Publications

Mason M, Shaw SC, Baird J, Barrett M, Lovelock D, Woods-Townsend K, Godfrey KM, Vogel CA, Crozier SR

Assessing children’s diets is currently challenging and burdensome. Abbreviated food frequency questionnaires (FFQ) have potential to assess dietary patterns in a rapid and standardised manner. Using nationally representative UK dietary intake and biomarker data, we developed abbreviated FFQs to calculate dietary quality scores for pre-school and primary school-aged children. 

UK National Diet and Nutrition Survey (2008-2016) weekly consumption frequencies of 129 food groups from four-day diaries were cross-sectionally analysed using principal component analysis. A 129-item score was derived, alongside a 12-item score based on foods with the six highest and six lowest coefficients. Participants included 1,069 pre-schoolers and 2,565 primary school children. 

https://doi.org/10.1017/s0007114525103449

May 2025

Simons G, Klepacz N, Baldwin DS

Doctors globally are increasingly experiencing high workloads and challenging working conditions and, consequently, are reporting high levels of stress, anxiety, depression,1 emotional distress, burn-out risk and suicidal feelings. This negatively impacts patient care quality, safety and satisfaction and leads to declining job satisfaction and doctors leaving the workforce. In a UK context, the 2023 National Health Service (NHS) staff survey found that 44% of doctors felt unwell in the previous 12 months because of work-related stress, and 38% often or always found their work emotionally exhausting. Emphasis is often placed on doctors to be more resilient, with stigma and a fear of potential repercussions preventing doctors from speaking up about their well-being. However, there is an emerging consensus that some aspects of doctors’ training, working conditions and organisational support negatively impact well-being. The well-being of doctors significantly impacts workforce planning, cost, healthcare quality and patient outcomes. Dissatisfaction with role/place of work or NHS culture was cited as the top reason for leaving the workforce in a General Medical Council survey, with burn-out/work-related stress as the third most cited reason behind retirement. Poor mental well-being of staff is estimated to cost the NHS at least £12.1 billion per year; tackling poor mental well-being and reducing the number of staff leaving the NHS could save up to £1 billion. The UK’s health system prioritises patient care—often over staff well-being—but long-term patient care and safety depend on staff well-being.

The need to address doctor well-being is well recognised, with government and industry reports highlighting the need for improvement. While recognising the urgent need to address doctors’ well-being, these reports often fail to operationalise well-being or specify the outcome or measurement tools required to gauge the success of their recommendations. For example, the ‘NHS Long Term Plan’ aims to make the NHS ‘the best place to work’ but provides little detail on implementation or how success will be captured or measured. The NHS Long Term Workforce Plan commits to implementing actions from the NHS People Plan to ensure that staff have access to well-being services and support; however, the British Medical Association has questioned how this ambition will be made a reality. Many employers and education deaneries now provide well-being programmes for doctors and implement the NHS health and well-being framework. However, evidence of the success of these (and similar) programmes—often aimed at individual coping strategies, resilience and productivity—suggests limited effect. The lack of consensus on what doctor well-being is and how it should be measured means that the monitoring and evaluation of these strategies are inconsistent.

The ongoing and accurate measurement of doctors’ well-being is necessary to understand local and specific needs and ensure the effective delivery of staff services. It is, therefore, vital for both research and governance to take a consistent data-driven and evidence-based approach to doctors’ well-being, taking account of the many dimensions (ie, social, cultural, environmental and economic) and levels (ie, individual, organisational and societal) that comprise this complex issue. However, work has not yet been undertaken to standardise the definition and measurement of doctor well-being. In addition, ‘well-being’ has often been used interchangeably with, or to describe, mental health, with previous research focusing largely on ‘pathologies’ such as depression, anxiety and burnout rather than positive measures of well-being. Consequently, workplace well-being has become a measure of the absence of mental health disorders. A salutogenic approach that measures positive determinants, context, mechanisms and individual and group well-being should be preferred when considering doctor well-being. A salutogenic approach is a positive approach that looks prospectively at how to create, enhance and improve well-being; as opposed to a pathogenic approach that looks retrospectively at the disease burden of doctors (usually mental health diagnoses).

Our systematic review found well-being outcomes and measurement tools used in doctor well-being research were heterogeneous, demonstrating the need for a core outcome set (COS). COSs are consensus minimum groups of outcomes with recommended reliable and valid measurement tools. Reaching agreement among stakeholders—including NHS doctors—ensures a consistent and comprehensive focus, facilitating comparison between organisations through the generation of ‘big data’, and in doing so, provides decision-makers with the evidence needed to inform future workforce strategies, interventions and actions. We used a salutogenic and consensus-based approach to develop a COS to capture and report on the well-being of doctors in the NHS. To our knowledge, this study represents the first time a non-pathological concept—well-being—has been applied to the COS-STAndards for Development (COS-STAD) guidance.

https://doi.org/10.1136/bmjopen-2024-094973

May 2025

Saville C, Jones J, Meredith P, Dall'Ora C, Griffiths P

Understaffing by nursing staff in hospitals is linked to patients coming to harm and dying unnecessarily. There is a vicious cycle whereby poor work conditions, including understaffing, can lead to nursing vacancies, which in turn leads to further understaffing. Is hospital investment in nursing staff, to eliminate understaffing on wards, cost-effective?

This longitudinal observational study analysed data on 185 adult acute units in four hospital Trusts in England over a 5-year period. We modelled the association between a patient's exposure to ward nurse understaffing (days where staffing was below the ward mean) over the first 5 days of stay and risk of death, risk of readmission and length of stay, using survival analysis and linear mixed models. We estimated the incremental cost-effectiveness of eliminating understaffing by registered nurses (RN) and nursing support (NS) staff, estimating net costs per quality-adjusted life year (QALY). We took a hospital cost perspective.

https://doi.org/10.1136/bmjqs-2024-018138

April 2025

Woodrow M, Benedikz E, Bryant LD, Illés J, Jagpal P, Jennings HM, Monks E, Nayak V, Reza MM, Saha S, Upadhyaya M, Williams K, Winpenny JP, Zamani R, Alwan NA

Approximately 18% of the population of England and Wales belong to a black, Asian, mixed or other ethnic group. If this demography was reflected amongst UK academic professors, we would expect approximately 9% of professors to be female and belonging to ethnic minorities groups. Latest data demonstrate that the proportion of professors who are women from ethnic minorities falls far short of this, with about two-thirds (63.6%) of professors white males, about one quarter (26.5%) white female, 7.2% males from ethnic minority backgrounds and only 2.7% females from ethnic minority backgrounds .

