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Despite recent attention, research is yet to adequately focus on sports coaches' intellectual development as a consequence of their formal learning experiences. Drawing on the work of Perry, the aim of this article was to explore how the intellectual development of undergraduate sports coaching students was affected by the social pedagogical setting exposed to. Twenty-seven students from two different universities were selected through network and convenience sampling, and "tracked" over their three year course(s) of study. Data were gathered through focus groups, video diaries and reflective written logs. Findings revealed that over the course of their study students generally progressed from a dualist to a more relativist view of the world. Such a movement, however, was far from unproblematic and uniform. Rather, it was subject to the vagaries of assessment, course structure, the epistemic range of modules experienced, and in particular the relationships established with staff members.

At intervals of 3-4 years, research quality in English universities has been externally reviewed 5 times over the past 16 years. Assessment is based on peer-review of material submitted by universities to 70 separate subject panels. The principal component is information on research output, usually publications, from all academic staff identified as "research active". Research quality is rated on a numerical (1-5*), criteria-based scale. Ratings in all subject areas and across all universities have increased to give an average rating in 2001 corresponding to a level of "attainable national excellence". Between universities there are significant variations. In the prestigious Loxbridge group, where almost all academic staff are research-active, 90% of subject areas achieved ratings at level 5 in 2001; in contrast, in the New universities, where only 40% of academic staff is research-active, level 5 was achieved in 7% of subject areas. A combination of high research quality and high cost research (medicine, science, engineering) concentrated in the Old universities is similary evident in the distribution of research funding. Income from both research subsidy and research grants and contracts is divided: Old universities, 94% (Loxbridge, 35%), New universities, 6%. High institutional costs of the assessment process, particularly for areas of low-cost research, and increasing concern about the inadequacies of the rating system and failure of its direct link to funding suggest that substantial revision will be needed for future assessment exercises.

BackgroundThere is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects.MethodAll patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls.ResultsThere was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample.ConclusionsExposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis. [ABSTRACT FROM PUBLISHER]

Background. Childhood adversity has been associated with onset of psychosis in adulthood but these studies have used only general definitions of this environmental risk indicator. Therefore, we sought to explore the prevalence of more specific adverse childhood experiences amongst those with and without psychotic disorders using detailed assessments in a large epidemiological case-control sample (AESOP). Method. Data were collected on 182 first-presentation psychosis cases and 246 geographically matched controls in two UK centres. Information relating to the timing and frequency of exposure to different types of childhood adversity (neglect, antipathy, physical and sexual abuse, local authority care, disrupted living arrangements and lack of supportive figure) was obtained using the Childhood Experience of Care and Abuse Questionnaire. Results. Psychosis cases were three times more likely to report severe physical abuse from the mother that commenced prior to 12 years of age, even after adjustment for other significant forms of adversity and demographic confounders. A non-significant trend was also evident for greater prevalence of reported severe maternal antipathy amongst those with psychosis. Associations with maternal neglect and childhood sexual abuse disappeared after adjusting for maternal physical abuse and antipathy. Paternal maltreatment and other forms of adversity were not associated with psychosis nor was there evidence of a dose--response effect. Conclusions. These findings suggest that only specific adverse childhood experiences are associated with psychotic disorders and only in a minority of cases. If replicated, this greater precision will ensure that research into the mechanisms underlying the pathway from childhood adversity to psychosis is more fruitful. [ABSTRACT FROM AUTHOR]

The article examines whether there are disparities in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients in Great Britain. Results reveal no evidence in support of the hypothesis. Compared with ethnic controls, white British patients and African-Caribbean/black African patients had ventricular enlargement and increased lenticular nucleus volume. African-Caribbean/black African patients had reduced global grey matter and increased lingual gyrus grey-matter volume.

Objective:  We sought to investigate the prevalence and social correlates of psychotic-like experiences in a general population sample of Black and White British subjects. Method:  Data were collected from randomly selected community control subjects, recruited as part of the ÆSOP study, a three-centre population based study of first-episode psychosis. Results:  The proportion of subjects reporting one or more psychotic-like experience was 19% ( n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic-like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. Conclusion:  The higher prevalence of psychotic-like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course. [ABSTRACT FROM AUTHOR]

BackgroundNumerous studies have reported high rates of psychosis in the Black Caribbean population in the UK. Recent speculation about the reasons for these high rates has focused on social factors. However, there have been few empirical studies. We sought to compare the prevalence of specific indicators of social disadvantage and isolation, and variations by ethnicity, in subjects with a first episode of psychosis and a series of healthy controls.MethodAll cases with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were recruited over a 3-year period. Data relating to clinical and social variables were collected from cases and controls.ResultsOn all indicators, cases were more socially disadvantaged and isolated than controls, after controlling for potential confounders. These associations held when the sample was restricted to those with an affective diagnosis and to those with a short prodrome and short duration of untreated psychosis. There was a clear linear relationship between concentrated disadvantage and odds of psychosis. Similar patterns were evident in the two main ethnic groups, White British and Black Caribbean. However, indicators of social disadvantage and isolation were more common in Black Caribbean subjects than White British subjects.ConclusionsWe found strong associations between indicators of disadvantage and psychosis. If these variables index exposure to factors that increase risk of psychosis, their greater prevalence in the Black Caribbean population may contribute to the reported high rates of psychosis in this population. [ABSTRACT FROM AUTHOR]

