Search

Social prescribing is a non-clinical approach to addressing social, environmental, and economic factors affecting how people feel physical and/or emotionally. It involves connecting people to “community assets” (e.g., local groups, organizations, and charities) that can contribute to positive well-being. We sought to explain in what ways, for whom, and why the cultural sector can support social prescribing with older people. We conducted semi-structured interviews with 28 older people (aged 60+) and 25 cultural sector staff. The following nine concepts, developed from interview data, progressed the understanding of tailoring cultural offers, which came from our previous realist review— immersion, buddying, café culture, capacity, emotional involvement, perseverance, autonomy, elitism, and virtual cultural offers. Through tailoring, we propose that older people might experience one or more of the following benefits from engaging with a cultural offer as part of social prescribing—being immersed, psychological holding, connecting, and transforming through self-growth.

Our previous work identified that nine leading guidance documents for seven different types of systematic review advocated the same process of literature searching. We defined and illustrated this process and we named it ‘the Conventional Approach’. The Conventional Approach appears to meet the needs of researchers undertaking literature searches for systematic reviews of clinical interventions. In this article, we report a new and alternate process model of literature searching called ‘A Tailored Approach’. A Tailored Approach is indicated as a search process for complex reviews which do not focus on the evaluation of clinical interventions. The aims of this article are to (1) explain the rationale for, and the theories behind, the design of A Tailored Approach; (2) report the current conceptual illustration of A Tailored Approach and to describe a user’s interaction with the process model; and (3) situate the elements novel to A Tailored Approach (when compared with the Conventional Approach) in the relevant literature. A Tailored Approach suggests investing time at the start of a review, to develop the information needs from the research objectives, and to tailor the search approach to studies or data. Tailored Approaches should be led by the information specialist (librarian) but developed by the research team. The aim is not necessarily to focus on comprehensive retrieval. Further research is indicated to evaluate the use of supplementary search methods, methods of team-working to define search approaches, and to evaluate the use of conceptual models of information retrieval for testing and evaluation.

Older people’s well-being can be bolstered by engaging with cultural activities and venues. They may be encouraged to try cultural offers by a link worker as part of social prescribing. However, the cultural sector, like all parts of life, was affected by the COVID-19 pandemic; this has had implications for cultural offers available to link workers. A study was conducted to explore the views and experiences of link workers in using the cultural sector within social prescribing, particularly for older people (aged 60+) during the pandemic. An online questionnaire was distributed to and completed by link workers in the UK. Data were analysed mainly using descriptive statistics. Open text responses were clustered into similar ideas to create key concepts. Useable responses were received from 148 link workers. They highlighted a general lack of interaction between link workers and the cultural sector about how the latter could support social prescribing. Results suggested that personal familiarity with cultural offers might prompt link workers to refer to them. Some respondents proposed that cultural offers were regarded as elitist, which deterred them from referring there. However, there was a general acknowledgement that the cultural sector could contribute to social prescribing. Link workers need to regard the cultural sector as accessible, appropriate, adequate, affordable and available before referring older people to cultural offers as part of social prescribing. Link workers may benefit from becoming more familiar with cultural sector staff and offers, including online resources, so they can then propose them to patients with confidence.

Aim: The present study aimed to investigate barriers to healthcare and their relationships to social and emotional well-being and intersectional inequalities for autistic adults during COVID-19 restrictions in the UK. Background: Autistic adults experience severe health inequalities and report more barriers to accessing health services compared to other both disabled and non-disabled populations. The COVID-19 pandemic has impacted many areas of society that may have increased vulnerability of autistic people to social and health inequalities, including delivery of healthcare from in-person to remote methods. Method: One hundred twenty-eight autistic adults who lived in the UK took part in an online survey. Measures included the Barriers to Healthcare Checklist (Short Form) and PROMIS outcome measure bank to assess emotional well-being and social support. Participants rated their agreement with items, retrospectively considering three different points of the trajectory of COVID-19 restrictions: before COVID-19, during the first lockdown in spring 2020, and in the month prior to taking the survey during autumn 2020. They completed a follow-up survey six months later to continue to assess change as restrictions in the UK were eased. Findings: The average number of barriers to healthcare showed no significant change between all four time points. However, the nature of barriers to healthcare changed at the point of lockdown and persisted beyond the easing of COVID-19 restrictions. Barriers to healthcare were associated with some social and emotional well-being variables and demographic groups including gender, education and presence of additional disabilities. The findings may help to identify areas to target to improve access to both remote and in-person health systems for autistic people as modes of delivery continue to change over time.