The concept of intersectionality acknowledges that no individual has a single-dimension identity and that social constructs shaping identity dimensions can lead to compound disadvantage. Intersectionality critical theory conceptualises knowledge as contextual, relational, and reflective of political and economic power. For example, the experiences of a lesbian black woman are vastly different to those of a heterosexual white woman, even though they share one dimension of their identity (gender). Multiple other identity dimensions may shape life experiences, such as disability, caring responsibilities, language, or migration status, and may overlap in a way that exacerbates the experiences of disadvantage and hardship. Addressing inequities and structural discrimination through the lens of intersectionality is not easy, though much needed. Analyses of research funding programmes show that disparities span across more than one identity dimension. For example, over the course of seven decades, the prestigious Lasker biomedical research award was given to only one non-white woman out of 397. Intersectional inequalities can span across pay, recognition and promotion, and the answer is not to prioritise one identity dimension over the other as some initiatives do (e.g., gender over ethnicity, but to adopt an intersectional approach to addressing inequities entrenched in the sector.

The most significant initiative developed to redress gender imbalance in UK higher education, Athena Swan, has recently increased its focus on intersectionality; however clear impact cases are still rare. Still relatively new, Advance HE’s Race Equality Charter and the BMA’s Racial Harassment Charter for Medical Schools, which provide frameworks for institutions’ action against discrimination, have not yet enabled large-scale change in the race profile of staff in Higher Education Institutions (HEI) or academic medicine.

There is evidence that having a same-gender role model is influential for early-career women in some medical specialties. Mentorship is an activity in which professionals engage to help develop the next generation of professionals in their field and a popular initiative widely regarded as being a useful way to try to address inequalities in the workplace. However, there is limited evidence around how mentoring can help achieve equity in the higher education sector or on whether matching mentor/mentees based on intersectional backgrounds is beneficial, and, if so, how. Evidence of mentoring effectiveness in reducing gender inequalities is largely lacking and evaluation of mentoring schemes needs to be more robust. This paper describes the formation, design and evaluation of the Academic Intersectionality Mentoring in Medical Schools scheme (AIMMS Mentoring).

https://doi.org/10.1371/journal.pone.0318326

April 2025

Fogg C, King P, Parsons V, Dunbar N, Woutersen M, Branson J, Pocock H, Jadzinski P, Lofthouse-Jones C, Walsh B, Smith D

Ambulance trusts across the UK serve vast and varied regions, impacting equitable healthcare access, especially for older patients facing urgent, non-life-threatening conditions. Detailed variation in demand and service provision across these regions remains unexplored but is crucial for shaping effective care policies and organisation. Geospatial mapping techniques have the potential to improve understanding of variation across a region, with benefits for service design.

The aim of this project was to explore the feasibility of using geospatial techniques to map emergency 999 calls and outcomes for older adults within an academic-healthcare collaboration framework.

https://doi.org/10.1136/bmjoq-2024-002977

April 2025

See H, Gowling E, Boswell E, Aggarwal P, King K, Smith N, Lim S, Baxter M, Patel HP

Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality.

An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. 

This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.

https://doi.org/10.1007/s40266-025-01205-5

April 2025

Radcliffe E, Saucedo AR, Howard C, Sheikh C, Bradbury K, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Ibrahim K

Reducing polypharmacy and overprescribing in older people living with frailty is challenging. Evidence suggests that this could be facilitated by structured medication review (SMR) and deprescribing processes involving the multidisciplinary team (MDT). This study aimed to develop an MDT SMR and deprescribing intervention in primary care for older people living with frailty.

Intervention development was informed by the Medical Research Council framework for complex intervention and behaviour change and implementation theories. Intervention planning included: 1) a realist review of 28 papers that identified 33 context-mechanism-outcome configurations for successful MDT SMR and deprescribing in primary care, 2) a qualitative study with 26 healthcare professionals (HCPs), 13 older people with polypharmacy and their informal carers. The intervention's guiding principles were developed and intervention functions proposed, discussed and refined through an iterative process in four online co-design stakeholder workshops.

https://doi.org/10.1371/journal.pone.0319615

April 2025

Dall'Ora C, Meredith P, Saville C, Jones J, Griffiths P

Rates of work-related stress and sickness absence are high among nurses. The consequences of sickness absence are severe for health systems' efficiency and productivity.

Our objective is to examine the association between nurse staffing configurations and sickness absence in hospital inpatient unit nursing teams.

 This retrospective longitudinal case-control study using routinely collected hospital data among 4 general acute care hospitals in England examined 18 674 registered nurses (RNs) and nursing support (NS) staff working in 116 hospital units. Data were analyzed from April 1, 2015, to February 29, 2020.

https://doi.org/10.1001/jamanetworkopen.2025.5946

April 2025

Shewbridge A, Wiseman T, Richardson A

This study aimed to understand and characterize how culture affected behavior and decision-making about treatment and care in West African women with breast cancer living in the United Kingdom.