Background: People from Black ethnic groups (African-Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage.Aims: To investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage.Method: A population-based incidence and case-control study of first-episode psychosis (Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP)). A total of 482 participants answered questions about perceived disadvantage.Results: Black ethnic groups had a higher incidence of psychosis (OR= 4.7, 95% CI 3.1-7.2). After controlling for religious affiliation, social class and unemployment, the association of ethnicity with psychosis was attenuated (OR=3.0, 95% CI 1.6-5.4) by perceptions of disadvantage. Participants in the Black non-psychosis group often attributed their disadvantage to racism, whereas Black people in the psychosis group attributed it to their own situation.Conclusions: Perceived disadvantage is partly associated with the excess of psychosis among Black people living in the UK. This may have implications for primary prevention. [ABSTRACT FROM AUTHOR]

In order to determine the prevalence and risk factors for necrotic enteritis in broilers, a cross-sectional survey was conducted among 857 farms, rearing broilers for nine UK poultry companies. The main data collection tool was a postal questionnaire directed at farm managers. Additional information on disease occurrence on the farm was collected from veterinary postmortem reports. The response rate to the questionnaire was 75%, ranging from 54% to 90% within companies. During 2001, 32.8% of the respondents indicated that they had observed a case of necrotic enteritis (95% confidence interval, 29.1 to 36.8) in at least one flock. The disease was most often reported during the months October to February. The point prevalence (necrotic enteritis occurrence in the most recently reared flock) reported by farm managers was 12.3% (95% confidence interval, 9.8 to 15.2). Multilevel logistic regression was performed with the poultry company as the random effect, using the occurrence of necrotic enteritis in the farm's most recently reared flock as the dependent variable. Strong associations were found between the outcome variable and the occurrence of wet litter (odds ratio, 2.39; 95% confidence interval, 1.27 to 4.52; P=0.007) and coccidiosis (odds ratio, 4.68; 95% confidence interval, 1.74 to 12.55; P=0.002). In addition, the use of ammonia as a disinfectant for coccidial oocysts appeared to be an independent risk factor (odds ratio, 3.44; 95% confidence interval, 1.53 to 7.71; P=0.003). Finally, the positive association between the use of plasterboard walls in poultry houses and the occurrence of necrotic enteritis might point to an important role of cleaning and disinfection in the epidemiology of this disease (odds ratio, 3.72; 1.38 to 10.00; P=0.009). [ABSTRACT FROM AUTHOR]

A postal questionnaire was sent to the managers of 857 broiler farms in the UK to determine the prevalence and risk factors for wet lifter. The response rate was 75 percent. Wet litter was reported by 75 per cent (95 percent confidence interval [cl] 71.3 to 78.3) of the respondents in at least one flock during the year 2001 and 56.1 percent (95 percent cl 52.O to 60.0) of them reported that they had an outbreak of wet litter in their most recently reared flock. Wet litter occurred more often during the winter months and farms using side ventilation systems were at an increased risk (odds ratio 1.74; 95 percent cl 1.09 to 2.76). A multivariable analysis was carried out using two different definitions of wet litter as outcome variables - all cases of wet litter, and cases of wet litter associated with disease. Consistent risk factors for both outcomes were coccidiosis, feed equipment failures and the availability of separate farm clothing for each house. Cases of wet lifter associated with disease were reported by 33.7 percent (95 per cent cl 28.8 to 39.1) of the managers in their last flock and were associated with the use of hand sanitisers and broiler houses with walls made of concrete. [ABSTRACT FROM AUTHOR]

Background: Many studies have found high levels of compulsory admission to psychiatric hospital in the UK among African-Caribbean and Black African patients with a psychotic illness.Aims: To establish whether African-Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres.Method: All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (AESOP) study. For this analysis we included all White British, other White, African-Caribbean and Black African patients from the AESOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.Results: African-Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African-Caribbean men were the most likely to be compulsorily admitted.Conclusions: These findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African-Caribbean and Black African patients. [ABSTRACT FROM AUTHOR]

Background: Previous research has found that African-Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres.Method: We included all White British, other White, African-Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.Results: Compared with White British patients, general practitioner referral was less frequent for both African-Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders.Conclusions: These findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals. [ABSTRACT FROM AUTHOR]

Background: There has been a relative dearth of epidemiological research into bipolar affective disorder. Furthermore, incidence studies of bipolar disorder have been predominantly retrospective and most only included hospital admission cases.Aims: To determine the incidence of operationally defined bipolar disorder in three areas of the UK and to investigate any differences in gender and ethnicity.Method: All patients who contacted mental health services with first-episode psychosis or non-psychotic mania between September 1997 and August 1999 were identified and diagnosed according to ICD-10 criteria. Incidence rates of bipolar affective disorder were standardised for age and stratified by gender and ethnic group across the three areas.Results: The incidence rate per 100,000 per year in south-east London was over twice that in Nottingham and Bristol. There was no significant difference in the rates of disorder in men and women. Incidence rates of bipolar disorder in the combined Black and minority ethnic groups in all three areas were significantly higher than those of the comparison White groups.Conclusions: The incidence of bipolar disorder was higher in south-east London than in the other two areas, and was higher among Black and minority ethnic groups than in the White population. [ABSTRACT FROM AUTHOR]

Describes the working patterns in the health authority departments of public health in Great Britain. Areas of work of contemporary public health practitioners; Disadvantages of having different names for the same functions or differing emphasis on what authorities actually do; Improvements in living conditions that were the mostly important determinants of health.

Editorial. Comments on the implementation of the Regional Development Agencies (RDA) in United Kingdom. Significance of RDA in developing the skills dimension of regional economic strategies; Focus of RDA in promoting the 1998 White Paper on Competitiveness; Criticisms on the government program.

