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While there is growing interest in the intersection of music and health, current scientific literature in this field often lacks the rigor and strength of studies grounded in quantitative research. Also, a lack of framework to organize data decentralizes the information. The broad definition and subjective nature of music makes it difficult to design evaluations that would yield strong evidence to support the holistic benefits on well-being. This paper proposes a three-category framework to organize raw data to trace the interactions and interlinked nature of the effects of participating in group music activities. The proposed method was used to evaluate two choirs in the Royal Borough of Kensington and Chelsea (RBKC), UK: the Sing to Live, Live to Sing in 2016, a singing program based in community centers across RBKC, and the GLUE Sings program, an adolescent music-making and singing program piloted by the Tabernacle W11 in 2018 to increase community engagement and participation after the 2017 Grenfell Fire. Both programs were found to better the holistic well-being of their respective participants. While the framework is useful in these evaluations, future research would benefit even more through utilizing mixed methodologies and increasing collaboration amongst funders, researchers, and program managers.

ObjectivesChanges in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods.DesignLongitudinal panel survey at the LA level (2008–2015) using fixed effects linear regression.Setting324 LAs in England.Main exposureExpenditure per capita on total LA services, highways and transport services, and housing services.Main outcome measuresLA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure.ResultsTotal LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI −0.093 to –0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI −0.009 to –0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI −0.010 to –0.002).ConclusionChanges in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population. Individual-level research is needed to further elucidate these relationships.

Personal measurements of radiofrequency electromagnetic fields (RF-EMF) have been used in several studies to characterise personal exposure in daily life, but such data are limitedly available for adolescents, and not yet for the United Kingdom (UK). In this study, we aimed to characterise personal exposure to RF-EMF in adolescents and to study the association between exposure and rules applied at school and at home to restrict wireless communication use, likely implemented to reduce other effects of mobile technology (e.g. distraction). We measured exposure to RF-EMF for 16 common frequency bands (87.5 MHz–3.5 GHz), using portable measurement devices (ExpoM-RF), in a subsample of adolescents participating in the cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP) from Greater London (UK) (n = 188). School and home rules were assessed by questionnaire and concerned the school's availability of WiFi and mobile phone policy, and parental restrictions on permitted mobile phone use. Adolescents recorded their activities in real time using a diary app on a study smartphone, while characterizing their personal RF-EMF exposure in daily life, during different activities and times of the day. Data analysis was done for 148 adolescents from 29 schools who recorded RF-EMF data for a median duration of 47 h. The majority (74%) of adolescents spent part of their time at school during the measurement period. Median total RF-EMF exposure was 40 μW/m2 at home, 94 μW/m2 at school, and 100 μW/m2 overall. In general, restrictions at school or at home made little difference for adolescents’ measured exposure to RF-EMF, except for uplink exposure from mobile phones while at school, which was found to be significantly lower for adolescents attending schools not permitting phone use at all, compared to adolescents attending schools allowing mobile phone use during breaks. This difference was not statistically significant for total personal exposure. Total exposure to RF-EMF in adolescents living in Greater London tended to be higher compared to exposure levels reported in other European countries. This study suggests that school policies and parental restrictions are not associated with a lower RF-EMF exposure in adolescents.