A critical ethnographic design was used with a sample consisting of 32 West African women, 27 supporters, and 18 health care professionals. Data were collected through 263 hours of participant observation and 98 informal and 10 formal interviews in a London cancer unit. Study materials and approach were informed by patient and public involvement group recommendations. Data were analyzed using an adapted Carspecken critical ethnographic approach.

https://doi.org/10.1016/j.soncn.2025.151878

April 2025

Young A, Fandinga C, Davis C, Andrews E, Johnson MJ, Bharucha T, Beattie RM, Marino LV

Congenital Heart Disease (CHD) is one of the most common congenital disorders occurring in about 9–10 per 1000 live births worldwide. Advances in surgical techniques have improved survival and clinical outcomes. Despite this, many infants with CHD experience growth failure prior to surgery which is associated with poorer neurodevelopmental outcomes, increased risk of mortality, and metabolic syndrome in adulthood. Although most infants are born with a normal weight-for-age, growth failure often occurs within the first few weeks of life with a reported prevalence of malnutrition during the first 12 months. Poor growth appears to occur irrespective of geographical location or disease severity. Features correlated with increased risk of malnutrition are antenatal diagnosis, associated genetic syndrome, birth weight ≤3 kg, complexity of CHD (≥2 significant lesions, or double outlet right ventricle or single ventricle physiology), cardiac surgery after 30 days of life, or diuretic medication before surgery or 1 month following surgery. Up to 35 % of infants with CHD experience nutrition and feeding difficulties as a result of i) restricted intake, ii) increased metabolic demand or iii) increased losses and often require the use of nutrient energy dense feeds or nasogastric tube feeding. Nutrition awareness tools providing a standardised approach to identifying infants and children with CHD at risk may provide opportunities to for earlier nutrition support.

In other groups of vulnerable infants (e.g. preterm infants) at risk of poor growth, the implementation of nutritional care pathways has been associated with reduced incidence of growth faltering and subsequent malnutrition. Similar efforts to prevent malnutrition in a CHD cohort during the first month of life, with to the use of nutrient energy dense feeds to support growth before surgery, have been shown to reduce weight loss following cardiac surgery and promote post-operative catch-up weight gain and reduce the length of paediatric intensive care unit (PICU) and hospital stay . In 2017, we developed a nutrition pathway to promote weight gain in infants with CHD before surgery using Delphi consensus methodology. Following this, the pathway was implemented into a regional paediatric cardiology service. An initial study (n = 44) considering the use of a nutrition pathway to support growth in infants with CHD before surgery demonstrated significantly improved growth outcomes at 4 and 12 months of age. We therefore aimed to evaluate the impact of this consensus-based nutrition pathway on growth in a larger cohort of infants with CHD following the implementation in a regional paediatric cardiology service over a five-year period.

https://doi.org/10.1016/j.clnu.2025.03.012

May 2025

Belfrage S, Husted M, Fraser S, Patel S, Faulkener J

Health literacy refers to the skills needed to access, understand, and navigate health information and services. Limited parental health literacy is associated with ineffective preventive behaviours and worse child health outcomes. People with limited financial and social resources are more likely to have limited health literacy. Profiling health literacy strengths and limitations of a population allows the multidimensional nature of health literacy to be considered and highlight patterns of need.

This study aimed to identify the health literacy profiles of parents of children aged 0–4 years in two cities in the United Kingdom with high levels of deprivation (Portsmouth, Southampton), and develop vignettes to illustrate their diverse experiences.

https://doi.org/10.1080/28355245.2025.2489383

April 2025

Hydes TJ, Kennedy OJ, Glyn-Owen K, Buchanan R, Parkes J, Cuthbertson DJ, Roderick P, Byrne CD

The aim of this study was to determine whether liver fibrosis is associated with heart failure in a general population cohort, and if genetic polymorphisms (PNPLA3 rs738409; TM6SF2 rs58542926), linked to increased risk of liver fibrosis and decreased risk of coronary artery disease, modify this association.

https://doi.org/10.1016/j.cgh.2024.03.045

May 2024

Alwan NA, Stannard S, Berrington A, Paranjothy S, Hoyle RB, Owen RK, Fraser SDS

If you work in public health or epidemiology, you will be familiar with the term ‘modifiable risk factors’. Searching PubMed in December 2023 for titles that included the term ‘modifiable risk’ returned 1222 results. Expanding this search to include both titles and abstracts returned 13,958 results. The term often refers to health behaviours such as smoking, alcohol intake, exercise, and diet. However, there does not seem to be a specific definition of what is classed as ‘modifiable’ in the context of the risk of ill health. Although the term is also used to refer to factors indirectly affecting health, such as education or housing, current use tends to focus on individual behaviours, largely neglecting the role of systemic and structural determinants of disease and health inequities.

https://doi.org/10.1371/journal.pgph.0002887

March 2024

Stannard S, Berrington A, Fraser SDS, Paranjothy S, Hoyle RB, Owen RK, Akbari A, Shiranirad M, Chiovoloni R, Alwan NA

Many studies use a reductionist approach to isolate the influence of one factor in childhood on multimorbidity rather than consider the combined effect of wider determinants. We explored how potential multiple early life determinants of multimorbidity can be characterised across three UK cohort studies. We used the National Child Development Study (NCDS), the 1970 British Cohort Study (BCS70), and the Aberdeen Children of the 1950s Study (ACONF) to identified early life variables that fit into 12 conceptualised domains of early life determinants of multimorbidity. Variables were assigned into 12 domains; principal component analysis reduced the dimensionality of the data and structured variables into subgroups. The data audit identified 7 domains in ACONF, 10 domains in NCDS and 12 domains in BCS70. Dominant components included maternal fertility histories within the prenatal, antenatal and birth domain, long-term illnesses within the child health domain, educational ability within the child education and health literacy domain, ethnicity within the demography domain, parental health behaviours within the transgenerational domain, housing within the socioeconomic domain and parental-child interactions within the parental-family domain. We demonstrated that if multiple large scale longitudinal studies are used, there is enough data available for researchers to consider conceptualising early life risk factors of multimorbidity across groups or domains. Such conceptualisation can help challenge the existing understanding of disease aetiology and develop new ideas for prevention of multimorbidity.

https://doi.org/10.1038/s41598-024-72275-5

September 2024

Ventre JP, Manning F, Mahmoud A, Brough G, Timmons S, Hawley-Hague H, Skelton DA, Goodwin VA, Todd CJ, Kendrick D, Logan P, Orton E

Factors influencing fall prevention programmes across three regions of the UK: the challenge of implementing and spreading the Falls Management Exercise (FaME) programme in a complex landscape

The occurrence of falls in adults 65+ years remains a common and costly issue worldwide. There is current evidence to suggest that falls can be prevented using evidence-based strength and balance interventions, such as the six-month Falls Management Exercise (FaME) programme. Perspectives of multiple key partners and providers of the FaME programme could inform future implementation and fall prevention strategies.