In a four-year follow-up study of 1042 elderly people (aged 65 years or older), randomly sampled from the community, levels of dementia were assessed using a two-phase case-finding procedure (screening followed by clinical interview) among survivors. Clinical information on those not reinterviewed was provided by death certificates, hospital case notes, or postal questionnaires. The weighted four-year cumulative incidence of dementia was 3.7% (95% confidence intervals: 2.4%-5.0%), with age-specific rates of 0.9%, 2.8%, 5.2%, 9.0%, and 8.7% for the age groups 65-69, 70-74, 75-79, 80-84, and 85-89 years respectively. While consistent with data from other British regions, it remains likely that these rates underestimate true incidence. [ABSTRACT FROM AUTHOR]

Despite the clinical benefits and safety profile of primary percutaneous coronary intervention (PCI), the health care system in the UK has been slow to adopt this strategy as first line management for ST segment elevation myocardial infarction. The cost implications of a 24 hour a day, seven days per week primary PCI service and the absence of an existing efficient working model within the National Health Service (NHS) framework are two of the major deterrents for provision of such a service. The existent cost effectiveness data for primary PCI is critically reviewed, with particular reference to the NHS. [ABSTRACT FROM AUTHOR]

The article discusses a study that discusses the role of a workplace-based risk assessment in improving a lifetime cardiovascular disease risk in male steelworkers in Great Britain. It informs that the study included a sample of male employees from a local steelworks in Carmarthenshire, South Wales, and undergone cardiovascular disease (CVD) and diabetes risk assessment and the results showed that workplace-based CVD initiatives were beneficial to shift workers.

Abstract: Background: Family involvement in help-seeking is associated with a shorter duration of untreated psychoses [DUP], but it is unknown whether neighbourhood-level factors are also important. Methods: DUP was estimated for all cases of first-episode psychoses identified over 2 years in 33 Southeast London neighbourhoods (n=329). DUP was positively skewed and transformed to the natural logarithm scale. We fitted various hierarchical models, adopting different assumptions with regard to spatial variability of DUP, to assess whether there was evidence of neighbourhood heterogeneity in DUP, having accounted for a priori individual-level confounders. Results: Neighbourhood-level variation in DUP was negligible compared to overall variability. A non-hierarchical model with age, sex and ethnicity covariates, but without area-level random effects, provided the best fit to the data. Discussion: Neighbourhood factors do not appear to be associated with DUP, suggesting its predictors lie at individual and family levels. Our results inform mental healthcare planning, suggesting that in one urbanised area of Southeast London, where you live does not affect duration of untreated psychosis. [Copyright &y& Elsevier]

Abstract: In 2004, the United Kingdom began for the first time a systematic, countrywide initiative to increase organ donations. The approach, based on international research and with consultation from the United States, entailed encouraging the early identification and referral of potential donors, training critical care physicians in breaking bad news and in collaborating with donor coordinators, training coordinators in donation conversation skills, and getting them in to speak with families. The strategy represented a large culture change in the procurement of organs in the United Kingdom and has met resistance. However, the change has started to take hold and, despite a dramatic and unexpected 21% reduction in potential brain stem death donors over a 4-year period, is showing positive results. Herein we have described the historical model for procuring organs in the United Kingdom, the development of the new strategy, its components, and the results of its implementation, in terms of earlier referrals, the identification of non–heart-beating donors, the collaboration between physicians and coordinators in speaking with families and in converted donors. [Copyright &y& Elsevier]

Introduction: The Dementias Platform UK (DPUK) Data Portal is a data repository bringing together a wide range of cohorts. Neurodegenerative dementias are a group of diseases with highly heterogeneous pathology and an overlapping genetic component that is poorly understood. The DPUK collection of independent cohorts can facilitate research in neurodegeneration by combining their genetic and phenotypic data., Methods: For genetic data processing, pipelines were generated to perform quality control analysis, genetic imputation, and polygenic risk score (PRS) derivation with six genome-wide association studies of neurodegenerative diseases. Pipelines were applied to five cohorts., Discussion: The data processing pipelines, research-ready imputed genetic data, and PRS scores are now available on the DPUK platform and can be accessed upon request though the DPUK application process. Harmonizing genome-wide data for multiple datasets increases scientific opportunity and allows the wider research community to access and process data at scale and pace., (© 2024 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom., Methods: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design., Results: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial., Conclusions: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable., Trial Registration: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022., (© 2024. The Author(s).)

Congenital hyperinsulinism (CHI) is a condition characterised by severe and recurrent hypoglycaemia in infants and young children caused by inappropriate insulin over-secretion. CHI is of heterogeneous aetiology with a significant genetic component and is often unresponsive to standard medical therapy options. The treatment of CHI can be multifaceted and complex, requiring multidisciplinary input. It is important to manage hypoglycaemia in CHI promptly as the risk of long-term neurodisability arising from neuroglycopaenia is high. The UK CHI consensus on the practice and management of CHI was developed to optimise and harmonise clinical management of patients in centres specialising in CHI as well as in non-specialist centres engaged in collaborative, networked models of care. Using current best practice and a consensus approach, it provides guidance and practical advice in the domains of diagnosis, clinical assessment and treatment to mitigate hypoglycaemia risk and improve long term outcomes for health and well-being., Competing Interests: IB has received honoraria for advisory opinion from Merck and Diurnal Pharmaceuticals. He is the UK CI for clinical trials funded by Zealand Pharmaceuticals and has received grant funding from Merck, Diurnal and Crinetics Pharmaceuticals. IB is the Chair of the BSPED-NIHR Clinical Studies Group and the Chair of the ESPE Communications Committee. He is a co-opted member of the NICE Head Injury Update Committee. IB has advisory roles with several patient organisations including the Pituitary Foundation, Living with CAH, CHC and CHI. MGS has received funding/speaker honorium from Novo Nordisk, Sandoz, Pfizer and received honorarium for consultancies/advisory boards from Novo Nordisk, Pfizer and Merck. RK has received grant funding and honoraria for advisory opinion from Merck. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Shaikh, Lucas-Herald, Dastamani, Salomon Estebanez, Senniappan, Abid, Ahmad, Alexander, Avatapalle, Awan, Blair, Boyle, Chesover, Cochrane, Craigie, Cunjamalay, Dearman, De Coppi, Erlandson-Parry, Flanagan, Gilbert, Gilligan, Hall, Houghton, Kapoor, McDevitt, Mohamed, Morgan, Nicholson, Nikiforovski, O'Shea, Shah, Wilson, Worth, Worthington and Banerjee.)