Adults on the autism spectrum are affected by health disparities which significantly reduce life expectancy and experience barriers to accessing healthcare. Social prescribing is a holistic approach that diverts patients from primary care to health-enhancing activities in communities. However, there has been a lack of research attention to how autistic people navigate the social prescribing pathway and the ability of these approaches to address existing disparities. This mapping review aimed to synthesise features of non-medical, community-based interventions for autistic adults to assess their suitability for a social prescribing approach. A systematic search and screening process was used to identify literature reviews from medical databases (Embase, Medline, PsycINFO, CINAHL and Cochrane reviews) and grey literature. We extracted data from 24 reviews and 19 studies including types of services, participants, outcomes, settings and procedures. A narrative and visual synthesis is used to map the variety of services and interventions identified, the outcome measures used, and the barriers and facilitators to progression through services in relation to a realist social prescribing framework. The review found that there has been minimal evaluation of holistic, low intensity services for autistic adults, such as those offered in social prescribing approaches. Outcome measures remain focused on features of autism and reveal less about the effects of interventions on health and wellbeing. Aspects of the social prescribing model were identified in the features of service pathways, but findings also suggested how social prescribing could be adapted to improve accessibility for autistic people.

Social prescribing enables primary care to refer individuals with health and/or social issues to a ‘link worker' whom provides ‘holistic' support to patients and refers them to further agreed non-clinical activities (e.g. walking group) and/or social services (e.g. housing). Social prescribing has the potential to help managing or addressing a wide range of health and social issues, particularly pertinent in a pandemic and post pandemic world, centred around individual choice, and based on maximising the asset offered by the voluntary sector. Yet, evidence and policy development have gone hand in hand, and sometimes in reverse in England. The NHS made a good case and rationale for implementing social prescribing before the concomitant evidence base had rigorously proven its impact. Researchers are now in a position of trying to evidence (and communicate what good evidence might be) whether what has been rolled out works, in what ways, and for whom. In contributing to the development of the evaluation of social prescribing, the main challenge experienced was that what counts as good evidence depends entirely on ‘what is meant' by social prescribing. Social prescribing was found to be a pathway consisting of a set of relationships and set of activities/complex interventions as part of that pathway, therefore asking ‘what works' is not trivial. So, for the patient pathway there is a need for robust, well conducted evidence syntheses from different parts of the pathway, good qualitative work around the experiences of referrers and individuals, secondary data analysis of the health service use, effectiveness work on the activities themselves, all crucially underpinned by strong data monitoring and capture. Working with a very broad range of stakeholders (commissioners, healthcare providers, activity providers, link workers, and individuals with lived experience) goes some way to communicating this complexity and helping base decisions on the most appropriate evidence.

The use of non‐medical referral, community referral or social prescribing interventions has been proposed as a cost‐effective alternative to help those with long‐term conditions manage their illness and improve health and well‐being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of ‘if‐then’ statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web‐based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the 'Beyond the Building Blocks' framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs. publishersversion published

This handbook is about how Nature on Prescription can be used to support people’s mental health, and makes evidence-based suggestions for how to develop and implement a high-quality scheme, in the new social prescribing landscape. The handbook is primarily aimed at nature-based providers of group nature-based interventions that target common mental health conditions, and that are (or will be) delivered via social prescribing schemes. The content will also be of interest to link workers, general practitioners, mental health practitioners, and researchers with an interest in social prescribing. The content is intended to assist development of interventions that are beneficial, safe, and sustainable. We hope this handbook may: help avoid pitfalls that may lead to Nature on Prescription failing to support people appropriately; make the most of programmes from the earliest stages; help reach desired outcomes for both organisations and participants; and help in designing appropriate evaluations. In this handbook we draw on research evidence and learnings from past and ongoing nature-based interventions, and from other relevant fields. There is a wealth of experience from people who have been involved in delivery of nature-based interventions in the UK. The content of the handbook is also informed by interviews carried out with these individuals and other relevant stakeholders.

Social prescribing (SP) is increasing in popularity in the UK and can enable healthcare providers to respond more effectively to a range of non-clinical needs. With the NHS commitment to establish an SP link worker in all GP practices, there is a rapid increase in the number of SP schemes across the country. There is currently insufficient evidence concerning the implementation and acceptability of SP schemes. In this paper, we report our analysis of the descriptions of the experiences of SP link workers, regarding the early implementation of SP link workers in two SP programmes in the South West. Data were gathered using the 'Researcher in Residence' (RiR) model, where the researcher was immersed in the environments in which the SP was managed and delivered. The RiR undertook conversations with 11 SP link workers, 2 SP link worker managers and 1 SP counsellor over six months. The RiR visited seven link workers at their GP practices (service 1) and four at their head office (service 2). The RiR met with the link worker managers at their offices, and the RiR spoke with the SP counsellor on the telephone. Data from these conversations were analysed using Thematic Analysis and six codes were constructed to advance our understanding of the components of early implementation of the SP programmes. Training (particularly around mental health), workforce support, location and SP champions within GP practices were found to be key strategies of SP implementation, link worker involvement acting as a conduit for the impacts of these strategies. This paper suggests that the implementation of SP programmes can be improved by addressing each of these areas, alongside allowing link workers the flexibility and authority to respond to challenges as they emerge.

