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SUMMARYA selection of summaries of post-medieval archaeological fieldwork carried out across Britain, Northern Ireland and Crown Dependencies in 2023 have been compiled for this annual round-up. These are indexed with thematic keywords. Formatting conventions and notes for future contributors are also outlined. [ABSTRACT FROM AUTHOR]

Devolution in the United Kingdom heralded a significant change in democratic arrangements including associated accountability mechanisms in the form of public accounts committees (PACs) in Scotland, Wales and Northern Ireland. This paper investigates whether devolved arrangements have resulted in enhanced accountability. Based on documentary sources, survey data, and interviews with key stakeholders, this study finds that all three jurisdictions have a high level of public accountability, with Wales being the most effective PAC. While there are significant differences in the information and discussion phases of the committees' work, all three regions have comparable outcomes as a result of their deliberations. [ABSTRACT FROM AUTHOR]

Background and aims: On 1 May 2018, Scotland introduced minimum unit pricing (MUP), a strength‐based floor price below which alcohol cannot be sold, throughout all alcoholic beverages. The legislation necessitates an evaluation of its impact across a range of outcomes that will inform whether MUP will continue beyond its sixth year. We measured the impact of MUP on per‐adult alcohol sales (as a proxy for consumption) after 3 years of implementation. Design, setting and participants: Controlled interrupted time‐series regression was used to assess the impact of MUP on alcohol sales in Scotland after 3 years of implementation, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on‐trade alcohol sales (in off‐trade analyses) and substitution between drink categories (in drink category analyses) as covariates. Measurements: Weekly data were assessed on the volume of pure alcohol sold in Scotland and EW between January 2013 and May 2021, expressed as litres of pure alcohol per adult. The impact of MUP on total (on‐ and off‐trade combined), off‐trade and on‐trade alcohol sales was assessed separately. Results: The introduction of MUP in Scotland was associated with a 3.0% (95% confidence interval = 1.8−4.2%) net reduction in total alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. This reflects a 1.1% fall in Scotland in contrast to a 2.4% increase in EW. The reduction in total alcohol sales in Scotland was driven by reduced sales of beer, spirits, cider and perry. The reduction in total sales was due to reductions in sales of alcohol through the off‐trade. There was no evidence of any change in on‐trade alcohol sales. Conclusion: Minimum unit pricing has been effective in reducing population‐level alcohol sales in Scotland in the 3 years since implementation. [ABSTRACT FROM AUTHOR]

Practice-based education is an essential component of pre-registration physiotherapy programs, and there is a need for a contemporary review of practice-based educational experiences. The aim of this study was to explore physiotherapy practice educators' experiences of supporting learners to inform considerations for future workforce development. This was a mixed methods sequential explanatory study based in the United Kingdom (UK). Phase one of the study utilized an online survey disseminated via the Chartered Society of Physiotherapy (CSP) professional networks. Phase two consisted of three semi-structured focus group interviews with participants who expressed an interest via completion of the online survey. All were registered or associate CSP members who actively support practice-based education. A total of 208 participants completed the online survey and a sub-set of 15 participated in online focus groups. Quantitative survey data were analyzed using descriptive statistics. Initial thematic analysis of qualitative data from both phases was undertaken by one researcher. Subsequent analyses were carried out independently by the remaining research team, and comparisons were made to agree on codes, categories, and themes. The practice educator is vital in developing the future workforce (30%, n = 61, strongly agree). Identified challenges included supervising more than one learner (34%, n = 67 not at all experienced) and using technology to provide alternative placement models (45%, n = 87 not at all experienced). Practice educators need accessible opportunities for professional development. Practice-based education should be embedded as an integral component of all staff roles. A team approach is essential to developing the future physiotherapy workforce. [ABSTRACT FROM AUTHOR]

Objectives Evidence suggests spouses influence each other's subjective views on aging. Aligned with the Theory of Dyadic Illness Management, we investigated for the first time similarities in felt age (how old people feel relative to their chronological age) between people with dementia and their spousal caregivers, and how each partner's felt age was related to psychological correlates in the other partner. Methods We used baseline (2014–2016) data from 1,001 people with dementia and their spousal caregivers who participated in the British Improving the experience of Dementia and Enhancing Active Life study. We ran linear regressions to analyze the extent to which the felt age of people with dementia and their caregivers were similar, and whether relationship quality was associated with the similarity. We utilized actor–partner interdependence models to analyze whether the felt age of people with dementia and their caregivers were associated with each other's well-being, satisfaction with life, and self-efficacy. Results The felt age of people with dementia was associated with the felt age of their caregivers (β = 0.10; p =.001). Caregivers and people with dementia reported a more similar felt age when caregivers rated the caregiving relationship more positively (β = 0.07; p =.04). Caregivers' felt age was associated with well-being (β = 0.07; p =.02) and satisfaction with life (β = 0.06; p =.04), but not with self-efficacy, in people with dementia. Discussion Felt age in caregivers and people with dementia may be interwoven, and important psychological variables in people with dementia are related to caregivers' felt age. Findings offer empirical evidence on dementia caregiving dynamics and how family relationships are related to views on aging. [ABSTRACT FROM AUTHOR]

Objectives: To explore how the use of, and trust in, different sources of advice and information on COVID-19 differed across the four UK nations and between different sociodemographic groups and their associations with COVID-19 vaccination status. Methods: We used a UK-wide representative survey conducted in July 2021, which included data on uptake of COVID-19 vaccination, trust in information sources, use of sources and geographical and sociodemographic variables. We used multivariate logistic regression to identify factors associated with completed or planned COVID-19 vaccination. Results: Trust in the NHS, followed by trust in scientists, were the strongest predictors of vaccination intention. NHS websites were the most used (56% across the UK); only the Scottish government website had a higher level of reported use (58%). Using either source was associated with a positive vaccination status as were use of the GP and television as sources of advice. Use of social media, family and friends, and 'none' of the sources enquired about, were all linked to a lower likelihood of being or intending to get vaccinated. Compared to those in England, respondents in other UK nations were less likely to trust the central UK government for advice on COVID-19. There was considerable variation by age in trust and use of some, but not all, sources of advice, with predicted probabilities ranging from 35% among the youngest age group to 62% among those aged 65 years or older. There were also significant differences by annual household income and by occupational class for trust in government, with higher incomes correlating with greater likelihood of trust. Conclusions: This study demonstrates high levels of trust in the key sources of public health advice and there was a positive association between using official sources of advice and vaccination intentions, even in the context of overall high vaccination rates. Our findings highlight the need for the UK and devolved governments to value the importance of public trust in the health system and take appropriate measures to avoid undermining such trust. [ABSTRACT FROM AUTHOR]

