced using a combination of specialist and expert opinion alongside a literature review with close involvement of key stakeholders, both public and professional. The new guidance helps to ensure a patient-centred approach where each person is considered an individual with their risk of injury and management measures tailored to their specific needs. [ABSTRACT FROM AUTHOR]

Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. [ABSTRACT FROM AUTHOR]

Mental disorders and alcohol misuse are often comorbid, and this comorbidity is more common in those who develop mental disorders following exposure to traumatic events. To investigate the relationship between combat exposure and operational role (support versus combat) with mental disorders and associated comorbidity in a UK military cohort. 4896 participants from a UK military cohort reported their operational role and frequency of exposure to combat events during deployment. Outcome measures included self-reported post-traumatic stress disorder, common mental disorder and alcohol misuse. Personnel reporting higher levels of combat exposure were more likely to meet criteria for two or more co-occurring mental disorders (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.73–5.58). While having a combat role increased the risk of developing co-occurring disorders compared to having a support role (OR 1.67, 95% CI 1.26–2.23), this effect diminished following adjustment for variables including combat exposure (OR 0.89, 95% CI 0.62–1.27). Combat exposure may play a greater role in the development of comorbid mental disorders than operational role, i.e. job title. Clinicians treating military personnel should be alert to the increased risk of comorbid mental disorders and alcohol misuse among those with a history of combat exposure. [ABSTRACT FROM AUTHOR]

Background: Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist 'Tier 3' Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity. Methods: This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted. Discussion: This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients. Trial registration: ISRCTN number 22088800. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the extent to which validated online screening measures of cognitive impairment, psychosocial wellbeing, and cardiovascular health are associated with a validated hearing screener in a sample of adults based in the United Kingdom. Method: Sixty-one adults (43 female; Mage = 44.7 years) participated in a cross-sectional study delivered remotely. Participants completed the hearWHO smartphone application, a digits-in-noise hearing screener, and the Modified Telephone Interview for Cognitive Status (TICS-M), a screening tool for cognitive impairment. Psychosocial well-being (social isolation and loneliness) and cardiovascular health were assessed through self-report. Results: Separate independent analyses of variance, with age, gender, and education as covariates, demonstrated participants who failed the hearWHO screener had poorer scores on the TICS-M, engaged in less physical activity, and reported more sedentary behavior and greater social isolation. Multivariate regression analyses revealed that lower TICS-M scores, having obtained less education, identifying as female, and reporting greater sedentary behavior and social isolation were the strongest predictors of lower hearWHO scores. Conclusions: The results from this study suggest that poorer hearing, as measured by the hearWHO screener, is independently associated with having worse cognitive function, more time spent being sedentary, and greater social isolation. Thus, this study demonstrates the potential of online screening measures to identify additional health conditions that confer risk to chronic disease as hearing loss manifests. This could help to inform the development of tailored treatment and support to improve an individual's readiness to seek help for and manage both their general and hearing health. [ABSTRACT FROM AUTHOR]

Background: Family caregivers provide the majority of palliative care. The impact of family caregiving on employment and finances has received little research attention in the field of palliative care. Aim: The aim of this study was to explore perspectives and experiences of combining paid employment with palliative care family caregiving, and to assess the availability and suitability of employment support across three countries – the United Kingdom (UK), Aotearoa New Zealand and Canada. Design: A qualitative descriptive study design was used. Semi-structured interviews were held with 30 key informants with professional or personal experience in palliative care from the UK (n = 15), Aotearoa New Zealand (n = 6) and Canada (n = 9). Interviews were recorded, transcribed and analysed using the principles of thematic analysis. Results: Four main themes were identified: (1) significant changes to working practices are required to enable end of life family carers to remain in work; (2) the negative consequences of combining caregiving and employment are significant, for both patient and carer; (3) employer support for working end of life caregivers is crucial but variable and; (4) national, federal and government benefits for working end of life family carers are necessary. Conclusion: Supporting carers to retain employment whilst providing care has potential benefits for the patient at end of life, the caregiver, and the wider economy and labour market. Employers, policymakers and governments have a role to play in developing and implementing policies to support working carers to remain in employment. [ABSTRACT FROM AUTHOR]

Organ donation networks audit and report on national or regional organ donation performance, however there are inconsistencies in the metrics and definitions used, rendering comparisons difficult or inappropriate. This is despite multiple attempts exploring the possibility for convergently evolving audits so that collectives of donation networks might transparently share data and practice and then target system interventions. This paper represents a collaboration between the United Kingdom and Australian organ donation organisations which aimed to understand the intricacies of our respective auditing systems, compare the metrics and definitions they employ and ultimately assess their level of comparability. This point of view outlines the historical context underlying the development of the auditing tools, demonstrates their differences to the Critical Pathway proposed as a common tool a decade ago and presents a side-byside comparison of donation definitions, metrics and data for the 2019 calendar year. There were significant differences in donation definition terminology, metrics and overall structure of the audits. Fitting the audits to a tiered scaffold allowed for reasonable comparisons however this required substantial effort and understanding of nuance. Direct comparison of international and inter-regional donation performance is challenging and would benefit from consistent auditing processes across organisations. [ABSTRACT FROM AUTHOR]