Background: Role models have been identified as a potential means to tackle the persisting low levels of physical activity among young girls. The aim of this research was to explore the involvement of community- and peer role models within the CHARMING (CHoosing Active Role Models to INspire Girls) intervention, an intervention which aims to increase and sustain physical activity among 9-10-year-old girls. The research questions were, is it feasible and acceptable to recruit role models? and what are the perceived barriers and facilitators to the inclusion of peer role models within the intervention?, Methods: A mixed methods process evaluation was embedded within a larger feasibility study, involving three secondary schools and four adjoining primary schools in South Wales, United Kingdom. One-to-one interviews were conducted with teachers (N = 10) across the seven schools and community role models (N = 10). Focus groups were conducted with 18 peer role models (older girls from adjoining secondary schools) and 18 girls aged 9-10-years who had participated in the intervention. Primary school teachers kept observation logs of each intervention session. A researcher completed observation logs of two random sessions per school. Qualitative data were analysed using thematic analysis with a combined deductive and inductive coding approach. Observation data were analysed using descriptive statistics. Data were triangulated and comparative analyses conducted across schools., Results: Twenty-three peer role models (aged 12-16-years) and 16 community role models participated in intervention delivery. Overall, the inclusion of both types of role models was shown as acceptable and feasible within the CHARMING intervention. Observation data highlighted key areas (i.e., intervention components delivered inconsistently) for further qualitative exploration. Six themes were identified during analyses; reach and access, communication, logistics, existing systems, interpersonal relationships, and perceived impacts. Themes were intertwined across the barriers and facilitators of recruitment and implementation. Areas for future improvement were highlighted., Conclusions: Findings can be used to optimise the CHARMING intervention and inform wider interventions or policies employing several role models across settings to promote physical activity among children., (© 2023. BioMed Central Ltd., part of Springer Nature.)

The research goals were to obtain an understanding of who the users of e-books in the NHS are, what they are using e-books for, and when and how they use them. This article presents the methodology used and the findings from the research. It also explores the outputs and next steps from the research, both for the individual countries and collectively. The Five Nations group, (library leads in England, Northern Ireland, Ireland, Scotland and Wales) commissioned research into healthcare staff use and non-use of e-books to understand the behaviours, needs and expectations of healthcare staff and to identify shared challenges around e-books to inform policy and practice., (© 2023 The Authors Health Information and Libraries Journal published by John Wiley & Sons Ltd on behalf of Health Libraries Group.)

To examine the association between common comorbidities, eGFR and loci involved in the hyperuricaemia-gout transition. This study was conducted in people with gout from the UK Biobank. Logistic regression was used to examine the association between self-reported physician-diagnosed hypertension, diabetes, hypercholesterolemia and ischaemic heart disease (IHD) with the following variants: rs1260326(GCKR), rs16890979(SLC2A9), rs2231142(ABCG2), rs1229984(ADH1B) and rs2078267(SLC22A11) and adjusted for age, sex and 10-principal components. Linear regression was used to examine the association with eGFR. 7,049 participants with gout were included. After adjusting for multiple testing, there was a statistically significant positive association between urate lowering allele at SLC2A9 and hypertension, and negative association between urate raising allele at ABCG2 and hypertension (OR 1.17 and OR 0.86, respectively). Number of urate lowering risk alleles associated with hypertension [OR (95%CI) 1.13 (1.06-1.21)]. High eGFR associated with urate raising allele at rs2231142 (β = 1.38). The SNP in ADH1B that protects from alcohol excess showed a negative association with IHD (OR 0.53). Unlike in general population studies urate lowering genetic variants associate with hypertension in gout patients with dose-response. This may be due to high prevalence of other risk factors of hypertension such as obesity, poor diet etc. and needs validation in independent datasets., (© 2022. The Author(s).)

During the second wave of the COVID-19 pandemic, district nursing teams were overwhelmed with their caseload due to the palliative care needs of their patients. This led to patients with wet legs and chronic wounds deteriorating due to staffing levels. Therefore, the Swansea Bay University Health Board and Lymphoedema Network Wales teams redeployed two working time equivalents (WTE) into the community to take over the management of these patients with chronic wounds for 4 months. The clinicians came from a variety of different backgrounds, including nursing, physiotherapy, emergency medicine and occupational therapy. Between the teams, 866 visits were carried out over the 4-month period, where patients' compression therapy was altered to promote healing and reduce oedema. At the end of the 4-month period, 21% of the patients were discharged off the district nursing caseload completely, while of the 60% who were still active caseload patients, 35% were in increased compression and 20% had reduced need for visits.