Given the growing global increase in harm from alcohol and substance use, and the inadequacy of standard treatment to tackle the challenge, the use of physical activity (PA) interventions has received increased attention. The aim of this review is to identify common and cross cutting themes relating to how and why physical activity may impact on reduction of/abstinence from alcohol and other drug use to support future intervention design (including aspects of physical activity, barriers and facilitators, and elements of support which may have an impact). Twenty papers including qualitative data were included in the synthesis. A deductive coding framework was created and sought to identify biological, environmental and psycho-social barriers, facilitators and mechanisms of participants’ experience of engaging with physical activity interventions. Key themes supported in the evidence included how interventions influence use (e.g. reduced cravings, increases in bodily awareness and health and fitness, the development of positive focus and new identity, and increases in mood and quality of life); the impact of frequency, intensity, type, duration and timing of physical activity; perceived barriers and facilitators to engaging in physical activity (e.g. health and fitness, access and affordability, perceptions of others); and details of how much support and in what form best supports sustained changes in physical activity (e.g. social support and environment). Despite evidence being sparse, key barriers and facilitators pertinent to intervention design were identified. Recommendations for future research are indicated and the evidence promotes the need for individually tailored programmes of support for physical activity.

Background The use of non-health service referral, or ’social prescribing’ interventions have been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. We are generating theory through review and primary data collection relating to the social prescribing system, how to maximise the benefits of this system and how it might be implemented. Methods A realist synthesis and evaluation. Working with three UK case-sites who are all at various stages in the process of setting up social prescription services, we are conducting patient pathway analyses, focus groups, and interviews. An important component of this work is iterative, targeted reviews of the literature relating to these pathways and identified mechanisms to assess effectiveness and reach. Results The study is ongoing; however, we are testing prototype theory generated in a previous realist review (presented last year) and elaborating on which mechanisms within each pathway relate to suitable population types and aspects of wellbeing. Conclusions We aim to draw together service delivery practitioners, users, researchers and clinicians to create specified theory for setting up social prescription services. This guidance will be context sensitive and make recommendations for increasing acceptability and spread of complex system service delivery and interventions. Key messages We are building highly specified, context sensitive system specification and ‘lessons learned’ implementation guidance for social prescribing programmes in the UK. We are producing these outputs through collaborative partnerships with services delivering programmes as they develop, using realist evaluation and qualitative comparative methods.

Objectives There is currently no widely accepted estimate of the proportion of people in England that self-identifies as lesbian, gay or bisexual (LGB), which is needed if we are to compare health inequality between different population groups. Using systematic review methods, this study identified all national social surveys with a question on sexual orientation and pooled those which represented the overall population of England. LGB proportions were synthesized into an aggregated mean estimate using weights based on sample size, response rate and missing data. The modelled estimate was stratified by socio-demographic and geographical variables. Results Twenty-two national surveys were identified of which 15 were suitable for pooling. Synthesis resulted in a weighted mean estimate of 2.50% of the adult population of England identifying as LGB or ‘other’. The proportion was highest in men, people below 45 years of age and the London region. The (theoretical) upper limit was 5.89% if all non-responders were assumed to identify as LGB. The reported 2.50% presents a minimum and may be influenced by respondents’ perceptions of confidentiality and social acceptance. It is however the most robust estimate currently available and can be used as baseline to understand health and wellbeing needs of different groups. Electronic supplementary material The online version of this article (10.1186/s13104-017-2921-1) contains supplementary material, which is available to authorized users.

Aims Concerns have been raised about a perceived rise in children and young people admitted to paediatric wards with mental health difficulties, and about the support available for them. However, there has been no detailed analysis to date of mental health (MH) related admissions data. The main aims of this project were to investigate regional MH-related paediatric admissions by: Describing the prevalence of admissions with an MH code, and the most common codes associated with admissions. Examining trends in prevalence over time. Methods We used data from 2006–2017 obtained from six acute trusts in one region as part of an ongoing hospital admissions project. A comprehensive coding list was developed to identify admissions with MH-related codes; subdivided into codes for mental, behavioural and neurodevelopmental disorders and codes for intentional self-harm. For each Trust we calculated the proportion of all admissions that had an MH-related code, identified the most common codes, and examined changes in prevalence of MH-related admissions over time. We also described whether MH-related diagnoses were coded as primary diagnoses. Results The overall proportion of admissions which were MH-related varied by trust from 0.45% to 7.97%, and the proportion with an intentional self-harm code ranged from 0.30% to 3.41%. In all trusts, less than 1% of admissions had an MH-related code as the primary diagnosis. The proportion of admissions with an MH-related code increased over time, both for mental, behavioural and neurodevelopmental disorders and for intentional self-harm, for all trusts. The most common MH-related codes used as primary diagnoses were acute alcohol intoxication and anorexia nervosa. Conclusion Our findings suggest there has been a rise in MH-related paediatric admissions over time, and that this rise is not solely due to an increase in self-harm. This has implications for prevention, for planning appropriate care and pathways for those admitted with an MH problem, and for staff training and support. Perhaps most importantly, Trusts that only capture primary diagnosis codes risk underestimating mental health needs in the paediatric population. Acknowledgement Thanks to National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula and to the Academy of Medical Sciences INSPIRE programme who funded the lead author for a medical student summer scholarship.