Introduction: The last 3 years have seen substantial changes in Great Britain (GB) including the COVID‐19 pandemic, cost‐of‐living crisis and policy changes such as minimum unit pricing. We examined changes in purchasing cross‐border, illicit and home‐brewed alcohol among risky drinkers over this period. Methods: Data were used from 22,086 adult (≥18 years) increasing/higher‐risk drinkers (AUDIT‐C ≥5) participating in a monthly cross‐sectional survey between October 2020 and August 2023. We estimated time trends in the proportion reporting obtaining alcohol from: (i) cross‐border (any/within‐GB/international); (ii) illicit; and (iii) home‐brewed sources in the past 6 months. Results: Between October 2020 and August 2023, the proportion reporting cross‐border alcohol purchases increased (from 8.5% to 12.5% overall; prevalence ratio [PR] = 1.47 [95% CI 1.17–1.86]). This was largely driven by an increase in cross‐border purchases abroad (PR = 1.52 [1.13–2.05]), with a smaller, uncertain increase in cross‐border purchases within GB (PR = 1.37 [0.96–1.95]). The prevalence of cross‐border alcohol purchasing was higher in Wales (13.8% [12.3–15.4%]) and Scotland (6.1% [5.4–6.8%]) than England (3.6% [3.3–3.9%]). There was little change in illicit alcohol purchasing in England or Wales (4.1% [3.7–4.4%]; 4.2% [3.2–5.1%]), but in Scotland it fell from 5.7% to 2.4% (PR = 0.42 [0.19–0.81]). Home‐brewed alcohol was rare (GB: 3.1% [2.9–3.4]) and stable. Discussion and Conclusions: The proportion of increasing/higher‐risk drinkers in GB purchasing cross‐border alcohol increased between October 2020 and August 2023, due to an increase in people buying alcohol abroad. Cross‐border alcohol purchases within GB were more commonly reported in Wales and Scotland. The small proportion purchasing illicit alcohol did not change substantially in England or Wales, but fell by half in Scotland. [ABSTRACT FROM AUTHOR]

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n  = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n  = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. [ABSTRACT FROM AUTHOR]

The relationship between inflammatory dietary patterns and the risk of depression/anxiety has not been clearly established due to differences in study populations, geographic regions, sex, and methods of calculating the inflammatory index. We drew upon a prospective cohort in the UK Biobank and calculated the energy-adjusted dietary inflammatory index (E -DII). The follow-up time was defined from the date of completing the last dietary survey questionnaire to the date of diagnosis of depression, anxiety, phobic anxiety, other types of anxiety, death, loss to follow-up, or the respective censoring dates for England (September 30, 2021), Scotland (July 31, 2021), and Wales (February 28, 2018). The final follow-up times end on September 30, 2021, July 31, 2021, and February 28, 2018, for England, Scotland, and Wales, respectively. During the follow-up process, if a participant develops the condition, dies, or is lost to follow-up, the follow-up is terminated. We used Cox regression to evaluate the connection between E -DII and depression/anxiety. We employed restricted cubic spline curves for nonlinear relationships. We also conducted mediation analyses to explore whether biological age mediated the relationship between E -DII and depression. Additionally, we investigated whether genetic susceptibility modified the relationship between E-DII and depression through interaction modeling. In the final analysis, we included a total of 151,295, 159,695, 165,649, and 160,097 participants for the analysis of depression, all types of anxiety, specific phobia anxiety, and other types of anxiety, respectively. For every one-unit increase in E -DII, the risk of experiencing depression and anxiety increased by 5 % and 4 %, respectively. We identified a "J"-shaped nonlinear relationship (P for nonlinear = 0.003) for both depression and anxiety. A significant association with an elevated risk of depression was observed when E -DII exceeded 0.440, and an increased risk of anxiety was noted when E-DII was more than −0.196. Mediation analysis demonstrated that PhenoAge age acceleration (AA) (For depression, proportion of mediation = 9.6 %; For anxiety, proportion of mediation = 10.1 %) and Klemera-Doubal method Biological Age (KDM AA) (For depression, proportion of mediation = 2.9 %; For anxiety, proportion of mediation = 5.1 %) acted as mediators between E -DII and the development of depression and anxiety (P < 0.05). Diets with pro-inflammatory characteristics are associated with a heightened risk of depression and anxiety. Furthermore, the association of pro-inflammatory diets and depression is mediated by biological age. • Survival analysis with dose-response examined diet's link to depression/anxiety. • Investigating how biological aging mediates inflammation-related diet's impact on depression and anxiety. • Further studies were conducted based on the genetic susceptibility of the participants. • An analysis based on data from a large cohort. [ABSTRACT FROM AUTHOR]

Background: Anticholinergic medication use is associated with cognitive decline and incident dementia. Our study, a prospective birth cohort analysis, aimed to determine if repeated exposure to anticholinergic medications was associated with greater decline, and whether decline was reversed with medication reduction. Methods: From the Medical Research Council (MRC) National Survey of Health and Development, a British birth cohort with all participants born in a single week of March 1946, we quantified anticholinergic exposure between ages 53 and 69 years using the Anticholinergic Cognitive Burden Scale (ACBS). We used multinomial regression to estimate associations with global cognition, quantified by the Addenbrooke's Cognitive Examination, 3rd Edition (ACE-III). Longitudinal associations between ACBS and cognitive test results (Verbal memory quantified by the Word Learning Test [WLT], and processing speed quantified by the Timed Letter Search Task [TLST]) at three time points (age 53, 60–64 and 69) were assessed using mixed and fixed effects linear regression models. Analyses were adjusted for sex, childhood cognition, education, chronic disease count and severity, and mental health symptoms. Results: Anticholinergic exposure was associated cross-sectionally with lower ACE-III scores at age 69, with the greatest effects in those with high exposure at ages 60–64 (mean difference − 2.34, 95% confidence interval [CI] − 3.51 to − 1.17). Longitudinally, both mild-moderate and high ACBS scores were linked to lower WLT scores, again with high exposure showing larger effects (mean difference with contemporaneous exposure − 0.90, 95% CI − 1.63 to − 0.17; mean difference with lagged exposure − 1.53, 95% CI − 2.43 to − 0.64). Associations remained in fixed effects models (mean difference with contemporaneous exposure −1.78, 95% CI −2.85 to − 0.71; mean difference with lagged exposure − 2.23, 95% CI − 3.33 to − 1.13). Associations with TLST were noted only in isolated contemporaneous exposure (mean difference − 13.14, 95% CI − 19.04 to − 7.23; p < 0.01). Conclusions: Anticholinergic exposure throughout mid and later life was associated with lower cognitive function. Reduced processing speed was associated only with contemporaneous anticholinergic medication use, and not historical use. Associations with lower verbal recall were evident with both historical and contemporaneous use of anticholinergic medication, and associations with historical use persisted in individuals even when their anticholinergic medication use decreased over the course of the study. [ABSTRACT FROM AUTHOR]

The core function of joint registries is to collect, collate, and present data about patients who undergo joint replacement surgery, and afford clinicians and administrators a range of analytic functions to monitor service performance. This article describes the development, evolution, and future of arthroplasty registries, drawing particularly from the experience of the Scottish Arthroplasty Project (SAP). The SAP was established in 1999 and is one of the oldest arthroplasty registries in the world. It collects information on patients undergoing hip, knee, ankle, shoulder, and elbow arthroplasty. The primary aim is to encourage continual improvement in the quality of care provided for arthroplasty patients in Scotland. It is distinct in terms of administration and methodology from the National Joint Registry (NJR) of England, Wales, and Northern Ireland as it monitors patients rather than implants. Since its inception, its work has contributed to a reduction in overall complication rates and a significant decrease in hospital length of stay for the growing number of patients undergoing arthroplasty. It continues to provide a robust database that is used to underpin national guidance through data-driven research. The research carried out by dedicated SAP fellows has enhanced the research portfolio of the SAP and raised its profile through high quality peer-reviewed publications. The SAP continues to evolve and by collaborating with other Scottish registries it will provide larger datasets containing greater diversity and granularity of information. These developments as well as ongoing analysis of existing areas ensure that the SAP continues to maintain and improve standards in arthroplasty across Scotland. [ABSTRACT FROM AUTHOR]