Background The 2008 Great Recession significantly impacted economies and individuals globally, with potential impacts on food systems and dietary intake. We systematically reviewed evidence on the impact of the Great Recession on individuals’ dietary intake globally and whether disadvantaged individuals were disproportionately affected. Methods We searched seven databases and relevant grey literature through June 2020. Longitudinal quantitative studies with the 2008 recession as the exposure and any measure of dietary intake (energy intake, dietary quality, and food/macronutrient consumption) as the outcome were eligible for inclusion. Eligibility was independently assessed by two reviewers. The Newcastle Ottawa Scale was used for quality and risk of bias assessment. We undertook a random effects meta-analysis for changes in energy intake. Harvest plots were used to display and summarise study results for other outcomes. The study was registered with PROSPERO (CRD42019135864). Results Forty-one studies including 2.6 million people met our inclusion criteria and were heterogenous in both methods and results. Ten studies reported energy intake, 11 dietary quality, 34 food intake, and 13 macronutrient consumption. The Great Recession was associated with a mean reduction of 103.0 cal per adult equivalent per day (95% Confidence Interval: − 132.1, − 73.9) in high-income countries (5 studies) and an increase of 105.5 cal per adult per day (95% Confidence Interval: 72.8, 138.2) in middle-income countries (2 studies) following random effects meta-analysis. We found reductions in fruit and vegetable intake. We also found reductions in intake of fast food, sugary products, and soft drinks. Impacts on macronutrients and dietary quality were inconclusive, though suggestive of a decrease in dietary quality. The Great Recession had greater impacts on dietary intake for disadvantaged individuals. Conclusions The 2008 recession was associated with diverse impacts on diets. Calorie intake decreased in high income countries but increased in middle income countries. Fruit and vegetable consumption reduced, especially for more disadvantaged individuals, which may negatively affect health. Fast food, sugary products, and soft drink consumption also decreased which may confer health benefits. Implementing effective policies to mitigate adverse nutritional changes and encourage positive changes during the COVID-19 pandemic and other major economic shocks should be prioritised.

Background In 2010, the UK government implemented austerity measures, involving reductions to public spending and welfare reform. We aimed to systematically review the relationship of austerity policies with food insecurity including foodbank use in the UK. Methods We undertook a narrative systematic review (CRD42020164508) and searched seven databases, grey literature, and reference lists through September 2020. Studies with austerity policies (including welfare reform) as exposure and food insecurity (including foodbank use as a proxy) as study outcome were included. We included quantitative longitudinal and cross-sectional studies. Two reviewers assessed eligibility, extracted data directly from studies, and undertook quality assessment. Findings Eight studies were included: two individual-level studies totalling 4129 participants and six ecological studies. All suggested a relationship between austerity and increased food insecurity. Two studies found that austerity policies were associated with increased food insecurity in European countries including the UK. Six studies found that the welfare reform aspect of UK austerity policies was associated with increased food insecurity and foodbank use. Sanctions involving delays to benefits as a response to a claimant not actively seeking work may increase food insecurity, with studies finding that increases of 100 sanctions per 100,000 people may have led to increases of between 2 and 36 food parcels per 100,000 population. Interpretation UK austerity policies were consistently linked to food insecurity and foodbank use. Policymakers should consider impacts of austerity on food insecurity when considering how to reduce budget deficits. Funding NIHR School for Public Health Research.

Background: The 2008 Great Recession significantly impacted economies and individuals globally, with potential impacts on food systems and dietary intake. We systematically reviewed evidence on the impact of the Great Recession on children’s and adults’ dietary intake globally and whether disadvantaged individuals were disproportionately affected.Methods: We searched seven databases and relevant grey literature through June 2020. Longitudinal quantitative studies with the 2008 recession as the exposure and any measure of dietary intake (energy intake, dietary quality and food/macronutrient consumption) as outcomes were eligible for inclusion. Eligibility was independently assessed by two reviewers. The Newcastle Ottawa Scale was used for quality assessment. We undertook a random effects meta-analysis for changes in energy intake. Harvest plots were used to display and summarise study results for other outcomes. The study was registered with PROSPERO (CRD42019135864).Results: Forty-one studies including 2.6 million people met our inclusion criteria and were heterogenous in both methods and results. Ten studies reported energy intake, 11 dietary quality, 34 food intake, and 15 macronutrient consumption. The Great Recession was associated with a mean reduction of 39.9 calories per adult equivalent per day (95% Confidence Interval: -119.9, 40.2) in the meta-analysis of seven studies. We found reductions in dietary quality and small decreases in fruit and vegetable intake. We also found reductions in intake of meat and fish, fast food, sugary products, and soft drinks alongside an increase in the consumption of eggs and legumes. Impacts on macronutrients were inconclusive. Of 17 studies examining inequalities, 14 found that the Great Recession was associated with greater reductions in dietary intake and quality among more disadvantaged individuals. Only 4 studies investigated children’s intakes. Conclusions: The 2008 recession was associated with poorer dietary quality and decreased fruit and vegetable consumption, especially for more disadvantaged individuals. Implementing effective policies to mitigate adverse nutritional changes during the COVID pandemic and other major economic shocks should be prioritised.