Partners and providers involved in local community fall prevention pathways were purposefully recruited from three geographical areas across the UK. Semistructured interviews were conducted to gain a broad understanding of factors affecting the adoption, implementation and spread of FaME. Data were analysed using an inductive thematic approach and mapped to the Consolidated Framework for Implementation Research (CFIR).

https://doi.org/10.1093/ageing/afaf083

March 2025

Ostinelli EG, Schulze M, Zangani C, Farhat LC, Tomlinson A, Del Giovane C, Chamberlain SR, Philipsen A, Young S, Cowen PJ, Bilbow A, Cipriani A, Cortese S

The comparative benefits and harms of available interventions for ADHD in adults remain unclear. We aimed to address these important knowledge gaps.

In this systematic review and component network meta-analysis (NMA), we searched multiple databases for published and unpublished randomised controlled trials (RCTs) investigating pharmacological and non-pharmacological interventions for ADHD in adults from database inception to Sept 6, 2023. 

Our primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). We estimated standardised mean differences (SMDs) and odds ratios (ORs) using random effects pairwise and component NMA, dismantling interventions into specific therapeutic components. 

People with relevant lived experience were involved in the conduct of the research and writing process.

https://doi.org/10.1016/s2215-0366(24)00360-2

January 2025

Booth A, Morgan S, Walker I, Mitchell A, Barlow-Pay M, Chapman C, Cochrane A, Filby E, Fleming J, Hewitt C, Raftery J, Torgerson D, Weir L, Parkes J

Young adults represent a third of the United Kingdom prison population and are at risk of poor health outcomes, including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of criminal sanctions and address the root causes of offending. However, evidence of their effectiveness has not yet been established. The Gateway programme, issued as a conditional caution, aimed to improve the life chances of young adults committing low-level offences. Participants agreed not to reoffend during the 16-week caution and, following a needs assessment, received individual support from a Gateway navigator and attended two workshops encouraging analysis of own behaviour and its consequences.

Our objective is to evaluate the effectiveness and cost-effectiveness of Gateway in relation to health and well-being of participants compared to usual process (court summons or a different conditional caution).

https://doi.org/10.3310/ntfw7364

Sept 2024

El Asmar ML, Mortagy M, White B, Burns D, Ramage J

Neuroendocrine neoplasms (NEN) are a group of rare cancers predominantly found in the
bronchopulmonary and gastrointestinal systems. NEN incidence has been increasing globally
(White, Rous et al. 2022). NEN can be categorised into well-differentiated neuroendocrine
tumours (NET) and poorly differentiated, high-grade neuroendocrine carcinomas (NEC) (Rindi,
Klimstra et al. 2018).

Gastroenteropancreatic NEN (GEPNEN) characteristically present between the ages 50 and 60
(Horton, Kamel et al. 2004), and can be difficult to diagnose, as they either present
asymptomatically and are diagnosed incidentally (e.g. post-appendicectomy), as non-specific
bowel symptoms causing delays in diagnosis or with symptoms resulting from mass effect of the
tumour within the abdomen (Oronsky, Ma et al. 2017, Tadman, Davies et al. 2019).

Research suggests that the time from the onset of symptoms to the diagnosis of NEN averages 5 to 7 years (Modlin, Kidd et al. 2005). This process often involves several visits to the GP and frequent misdiagnoses such as
irritable bowel syndrome (IBS) or gastritis. Lung NEN may present with cough, wheeze, shortness
of breath, chest pain, or haemoptysis, depending on tumour aggressiveness and location, or may
be found incidentally on imaging (Ramage, Davies et al. 2005, Tadman, Davies et al. 2019).

Route to diagnosis is recorded for patients with NEN within England’s National Cancer Registry
and Analysis Service (NCRAS) database. The emergency pathway for the diagnosis and initial
treatment of NEN can be regarded as a proxy for a delayed diagnosis, as it suggests that the case
has not undergone diagnostic evaluation at an earlier phase of symptom presentation. Disease
stage at presentation may also reflect delays in diagnosis. The factors in NEN associated with
emergency presentations or late presentation are unclear

Knowledge of factors leading to NEN presentation helps health commissioners target populations at higher risk to reduce delays to diagnosis. Addressing delays and inequity in the timely diagnosis of NEN aligns with targets set
by the NHS Long Term Plan and the UK Rare Diseases Framework (UK 2021).

This article aims to assess factors associated with emergency versus routine presentation at the
time of diagnosis of NEN, to assess factors associated with late presentation (higher stage) at
diagnosis of NEN, and to correlate these with overall survival.

http://dx.doi.org/10.1530/EO-25-0012

April 2025

Svensson I, Bridges J, Ellis J, Brady N, Dello S, Hooft J, Kleine J, Kohnen D, Lehane E, Lindqvist R, Maier CB, Mc Carthy VJC, Strømseng Sjetne I, Eriksson LE, Smeds Alenius L

Magnet hospitals, a concept developed in the U.S., have been associated with improved nurse recruitment and retention, and better patient outcomes. Magnet principles may be useful to address workforce challenges in European hospitals, but they have not been implemented or evaluated on a large scale in the European hospital context.

This study aims to explore the initial phase of implementing Magnet principles in 11 acute care hospitals in six European countries. The specific objectives of the study were to investigate the type of work that characterises the early phase of implementation and how implementation leaders engage with their context.

https://doi.org/10.1016/j.ijnurstu.2024.104754

June 2024

Gafari O, Agyapong-Badu S, Alwan NA, Tully MA, McDonough S, Stokes M, Barker M

This mixed-methods study identified physical activity (PA) and healthy eating messages produced during the COVID-19 pandemic and explored how they were received by UK ethnic minority communities. A scoping review of research and grey literature identified categories of PA and healthy eating messaging targeted at ethnic minorities. Individual and group interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. There was active community engagement in all study phases to ensure relevance and co-production of findings.