Objective: Chronological age (CAge), biological age (BAge), and accelerated age (AAge) are all important for aging‐related diseases. CAge is a known risk factor for benign prostatic hyperplasia (BPH); However, the evidence of association of BAge and AAge with BPH is limited. This study aimed to evaluate the association of CAge, Bage, and AAge with BPH in a large prospective cohort. Method: A total of 135,933 males without BPH at enrolment were extracted from the UK biobank. We calculated three BAge measures (Klemera–Doubal method, KDM; PhenoAge; homeostatic dysregulation, HD) based on 16 biomarkers. Additionally, we calculated KDM‐BAge and PhenoAge‐BAge measures based on the Levine method. The KDM‐AAge and PhenoAge‐AAge were assessed by the difference between CAge and BAge and were standardized (mean = 0 and standard deviation [SD] = 1). Cox proportional hazard models were applied to assess the associations of CAge, Bage, and AAge with incident BPH risk. Results: During a median follow‐up of 13.150 years, 11,811 (8.690%) incident BPH were identified. Advanced CAge and BAge measures were associated with an increased risk of BPH, showing threshold effects at a later age (all P for nonlinearity <0.001). Nonlinear relationships between AAge measures and risk of BPH were also found for KDM‐AAge (P = 0.041) and PhenoAge‐AAge (P = 0.020). Compared to the balance comparison group (−1 SD < AAge < 1 SD), the accelerated aging group (AAge > 2 SD) had a significantly elevated BPH risk with hazard ratio (HR) of 1.115 (95% CI, 1.000–1.223) for KDM‐AAge and 1.180 (95% CI, 1.068–1.303) for PhenoAge‐AAge, respectively. For PhenoAge‐AAge, subgroup analysis of the accelerated aging group showed an increased HR of 1.904 (95% CI, 1.374–2.639) in males with CAge <50 years and 1.233 (95% CI, 1.088–1.397) in those having testosterone levels <12 nmol/L. Moreover, AAge‐associated risk of BPH was independent of and additive to genetic risk. Conclusions: Biological aging is an independent and modifiable risk factor for BPH. We suggest performing active health interventions to slow biological aging, which will help mitigate the progression of prostate aging and further reduce the burden of BPH. [ABSTRACT FROM AUTHOR]

Existing research on party leader questioning in legislatures usually focuses on single case studies, less-than-ideal behaviours across leaders, and often post-election periods. Our article compares hostility and positivity in behaviours across three parliaments and, because of the COVID-19 crisis, across different time periods and modes of operation (live, hybrid, and online) while controlling for the same leaders. Using content analysis at the sentence level (N = 3554), our data contrast parliamentary leader hostility and positivity levels in the UK, Scottish, and Welsh Parliaments across three time periods: pre-COVID-19, initial, and lockdown COVID-19. Findings for positivity are mixed, but for hostility, we find that while the initial shock of the COVID-19 crisis suppressed hostility, Westminster has higher ratios of hostility across all three time periods, and that format of operation has little effect on behaviour. Findings suggest less hostility in Scotland and Wales than in Westminster adding possible weight to 'new politics' arguments. [ABSTRACT FROM AUTHOR]

The UK Biobank study contains several sources of diagnostic data, including hospital inpatient data and data on self-reported conditions for approximately 500,000 participants and primary-care data for approximately 177,000 participants (35%). Epidemiologic investigations require a primary disease definition, but whether to combine data sources to maximize statistical power or focus on only 1 source to ensure a consistent outcome is not clear. The consistency of disease definitions was investigated for venous thromboembolism (VTE) by evaluating overlap when defining cases from 3 sources: hospital inpatient data, primary-care reports, and self-reported questionnaires. VTE cases showed little overlap between data sources, with only 6% of reported events for persons with primary-care data being identified by all 3 sources (hospital, primary-care, and self-reports), while 71% appeared in only 1 source. Deep vein thrombosis–only events represented 68% of self-reported VTE cases and 36% of hospital-reported VTE cases, while pulmonary embolism–only events represented 20% of self-reported VTE cases and 50% of hospital-reported VTE cases. Additionally, different distributions of sociodemographic characteristics were observed; for example, patients in 46% of hospital-reported VTE cases were female, compared with 58% of self-reported VTE cases. These results illustrate how seemingly neutral decisions taken to improve data quality can affect the representativeness of a data set. [ABSTRACT FROM AUTHOR]

Background: The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2–13 (and 14–15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. Methods: End‐of‐season adjusted vaccine effectiveness (VE) estimates against sentinel primary‐care attendance for influenza‐like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. Methods: Results In the mainland United Kingdom, end‐of‐season VE against all laboratory‐confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: −6% to 54%). VE for those aged 18–64, who largely received cell‐based vaccines, was 47% (95% CI: 37%–56%). Overall VE for 2–17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%–76%). Conclusion: The paper provides evidence of moderate influenza VE in 2022/23. [ABSTRACT FROM AUTHOR]

Background: Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. Methods and findings: A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. Conclusions: The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process. In this multi-centre UK wide study including >6000 participants, Chloe Swords and co-workers explore referral patterns for cochlear implantation vary across the UK according to ethnicity and socioeconomics. Author summary: Why was this study done?: • This study was undertaken to investigate referral patterns for cochlear implantation among patients meeting pure tone audiometric threshold criteria in Great Britain and to identify if socioeconomic or ethnic disparities effect the likelihood of referral. What did the researchers do and find?: • Researchers conducted an observational study across 36 secondary care Otolaryngology and Audiology units in Great Britain, focusing on adults who met pure tone audiometric threshold criteria for cochlear implant assessment. • Of 6,171 included adults identified, 36% were informed of their potential eligibility for a cochlear implant, but only 9% were actually referred for assessment. • Referral likelihood was lower for those in more deprived areas, living in London, of male sex, or older age. • Ethnic minorities, particularly of Asian or black backgrounds, were also less likely to be informed about their eligibility. What do these findings mean?: • These data suggest that the majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are not being referred appropriately for cochlear implant assessments, indicating significant disparities in patient management based on socioeconomic status, ethnicity, and sex. • These disparities suggest a need for targeted efforts to improve referral rates among underrepresented groups and to ensure all patients are informed of their treatment options. • Further research is required to understand and address these disparities, with initiatives to ensure informed decision-making, educate healthcare providers, and explore reasons for declining cochlear implant assessments, especially among older ethnic minority groups. • Study limitations include its observational retrospective nature, potential inaccuracies in the reporting of sex and gender, and the impact of the COVID-19 pandemic on referral protocols. [ABSTRACT FROM AUTHOR]

The Conservative Party has usually done well in rural areas, but its 'green wall' is now under threat from Labour more than the Liberal Democrats. Farmers did not support Brexit any more than the general population, and in income terms they are currently doing well, but fear for the future. In addition, food security issues are more complex than they are portrayed, as are the relations with the devolved governments. In Scotland, the government there is much more popular among Scottish farmers whilst the government in Wales is doing much worse among farming communities. [ABSTRACT FROM AUTHOR]