Background The 2007-2009 Great Recession significantly impacted global economies, industries, and individuals around the world, with a potential impact on health behaviours including dietary intake. Given the global reach and severity of the Great Recession, changes in food intakes may impacted health and health inequalities internationally. We conducted a systematic review examining whether the Great Recession had an impact on food intakes. Methods We searched MEDLINE, Embase, PsycINFO, Health Management Information Consortium (HMIC), CINAHL and Web of Science databases, along with relevant grey literature, in June 2020. Primary quantitative studies with the Great Recession as the exposure and food intake as the outcome and with two time points were eligible for inclusion in this review, assessed independently by two reviewers. The Newcastle Ottawa scale was used for quality assessment. The study was registered with PROSPERO (CRD42019135864). Results Forty-one studies from twenty-five countries were included in this review. Studies were heterogeneous in methods and results. Nine of ten studies on energy intake found that total energy intake decreased over the recession. Eight of eleven studies on dietary quality found that the recession was associated with poorer diet. Thirty-four studies assessed impact on individual food groups. They found that consumption of fruits and vegetables, meat and fish, and fast food, confectionery and soft drinks generally decreased while egg and legume consumption increased and carbohydrate consumption exhibited little change. The impact was generally greater on those of lower socio-economic position. Conclusions While our review presents mixed findings about the impact of the Great Recession on food intake, there is consistent evidence of a negative impact on diets. Identifying effective policies which mitigate adverse changes in nutrition during economic downturns should be prioritised at the national and international level. Key messages Our systematic review of the Great Recession and food intakes demonstrates potential relationships between economic downturns and nutrition – these relationships may be important for health globally. Our systematic review demonstrates that it is important for policy-makers and public health professionals to consider mitigating potential nutritional impacts during economic recessions.

Our inquiry investigated the barriers to, and facilitators for, the involvement of Black and Minority Ethnic (BME) and ‘seldom-heard’ communities, in a study researching the impact of mobile phone and wireless device usage on adolescents’ cognition, behaviour and mental health. The aim was to co-produce solutions to increase participation, and we used focus groups, telephone interviews, a community event and a public and patient involvement (PPI) café to conduct the inquiry. Five themes emerged from the data: two enablers – the value and benefits of research; and three barriers – concerns about research and about communication, and practical constraints. A central cross-cutting theme, the concept of trust, was evident from the data, and extended across all themes, including across the solutions to non-participation. When the data collection and analysis were completed, we ran a symposium for researchers and members of the public to share our findings and to co-produce solutions. The symposium generated ideas about improving participation, including tailoring participant information, engaging with local advocates and involving people in research design and delivery.