Objectives: To examine the association between comorbidities and serum urate (SU), gout and comorbidities, and to determine whether the association between gout and comorbidities is independent of SU., Methods: We performed a case-control study using UK Biobank data. Two separate analyses were conducted: one excluding participants with gout to investigate the association between comorbidities and SU and the other with participants with gout as the index condition to examine the association between gout and comorbidities. SU was measured at the baseline visit. Self-reported physician-diagnosed illnesses were used to define gout and comorbidities, except for chronic kidney disease (CKD), which was defined using an estimated glomerular filtration rate cut-off. Participants prescribed urate-lowering treatment were also classified as gout. Logistic regression was used to examine associations. Odds ratios (ORs) and 95% CIs were calculated and adjusted for covariates including comorbidities and SU., Results: Data for 458 781 UK Biobank participants were used to examine the association between comorbidities and SU. There was an association between hypertension, ischaemic heart disease (IHD), congestive cardiac failure (CCF), hyperlipidaemia, CKD and SU with and adjusted OR (aOR) of 1.10-3.14 for each 1 mg/dl SU increase. A total of 10 265 gout cases and 458 781 controls were included in the analysis of association between gout and comorbidities. Gout associated independently with hypertension, IHD, CCF, hyperlipidaemia and diabetes, with aORs of 1.21-4.15 after adjusting for covariates including SU., Conclusion: Comorbidities associate with increasing SU. The association between gout and cardiometabolic comorbidities was independent of SU, suggesting separate SU-independent mechanisms such as inflammation driven by crystal deposition, pro-inflammatory genotype or non-purine dietary factors., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Physical inactivity is the fourth leading cause of mortality worldwide. Early childhood is a critical period when healthy behaviours can be instilled for a future active lifestyle. We explored community, societal and environmental factors affecting child and family physical activity and sought parent recommendations to support physical activity in families with young children., Methods: We interviewed 61 parents expecting a child or with a baby ≤12 months (35 mother and father paired interviews and 26 interviews with mothers only). We purposively sampled families for neighbourhood deprivation status (Townsend Index; 26 affluent; 35 deprived). We conducted thematic analysis of interview transcripts using Bronfenbrenner's socio-ecological framework to guide interpretation., Results: We identified four themes: work family-life balance; spaces for activity; beliefs and attitudes; and physical activity facilitators. We found that parents from deprived neighbourhoods were more likely to be underactive because of a complex web of community, social and personal factors which reduced motivation and hindered opportunity for physical activity. To increase knowledge and opportunity, respondents suggested 'help not tell' messages covering 'why', 'how' and 'where' information about physical activity, and using physical activity to support community engagement and social interaction., Conclusions: Recommendations from parents highlight effective communication about the importance of early child and family physical activity and improved community access to safe facilities and opportunities. Both parents need to be engaged in designing interventions to support greater physical activity and healthy behaviours which are relevant and achievable in individuals' lives., (© 2020 The Authors Health Expectations Published by John Wiley & Sons Ltd.)

Background: Mutations of the insulin receptor (INSR) gene lead to a wide spectrum of inherited insulin resistance (IR) syndromes. Among these, type A-IR, usually caused by dominant negative INSR mutations, generally presents peri-pubertally in girls., Case: A 2.8-year-old girl was referred due to recurrent postprandial and fasting hypoglycemia. She had been born at full-term with birth weight 1.89 kg, and had developed transient neonatal diabetes. Examination showed satisfactory growth, reduced adipose tissue, acanthosis nigricans, and isolated thelarche. After 12 h of fasting, she developed hypoglycemia (glucose 2.8 mmol/L), with inappropriately raised plasma insulin concentration of 5.4 mU/L and suppressed fatty acids and ketone bodies. Oral glucose tolerance testing showed severely increased plasma insulin concentration (>300 mU/L) with hypoglycemia (glucose 1.6 mmol/L) at 2.5 h. She was initially managed on dietary modifications, cornstarch, and then trialed on acarbose for postprandial hyperinsulinemic hypoglycemia (PPHH) with some response. However, she was noted to have increased frequency of hyperglycemia after a couple of years of treatment. She was then switched to metformin and continued to have dietary carbohydrate modification including cornstarch that improved fasting tolerance, hyperglycemia, and postprandial hypoglycemia. Genetic testing identified heterozygous deletion of the last exon of the INSR gene, exon 22., Conclusion: We present a case of type A-IR, caused by a novel INSR deletion, presenting unusually early with transient neonatal diabetes, followed by episodes of hypoglycemia and hyperglycemia during later childhood. Early life presentations, including neonatal diabetes and PPHH, should lead to consideration of type A-IR., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

We analyse the network structure of the British salmonid aquaculture industry from the perspective of infectious disease control. We combine for the first time live fish transport (or movement) data covering England and Wales with data covering Scotland and include network layers representing potential transmission by rivers, sea water and local transmission via human or animal vectors in the immediate vicinity of each farm or fishery site. We find that 7.2% of all live fish transports cross the England-Scotland border and network analysis shows that 87% of English and Welsh nodes and 72% of Scottish nodes are reachable from cross-border connections via live fish transports alone. Consequently, from a disease-control perspective, the contact structures of England and Wales and of Scotland should not be considered in isolation. We also show that large epidemics require the live fish movement network and so control strategies targeting movements can be very effective. While there is relatively low risk of widespread epidemics on the live fish transport network alone, the potential risk is substantially amplified by the combined interaction of multiple network layers., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis., Methods: We report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up., Results: Compared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning (p values⩽0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample (t = -2.32; p = 0.022) and in the schizophrenia diagnostic subgroup (t = -2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance (p values<0.01-0.001) and those born outside the UK (p values<0.05)., Conclusions: Verbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable - at a group level - at the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.

