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Background: In 2016, large-scale 20 miles per hour speed limits were introduced in the United Kingdom cities of Edinburgh and Belfast. This paper investigates the role that scientific evidence played in the policy decisions to implement lower speed limits in the two cities., Methods: Using a qualitative case study design, we undertook content analysis of a range of documents to explore and describe the evolution of the two schemes and the ways in which evidence informed decision-making. In total, we identified 16 documents for Edinburgh, published between 2006 and 2016, and 19 documents for Belfast, published between 2002 and 2016., Findings: In both cities, evidence on speed, collisions and casualties was important for initiating discussions on large-scale 20 mph policies. However, the narrative shifted over time to the idea that 20 mph would contribute to a wider range of aspirations, none of which were firmly grounded in evidence, but may have helped to neutralize opposing discourses., Discussion and Conclusions: The relationship between evidence and decision-making in Edinburgh and Belfast was neither simple nor linear. Widening of the narrative appears to have helped to frame the idea in such a way that it had broad acceptability, without which there would have been no implementation, and probably a lot more push back from vested interests and communities than there was., (© 2024. The Author(s).)

Objectives: To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort., Background: There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO., Methods: Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes., Results: There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42-4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25-2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10-0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %., Conclusions: In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes., Competing Interests: Declaration of competing interest Dr. William HT Smith has received payment from Boston and Abbott for Proctoring CTO PCI procedures locally in the past but not in the last 12 months. None of the other authors has any conflict of interest for this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Physical activity referral schemes (PARS) are a popular physical activity (PA) intervention in the UK. Little is known about the type, intensity and duration of PA undertaken during and post PARS. We calculated weekly leisure centre-based moderate/vigorous PA for PARS participants (n = 448) and PARS completers (n = 746) in Northumberland, UK, between March 2019-February 2020 using administrative data. We categorised activity levels (<30 min/week, 30-149 min/week and ≥150 min/week) and used ordinal regression to examine predictors for activity category achieved. PARS participants took part in a median of 57.0 min (IQR 26.0-90.0) and PARS completers a median of 68.0 min (IQR 42.0-100.0) moderate/vigorous leisure centre-based PA per week. Being a PARS completer (OR: 2.14, 95% CI: 1.61-2.82) was a positive predictor of achieving a higher level of physical activity category compared to PARS participants. Female PARS participants were less likely (OR: 0.65, 95% CI: 0.43-0.97) to achieve ≥30 min of moderate/vigorous LCPA per week compared to male PARS participants. PARS participants achieved 38.0% and PARS completers 45.3% of the World Health Organisation recommended ≥150 min of moderate/vigorous weekly PA through leisure centre use. Strategies integrated within PARS to promote PA outside of leisure centre-based activity may help participants achieve PA guidelines.

Background: Physical activity (PA) levels vary across specific population groups, contributing to health inequalities. Little is known about how local authority leisure centers contribute to population PA and whether this differs by age, sex, or socioeconomic group., Methods: The authors calculated weekly leisure center-based moderate/vigorous PA for 20,904 registered adult users of local authority leisure facilities in Northumberland, United Kingdom, between July 2018 and June 2019, using administrative data. The authors categorized activity levels (<30, 30-149, and ≥150 min/wk) and used ordinal regression to examine predictors for activity category achieved., Results: Registered users were mainly female (58.7%), younger (23.9% of users aged 18-29 y vs 10.1% of those aged 70+ y), and from the 2 most affluent socioeconomic quintiles (53.7%). Median weekly moderate/vigorous leisure center-based activity was 55 minutes per week (interquartile range: 30-99). Being female (odds ratio: 2.09; 95% confidence interval, 1.95-2.35), older (odds ratio: 1.14; 95% confidence interval, 1.11-1.16), and using a large facility (odds ratio: 1.21; 95% confidence interval, 1.03-1.42) were positive predictors of leisure center-based PA., Conclusion: Older adults and females were more likely to be active and achieve the recommended PA levels through usage of the centers. Widespread use of this novel measure of leisure center-based activity would improve the understanding of how local authority leisure centers can address physical inactivity and its associated inequalities.

Background: Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes., Methods: We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy., Results: Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change)., Conclusion: Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice.

Background: The family unit may be an important mechanism for increasing physical activity levels, yet little is known about what types of family-based interventions are effective. This study involved a formative evaluation of a 12 week intervention to encourage walking as a family based activity. The intervention consisted of several key elements including led walks and tailored resources, as well as remote support provided via the telephone. The project aimed to explore factors associated with successful delivery of the programme and to identify areas of improvement for future implementation., Methods: A total of nine interviews were undertaken with programme staff who were involved in either the set up or delivery of the intervention. In addition, four interviews and two focus groups were undertaken with participants to explore their experiences of the programme. The analysis involved both deductive and inductive reasoning., Results: In total, 114 people participated in the programme, which included 36 adults, 10 adolescents and 68 children (≤ 10 years of age). Adult participants reported several barriers to walking including concerns over their children's behaviour and their ability to maintain 'control' of their children. Walking in a group with other families gave parents confidence to go out walking with their children and provided a valuable opportunity for social interaction for parents and children alike. The most successful walks incorporated specific destinations and an activity to undertake upon reaching the destination. Incorporating other activities along the way also helped to keep the children engaged., Conclusions: The results of this study have highlighted the important contribution that formative research can make in informing and refining a programme to increase appropriateness and effectiveness. The study has helped to highlight the key characteristics associated with delivering a successful walking intervention to young families. It is recommended that practitioners undertake formative research when developing novel health promotion initiatives to help refine the programme protocols.