The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval −0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings., Highlights • A comprehensive systematic review of physical activity and alcohol and/or substance use. • Looks at the prevention, reduction, and treatment of alcohol and/or substance use. • Highlights what may be most effective and gaps in knowledge. • Considers different elements of physical activity interventions for best practice.

Background Alcohol and substance use results in significant human and economic cost globally and is associated with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving. Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use disorders are as high as 60–90%. Physical activity may offer an alternative or adjunct approach to reducing rates of alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners. Methods The objectives of this mixed methods systematic review are to describe and evaluate the quantitative and qualitative research obtained by a diverse search strategy on the impact of physical activity and its potential to:Reduce the risk of progression to alcohol and/or substance use (PREVENTION)Support individuals to reduce alcohol and/or substance use for harm reduction (REDUCTION), andPromote abstinence and relapse prevention during and after treatment for an alcohol and/or substance use disorder (TREATMENT). With the input of key stakeholders, we aim to assess how what we know can be translated into policy and practice. Quantitative, qualitative, service evaluations, and economic analyses will be brought together in a final narrative synthesis that will describe the potential benefits of physical activity for whom, in what conditions, and in what form. Discussion This review will provide details of what is known about physical activity and the prevention, reduction, and treatment of alcohol and/or substance use. The synthesised findings will be disseminated to policymakers, service providers, and commissioners in the UK. Systematic review registration PROSPERO number: CRD42017079322. Electronic supplementary material The online version of this article (10.1186/s13643-018-0674-0) contains supplementary material, which is available to authorized users.

PRISMA-P 2015 Checklist. (DOCX 32 kb)

BACKGROUND: We undertook a systematic review to evaluate the health benefits of environmental enhancement and conservation activities. We were concerned that a conventional process of study identification, focusing on exhaustive searches of bibliographic databases as the primary search method, would be ineffective, offering limited value. The focus of this study is comparing study identification methods. We compare (1) an approach led by searches of bibliographic databases with (2) an approach led by supplementary search methods. We retrospectively assessed the effectiveness and value of both approaches. METHODS: Effectiveness was determined by comparing (1) the total number of studies identified and screened and (2) the number of includable studies uniquely identified by each approach. Value was determined by comparing included study quality and by using qualitative sensitivity analysis to explore the contribution of studies to the synthesis. RESULTS: The bibliographic databases approach identified 21 409 studies to screen and 2 included qualitative studies were uniquely identified. Study quality was moderate, and contribution to the synthesis was minimal. The supplementary search approach identified 453 studies to screen and 9 included studies were uniquely identified. Four quantitative studies were poor quality but made a substantive contribution to the synthesis; 5 studies were qualitative: 3 studies were good quality, one was moderate quality, and 1 study was excluded from the synthesis due to poor quality. All 4 included qualitative studies made significant contributions to the synthesis. CONCLUSIONS: This case study found value in aligning primary methods of study identification to maximise location of relevant evidence.

Social prescribing is the topic of the moment. Many national organisations and individuals from policy, practice, and academia (such as NHS England, the RCGP, the Mayor of London, and National Institute for Health Research) are rightly advocating social prescriptions as an important way to expand the options available for GPs and other community-based practitioners to provide individualised care for people’s physical and mental health through social interventions. No robust figures exist but it is thought that around 20% of patients consult their GP for primarily social issues, given this and the driving forces of an ageing population, increased complex health and social needs, and increasing demand on services, social prescribing is rapidly gaining popularity. As a concept and a model for delivering health and social interventions, social prescribing has proliferated without a concomitant evidence base.1 This is partly due to resource limitations on evaluators and partly due to difficulties in conceptualising what social prescribing is and what good evidence for a complex service might look like. Here, we briefly outline different models of social prescribing, the current evidence base and its limitations, explore problems relating to what constitutes good evidence, and discuss some potential ways forward. An immediate difficulty is the range of activity that the term ‘social prescribing’ embraces. Such heterogeneity is a function of social prescribing being the demand-driven formalisation of referrals to existing community services and organisations, which is necessarily locally different. More generally, at one extreme there are narrow interventions that focus on one clinical area and aim to prevent or reduce progression to chronic disease. Such interventions tend to include targeted life-style interventions (for example physical activity, healthy eating or cooking), medicines management or group mentoring, and are typically accessed through the healthcare system. At the other extreme, a large number of schemes are …