Aims: Compare by occurrence era and age group how opioid‐related deaths (ORDs) and their counterpart evolved in Scotland vs. England and Wales during 2006–2020. For Scotland, compare coimplication rates between ORDs and non‐ORDs for any benzodiazepine, cocaine or gabapentin/pregabalin, and consider whether coimplication in ORDs depended on opioid‐specificity. Methods: Cross‐tabulations of drug misuse deaths (DMDs) obtained by 3 yearly occurrence era (2006–2008 to 2018–2020) and age group (under 25, 25–34, 35–44, 45–54, 55+ years) for England and Wales and subdivided by whether at least 1 opiate was mentioned on death certificate (DMD‐Os or not); and of Scotland's opioid‐related deaths (ORDs vs. non‐ORDs) together with (i) coimplication by any benzodiazepine, cocaine or gabapentin/pregabalin; and (ii) opioid‐specificity of ORDs. ORD is defined by heroin/morphine, methadone or buprenorphine being implicated in DMD. Results: Per era between 2012–2014 and 2018–2020, Scotland's ORDs increased by 54% and non‐ORDs by 34%. Increase in DMD‐Os in England and Wales was more modest. Cocaine was implicated in 83% of Scotland's 2690 non‐ORDs during 2006–2020; and any benzodiazepine in 53% of 8409 ORDs. However, in 2018–2020, coimplication rates in 2926 ORDs (880 non‐ORDs) were 81% (33%) for any benzodiazepine, 30% (74%) for cocaine and 38% (22%) for gabapentin/pregabalin. Coimplication rate in 2018–2020 for any benzodiazepine was lowest at 70% (616/877) for heroin/morphine ORDs; and, by age group, at 66% (160/241) for ORDs aged 55+ years. Conclusions: Drug testing to inform users, shared intelligence between police and public health for earlier detection of changes in supply and monitoring of prescribed daily‐dose of methadone are urgent. [ABSTRACT FROM AUTHOR]

In 2022, the Welsh Government announced plans to increase the size of the Welsh Parliament/Senedd Cymru, a culmination of two decades of elite-level argument over whether more members should parallel the institution's growing suite of legislative and fiscal powers. While an expanded legislature may improve the Senedd's capacity to scrutinise the executive, opposition has focused on increased costs that detract from core public spending. Using a novel survey experiment conducted in the 2021 Welsh Election Study, we assess public attitudes and find that support for expanding the Senedd is limited to those with a strong Welsh-only identity and pro-autonomy preferences. Although appeals to holding the executive to account do not broaden this base of support, a framing that the Senedd should be comparable in size to legislatures in Scotland and Northern Ireland does have a positive effect on voters with more median constitutional preferences. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to critically examine the effects of COVID-19 social discourses and policy decisions specifically on older adult volunteers in the UK, comparing the responses and their effects in England, Scotland, Wales and Northern Ireland, providing perspectives on effects of policy changes designed to reduce risk of infection as a result of COVID-19, specifically on volunteer involvement of and for older adults, and understand, from the perspectives of volunteer managers, how COVID-19 restrictions had impacted older people's volunteering and situating this within statutory public health policies. Design/methodology/approach: The study uses a critical discourse approach to explore, compare and contrast accounts of volunteering of and for older people in policy, and then compare the discourses within policy documents with the discourses in personal accounts of volunteering in health and social care settings in the four nations of the UK. This paper is co-produced in collaboration with co-authors who have direct experience with volunteer involvement responses and their impact on older people. Findings: The prevailing overall policy approach during the pandemic was that risk of morbidity and mortality to older people was too high to permit them to participate in volunteering activities. Disenfranchising of older people, as exemplified in volunteer involvement, was remarkably uniform across the four nations of the UK. However, the authors find that despite, rather than because of policy changes, older volunteers, as part of, or with the help of, volunteer involving organisations, are taking time to think and to reconsider their involvement and are renewing their volunteer involvement with associated health benefits. Research limitations/implications: Working with participants as co-authors helps to ensure the credibility of results in that there was agreement in the themes identified and the conclusions. A limitation of this study lies in the sampling method, as a convenience sample was used and there is only representation from one organisation in each of the four nations. Originality/value: The paper combines existing knowledge about volunteer involvement of and for older adults. [ABSTRACT FROM AUTHOR]

Background: Electronic healthcare records (EHRs) are an important resource for health research that can be used to improve patient outcomes in chronic respiratory diseases. However, consistent approaches in the analysis of these datasets are needed for coherent messaging, and when undertaking comparative studies across different populations. Methods and Results: We developed a harmonised curation approach to generate comparable patient cohorts for asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) using datasets from within Clinical Practice Research Datalink (CPRD; for England), Secure Anonymised Information Linkage (SAIL; for Wales) and DataLoch (for Scotland) by defining commonly derived variables consistently between the datasets. By working in parallel on the curation methodology used for CPRD, SAIL and DataLoch for asthma, COPD and ILD, we were able to highlight key differences in coding and recording between the databases and identify solutions to enable valid comparisons. Conclusion: Codelists and metadata generated have been made available to help re-create the asthma, COPD and ILD cohorts in CPRD, SAIL and DataLoch for different time periods, and provide a starting point for the curation of respiratory datasets in other EHR databases, expediting further comparable respiratory research. [ABSTRACT FROM AUTHOR]

Description Within the current climate of health care pressures, services are exploring ways in which to use resources to the best of their ability to ensure service users have timely, safe, and effective care as well as having positive outcomes and good experiences of the care they receive. The current paper explores a service level agreement between the private sector and a child and family service within the HSC. Within this agreement, has been the development of a pathway through which families on a psychological service waiting list, could be triaged, and allocated to a private clinic within which, psychological care could be provided from assessment through to discharge. The subjective experiences and initial outcomes of those involved have been largely positive. The paper describes, explores, and reflects on the process of collaborative practice. Terminology HSC – Health & Social Care. In England, Scotland and Wales, the National Health Service (NHS) provides health care services while local councils provide social care services. In Northern Ireland these services are combined under what is known as Health and Social Care (HSC) [ABSTRACT FROM AUTHOR]

Background: The use or non-use of mobile technologies and social media in residential outdoor adventurous education (OAE) remains contested and generates an often-cited for-and-against argument in both theory and practice. Purpose: This qualitative study explored instructor perceptions of mobile technologies and social media in their practice as members of instructional staff at the United Kingdom's Outward Bound Trust. Methodology/Approach: Grounded within a multiple-case study design, 20 members of instructional staff were interviewed online from three Outward Bound Trust centers across Wales, England, and Scotland. Findings/Conclusions: Two major themes are shared as statements: (1) phone-free outdoor experiences are more impactful for young people in contemporary society ; (2) social media is fake, outdoor adventurous education necessitates in-person and in-place interaction. These findings are presented within a postdigital conceptual lens which questions whether any residential outdoor experience can be truly "technology free." Implications: The study consolidates perspectives on mobile technologies and social media in the practices of residential OAE instructors. These perspectives are considered important in the framing and delivery of contemporary OAE practice. [ABSTRACT FROM AUTHOR]