Interviews were held with 41 study participants aged 18–86 years (20 men) residing in England and Wales using digital conferencing and in person. The scoping review identified 24 records containing messages grouped into three categories: 1) PA messages; 2) healthy eating messages; 3) risk messages. Five themes described participants’ views of these messages: 1) lack of awareness of messaging; 2) responses to PA messaging; 3) responses to healthy eating messaging; 4) perceptions of risk messaging and 5) perceptions of conflict in messages. 

The review revealed that physical activity and healthy eating messaging specifically targeting ethnic minority communities is limited. This limited messaging was almost entirely missed by these communities. When received, the messaging was not interpreted as intended, perceived to be conflicting and risk messaging was perceived as blaming. More work with ethnic minority communities needs to be done to co-produce meaningful and appropriate PA and healthy eating messaging in a timely manner

https://doi.org/10.1371/journal.pgph.0003345

OCtober 2024

Gafari O, Bahrami-Hessari M, Norton J, Parmar R, Hudson M, Ndegwa L, Agyapong-Badu S, Asante KP, Alwan NA, McDonough S, Tully MA, Calder PC, Barker M, Stokes M

Involving members of the public in health and medical research is important to improve quality, outcomes and applicability of research. Public involvement contributes to an effective translation of research findings for public health improvement, therefore improving health equity and reducing health research waste. Although different terminologies are used to formally describe the involvement of the public in research, the term patient and public involvement and engagement (PPIE), most widely used in the UK is adopted for the purposes of the present article. This article is to suggest methods for addressing the lack of diversity in public representation in research.

https://doi.org/10.1016/j.puhe.2024.05.007

August 2025

Fraser   SD, Holland E, Laidlaw L, Francis NA, Macdonald S, Mair FS et al

Living with multiple long-term conditions (MLTCs) involves ‘work’. A recent qualitative synthesis identified eight patient-centred work themes: ‘learning and adapting’, ‘accumulation and complexity’, ‘investigation and monitoring’, ‘health service and administration’ and ‘symptom’, ‘emotional’, ‘medication’ and ‘financial’ work. These themes may be underrepresented in electronic health records (EHRs). 

This study aimed to evaluate the representation of these themes and their constituent concepts in EHR data in a general population and among individuals with history of a mental health condition.

https://doi.org/10.1177/26335565251329869

April 2025

Hussain U, Ziauddeen N, Taylor E, Alwan NA

Overweight and obesity are global health issues, defined as abnormal or excessive fat accumulation that may harm health. Among children and adolescents worldwide, the rate of obesity in 2022 was four times higher than in 1990. The rise in childhood obesity has heightened focus on its long-term health consequences.

Research has primarily focused on maternal factors and childhood overweight/obesity, with less emphasis on paternal factors. Evidence suggests that paternal health is crucial; a cross-sectional study found children of fathers with obesity are at higher risk of metabolic disease, regardless of maternal weight.

Paternal smoking also impacts childhood health. A review of 14 studies found children whose mothers smoked during pregnancy were at increased risk of being overweight between ages 3–33. Limited research exists on the effect of paternal smoking on childhood overweight/obesity. An individual participant data meta-analysis of 229,158 families across 28 birth cohorts showed a higher risk of childhood overweight in children whose mothers smoked during the first trimester and throughout pregnancy, compared to those whose mothers did not smoke. This analysis also found that paternal smoking was associated with a higher risk of childhood overweight, independent of maternal smoking. However, the study focused on Europe and North America, and did not extend the observation period beyond 1-year post-birth, or tracking obesity risk progression over time.

A UK based cross-sectional study found no association between paternal smoking and childhood overweight/obesity but did find an association between maternal smoking and childhood overweight/obesity when considering prenatal cigarette smoke exposure.  A previous systematic review examining the association between environmental smoking exposure and childhood obesity found a positive association for both maternal and paternal smoking, with a higher effect estimate for maternal smoking. However, this review focussed on environmental smoking exposure for the mother and source of exposure was unclear in some of the included studies, our review aims to focus solely on paternal smoking during the pregnancy period.

When examining the relationship between paternal smoking and child obesity, any observed association may be due to confounding factors like paternal obesity. People with overweight/obesity may be more likely to start smoking. A Mendelian randomization study from the UK Biobank showed each standard deviation increment in BMI increased the risk of being a smoker.

We aimed to systematically review the literature to examine the consistency of evidence exploring the relationship between paternal smoking and/or paternal overweight/obesity with childhood overweight/obesity.

https://doi.org/10.1007/s13679-025-00617-z

March 2025

Haron A, Li L, Shuang J, Lin C, Mansoubi M, Shi X, Horn D, Reeves N, Bowling F, Bradbury K, Eccles A, Dogan S, Dawes H, Cooper G, Weightman A

Diabetic foot ulcers (DFUs) are a common complication of diabetes. This study aims to investigate the relationships between in-shoe plantar temperature, normal and shear stress during walking and rest periods for participants with and without diabetes. 

For this purpose, a novel temperature, normal and shear stress sensing system was developed and embedded in an insole at the hallux, first metatarsal head and calcaneus region. Ten participants living with diabetes with no history of previous ulceration and ten healthy participants were recruited. Participants walked on a treadmill for 15 min and then rested for 20 min wearing the sensing insole. Results showed high correlation (Spearman’s rs ≥ 0.917) between heat energy, total plantar temperature change, during walking and strain energy, cumulative stress squared in all participants. Importantly, between-group comparisons showed indications of thermal regulation differences in participants with and without diabetes, with the first metatarsal head site showing significantly higher temperature at the end of the active period (P = 0.0097) although walking speed and mechanical stress were similar. 