Exposure to green space is associated with a variety of positive health states. Research to date has focused primarily on 'generic' green space in urban areas, where green space is relatively scarce and where it is dominated by playing fields and parks. The current research adds to our understanding with an examination of relationships between different types of green space and mental health in rural areas in England (approximate rural population = 4 million). The aggregate land cover classes of Land Cover Map 2007 were linked to rural residential areas (Lower-level Super Output Areas) and then linked to rural participants (n = 2020) in the 18-year longitudinal British Household Panel Survey. Random effects regression of mental health (as measured by GHQ12 scores) against land cover enabled effects to be simultaneously estimated from both mean between-individual differences and from within-individual differences over time. The nine natural land cover classes (Broadleaved woodland; Coniferous woodland; Arable; Improved grassland; Semi-natural grassland; Mountain, heath and bog; Saltwater; Freshwater; Coastal) were not significantly associated with differences in mental health between individuals. However, significant relationships were observed between some types of land cover and within-individual change in mental health amongst individuals who relocated during the 18 annual waves of the panel. These findings indicate the presence of important health related ecosystem services from different land cover types that have not previously been investigated and which help more effective spatial planning and land use management. (C) 2015 Elsevier B.V. All rights reserved.

Background Indoor dampness increases the risk of indoor fungal growth. A complex interaction between occupant behaviors and the built environment are thought to affect indoor fungal concentrations and species diversity, which are believed to increase the risk of having asthma, exacerbation of asthma symptoms, or both. To date, no systematic review has investigated this relationship. Objective This review aims to assess the relationship between exposure to indoor fungi identified to the genera or species level on asthma outcomes in children and adults. Methods Ten databases were systematically searched on April 18, 2013, and limited to articles published since 1990. Reference lists were independently screened by 2 reviewers, and authors were contacted to identify relevant articles. Data were extracted from included studies meeting our eligibility criteria by 2 reviewers and quality assessed by using the Newcastle-Ottawa scale designed for assessment of case-control and cohort studies. Results Cladosporium , Alternaria , Aspergillus , and Penicillium species were found to be present in higher concentrations in homes of asthmatic participants. Exposure to Penicillium , Aspergillus , and Cladosporium species were found to be associated with increased risk of reporting asthma symptoms by a limited number of studies. The presence of Cladosporium , Alternaria , Aspergillus , and Penicillium species increased the exacerbation of current asthma symptoms by 36% to 48% compared with those exposed to lower concentrations of these fungi, as shown by using random-effect estimates. Studies were of medium quality and showed medium-high heterogeneity, but evidence concerning the specific role of fungal species was limited. Conclusion Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium , Aspergillus , and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium , Aspergillus , Cladosporium , and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

Additional file 3. Methodological characteristics of 22 surveys that included a question on sexual orientation. List of 22 included surveys with their name, data collection period, geographical coverage, study population, sampling method, sample size, response rate and mode of administration.

Purpose – Recent research (Barton and Husk, 2012) suggested that in the UK we are seeing a shift from the traditional “pub-club” drinking pattern to a “home-pub-club” pattern. In the latter model often excessive early evening drinking is occurring in the private sphere in the absence of external control, leading to problems when the drinkers enter the public sphere. Moreover, pre-loading has become a key aspect in the drinking patterns of many of the Night Time Economy (NTE) population with around 60-70 per cent of people drinking some alcohol prior to going out. In the previous work (Barton and Husk, 2012) 50 per cent of people were drinking significant quantities of alcohol prior to entering the NTE. The paper aims to discuss these issues. Design/methodology/approach – However, whilst these statistics give a general overview of patterns of drinking, they fail to provide the depth required to uncover potential mechanisms. It is generally assumed that the driving force behind this cultural shift in alcohol use is price. However, the feeling is that this is too simplistic. To explore this, the authors conducted a set of in-depth qualitative interviews with young people to ascertain why pre-loading is such an entrenched aspect of their drinking culture (n=20). Findings – This paper provides the preliminary findings of that research. It shows, amongst other things, that beyond the price factor many young people seemingly need alcohol to cope with the NTE; that they prefer the safety and control of the environment that drinking in the private sphere provides; and that some of them (despite drinking alcohol) simply do not like pubs. Originality/value – The paper adds to the discourse on pre-loading by suggesting richly described underlying mechanisms of action.