The socioeconomic inequalities found in child and adolescent mental wellbeing are increasingly acknowledged. Although interventions increasingly focus on school holidays as a critical period for intervention to reduce inequalities, no studies have modelled the role of summer holiday experiences in explaining socioeconomic inequalities in wellbeing. For this study, we analysed survey data of 103,971 adolescents from 193 secondary schools in Wales, United Kingdom, which included measures of family affluence, experiences during the summer holidays (hunger, loneliness, time with friends and physical activity) and mental wellbeing and internalising symptoms on return to school. Structural equation modelling was used to analyse the data. Although family affluence retained a direct inverse association with student mental wellbeing ( r = -0.04, p < 0.001), 65.2% of its association with mental wellbeing was mediated by the experiences over the summer holidays. FAS score was not directly associated with the student's self-reports of internalising symptoms ( r = 0.00, p > 0.05). Of all summer holiday experiences, the strongest mediational pathway was observed for reports of loneliness. Although more structural solutions to poverty remain essential, school holiday interventions may have significant potential for reducing socioeconomic inequalities in mental health and wellbeing on young people's return to school through reducing loneliness, providing nutritious food and opportunities for social interaction.

Objectives: To assess sleep duration-mortality relationships across a 27-year follow-up period in a well characterized random sample of older people, and to test the hypothesis that mortality risks associated with long sleep duration confound with, and can be explained by, low levels of functional capacity indicative of frailty., Methods: Face-to-face interviews conducted among 1002 randomly sampled older (65+) people in 1985 provided baseline profiles of health, functional capacity, physical activity, and sleep quality and duration. Health and functional status in each of 6 sleep duration categories (≤4, 5, 6, 7, 8, ≥9 h) was examined. At censorship in 2012, 927 deaths were recorded. Relationships between sleep duration and 27-year all-cause mortality were then examined in a series of incrementally adjusted Cox regression models., Results: Associations between sleep duration and measures of sleep quality were predominantly linear, with longer sleep times indicating superior sleep quality. Relationships between sleep duration and functional capacity, on the other hand, were predominantly quadratic, with most approximating a U-shaped function. Adjusted for age, gender, social class, insomnia symptoms, physical health, depression, BMI and smoking status, long sleep duration and continuous hypnotic drug use at baseline were significantly and independently associated with elevated mortality risk (HR: 1.37; 95% CI: 1.05-1.78; HR: 1.24; 95% CI: 1.01-1.51). When indices of frailty were added to the model, hazard ratios for long sleep duration and hypnotic drug became non-significant, while the lowest physical activity quintile and very slow walking speed significantly increased mortality risk (HR: 1.79; 95% CI: 1.40-2.30; HR: 1.41; 95% CI: 1.15-1.73 respectively)., Conclusions: In analyses of sleep-related mortality outcomes long sleep durations confound with, and may be indicative of, incipient frailty among older participants., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Single nucleotide variants (SNVs) within and surrounding the complement receptor 1 (CR1) gene show some of the strongest genome-wide association signals with late-onset Alzheimer's disease. Some studies have suggested that this association signal is due to a duplication allele (CR1-B) of a low copy repeat (LCR) within the CR1 gene, which increases the number of complement C3b/C4b-binding sites in the mature receptor. In this study, we develop a triplex paralogue ratio test assay for CR1 LCR copy number allowing large numbers of samples to be typed with a limited amount of DNA. We also develop a CR1-B allele-specific PCR based on the junction generated by an historical non-allelic homologous recombination event between CR1 LCRs. We use these methods to genotype CR1 and measure CR1-B allele frequency in both late-onset and early-onset cases and unaffected controls from the United Kingdom. Our data support an association of late-onset Alzheimer's disease with the CR1-B allele, and confirm that this allele occurs most frequently on the risk haplotype defined by SNV alleles. Furthermore, regression models incorporating CR1-B genotype provide a better fit to our data compared to incorporating the SNV-defined risk haplotype, supporting the CR1-B allele as the variant underlying the increased risk of late-onset Alzheimer's disease.

This case study demonstrates the benefits of early intervention and a proactive approach for a patient with chronic oedema living in the community. These benefited the patient and also supported value-based healthcare in the NHS. The patient's health and wellbeing significantly improved with an assessment of his chronic oedema and a management plan consisting of skincare, an exercise and movement programme and the introduction of a class 1 British standard compression garment.