This research demonstrates for the first time the correlation between strain energy and heat energy in-shoe during gait. Further research is needed to quantify relationships and investigate thermal regulation as a mechanism for DFU formation.

https://doi.org/10.1038/s41598-025-91934-9

March 2025

Ziauddeen N, Taylor E,  Alwan NA, Richards F, Margetts B, Lloyd T, Disegna M, Mason N, Taheem R and Smith D

Food clubs are a higher-agency food aid intervention that charge a small fee for a set number of items. Some incorporate longer-term solutions such as budgeting support and cooking skills. These are in place in England to help address inadequate reliable access to affordable, nutritious food. We used a convergent parallel mixed methods design to describe the food insecurity households accessing food clubs experience and to assess diet quality and wellbeing at the start and after at least three months of using food clubs in the South of England.

https://doi.org/10.1186/s12889-025-22353-8

March 2025

Blandford   A, Bindman J, Bradbury K, Cooper B, Costanza E, Edwards S et al

Human computer interaction (HCI) should inform the effectiveness and user experience of health technologies

at scale. The research question addressed in this study is what can be learned from the experience of applying

HCI methods in a time-critical, real-world situation with very limited access to the intended users. Such

practical experiences are rarely discussed in the literature, yet they are essential if HCI is to make an impact in

complex and challenging situations. This study is based on the development and deployment of a digital health

intervention (DHI) for clinically supported self-management of Long Covid called Living With Covid Recovery

(LWCR). The study covers the period May 2020 to July 2022 – i.e., the period of this research project, although

service delivery is ongoing.

The aims of the overall project were to develop, deploy and evaluate a clinically supported self-management

DHI for patients affected by Covid-19. Forms of evaluation include health economics and patient outcomes as

well as user interaction; the focus of the study reported here is on interaction design and evaluation of the

patient-facing app.

https://doi.org/10.1145/3711839

March 2025

Marshall J, Papavasiliou E, Fox C, Hawkes M, Irvine A, Moniz-Cook E, Pick A, Polley MJ, Reeve J, Robinson L, Rook G, Sadler E, Wolverson E, Walker S, Cross JL; SPLENDID Collaboration

Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) and their carers experience complex needs often exacerbated by social isolation and challenges in accessing support. Social prescribing (SP) seeks to enable PLWD and their carers to access community and voluntary sector resources to support them address such needs. Existing research, however, does not describe what SP interventions are currently in place in dementia care. Little is known about the needs these interventions are designed to address, the reasons that lead PLWD and their carers to participate in them, their effectiveness and the extent to which they could increase positive health outcomes if adopted and how.

https://bmjopen.bmj.com/content/14/4/e080551

April 2024

Ledger L, Hope J, Schoonhoven L, Worsley PR

In the UK, over 700 000 patients are affected by pressure ulcers (PUs) each year, and 180 000 of those are newly acquired each year. Guest et al in a cohort study evaluating the burden of wounds in the UK, found that annual NHS cost of wound management was £8.3 billion. Whilst the cost to the patient and their families cannot be easily quantified, studies have shown that PUs result in reduced mental and physical function, social restrictions and increased pain. 

Increasingly the focus on prevention has become paramount, with core concepts of preventative interventions built into the national and international practice guidelines, which include PU risk assessment, skin care, nutrition, repositioning/mobilisation, and the use of appropriate pressure redistributing equipment. Central to a PU prevention approach is accurate risk assessment conducted by the health care professional. This involves using standardised risk assessment instruments, including skin assessment and inspection alongside discussion with the patient. However, a recent systematic review found that it was inconclusive whether risk assessment with a common tool makes a difference to pressure ulcer incidence, when compared with training and risk assessment using clinical judgement, or risk assessment using clinical judgement alone. 

In clinical practice, it has traditionally been the nurse who has been responsible for PU risk assessment and providing advice to be followed by the patient. However, increasingly there has been a policy shift in emphasis from nurses instructing patients what to do, to a partnership model with shared decision-making. This shift places increased responsibility on the patient to understand their own PU risk and carry out preventative measures. This is particularly important in community settings, where due to the limited time capacity and resource of healthcare workers, contact can be episodic, with patients and their families increasingly required to carry out advice and manage their own care. However, there are issues with patient non-adherence to PU advice, particularly in community settings that generate further risk to patients including further skin breakdown and other complications such as muscle wastage and reduced function. 

A recent systematic review of the psychosocial factors impacting community-based PU prevention identified several key influences that may affect the ability to achieve concordance between individuals and healthcare professionals, including social influences and beliefs about capabilities. The review found that a concordant relationship was facilitated by the healthcare professional's motivation to work alongside patients and their priorities and the interpersonal skills to build rapport and increase trust.

The few studies that have focused on the role of patients in PU prevention in the community setting have identified that patient engagement may be influenced by a range of factors which include the complexity of tasks, history of PU damage, and the quality of nurse-patient interactions. There are also other considerations for varying levels of patient involvement such as ill health and cognitive ability to participate in preventative strategies. However, currently there is a significant gap in the research around the patient's own understanding of PU risk, and how contextual factors such as environment and wider health status might play a role in risk perception. Indeed, most studies to date have focused on the professional nursing view. 

There is a lack of evidence around the type of nursing approach used and nurse-patient interactions within the setting itself and how PU risk is negotiated. It is important to understand this to determine the context in which PU risk information is communicated and the relationship of this to adherence behaviour.

The aims of the study were to identify potential factors affecting patient adherence to preventative advice and to explore how pressure ulcer risk is negotiated between nurse and patient in the community setting.

https://doi.org/10.1016/j.jtv.2025.100890

March 2025

John J, Stannard S, Fraser SDS, Berrington A, Alwan NA

Multimorbidity is commonly defined as the co-occurrence of two or more Long-Term Conditions (LTCs). This phenomenon is growing in prevalence , including amongst younger age groups, and represents a significant public health issue. 

An estimated one in three individuals will develop multimorbidity in their lifetimes. Multimorbidity results in higher rates of premature mortality, reduced quality of life, and greater demand on health services. Previous evidence has demonstrated that multimorbidity is a significant driver of costs in many health and social care systems, independent of biological factors such as advanced age. Multimorbidity also potentiates health inequalities; it is well established that the prevalence of multimorbidity is higher, and the age of onset is up to ten years earlier, in the most disadvantaged communities, and amongst certain ethnic minorities. It is therefore vital that risk factors of multimorbidity are identified to facilitate timely detection and management of susceptible individuals, and aid the development and implementation of preventative interventions .

Research has demonstrated that certain early-life characteristics are associated with multimorbidity in adulthood.