This paper discusses some of the methodological issues in the measurement of ethnicity in the social survey. Measurement encounters two sets of interrelated problems: those of the definition and nature of ethnicity as a social phenomenon and its individual subjective experience and those of the derivation of valid and reliable categories. Commonly used single-item measures fail to capture many ethnic groups and may be of limited value. Extending categories in these will capture more groups, but can be unwieldy and produce small cell counts, whereas multiple measures can be more successful, but are practically less viable in general surveys. We conclude that whilst these difficulties are probably insurmountable, a strategy that is sensitive to the presence of ethnic groups in particular localities is a way forward, but this should also be part of a more sociologically nuanced approach to the collection of ethnic data.

Background There is growing research and policy interest in the potential for using the natural environment to enhance human health and well-being. This resource may be underused as a health promotion tool to address the increasing burden of common health problems such as increased chronic diseases and mental health concerns. Outdoor environmental enhancement and conservation activities (EECA) (for instance unpaid litter picking, tree planting or path maintenance) offer opportunities for physical activity alongside greater connectedness with local environments, enhanced social connections within communities and improved self-esteem through activities that improve the locality which may, in turn, further improve well-being. Objectives To assess the health and well-being impacts on adults following participation in environmental enhancement and conservation activities. Search methods We contacted or searched the websites of more than 250 EECA organisations to identify grey literature. Resource limitations meant the majority of the websites were from UK, USA, Canada and Australia. We searched the following databases (initially in October 2012, updated October 2014, except CAB Direct, OpenGrey, SPORTDiscus, and TRIP Database), using a search strategy developed with our project advisory groups (predominantly leaders of EECA-type activities and methodological experts): ASSIA; BIOSIS; British Education Index; British Nursing Index; CAB Abstracts; Campbell Collaboration; Cochrane Public Health Specialized Register; DOPHER; EMBASE; ERIC; Global Health; GreenFILE; HMIC; MEDLINE-in-Process; MEDLINE; OpenGrey; PsychINFO; Social Policy and Practice; SPORTDiscus; TRoPHI; Social Services Abstracts; Sociological Abstracts; The Cochrane Library; TRIP database; and Web of Science. Citation and related article chasing was used. Searches were limited to studies in English published after 1990. Selection criteria Two review authors independently screened studies. Included studies examined the impact of EECA on adult health and well-being. Eligible interventions needed to include each of the following: intended to improve the outdoor natural or built environment at either a local or wider level; took place in urban or rural locations in any country; involved active participation; and were NOT experienced through paid employment. We included quantitative and qualitative research. Includable quantitative study designs were: randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, cluster quasi-RCTs, controlled before-and-after studies, interrupted-time-series, cohort studies (prospective or retrospective), case-control studies and uncontrolled before-and-after studies (uBA). We included qualitative research if it used recognised qualitative methods of data collection and analysis. Data collection and analysis One reviewer extracted data, and another reviewer checked the data. Two review authors independently appraised study quality using the Effective Public Health Practice Project tool (for quantitative studies) or Wallace criteria (for qualitative studies). Heterogeneity of outcome measures and poor reporting of intervention specifics prevented meta-analysis so we synthesised the results narratively. We synthesised qualitative research findings using thematic analysis. Main results Database searches identified 21,420 records, with 21,304 excluded at title/abstract. Grey literature searches identified 211 records. We screened 327 full-text articles from which we included 21 studies (reported in 28 publications): two case-studies (which were not included in the synthesis due to inadequate robustness), one case-control, one retrospective cohort, five uBA, three mixed-method (uBA, qualitative), and nine qualitative studies. The 19 studies included in the synthesis detailed the impacts to a total of 3,603 participants: 647 from quantitative intervention studies and 2630 from a retrospective cohort study; and 326 from qualitative studies (one not reporting sample size). Included studies shared the key elements of EECA defined above, but the range of activities varied considerably. Quantitative evaluation methods were heterogeneous. The designs or reporting of quantitative studies, or both, were rated as ‘weak’ quality with high risk of bias due to one or more of the following: inadequate study design, intervention detail, participant selection, outcome reporting and blinding. Participants’ characteristics were poorly reported; eight studies did not report gender or age and none reported socio-economic status. Three quantitative studies reported that participants were referred through health or social services, or due to mental ill health (five quantitative studies), however participants' engagement routes were often not clear. Whilst the majority of quantitative studies (n = 8) reported no effect on one or more outcomes, positive effects were reported in six quantitative studies relating to short-term physiological, mental/emotional health, and quality-of-life outcomes. Negative effects were reported in two quantitative studies; one study reported higher levels of anxiety amongst participants, another reported increased mental health stress. The design or reporting, or both, of the qualitative studies was rated as good in three studies or poor in nine; mainly due to missing detail about participants, methods and interventions. Included qualitative evidence provided rich data about the experience of participation. Thematic analysis identified eight themes supported by at least one good quality study, regarding participants' positive experiences and related to personal/social identity, physical activity, developing knowledge, spirituality, benefits of place, personal achievement, psychological benefits and social contact. There was one report of negative experiences. Authors' conclusions There is little quantitative evidence of positive or negative health and well-being benefits from participating in EECA. However, the qualitative research showed high levels of perceived benefit among participants. Quantitative evidence resulted from study designs with high risk of bias, qualitative evidence lacked reporting detail. The majority of included studies were programme evaluations, conducted internally or funded by the provider. The conceptual framework illustrates the range of interlinked mechanisms through which people believe they potentially achieve health and well-being benefits, such as opportunities for social contact. It also considers potential moderators and mediators of effect. One main finding of the review is the inherent difficulty associated with generating robust evidence of effectiveness for complex interventions. We developed the conceptual framework to illustrate how people believed they benefited. Investigating such mechanisms in a subsequent theory-led review might be one way of examining evidence of effect for these activities. The conceptual framework needs further refinement through linked reviews and more reliable evidence. Future research should use more robust study designs and report key intervention and participant detail.