Background: Progressive optic nerve damage in glaucoma results in vision loss, quantifiable with visual field (VF) testing. VF measurements are, however, highly variable, making identification of worsening vision ('progression') challenging. Glaucomatous optic nerve damage can also be measured with imaging techniques such as optical coherence tomography (OCT)., Objective: To compare statistical methods that combine VF and OCT data with VF-only methods to establish whether or not these allow (1) more rapid identification of glaucoma progression and (2) shorter or smaller clinical trials., Design: Method 'hit rate' (related to sensitivity) was evaluated in subsets of the United Kingdom Glaucoma Treatment Study (UKGTS) and specificity was evaluated in 72 stable glaucoma patients who had 11 VF and OCT tests within 3 months (the RAPID data set). The reference progression detection method was based on Guided Progression Analysis™ (GPA) Software (Carl Zeiss Meditec Inc., Dublin, CA, USA). Index methods were based on previously described approaches [Analysis with Non-Stationary Weibull Error Regression and Spatial enhancement (ANSWERS), Permutation analyses Of Pointwise Linear Regression (PoPLR) and structure-guided ANSWERS (sANSWERS)] or newly developed methods based on Permutation Test (PERM), multivariate hierarchical models with multiple imputation for censored values (MaHMIC) and multivariate generalised estimating equations with multiple imputation for censored values (MaGIC)., Setting: Ten university and general ophthalmology units (UKGTS) and a single university ophthalmology unit (RAPID)., Participants: UKGTS participants were newly diagnosed glaucoma patients randomised to intraocular pressure-lowering drops or placebo. RAPID participants had glaucomatous VF loss, were on treatment and were clinically stable., Interventions: 24-2 VF tests with the Humphrey Field Analyzer and optic nerve imaging with time-domain (TD) Stratus OCT™ (Carl Zeiss Meditec Inc., Dublin, CA, USA)., Main Outcome Measures: Criterion hit rate and specificity, time to progression, future VF prediction error, proportion progressing in UKGTS treatment groups, hazard ratios (HRs) and study sample size., Results: Criterion specificity was 95% for all tests; the hit rate was 22.2% for GPA, 41.6% for PoPLR, 53.8% for ANSWERS and 61.3% for sANSWERS (all comparisons p  ≤ 0.042). Mean survival time (weeks) was 93.6 for GPA, 82.5 for PoPLR, 72.0 for ANSWERS and 69.1 for sANSWERS. The median prediction errors (decibels) when the initial trend was used to predict the final VF were 3.8 (5th to 95th percentile 1.7 to 7.6) for PoPLR, 3.0 (5th to 95th percentile 1.5 to 5.7) for ANSWERS and 2.3 (5th to 95th percentile 1.3 to 4.5) for sANSWERS. HRs were 0.57 [95% confidence interval (CI) 0.34 to 0.90; p  = 0.016] for GPA, 0.59 (95% CI 0.42 to 0.83; p  = 0.002) for PoPLR, 0.76 (95% CI 0.56 to 1.02; p  = 0.065) for ANSWERS and 0.70 (95% CI 0.53 to 0.93; p  = 0.012) for sANSWERS. Sample size estimates were not reduced using methods including OCT data. PERM hit rates were between 8.3% and 17.4%. Treatment effects were non-significant in MaHMIC and MaGIC analyses; statistical significance was altered little by incorporating imaging., Limitations: TD OCT is less precise than current imaging technology; current OCT technology would likely perform better. The size of the RAPID data set limited the precision of criterion specificity estimates., Conclusions: The sANSWERS method combining VF and OCT data had a higher hit rate and identified progression more quickly than the reference and other VF-only methods, and produced more accurate estimates of the progression rate, but did not increase treatment effect statistical significance. Similar studies with current OCT technology need to be undertaken and the statistical methods need refinement., Trial Registration: Current Controlled Trials ISRCTN96423140., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 22, No. 4. See the NIHR Journals Library website for further project information. Data analysed in the study were from the UKGTS. Funding for the UKGTS was provided through an unrestricted investigator-initiated research grant from Pfizer Inc. (New York, NY, USA), with supplementary funding from the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. Imaging equipment loans were made by Heidelberg Engineering, Carl Zeiss Meditec and Optovue (Fremont, CA, USA). Pfizer, Heidelberg Engineering, Carl Zeiss Meditec and Optovue had no input into the design, conduct, analysis or reporting of any of the UKGTS findings or this work. The sponsor for both the UKGTS and RAPID data collection was Moorfields Eye Hospital NHS Foundation Trust. David F Garway-Heath, Tuan-Anh Ho and Haogang Zhu are partly funded by the NIHR Biomedical Research Centre based at Moorfields Eye Hospital and UCL Institute of Ophthalmology. David F Garway-Heath's chair at University College London (UCL) is supported by funding from the International Glaucoma Association.

The impact of self esteem and Locus of Control (LoC) on clinical presentation across different ethnic groups of patients at their first psychotic episode (FEP) remains unknown. We explored these constructs in 257 FEP patients (Black n=95; White British n=119) and 341 controls (Black n=70; White British n=226), and examined their relationship with symptom dimensions and pathways to care. FEP patients presented lower self-esteem and a more external LoC than controls. Lower self esteem was associated with a specific symptoms profile (more manic and less negative symptoms), and with factors predictive of poorer outcome (longer duration of untreated psychosis (DUP) and compulsory mode of admission). A more external LoC was associated with more negative symptoms and an insidious onset. When we explored these constructs across different ethnic groups, we found that Black patients had significantly higher self esteem than White British. This was again associated with specific symptom profiles. While British patients with lower self esteem were more likely to report delusions, hallucinations and negative symptoms, Black patients with a lower self esteem showed less disorganization symptoms. These findings suggest that self esteem and LoC may represent one way in which social experiences and contexts differentially influence vulnerable individuals along the pathway to psychosis., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BME) population in the UK. One important, but relatively less researched explanation of these high rates may be social adversity associated with acculturation processes. Strong identification with an ethnic minority group subjected to social disadvantage may exert adverse effects on individuals from BME groups. Using data from a large epidemiological case-control study of first-episode psychosis, we aimed to investigate whether strong ethnic identification is a factor contributing to the excess of psychosis in BME groups compared with the White British, after adjustment for perceptions of disadvantage. All cases with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in London and Nottingham, UK, and geographically matched community controls were included in the study. Data were collected on socio-demographic and clinical characteristics, perceptions of disadvantage, and identification with one's own ethnic group. Analysis was performed on data from 139 cases and 234 controls. There was evidence that, as levels of ethnic identification increased, the odds of psychosis increased in the BME but not in the White British group, independent of potential confounders. However, the association between strong ethnic identity and psychosis in BME individuals was attenuated and non-significant when controlled for perceived disadvantage. Strong identification with an ethnic minority group may be a potential contributory factor of the high rates of psychosis in the BME population, the effects of which may be explained by perceptions of disadvantage., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background: Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life. The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined., Methods/design: The ICON (Intensive Care Outcome Network) study is a multi-centre, longitudinal study of survivors of critical illness. Patients will be recruited prior to hospital discharge from 20-30 ICUs in the UK and will be assessed at 3, 6, and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 (SF-36) and the EuroQoL (EQ-5D); anxiety and depression as measured by the Hospital Anxiety and Depression Scale (HADS); and post traumatic stress disorder (PTSD) symptoms as measured by the PTSD Civilian Checklist (PCL-C). Postal questionnaires will be used., Discussion: The ICON study will create a valuable UK database detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness. Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality, prognosis and treatment effects is dependent on accurate determination of prevalence. The results will also inform economic modelling of the long-term burden of critical illness., Trial Registration: ISRCTN69112866.