Background: There has been media coverage surrounding the dangers of heavy drinking and benefits of moderation, with TV and radio presenter, Adrian Chiles, documenting his experience of moderating alcohol consumption in an online article for the Guardian. By analysing the comments in response to Chiles' article, this study aimed to explore (i) posters' (someone who has posted a comment in response to the article) attitudes or beliefs toward moderating alcohol and (ii) posters' experiences of moderating or abstaining from alcohol. Method: A secondary qualitative analysis of online comments in response to an article about moderating alcohol consumption. Main outcome measures: Comments (n = 784) in response to a United Kingdom online news article about moderating alcohol consumption were extracted and inductive thematic analysis was used. Results: For aim one, two themes were developed; "general attitudes toward drinking" and "general attitudes toward reducing consumption". These themes reflect negative perceptions of alcohol and issues around changing attitudes. For aim two, three themes were developed: "moderation vs. abstention", "reflection on past drinking behaviours", and "current drinking behaviours". These themes represent posters' experiences and implications changing their drinking habits. Conclusion: Our analysis provides a novel insight into perceptions and experiences of moderating or abstaining from alcohol. Alcohol is embedded within United Kingdom culture, creating difficulties for those who choose to moderate or abstain from alcohol. Our analysis highlights the need for public health to focus on shifting the current drinking culture, through clearer drinking guidelines and a wider availability of alcohol-free alternatives. [ABSTRACT FROM AUTHOR]

Background: It is a familiar story. A promising multiple sclerosis (MS) treatment clears the three regulatory hurdles of safety, quality and efficacy, only to fall at the fourth: cost-effectiveness. This has led to concerns about the validity of the measures typically used to quantify treatment effects in cost-effectiveness analyses and in 2012, in the United Kingdom, the National Institute for Health and Care Excellence called for an improvement in the cost-effectiveness framework for assessing MS treatments. Objective and Methods: This review describes what is meant by cost-effectiveness in health/social care funding decision-making, and usual practice for assessing treatment benefits. Results: We detail the use of the quality-adjusted life-year (QALY) in resource allocation decisions, and set out limitations of this approach in the context of MS. Conclusion: We conclude by highlighting methodological and policy developments which should aid addressing these limitations. [ABSTRACT FROM AUTHOR]

Background and Aims: Although English Stop Smoking Services routinely offer dual nicotine replacement therapy (NRT) to help pregnant women to quit smoking, little is known about how nicotine and tobacco smoke exposures following this compare with that from smoking. We compared, in pregnant women when smoking and after being offered dual NRT, saliva cotinine and exhaled carbon monoxide (CO) concentrations and numbers of daily cigarettes smoked. Design and Setting: Secondary analysis of data from three sequential, observational, mixed-methods cohort studies conducted as part of the Nicotine Replacement Effectiveness and Delivery in Pregnancy programme. Participants were recruited on-line or in Nottingham University Hospitals (UK) antenatal clinics between June 2019 and September 2020. Participants: Forty pregnant women, who agreed to try stopping smoking. Intervention: Participants were offered dual NRT, agreed a smoking quit date and received an intervention to improve adherence to NRT. Measurements: Saliva cotinine and exhaled CO concentrations and reported number of cigarettes smoked per day. Findings: There were no differences in saliva cotinine concentrations at baseline and day 7 post quit date [n = 20, mean difference = -32.31 ng/ml, 95% confidence interval (CI) = -68.11 to 3.5 ng/ml; P = 0.074, Bayes factor = 0.04]. There were reductions in the reported number of cigarettes smoked per day (n = 26, mean difference = -7 cigarettes, 95% CI = -8.35 to -5.42 cigarettes, P < 0.001) and concurrently in exhaled CO concentrations (n = 17, ratio of geometric means = 0.30 p.p.m., 95% CI = 0.17-0.52 p.p.m.; P < 0.001). Conclusion: Pregnant women who smoke and are offered dual nicotine replacement therapy (NRT) appear to show no change in their exposure to cotinine compared with their pre-NRT exposure levels but they report smoking fewer cigarettes, as validated by reductions in exhaled carbon monoxide concentrations. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The aim of this study was to review the UK national trends in activity and outcome in coronary artery bypass graft (CABG) over a 15-year period (2002–2016). METHODS Validated data collected (2002–2016) and uploaded to National Institute for Cardiovascular Outcomes Research were used to generate summary data from the National Adult Cardiac Surgery Audit Database for the analysis. Logistic European System of Cardiac Operative Risk Evaluation was used for risk stratification with recalibration applied for governance. Data were analysed by financial year and presented as numerical, categorical, %, mean and standard deviation where appropriate. Mortality was recorded as death in hospital at any time after index CABG operation. RESULTS A total of 347 626 CABG procedures (282 883 isolated CABG, 61 109 CABG and valve and 4132 redo CABG) were recorded. Over this period annual activity reduced from 66.6% of workload to 41.7%. The mean age for isolated CABG was 65.7 years. The mean log European System of Cardiac Operative Risk Evaluation was 3.1, 5.9 and 23.2 for elective, urgent and emergency isolated CABG, respectively. There was a decline in the observed mortality for all procedures. Overall mortality for isolated CABG surgery is now 1.0% and only 0.6% for elective operations. CONCLUSIONS Quality of care and risk-adjusted mortality rates have consistently improved over the last 15 years despite the increasing risk profile of patients. There have been a consistent decline in overall case volumes and a three-fold increase in elderly cases. [ABSTRACT FROM AUTHOR]