In this article we examine the complex processes involved in small-scale ethnicity emergence and legitimation, and highlight the multi-dimensional elements present in moving from a strong regional identity to an externally legitimate ethnic group. We use Cornwall as a case study: administered as an English county, there has been a historic ethno-cultural movement for recognition alongside recent inclusion in national statistics; however, legitimation by external elites has been problematic. The first sections outline the Cornish as a group; we argue that however one conceptualises ‘ethnicity’, the people of Cornwall must constitute such a group. We examine the dichotomous effects of the interplay between strong regional assertion and a Cornish ethnicity more formally. In the latter sections we apply these arguments to broader sociological discussions around the legitimation of particular groups, and show that the Cornish are indicative of the wider theoretical literature. In conclusion, we assert that the Cornish are representative of the push/pull mechanisms felt acutely in any core/periphery power relations, and should be seen as central to emerging small-scale ethnic groups more generally.

In this paper we outline results from exploratory research which aimed to provide better estimates of self-identified Cornish ethnic group affiliation in Cornwall, a county in the South West of the UK. For the first time the 2001 England and Wales Census recorded a ‘write-in’ Cornish identity category – however the lack of a dedicated tick-box and limited publicity around the option meant that the result was likely to undercount the true population. We utilise data from a range of sources about Cornish ethnicity to derive weights for the Census result based around statistical means. We subsequently apply these weights to posit a more likely estimate of 25-30% rather than the 6.7% reported. The limitations inherent in such an exploratory model of analysis limit our conclusions, but we feel that our result engages with the methodological literature around small-scale survey measures as well as the ethnicity measurement literature more broadly. We conclude that a group of individuals who share some commonality of response, regardless of the methodological or philosophical problems surrounding the measure, are an interesting topic of study for social science and can inform subsequent analyses of relative position.

PurposeThe aim of this paper is to focus on the impact of alcohol pre‐loading on behaviour in the night time economy (NTE).Design/methodology/approachThe project was commissioned by Devon and Cornwall Police. During the course of six months in late 2010/early 2011, 597 arrestees were asked a series of questions relating to their drinking patterns on the evening prior to their arrest.FindingsThe research shows that there is a shift from the traditional “pub‐club” drinking pattern to a “home‐pub‐club” pattern where excessive early evening drinking is occurring in the private sphere in the absence of external control. Moreover, pre‐loading has become a key aspect in the drinking patterns of many of the NTE population with around 50 per cent of people drinking significant quantities of alcohol prior to entering the NTE. It also demonstrates that those that pre‐load self‐report higher levels of drinking and thus higher levels of intoxication than those that do not.Research limitations/implicationsFindings are constrained by sample bias, as all informants came from the criminal justice system.Social implicationsWhen looking specifically at the relationship between pre‐loading and violence, the research showed that there is a relationship between high levels of self‐reported intoxication and self‐reported feelings of aggression, especially in males. This manifested in the NTE as flash points which seemed to occur at entry points to pubs and clubs. Those pre‐loaders that were arrested for violent crimes cite excessive drinking as the significant factor in their behaviour. The research concludes that pre‐loading alcohol prior to entering the NTE is a major challenge to those charged with keeping order in and around city centre pubs and clubs.Originality/valueThe paper adds to the discourse on alcohol related violence in the night time economy, and the negative consequences of pricing drinkers out of licensed premises.