Background: Rates of blood testing have increased over the past two decades. Reasons for testing cannot easily be extracted from electronic health record databases. Aim: To explore who requests blood tests and why, and what the outcomes of testing are in UK primary care. Design and setting: A retrospective audit of electronic health records in general practices in England, Wales, Scotland, and Northern Ireland was undertaken. Method: Fifty-seven clinicians from the Primary care Academic CollaboraTive (PACT) each reviewed the electronic health records of 50 patients who had blood tests in April 2021. Anonymised data were extracted including patient characteristics, who requested the tests, reasons for testing, test results, and outcomes of testing. Results: Data were collected from 2572 patients across 57 GP practices. The commonest reasons for testing in primary care were investigation of symptoms (43.2%), monitoring of existing disease (30.1%), monitoring of existing medications (10.1%), and follow up of previous abnormalities (6.8%); patient requested testing was rare in this study (1.5%). Abnormal and borderline results were common, with 26.6% of patients having completely normal test results. Around one-quarter of tests were thought to be partially or fully unnecessary when reviewed retrospectively by a clinical colleague. Overall, 6.2% of tests in primary care led to a new diagnosis or confirmation of a diagnosis. Conclusion: The utilisation of a national collaborative model (PACT) has enabled a unique exploration of the rationale and outcomes of blood testing in primary care, highlighting areas for future research and optimisation. [ABSTRACT FROM AUTHOR]

Undervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes—ie, COVID-19 hospitalisation or death—compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK. We used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022. The numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94–326) in the 5–15 years age group, 1544 (1399–1689) in those aged 16–74 years, and 5426 (5340–5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61–2·78) for one dose fewer than recommended, 3·13 (2·93–3·34) for two fewer, 3·61 (3·13–4·17) for three fewer, and 3·08 (2·89–3·29) for four fewer. Rates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes. UK Research and Innovation National Core Studies: Data and Connectivity. [ABSTRACT FROM AUTHOR]

Research has established powerful relationships between career guidance, work, and wellbeing. However, some practitioners have only low or moderate confidence in using guidance to support wellbeing. Catalysed by Covid-19, this practitioner-researcher collaboration explored the question: how can we embed wellbeing more explicitly into guidance practice? Concerns and potential solutions were examined with 36 career development practitioners, service managers, and researchers from Canada, England, Scotland, and Wales. This article presents the results of a subsequent pilot in Scotland and Wales to test the resulting initial guidance interview framework. Quantitative evaluations, supported by four case examples, show customer wellbeing progress during initial guidance interviews and gains in practitioner confidence following training. [ABSTRACT FROM AUTHOR]

The UK Biobank has made general practitioner (GP) data (censoring date 2016–2017) available for approximately 45% of the cohort, whilst hospital inpatient and death registry (referred to as "HES/Death") data are available cohort-wide through 2018–2022 depending on whether the data comes from England, Wales or Scotland. We assessed the importance of case ascertainment via different data sources in UKB for three diseases that are usually first diagnosed in primary care: Parkinson's disease (PD), type 2 diabetes (T2D), and all-cause dementia. Including GP data at least doubled the number of incident cases in the subset of the cohort with primary care data (e.g. from 619 to 1390 for dementia). Among the 786 dementia cases that were only captured in the GP data before the GP censoring date, only 421 (54%) were subsequently recorded in HES. Therefore, estimates of the absolute incidence or risk-stratified incidence are misleadingly low when based only on the HES/Death data. For incident cases present in both HES/Death and GP data during the full follow-up period (i.e. until the HES censoring date), the median time difference between an incident diagnosis of dementia being recorded in GP and HES/Death was 2.25 years (i.e. recorded 2.25 years earlier in the GP records). Similar lag periods were also observed for PD (median 2.31 years earlier) and T2D (median 2.82 years earlier). For participants with an incident GP diagnosis, only 65.6% of dementia cases, 69.0% of PD cases, and 58.5% of T2D cases had their diagnosis recorded in HES/Death within 7 years since GP diagnosis. The effect estimates (hazard ratios, HR) of established risk factors for the three health outcomes mostly remain in the same direction and with a similar strength of association when cases are ascertained either using HES only or further adding GP data. The confidence intervals of the HR became narrower when adding GP data, due to the increased statistical power from the additional cases. In conclusion, it is desirable to extend both the coverage and follow-up period of GP data to allow researchers to maximise case ascertainment of chronic health conditions in the UK. [ABSTRACT FROM AUTHOR]

Despite a widespread focus on grandparents, a large proportion of kinship care in the UK is provided by older siblings. What drives older siblings to become kinship carers, and how this might differ from other kinship carers, is not well represented in academic literature. In this study, narrative interviews were carried out with thirteen adults across England, Scotland, and Wales who had experience being the main carer for their younger sibling(s) when their parents could not care for them sufficiently. The narrative method elicited holistic accounts of participants experiences of being a sibling carer, and the analysis generated three groups of narrative accounts highlighting how and why some sibling kinship care arrangements come about—with siblings wanting to bring their younger siblings back into their family; siblings trying to keep their younger siblings in their family; or older siblings stepping in to fill a gap in parenting at home. The paper draws on the narrative accounts of participants to build the groups, presenting an illustrative narrative account to represent each group. Importantly, these accounts demonstrate how becoming a kinship carer as an older sibling may, or may not, be recognised or fit into wider narratives of what becoming a kinship carer looks like. It is hoped that these accounts will prompt practitioners and policymakers to look more closely at the role of siblings when considering who is and who should be involved in deciding how to support children to remain within their family network. [ABSTRACT FROM AUTHOR]

Background: Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people's perceptions of remote consultations and identify potential resulting inequalities. Aim: To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. Design and setting: A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. Method: In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. Results: A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = −0.82, 95% confidence interval [CI] = −1.41 to −0.23) or those with low or no qualifications (B = −1.65, 95% CI = −2.29 to −1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = −1.94, 95% CI = −3.11 to −0.78), although caution is warranted due to small group numbers. Conclusion: These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations. [ABSTRACT FROM AUTHOR]

Using both "off the shelf" remote sensing software, machine learning and computational algorithms, this article details a new methodology to extract building and urban footprints from historical maps. We applied these methods to create the first dataset of all built-up areas (BUA) in Britain in the early nineteenth century, covering all locations with buildings in England, Wales, and Scotland. The developed methods can now be applied to other maps and regions to provide useful quantitative data for analyzing long-term urban development. The code and data created are made available with this article. [ABSTRACT FROM AUTHOR]

Simple Summary: Existing cross-cultural research on animal welfare often overlooks the way that policy and law are not the exclusive domain of central government. This can result in an over-simplification or misrepresentation of the true situation. The political culture and institutional arrangements for governing the modern state are more complex than a "one-size-fits-all" approach. It is argued that cross-cultural research needs to give greater attention to differences within as well as between unitary states. Specifically, it needs to examine developments in constituent nations and territories. Here we illustrate this by drawing on new research in the United Kingdom, and examine how 'devolution'—or decentralized government for Wales and Scotland—is providing contrasting opportunities for NGOs, campaigners, and the public to lobby to improve animal welfare policy based on local practices, beliefs, and demands (collectively known as the "political culture"). Our findings show how this is important because it results in contrasting animal welfare policies and laws in the constituent nations of the UK. It is argued that extant cross-cultural research on animal welfare often overlooks or gives insufficient attention to new governance theory, civil society, politics, and the realities of devolved or (quasi-)federal, multi-level governance in the modern state. This paper synthesizes relevant social theory and draws on new empirical findings of civil society accounts of campaigning on animal welfare policies and law in the United Kingdom. It is presented as a corrective to arguably reductive, earlier unitary state-based analyses. Our core, evidence-based argument is that cognizance of civil society activism and the contrasting institutional governance structures and political cultures of constituent nations in unitary states—such as the UK—are providing opportunities for the territorialization of legally grounded animal welfare regimes, and culturally distinctive practices. [ABSTRACT FROM AUTHOR]