Background: Aggressive behaviour is increased among those with schizophrenia but less is known about those with affective psychoses. Similarly, little is known about aggressive behaviour occurring at the onset of illness., Method: The main reasons for presentation to services were examined among those recruited to a UK-based first episode psychosis study. The proportion of individuals presenting with aggressive behaviour was determined and these individuals were compared to those who were not aggressive on a range of variables including sociodemographic, clinical, criminal history, service contact, and symptom characteristics. Among the aggressive group, those who were physically violent were distinguished from those who were not violent but who were still perceived to present a risk of violence to others., Results: Almost 40% (n=194) of the sample were aggressive at first contact with services; approximately half of these were physically violent (n=103). Younger age, African-Caribbean ethnicity and a history of previous violent offending were independently associated with aggression. Aggressive behaviour was associated with a diagnosis of mania and individual manic symptoms were also associated with aggression both for the whole sample and for those with schizophrenia. Factors differentiating violent from non-violent aggressive patients included male gender, lower social class and past violent offending., Conclusions: Aggressive behaviour is not an uncommon feature in those presenting with first episode psychosis. Sociodemographic and past offending factors are associated with aggression and further differentiate those presenting with more serious violence. A diagnosis of mania and the presence of manic symptoms are associated with aggression.

In spite of the substantial academic effort being devoted to the subject of health care rationing, there is little clarity about the views of those working in health care who have to implement rationing nor about the views of citizens who are (potentially) affected by the rationing of care. This paper reports the findings of a study conducted using focus groups and semi-structured interviews to explore and compare beliefs about rationing among citizens and those with a role in the health service (service informants) within the context of health care provision in the UK. Citizen and service informants both identified external pressures on the resources available for health care including technological improvement, the ageing population and increasing public expectations. Citizens, however, also identified such factors as the political choice to provide insufficient funds to the health service and the wasteful use of resources that are available. The predominant view was that these latter factors were amenable to change and thus that there are alternatives to the rationing of care. Some citizens accepted that some health care rationing might be necessary. Service informants, on the other hand, were cynical about prospects of increased funding and viewed further reductions in management as untenable. For them, rationing was an inevitability to be managed. A number of these informants felt that rationing should become more explicit, suggesting that openness made rationing both more democratic and more practical. Others, however, believed that explicit rationing would have a number of uncomfortable implications. The paper concludes by suggesting that if rationing is to become more explicit, its inevitability, as perceived by those working within health care, will have to be communicated to citizens.

There are a number of impulses towards public participation in health care decision making including instrumentalist, communitarian, educative and expressive impulses and the desire for increased accountability. There has, however, been little research looking systematically at the public's preferences for being involved in particular types of rationing decisions, nor indeed, has there been a critical examination of the degree of involvement desired by the public. The research reported here uses findings from focus groups and in-depth interviews to explore these questions. Eight focus groups were conducted with a total of 57 informants, four amongst randomly selected members of the public and four with informants from health and non-health related organisations. Nineteen interviews were conducted to allow the elaboration of focus group comments, to probe views more deeply and to pursue emerging themes. The findings show variations in the willingness of members of the public to be involved in health care decisions and consistency across the different forms of the public as represented by the focus groups with randomly selected citizens and pre-existing organisations. There was a strong desire in all the groups for the public to be involved both at the system and programme levels, with much less willingness to be involved at the individual level. At the system and programme levels informants generally favoured consultation, without responsibility for decisions, but with the guarantee that their contribution would be heard and that decisions taken following consultation would be explained. At the patient level informants felt that the public should participate only by setting criteria for deciding between potential beneficiaries of treatment. The public has much to contribute, particularly at the system and programme levels, to supplement the inputs of health care professionals.

A cross-sectional survey of a convenience-sample of 740 cats was undertaken to obtain an estimate of the prevalence of Bordetella bronchiseptica infection, and to identify risk factors that might predispose them to the infection. Data on individual cats and household variables, including disease status and animal contacts were obtained by questionnaire. B bronchiseptica was isolated from 82 (11 per cent) of the cats sampled. The prevalence of B bronchiseptica varied with the type of household sampled, being 19.5 per cent in rescue catteries, 9 per cent in breeding catteries, 13.5 per cent in research colonies, and 0 per cent in household pets. On the basis of a univariable analysis, 19 of 29 predictor variables were found to be significantly associated with the isolation of B bronchiseptica, including an association with cats in rescue catteries, and with cats from premises with larger numbers of animals. Separate analysis of the rescue cattery subpopulation showed a highly significant association on multivariable analysis with current respiratory disease, suggesting that different risk factors may operate in this type of environment. In the whole sample there was also strong association with cats from households containing a dog with recent respiratory tract disease. The clinical signs observed in the B bronchiseptica-positive cats included sneezing, ocular and nasal discharges and coughing, although only the association with sneezing was statistically significant. There was no significant association between the isolation of B bronchiseptica and the isolation of respiratory viruses, suggesting that in some circumstances B bronchiseptica may be able to cause disease independently.