Background Patient portals are digital health tools adopted by health care organizations. The portals are generally connected to the electronic health record of the health care organization and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments, or message the health care provider. Patient portals may be beneficial for both patients and the health care system. Patient portals can widely differ from one context to another due to the differences in the portal functionalities and capabilities and it is anticipated that outcomes associated with the functionalities also differ. Current systematic reviews report outcomes associated with patient portal uptake but do not explicitly specify the patient portal functionalities. Objective The aim of this systematic review is to synthesize the evidence on health and health care quality outcomes associated with patient portal use among adult (18 years or older) patients. The review research questions are as follows: What kind of health outcomes do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? and What kind of health care quality outcomes, including health care utilization outcomes, do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? Methods The systematic review will be conducted by searching the MEDLINE, EMBASE, and Scopus databases for relevant literature. The review inclusion criteria will be studies about adult patients (18 years or older), studies only about tethered patient portals, and studies with or without a comparator. We will report patient portal–associated health and health care quality outcomes based on the patient portal functionalities. All quantitative primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials and the National Heart, Lung, and Blood Institute’s quality assessment tools. Data will be synthesized using narrative synthesis and will be reported according to the patient portal functionalities, country, disease, and health care system model. Results Searches will be conducted in September 2019, and the review is anticipated to be completed by the end of June 2020. Conclusions This systematic review will provide an overview of health and health care quality outcomes associated with patient portal use among adult patients, providing detailed information about the functionalities of the portals and their associations with the outcomes. The review could potentially help patient portal evaluation studies by providing insights into outcomes associated with the different functionalities of patient portals. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141131 International Registered Report Identifier (IRRID) PRR1-10.2196/14975

Despite Social Networking Sites (SNS) having a minimum age of 13, younger adolescents are using them. In this study, we examine self-reported overall SNS use and SNS use if awake at night in relation to Health-Related Quality of Life (HRQOL, measured by KIDSCREEN-10) and behaviour (measured by Strengths and Difficulties Questionnaire, SDQ) in 5,229 adolescents aged 11-12 in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) cohort. Two-thirds of the study population used SNS. Weekday and weekend SNS use on mobile phones and other devices was significantly associated with lower HRQOL in females (all p-values for linear trend < 0.01) but not males. Using SNS if awake at night was also significantly associated with lower HRQOL in females (adjusted β-coefficient - 2.20 (95% CI - 3.18, - 1.22)). Higher SNS use on mobile phones and other devices was associated with increased behavioural difficulties in both genders (p-value for trend < 0.001). Similarly, SNS use if awake at night was associated with greater behavioural difficulties (adjusted β-coefficient 2.54 (95% CI 2.09, 2.98)). We recommend further longitudinal research in this area\ud in order have a better understanding of the direction of relationships between SNS and wellbeing and behaviour in adolescents.

BACKGROUND Patient portals are digital health tools adopted by health care organizations. The portals are generally connected to the electronic health record of the health care organization and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments, or message the health care provider. Patient portals may be beneficial for both patients and the health care system. Patient portals can widely differ from one context to another due to the differences in the portal functionalities and capabilities and it is anticipated that outcomes associated with the functionalities also differ. Current systematic reviews report outcomes associated with patient portal uptake but do not explicitly specify the patient portal functionalities. OBJECTIVE The aim of this systematic review is to synthesize the evidence on health and health care quality outcomes associated with patient portal use among adult (18 years or older) patients. The review research questions are as follows: What kind of health outcomes do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? and What kind of health care quality outcomes, including health care utilization outcomes, do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? METHODS The systematic review will be conducted by searching the MEDLINE, EMBASE, and Scopus databases for relevant literature. The review inclusion criteria will be studies about adult patients (18 years or older), studies only about tethered patient portals, and studies with or without a comparator. We will report patient portal–associated health and health care quality outcomes based on the patient portal functionalities. All quantitative primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials and the National Heart, Lung, and Blood Institute’s quality assessment tools. Data will be synthesized using narrative synthesis and will be reported according to the patient portal functionalities, country, disease, and health care system model. RESULTS Searches will be conducted in September 2019, and the review is anticipated to be completed by the end of June 2020. CONCLUSIONS This systematic review will provide an overview of health and health care quality outcomes associated with patient portal use among adult patients, providing detailed information about the functionalities of the portals and their associations with the outcomes. The review could potentially help patient portal evaluation studies by providing insights into outcomes associated with the different functionalities of patient portals. CLINICALTRIAL International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141131 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/14975