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Objectives: The detrimental association of mortality with sleep apnoea may increase with apnoea severity. To assess the association between life-course severe sleep apnoea and all-cause mortality and to investigate whether and to what extent the association was compensated by physical activity. Methods: The prospective cohort study included 407,128 individuals (mean age 56.26 years) from the UK Biobank. Severe sleep apnoea was defined as hospital admission. Moderate-to-vigorous physical activity (MVPA) was measured from frequency per week and duration per day via self-report. Cox proportional hazards regression models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: A total of 29,004 death (7.1%) events occurred (median of follow-up 12.7 years). The multi-adjusted HRs (95% CIs) of all-cause mortality were 1.57 (1.12–2.21) for early-life severe sleep apnoea, 1.30 (1.16–1.46) for mid-life severe sleep apnoea, and 2.75 (1.31–5.77) for early- to mid-life severe sleep apnoea, respectively. In joint effect analysis, compared to participants with an inactive level of physical activity and mid-life severe sleep apnoea, the HR (95% CI) of all-cause mortality was 0.57 (0.44–0.74) in those with sufficient physical activity and mid-life severe sleep apnoea. For physical activity intensity, a medium proportion of vigorous physical activity (VPA) per week buffered 56% impacts of mid-life severe sleep apnoea on all-cause mortality (HR = 0.44; 95% CI, 0.31–0.64). Conclusions: Not only mid-life severe sleep apnoea but also early-life severe sleep apnoea is positively associated with all-cause mortality. MVPA could compensate for the risk of all-cause mortality in relation to mid-life severe sleep apnoea. [ABSTRACT FROM AUTHOR]

Between the late 1940s and the early 1970s, the majority of teenage girls in Britain attended secondary modern schools. Yet, histories of the meaning and experience of postwar education continue to neglect this constituent of postwar women, favouring grammar-school leavers. This article draws upon a set of fifty-eight newly mined life histories from two postwar birth cohort studies to recapture the perspectives of ordinary women who attended secondary modern schools in England, Wales, and Scotland between c.1957 and c.1963. The longitudinal sources show that these women developed their attitudes to education gradually, across their lifecourses. Hairdressing, which stood for a desire for clean, creative, and autonomous paid work that could be balanced with domesticity, is identified as a reoccurring theme in the testimonies of secondary modern women. The article diagnoses secondary modern women with the hairdresser blues, a formulation that encapsulates their collective expectations, disappointments, and regrets born out of their closely interlinked experiences of schooling and paid work across the 1960s and early 1970s. These women's educational attitudes were defined by the cumulative realization that a secondary modern education might not even be able to make you into a hairdresser. The article ultimately suggests that it was more often the hairdresser blues rather than 'missing out' on the prestigious grammar school that politicized secondary modern schools for the ordinary women who attended them. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the accuracy of patient information leaflets about electroconvulsive therapy (ECT) used in Northern Ireland, Scotland and Wales, and their compliance with the principle of informed consent. Design and Methods: To replicate an audit in England, Freedom of Information Act requests were sent to the 26 providers of ECT for their ECT patient information leaflet. These were scored, by two independent raters, on the same 40‐item accuracy measure used in the England audit. Results: The number of accurate statements (out of a possible 29) ranged from seven to 20, with a mean of 16.9. The most frequently omitted statements included: cardiovascular risks (mentioned by five leaflets), that it is not known how ECT works (3), risk of mortality (2), risks from multiple general anaesthetic procedures (2), how to access a legal advocate (2) and that that there is no evidence of long‐term benefits (1). The leaflets made between six and nine inaccurate statements (out of 11) with a mean of 7.0. Nineteen minimised memory loss, blamed the memory loss on depression, claimed that ECT is the 'most effective treatment' and asserted it has very high response rates without mentioning similar placebo response rates. All 23 leaflets wrongly told patients that ECT saves lives. Conclusions: Electroconvulsive therapy information leaflets in these three nations are barely more accurate than those in England and do not comply with the ethical principle of informed consent. Patients and families across the UK are systematically being misled about the risks they are taking and the limited nature of ECT's benefits. [ABSTRACT FROM AUTHOR]

Background: Alcohol and smoking brief interventions (BIs) in general practice have been shown to be effective in lowering alcohol and smoking-related harm. Aim: To assess prevalence of self-reported BI receipt among increasing or higher-risk drinkers and past-year smokers in England, Scotland, and Wales, and associations between intervention receipt and socioeconomic position. Design & setting: Cross-sectional study using data from a monthly population-based survey in England, Scotland, and Wales. Method: The study comprised 47 799 participants (15 573 increasing or higher-risk drinkers [alcohol use disorders identification test consumption score ≥5] and 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported. Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression. Results: Among adults in England, Scotland, and Wales, 32.2% (95% confidence interval [CI] = 31.8 to 32.7) reported increasing or higher-risk drinking and 17.7% (95% CI = 17.3 to 18.1) past-year smoking. Among increasing or higher-risk drinkers, 58.0% (95% CI = 57.1 to 58.9) consulted with a GP in the past year, and of these, 4.1% (95% CI = 3.6 to 4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI = 54.5 to 57.1) attended general practice in the past year; of these, 41.0% (95% CI = 39.4 to 42.7) stated receiving BIs. There was a tendency for patients from socioeconomically disadvantaged backgrounds to receive more alcohol (adjusted odds ratio [aOR] 1.38, 95% CI = 1.10 to 1.73) or smoking BIs (aOR 1.11, 95% CI = 0.98 to 1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within Great Britain. Conclusion: BIs in general practice are more common for smoking than for alcohol. A greater proportion of BIs for alcohol were found to be delivered to people who were from socioeconomically disadvantaged backgrounds and who were increasing or higher-risk drinkers. [ABSTRACT FROM AUTHOR]

Extinctions occur naturally in all environments, but rates have accelerated rapidly during the Anthropocene, especially in fresh water. Despite supporting many fish species of conservation importance, there has never been a formal assessment of their extinction risks in Britain, which has impeded their inclusion in relevant legislation and policy. This study therefore used the International Union for the Conservation of Nature (IUCN) Red List of Threatened Species™ Categories and Criteria to conduct the first systematic assessment of the extinction risks and threats facing the native freshwater and diadromous fishes of Britain. In addition, national assessments were produced for England, Scotland and Wales, reflecting the level at which environmental policy decisions are taken in Britain.Seven species were categorized as being threatened with extinction at the regional level, with European eel Anguilla anguilla and allis shad Alosa alosa classified as Critically Endangered, Atlantic salmon Salmo salar, vendace Coregonus albula and European whitefish Coregonus lavaretus classified as Endangered, and Arctic charr Salvelinus alpinus and twaite shad Alosa fallax classified as Vulnerable. In addition, burbot Lota lota was classified as Regionally Extinct, ferox trout Salmo ferox was categorized as Data Deficient, and 25 species were categorized as Least Concern. European sturgeon Acipenser sturio and houting Coregonus oxyrinchus, although probably native, qualified as only vagrants in fresh water, so were categorized as Not Applicable.The assessments provide objective baselines against which future changes can be determined, and a key evidence base to support policy and management decisions for the conservation of freshwater and diadromous fish species and their habitats in Britain. It is recommended that the assessments are repeated every 10 years, which would enable changes in conservation status, the effectiveness of policies and where targeted interventions may be required to be examined using the Red List Index. [ABSTRACT FROM AUTHOR]

