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The education systems of the four UK nations are diverging, and the education system in Wales is undergoing major reform with substantially increased emphasis on health and wellbeing. Understanding the implementation of major policy and system reforms requires an understanding of system histories and starting points. This study aimed to explore the perceived roles of schools in contemporary society, and how this role has evolved over time; the aims of the reforms, with a particular focus on health and wellbeing; and perceived barriers and facilitators for implementation. Interviews were held with senior stakeholders in the Welsh education system who held a strategic role in shaping the reforms. These included senior members of government and schools with a remit in either design of the curriculum or educationalists' professional learning, Wales's school regulatory body, and those with a multidisciplinary remit in health and education. Interviews were subjected to thematic analysis, which produced a number of themes related to each objective, including 'a changing society and increasing expectations on schools', 'the perceived role of schools in supporting health and wellbeing', 'the aims of the reform', 'what will success look like?', 'national level barriers and facilitators' and 'community and school level barriers and facilitators'. Findings suggest that education system reform requires change at multiple levels of the education system. Consideration of each level, and the interactions between them, is necessary for achieving change.

Background: Health and education are intrinsically linked, while both are significantly patterned by socioeconomic status throughout the life course. Nevertheless, the impact of promoting health via schools on education is seen by some as a "zero-sum game"; ie, focusing resources on health improvement activity distracts schools from their core business of educating pupils, potentially compromising educational attainment. There is emerging evidence that school health improvement interventions may beneficially influence both health and attainment. However, few studies have examined the relationship between school health improvement activity and socioeconomic inequalities in educational attainment. Methods: Wales-wide, school-level survey data on school health policies and practices was linked with routinely collected data on academic attainment. Primary outcomes included attendance and academic attainment at age 14 (Key Stage 3) and 16 (Key Stage 4). Linear regression models were constructed separately for high and low Free School Meal (FSM) schools, adjusting for confounders. Interaction terms were fitted to test whether there was an interaction between FSM, health improvement activity, and outcomes. Results: There were positive associations between almost all school health variables and KS3 attainment among high, but not low FSM schools. Similarly, for attendance, there were positive associations of several health variables among high but not low FSM schools. There were no associations for KS4 attainment. Conclusions: Our findings did not support the "zero-sum game" hypothesis; in fact, among more deprived schools there was a tendency for better attendance and attainment at age 14 in schools with more embedded health improvement action.

Pediatric diarrheal disease is a significant source of morbidity and mortality in the developing world. While several studies have demonstrated an increased incidence of diarrheal illness in boys compared with girls in low- and middle-income countries (LMIC), the reasons for this difference are unclear. This secondary analysis of the dehydration: assessing kids accurately (DHAKA) derivation and validation studies included children aged

Key summary points: Aims: This study aimed to assess the knowledge, behaviour, and attitudes of healthcare professionals to frailty assessment in emergency surgical admissions. Findings: Frailty assessment is well supported by healthcare professionals working in surgery. However, in clinical practice, standardised tools are not routinely being used and only half of respondents were able to accurately identify frailty from clinical vignettes. Message: Better education around frailty assessment is needed for healthcare professionals working in surgery to improve perioperative pathway for people living with frailty. Purpose: Screening for frailty in people admitted with emergency surgical pathology can initiate timely referrals to enhanced perioperative services such as intensive care and geriatric medicine. However, there has been little research exploring surgical healthcare professionals' opinions to frailty assessment, or accuracy in identification. This study aimed to assess the knowledge, behaviour, and attitudes of healthcare professionals to frailty assessment in emergency surgical admissions. Methods: We designed a cross-sectional multicentre study developed by a multiprofessional team of surgeons, geriatricians, and supported by patients. A semi-structured survey examined attitudes and behaviours. Knowledge was assessed by comparing respondents' accuracy in scoring twenty-two surgical case vignettes using the Clinical Frailty Scale. Results: Eleven hospitals across England, Wales, and Scotland participated. Two hundred and eleven clinicians responded—20.4% junior doctors, 43.6% middle grade doctors, 24.2% senior doctors, 11.4% nurses and physician associates. Respondents strongly supported perioperative frailty assessment. Most were already assessing for frailty, although frequently not using a standardised tool. There was a strong call for more frailty education. Participants scored 2175 vignettes with 55.4% accurately meeting the gold standard; accuracy improved to 87.3% when categorised into "not frail/mildly frail/severely frail" and 94% when dichotomised to "not frail/frail". Conclusion: Frailty assessment is well supported by healthcare professionals working in surgery. However, standardised tools are not routinely being used, and only half of respondents could accurately identify frailty. Better education around frailty assessment is needed for healthcare professionals working in surgery to improve perioperative pathway for people living with frailty. [ABSTRACT FROM AUTHOR]

Background: Implementing health improvement is often perceived as diverting resource away from schools' core business, reflecting an assumption of a "zero-sum game" between health and education. There is some evidence that health behaviors may affect young people's educational outcomes. However, associations between implementation of school health improvement and educational outcomes remains underinvestigated. Methods: The study linked school-level data on free school meal (FSM) entitlement, educational outcomes, and school attendance, obtained from government websites, with data from the School Environment Questionnaire (SEQ) on health improvement activity collected in Wales (2015/2016). Spearman's rank correlation coefficients and linear regression models tested the extent of association between health improvement activity and attendance and educational outcomes. Results: SEQ data were provided by 100/115 network schools (87%), of whom data on educational performance were obtained from 97. The percentage of pupils entitled to FSM predicted most of the between-school variance in achievement and attendance. Linear regression models demonstrated significant positive associations of all measures of health improvement activity with attainment at Key Stage (KS) 3, apart from mental health education in the curriculum and organizational commitment to health. Student and parent involvement in planning health activities were associated with improved school attendance. There were no significant associations between health improvement and KS4 attainment. Conclusion: Implementing health improvement activity does not have a detrimental effect on schools' educational performance. There is tentative evidence of the reverse, with better educational outcomes in schools with more extensive health improvement policies and practices. Further research should investigate processes by which this occurs and variations by socioeconomic status.

Background: Children receive care and support from social services due to the risk of harm or impeded development or because of disability. This study aimed to identify typologies of adversity experienced by children receiving care and support from social services and to explore how typologies differ by sociodemographic characteristics. Methods: This is a cross‐sectional study of 'Children Receiving Care and Support' (N = 12 792) during 2017/2018 in Wales, UK. We sought to (1) examine the prevalence of household adversities experienced by children in receipt of care and support from social services; (2) identify typologies of household adversities; and (3) explore how typologies of household adversities differ by family characteristics (demographics, measures of social disadvantage, perinatal and care factors). Results: We found evidence for multiple risk factor constellations. The four‐class solution suggested four distinct classes of adversities: child disability (50.0%), low adversities (20.3%), family poor health (6.7%) and multiple risks (23.0%). Children in the 'multiple risk' class were significantly more likely to be younger, more deprived and 'looked after' by the local authority compared with those in the 'low adversities' class. Conclusions: Given the presence of different constellations of household adversities, policies and interventions that address multiple risk factors simultaneously may be more effective and have longer‐lasting benefits. [ABSTRACT FROM AUTHOR]