The effect of early life events on multimorbidity can be broadly explained by two main lifecourse epidemiological paradigms: the “critical period” theory, in which biological imprinting at important time-points, make an individual more susceptible to compromised health in adult life and; the “accumulation of risk” model, which states that cumulative adverse early-life events contribute to poor adult health. Both theories have potential relevance to the aetiology of multimorbidity, and have therefore been considered as a potential mechanism for this study.

It is plausible that events surrounding the birth of an individual represent an opportunity for early intervention, with the aim to prevent later-life multimorbidity. Yet, the association between multiple adverse neonatal events such as gestational age, birthweight, neonatal resuscitation, neonatal cyanosis, neonatal cerebral signs, duration to establishment of respiratory rate at birth, neonatal cephalohematoma, neonatal illnesses and breathing difficulties, and adult risk of multimorbidity is under-researched. Additionally, despite advancements in neonatal care in recent decades, the sizeable global burden posed by poor birth outcomes has persisted. Preterm birth rates have not seen a decline globally, constituting approximately 10% of all livebirths worldwide.

We hypothesised that an increased number of adverse neonatal events would be associated with a greater burden of multimorbidity across adulthood. By considering the outcome of multimorbidity at various ages between 34 and 46 years, we also investigated whether experiencing a greater number of adverse neonatal events at birth was associated with an earlier onset of multimorbidity.

https://doi.org/10.1371/journal.pone.0319200

March 2025

Woodrow M, Ziauddeen N, Smith D, Alwan NA

In the UK, the Office for National Statistics estimated in March 2024 that 2 million adults and children experience Long Covid (LC) (3.3% of the population), with 69% and 41% experiencing it for at least 1 and 2 years respectively and 19% reporting that LC limits their ability to undertake day to day activities ‘a lot’ . There is also evidence of inequalities in LC prevalence, with higher prevalence associated with being female, of older or middle age, having a higher body mass index (BMI) , smoking , and belonging to an ethnic minority group. Higher prevalence is also associated with greater deprivation . There is also unequal impact of the condition on people's lives and inequitable support for the condition. More research is needed to understand the extent of this inequality and the action needed to address it.

As a relatively novel condition, knowledge about LC is still in its infancy amongst researchers and health care professionals but there is even more lack of awareness, exacerbated by barriers and stigma, in the general population leaving unwell people unsure if they have LC. This high and unequal burden of illness from LC has significant implications for society in terms of the infrastructure of accessible diagnosis, support and treatment needed for people with LC.

The General Practice Patient Survey (GPPS) is an annual survey of GP-registered people aged 16 years+ in England, administered by Ipsos on behalf of NHS England. Established in 2007, it asks respondents about their experience of their local GP, other local NHS services and respondents' general health. In 2022 a new question was added that asked whether respondents had LC.

The aims of this study were to (1) explore prevalence of LC, (2) examine its potential sociodemographic and health characteristics and (3) explore factors associated with being unsure about having LC.

https://doi.org/10.1111/hex.70202

March 2025

Cook C, Reid L, Elsharkawy AM, Radley A, Smith S, McPherson S, Crockford D, Dillon JF, Wright M, Morris D, Malik H, Keall S, Powell J, Catt J, Hampton H, Boothman H, Shah S, Spear J, Ustianoski A, John P, Stevens H, Khakoo SI, Parkes J, Buchanan RM

Hepatitis C (HCV) is a blood-borne virus (BBV) that can cause severe liver scarring (known as cirrhosis) and primary liver cancer – most commonly hepatocellular carcinoma. There are now effective, widely available, well-tolerated oral treatments for HCV that have few contraindications and high rates of cure. In 2016, the World Health Organization (WHO) set a global target for the elimination of HCV by 2030 with elimination being defined as detection of 80% of prevalent cases and successful treatment in 90%. 

The identification of undiagnosed prevalent cases of HCV and incident infections is a major challenge for the HCV elimination programme. HCV is prevalent in socioeconomically deprived and marginalised groups, such as people who inject drugs (PWID), and most incident infections are occurring in this population. Therefore, specific programmes are required to increase testing and diagnoses in deprived and marginalised populations, including PWID. PWID do engage with opiate substitution therapy (OST) and needle and syringe programmes (NSPs) in community pharmacies, and PWID are known to develop strong and trusting relationships with their pharmacist. 

 Community pharmacies have been shown to be effective locations for HCV testing in PWID in multiple pilot studies, and pharmacy testing has been recommended in European guidelines for BBV testing. In 2020, NHS England (NHSE) commissioned a national advanced service for community pharmacies to perform HCV testing as part of the NHSE elimination strategy. However, there were significant differences between the NHSE commissioned service and the successfully published pilot services. 

The discrepancy between the success of the pilot services compared with the NHSE service suggests that the relative differences in service specification led to differential testing uptake. 

The aim of the I-COPTIC study is to define the characteristics of a successful community pharmacy HCV testing service to support future implementation.

https://doi.org/10.1016/j.puhe.2024.04.017

July 2024

Prieto J, Wilson J, Tingle A, Cooper E, Handley M, Rycroft-Malone J, Bostock J, Williams L, Loveday H

Urinary tract infection is the most diagnosed infection in older people. It accounts for more than 50% of antibiotic prescriptions in care homes and is a frequent reason for care home residents being hospitalised.