Evidence regarding the association between physical activity and Parkinson's disease (PD) risk is generally limited due to the use of self-report questionnaires. We aimed to quantify the separate and combined effects of accelerometer-measured light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time and exercise timing with incident PD. 96,422 participants without prior PD and with usable accelerometer data were included from UK Biobank. Time spent in sedentary activity, LPA, MVPA, and exercise timing were estimated using machine learning models. The study outcome was incident PD. Over a median follow-up duration of 6.8 years, 313 participants developed PD. There was a L-shaped association for LPA and MVPA, and a reversed L-shaped association for sedentary time, with the risk of incident PD (all P for nonlinearity < 0.001). Similar trends were found across three time-windows (morning, midday-afternoon, and evening). Compared with those with both low LPA (<3.89 h/day) and low MVPA (<0.27 h/day), the adjusted HR (95% CI) of PD risk was 0.49 (0.36–0.66), 0.19 (0.36–0.66) and 0.13 (0.09–0.18), respectively, for participants with high MVPA only, high LPA only, and both high LPA and high MVPA. Moreover, participants with both low LPA and high sedentary time (≥9.41 h/day) (adjusted HR, 5.59; 95% CI: 4.10–7.61), and those with both low MVPA and high sedentary time (adjusted HR, 3.93; 95% CI: 2.82–5.49) had the highest risk of incident PD. In conclusion, regardless of exercise timing (morning, midday-afternoon, and evening), there was an inverse association for accelerometer-measured MVPA and LPA, and a positive association for sedentary time, with incident PD. [ABSTRACT FROM AUTHOR]

Background Chronic kidney disease (CKD) is common but heterogenous and is associated with multiple adverse outcomes. The National Unified Renal Translational Research Enterprise (NURTuRE)-CKD cohort was established to investigate risk factors for clinically important outcomes in persons with CKD referred to secondary care. Methods Eligible participants with CKD stages G3–4 or stages G1–2 plus albuminuria >30 mg/mmol were enrolled from 16 nephrology centres in England, Scotland and Wales from 2017 to 2019. Baseline assessment included demographic data, routine laboratory data and research samples. Clinical outcomes are being collected over 15 years by the UK Renal Registry using established data linkage. Baseline data are presented with subgroup analysis by age, sex and estimated glomerular filtration rate (eGFR). Results A total of 2996 participants was enrolled. Median (interquartile range) age was 66 (54–74) years, eGFR 33.8 (24.0–46.6) mL/min/1.73 m2 and urine albumin to creatinine ratio 209 (33–926) mg/g; 58.5% were male. Of these participants, 1883 (69.1%) were in high-risk CKD categories. Primary renal diagnosis was CKD of unknown cause in 32.3%, glomerular disease in 23.4% and diabetic kidney disease in 11.5%. Older participants and those with lower eGFR had higher systolic blood pressure and were less likely to be treated with renin–angiotensin system inhibitors (RASi) but were more likely to receive a statin. Female participants were less likely to receive a RASi or statin. Conclusions NURTuRE-CKD is a prospective cohort of persons who are at relatively high risk of adverse outcomes. Long-term follow-up and a large biorepository create opportunities for research to improve risk prediction and to investigate underlying mechanisms to inform new treatment development. [ABSTRACT FROM AUTHOR]

The absence of young people in Catholic churches in many parts of the world, especially in the more economically advanced countries, is a cause for great anxiety within Catholic communities. This is expressed in relevant research literature and the three recent synodal syntheses of England and Wales, Ireland and Scotland. This article explores the key concept of synodality, some of the research on the religious affiliation (and disaffiliation) of Catholic young people and the voices and views of Catholic young people in the synodal process in the three syntheses. The views of the young people in the three syntheses are clustered under six themes: (1) absence from Church; (2) accusations of hypocrisy; (3) concerns about teaching on sexuality; (4) Catholic Social Teaching; (5) the importance of parents and (6) the ways in which young people can engage in the Church. Many of the comments of the young people in these three syntheses confirm some of the research findings and, crucially, the young people provide suggestions on the ways ahead in which they can be more active in the Church—'being' Church, rather than 'doing' Church. [ABSTRACT FROM AUTHOR]

Background: Living with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned. Methods: A long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services. Results: The four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place. Conclusions: An effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services. [ABSTRACT FROM AUTHOR]

Devolution was almost universally regarded as heralding a fundamental shift in the nature of the United Kingdom of Great Britain and Northern Ireland. But, since the 2016 Brexit referendum, the UK government has become increasingly hostile—not only towards the Labour and SNP‐run administrations in Scotland and Wales, but to the very existence of devolution. Recent legislative changes—particularly the UK Internal Market Act—have given central government carte blanche to intervene in what were previously regarded as areas of devolved competence. The inevitable result has been to render the governance arrangements for the devolved countries more adversarial and less stable than was previously the case. One immediate consequence of 'the death of devolution' has been to trigger calls by devolutionists for more far‐reaching changes to the state than were achieved in the late 1990s. It is far from clear, however, that such changes are politically achievable, raising the prospect of an extended period of stasis in which the current arrangements persist, not because they have any real supporters, but rather, because no alternative is possible. [ABSTRACT FROM AUTHOR]

Here we make an original, empirical contribution to debates on welfare pluralism, the mixed economies of welfare and territorial rescaling by comparing civil society approaches to tackling youth unemployment in England, Scotland and Wales. Our core finding is that academic and policy literature's frequent characterisation of the UK as a single Liberal welfare regime is based on methodological nationalism privileging state‐wide analyses. In short, a scalar fallacy pervasive in international welfare studies. In the context of the global rise of meso‐government and so‐called 'stateless nations' pressing for greater autonomy, our case‐study challenges the dominant paradigm. Our analysis shows the liberal characteristics of work‐first policy orientation and marketised civil society are concentrated in England then tempered by devolved (social) policy. Based on contrasting, left‐of‐centre and civic nationalist governing traditions, grounded in multi‐level electoral politics, we show the devolved nations taking a different approach to Westminster, partially eschewing the market and incorporating collectivism and co‐production. [ABSTRACT FROM AUTHOR]

Background: Transfer to a psychiatric hospital of prisoners who need inpatient treatment for a mental disorder is an important part of prison healthcare in the UK. It is an essential factor in ensuring the principle of equivalence in the treatment of prisoners. In England and Wales, delays in transferring unwell prisoners to hospital were identified by the 2009 Bradley Report. There has been no subsequent systematic review of progress in so doing nor a corresponding appraisal of transfer arrangements in other parts of the world. Aim: To conduct a systematic review of international literature about transfers of mentally unwell individuals from prison to hospital for the treatment of mental disorder since 2009. Method: Eight databases were searched for data‐based publications using terms for prison and transfer to hospital from 1 January 2009 to 4 August 2022. Inclusion criteria limited transfer to arrangements for pre‐trial and sentenced prisoners going to a health service hospital, excluding hospital orders made on the conclusion of criminal hearing. Results: In England, four articles were identified, all showing that transfer times remain considerably longer than the national targets of 14 days (range, 14 days to >9 months); one study from Scotland found shorter mean transfer times, but more patients had been transferred to psychiatric intensive care units than to secure forensic hospitals. There were only two studies that investigated prison to hospital transfers for mental disorder from outside the UK and only one reported time‐to‐transfer data. Conclusions: Findings from this literature review highlight failures to resolve transfer delays in England and provide little evidence about the problem elsewhere. Given the lack of data, it is unclear whether other countries do not have this problem or simply that there has been no research interest in it. A possible confounding factor here is that, in some countries, all treatment for prisoners' mental disorders occurs in prison. However, the principle that prisons are not hospitals seems important when people need inpatient care. Prospective, longitudinal cohort studies are urgently needed to map transfer times and outcomes. [ABSTRACT FROM AUTHOR]