Objectives & Background Being well acquainted with the oft-repeated premise that “children are not little adults”, we set out to test the hypothesis that paediatricians are little adults. Methods Design International cross-sectional study. Setting Six hospitals (both academic and non-academic centres) in the United Kingdom and New Zealand. Participants Sample of 61 paediatricians, 57 emergency medicine physicians, 31 general internal medicine physicians and 15 healthcare of the older person physicians were recruited; there were no losses to follow-up. All potentially eligible participants (doctors with >2 years experience in one of the above specialties) at the study sites were invited to take part; all willing participants were recruited. Specialties excluded were surgery, anaesthetics, intensive care (and the paediatric versions thereof) as well as specialties such as microbiology and pathology that have little patient-facing contact. Main outcome measures Height (cm), weight (kg), BMI, head circumference (cm), shoe size (UK system), gender, speciality, age, years in speciality, whole time equivalence, institution, country of birth, country of practise. Results Paediatricians were significantly shorter than non-paediatricians (mean height 168.0 v 173.9 cm; mean difference 5.9 cm; 95% confidence interval 2.8 to 9.1; p

Objective Evidence on how best to intervene to improve paediatric acute care and therefore reduce unplanned hospital admissions is weak. We describe service evaluation work at one hospital to assess interventions at critical clinical and service decision points. Design We conducted an observational study using routine daily-collected data (April 2009–December 2015) from a medium-sized district general hospital in south-west UK, using before-and-after comparisons of admissions-related data to evaluate two interventions implemented in April and November 2014, respectively: (1) an advice and guidance (A&G) phone line, where a senior paediatrician is available for general practitioners (GPs) and emergency department (ED) and (2) a Short Stay Paediatric Assessment Unit (SSPAU). We analysed data on all admitted children (

Background In social prescribing, people are referred by primary-care professionals to non-medical, community-based activities. The transfer between primary care and the community-based provider can be difficult, with low uptake and poor engagement with and adherence to interventions. There is an ambition to increase the use of social prescribing in the UK health service; however, to achieve this ambition the process of referral and retention needs improving. This study aimed to increase our understanding of what works and why in the social prescribing process and to apply this knowledge in primary-care settings where the use of the approach is being developed. Methods In a realist review of literature considering the process of social prescribing, bibliographic and grey literature searches were used to locate evidence. The relevance of the evidence was assessed and then used to develop theory. Findings were contextualised through focus groups in the partner primary-care setting. Findings Bibliographic and grey literature searches identified a total of 253 primary sources, and data were fully extracted from the most conceptually rich (n=109). Overarching programme theory integrating 40 active elements of the social prescribing process was developed through synthesis of the primary literature. This list was then refined through expert prioritisation leading to targeted searches conducted on key elements of the process relating to enrolment in, engagement with, and adherence to social prescribing. Key contexts and mechanisms contributing to successful uptake and enrolment included patient beliefs about suitable treatment options, presentation of the intervention and social prescribing process, accessibility of social prescribing (physically and psychologically), and supported uptake (eg, a link worker). Skilful and flexible intervention leadership and a change in the patient's condition were key contexts or mechanisms in maintaining adherence. Interpretation Use of a realist approach, with findings iteratively refined and applied in a primary-care setting, has facilitated a better understanding of what works in the social prescribing process. However, despite increasing interest in the approach, there is a paucity of information in the current evidence base about how social prescribing interventions are developed, offered, and delivered. Therefore, future social prescribing interventions should integrate process evaluations. Funding Part funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust.

BACKGROUND: Many studies suggest that exposure to natural environments ('greenspace') enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that "greenspace" is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents.METHODS: This ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics.RESULTS: Positive associations were observed between good health prevalence and the density of the greenspace types, "broadleaf woodland", "arable and horticulture", "improved grassland", "saltwater" and "coastal", after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of "saltwater". Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators.CONCLUSIONS: The findings indicate that the type, quality and context of 'greenspace' should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection.

List of organisations and websites searched. An exhaustive list of organisations contacted by the team, as well as websites hand-searched, for relevant studies. Table S2. Sample search strategy (MEDLINE) and databases searched. Search strategy submitted to the MEDLINE database is indicative of all database searches, with minor alterations for other databases. Table S3. Data extraction forms. Tables showing the variables extracted from both the qualitative and qualitative studies. Figure S1. Results flow diagram. PRISMA diagram showing included/excluded number of items at each stage of the review. Table S5. Quality/risk of bias assessments. Quality/risk of bias assessments of each study included in the review, as assessed by two team members independently. Table S6. Supplementary evidence details. Details of each study included in the supplementary searches. (DOCX 2294 kb)

Evidence for health and wellbeing benefits of exposure to natural environments is mixed; one possible explanation is that much of the research has treated nature generically as 'greenspace'. To exp...