Access to safe, clean and affordable water is a basic human right and a global goal towards which climate change poses new challenges that heavily impact the health and wellbeing of people across the globe and exacerbate or create new inequalities. These challenges are shaped by a number of geographical and social conditions that, apart from the risks of weather-driven impacts on water, include water governance and management arrangements in place, including pricing tariffs, and the interplay of social and economic inequalities. Building on examples from Australia, Scotland and England and Wales that illustrate access to water in different types of water provision systems, and regarding to aspects of access, quality and affordability, this paper explores the types of challenges related to water poverty in the context of climate crisis and reflects on the multiple dimensions of water poverty oriented social policy at the interplay of climate change associated risks. [ABSTRACT FROM AUTHOR]

Background: Long Covid is a widely recognised consequence of COVID-19 infection, but little is known about the burden of symptoms that patients present with in primary care, as these are typically recorded only in free text clinical notes. Aims: To compare symptoms in patients with and without a history of COVID-19, and investigate symptoms associated with a Long Covid diagnosis. Methods: We used primary care electronic health record data until the end of December 2020 from The Health Improvement Network (THIN), a Cegedim database. We included adults registered with participating practices in England, Scotland or Wales. We extracted information about 89 symptoms and 'Long Covid' diagnoses from free text using natural language processing. We calculated hazard ratios (adjusted for age, sex, baseline medical conditions and prior symptoms) for each symptom from 12 weeks after the COVID-19 diagnosis. Results: We compared 11,015 patients with confirmed COVID-19 and 18,098 unexposed controls. Only 20% of symptom records were coded, with 80% in free text. A wide range of symptoms were associated with COVID-19 at least 12 weeks post-infection, with strongest associations for fatigue (adjusted hazard ratio (aHR) 3.46, 95% confidence interval (CI) 2.87, 4.17), shortness of breath (aHR 2.89, 95% CI 2.48, 3.36), palpitations (aHR 2.59, 95% CI 1.86, 3.60), and phlegm (aHR 2.43, 95% CI 1.65, 3.59). However, a limited subset of symptoms were recorded within 7 days prior to a Long Covid diagnosis in more than 20% of cases: shortness of breath, chest pain, pain, fatigue, cough, and anxiety / depression. Conclusions: Numerous symptoms are reported to primary care at least 12 weeks after COVID-19 infection, but only a subset are commonly associated with a GP diagnosis of Long Covid. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is there an association between sedentary behavior and risk of all-cause dementia in older adults? Findings: In this retrospective study of prospectively collected data of 49 841 adults participating in the UK Biobank, more time spent in sedentary behaviors (determined through a machine learning–based analysis of wrist-worn accelerometer data) was significantly associated with higher risk of incident dementia. Meaning: Among older adults, more time spent in sedentary behaviors was associated with higher risk of incident all-cause dementia. Importance: Sedentary behavior is associated with cardiometabolic disease and mortality, but its association with dementia is unclear. Objective: To investigate whether accelerometer-assessed sedentary behavior is associated with incident dementia. Design, Setting, and Participants: A retrospective study of prospectively collected data from the UK Biobank including 49 841 adults aged 60 years or older without a diagnosis of dementia at the time of wearing the wrist accelerometer and living in England, Scotland, or Wales. Follow-up began at the time of wearing the accelerometer (February 2013 to December 2015) and continued until September 2021 in England, July 2021 in Scotland, and February 2018 in Wales. Exposures: Mean daily sedentary behavior time (included in the primary analysis) and mean daily sedentary bout length, maximum daily sedentary bout length, and mean number of daily sedentary bouts (included in the secondary analyses) were derived from a machine learning–based analysis of 1 week of wrist-worn accelerometer data. Main Outcome and Measures: Incident all-cause dementia diagnosis from inpatient hospital records and death registry data. Cox proportional hazard models with linear and cubic spline terms were used to assess associations. Results: A total of 49 841 older adults (mean age, 67.19 [SD, 4.29] years; 54.7% were female) were followed up for a mean of 6.72 years (SD, 0.95 years). During this time, 414 individuals were diagnosed with incident all-cause dementia. In the fully adjusted models, there was a significant nonlinear association between time spent in sedentary behavior and incident dementia. Relative to a median of 9.27 hours/d for sedentary behavior, the hazard ratios (HRs) for dementia were 1.08 (95% CI, 1.04-1.12, P <.001) for 10 hours/d, 1.63 (95% CI, 1.35-1.97, P <.001) for 12 hours/d, and 3.21 (95% CI, 2.05-5.04, P <.001) for 15 hours/d. The adjusted incidence rate of dementia per 1000 person-years was 7.49 (95% CI, 7.48-7.49) for 9.27 hours/d of sedentary behavior, 8.06 (95% CI, 7.76-8.36) for 10 hours/d, 12.00 (95% CI, 10.00-14.36) for 12 hours/d, and 22.74 (95% CI, 14.92-34.11) for 15 hours/d. Mean daily sedentary bout length (HR, 1.53 [95% CI, 1.03-2.27], P =.04 and 0.65 [95% CI, 0.04-1.57] more dementia cases per 1000 person-years for a 1-hour increase from the mean of 0.48 hours) and maximum daily sedentary bout length (HR, 1.15 [95% CI, 1.02-1.31], P =.02 and 0.19 [95% CI, 0.02-0.38] more dementia cases per 1000 person-years for a 1-hour increase from the mean of 1.95 hours) were significantly associated with higher risk of incident dementia. The number of sedentary bouts per day was not associated with higher risk of incident dementia (HR, 1.00 [95% CI, 0.99-1.01], P =.89). In the sensitivity analyses, after adjustment for time spent in sedentary behavior, the mean daily sedentary bout length and the maximum daily sedentary bout length were no longer significantly associated with incident dementia. Conclusions and Relevance: Among older adults, more time spent in sedentary behaviors was significantly associated with higher incidence of all-cause dementia. Future research is needed to determine whether the association between sedentary behavior and risk of dementia is causal. This study of prospectively collected data from the UK Biobank investigates whether accelerometer-assessed sedentary behavior is associated with incident dementia in adults aged 60 years or older without a diagnosis of dementia at the time of wearing the wrist accelerometer. [ABSTRACT FROM AUTHOR]

This article is a commentary on an audit of Electroconvulsive Therapy (ECT) patient information leaflets in Northern Ireland, Scotland, and Wales, which found that they do not comply with the ethical principle of informed consent. Stigma, rights, and trauma are discussed through the authors personal experience of multiple ECT treatments and research, and potential actions to address these failings are suggested. [ABSTRACT FROM AUTHOR]