This realist review developed and refined programme theories for preventing and recognising urinary tract infection, exploring what works, for whom and in what circumstances.

https://doi.org/10.3310/dadt3410

October 2024

Andrews N, Brooks C, Board M, Fraser S, Latter S, Aplin K, McCausland B, Radcliffe E, Amin J, Lim R, Van Leeuwen E, Ibrahim K

Polypharmacy is common amongst older people with dementia or mild cognitive impairment (MCI), increasing the risk of medication-related harm. Medicine optimisation and deprescribing to reduce polypharmacy is considered feasible, safe and can lead to improved health. However, for those living with dementia or MCI, this can be challenging. This systematic review aimed to summarise the evidence on the outcomes of medicine optimisation and deprescribing interventions for older people with dementia or MCI.

https://doi.org/10.1007/s40266-025-01189-2

March 2025

Ibrahim K, Cox NJ, Lim SER, Radcliffe E, Lundby C, Prokopidis K, Thompson W, Moriarty F

Polypharmacy (concomitant prescription of ≥ 5 medications) affects a third of older people, and evidence suggests an association with sarcopenia (loss of skeletal muscle mass/quality, muscle strength, and/or physical performance). As such, deprescribing has been recommended in routine management of sarcopenia, however it’s unknown whether deprescribing is beneficial. This systematic review aimed to understand effects of deprescribing on sarcopenia parameters in older adults.

https://doi.org/10.1186/s12877-025-05819-7

March 2025

Sole S, Serrat M, Martinez-Rubio D,Martinez-Navarro O, Fuente-Vidal A, Bravo C et al

Fibromyalgia presents a significant challenge to individsuals due to its pervasive pain symptoms. The Pain Beliefs and Perceptions Inventory (PBPI) offers a structured tool to delve into the nuanced beliefs surrounding pain. We aim to explore the feasibility of a condensed version of PBPI in assessing pain perceptions among individuals living with fibromyalgia in Catalonia, Spain.

https://doi.org/10.1016/j.ssmmh.2025.100404

March 2025

Frankland J, Lee K, Bridges J

People living with a dementia are an increasing proportion of those residing in long term care settings. A person-centred approach is widely accepted practice for this group, but there is evidence that this is not universally applied. Material Citizenship™ is a novel delivery of person-centred dementia care and training which promotes the importance of functional objects to enhance choice, control and agency.

This evaluation of Material Citizenship™ assessed mode of training delivery, perceived impact of the training on care delivery, and implementation challenges.

https://doi.org/10.31389/jltc.321

February 2025

Dheensa S, Bracewell K, Boughton G, Hepworth E, Myall M and Rowlands J

Due to the scant research about the cancer and Domestic Abuse intersection, we decided to analyze Domestic Homiceide Review (DHR) reports while acknowledging these limitations and engaging critically with them as a data source. No published research has explored this intersection using DHRs. 

Our research questions (RQs) were: 

according to DHR reports where the victim had a cancer diagnosis, or the victim was caring for a partner/family member with a cancer diagnosis: 

1 - how did the cancer diagnosis affect experiences of DA, risk of DA, and risk of domestic homicide and DA-related suicide, and how did DA affect the experience of cancer care?

2 - what were professionals’ documented identifications of DA, identifications of its risk factors, or responses to these for those affected by a cancer diagnosis? 

A less central research question was 

3 - to identify relevant learnings for the conduct of DHRs.

Overall, we aimed to develop and deepen understanding at the intersection of cancer and DA for researchers which

could in turn inform training and policy, primarily for UK cancer HCPs.

https://doi.org/10.1007/s10896-025-00839-8

February 2025

Hurley-Wallace   AL, Defty J, Richardson A, Wagland R

Patients with oncological emergencies require immediate specialist cancer care to ensure optimum outcomes. This is often a stressful, time-sensitive situation for patients and their families who describe having to navigate complex care pathways to access urgent treatment. Acute oncology was established as a subspecialty in the UK in 2009, with the goal to streamline emergency cancer care. 

Patient experiences of urgent care in acute oncology contexts have not specifically been explored; hence, it is unknown whether patient experiences of emergency cancer care have improved. This may be due to lack of a patient-reported experience measure for this purpose.

https://doi.org/10.1007/s00520-025-09245-8

February 2025

Richardson T,  Ferrie O, Smith D, Ellis-Nee C, Smart T, Gray E, Roberts N, Delgadillo J and Simmons-Dauvin M

Economic variables such as socioeconomic status and debt are linked with an increased risk of a range of mental

health problems and appear to increase the risk of developing of post-traumatic stress disorder (PTSD).

Previous research has shown that people living in more deprived areas have more severe symptoms of

depression and anxiety after treatment in England’s NHS Talking Therapies services. However, no research has

examined if there is a relationship between neighbourhood deprivation and outcomes for PTSD specifically.

This study was an audit of existing data from a single NHS Talking Therapies service

doi:10.1017/S1754470X25000029

February 2025

Corbett T, Meier N, Bridges J

The study aims to explore how healthcare workers (HCWs) navigate and experience time when caring for older cancer patients living with other illnesses.

This paper presents findings from a qualitative study of how HCWs conceptualise and navigate the temporal aspects of delivering personalised care to older people living with multimorbidity. Building on research from organisation studies and the sociology of time, we interviewed 19 UK HCWs about their experiences of delivering care to this patient group.

https://doi.org/10.1108/jhom-07-2024-0295

February 2025

Corser J, Yoldi I, Reeves ND, Culmer P, Venkatraman PD, Orlando G, Turnbull RP, Boakes P, Woodin E, Lightup R, Ponton G, Bradbury K

Diabetic foot ulcers are common and costly. Most cases are preventable, although few interventions exist to reliably support patients in performing self-care. Emerging technologies are showing promise in this domain, although patient and health care provider perspectives are rarely incorporated into digital intervention designs.

This study explored patient and health care provider feedback on a smart sensing sock to detect shear strain and alert the wearer to change their behavior (ie, pause activity and check their feet) and considered how patient experience and attitudes toward self-care are likely to impact uptake and long-term effective engagement with the device to curate guiding principles for successful future intervention development.

https://doi.org/10.2196/59608

February 2025

Chiovoloni R, Dylag JJ, Alwan NA, Berrington A, Boniface M, Fair N, Holland E, Hoyle R, Shiranirad M, Stannard S, Zlatev Z, Owen RK, Fraser S, Akbari A.

We have established the SAIL MELD-B electronic cohort (e-cohort SMC) and the SAIL MELD-B children and Young adults e-cohort (SMYC) as a part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) project. Each cohort has been created to investigate and develop a deeper understanding of the lived experience of the 'burdensomeness' of multimorbidity by identifying new clusters of burdensomeness concepts, exploring early life risk factors of multimorbidity and modelling hypothetical prevention scenarios.

https://doi.org/10.1136/bmjopen-2024-087946

April 2024

Hope J, Dall'Ora C, Redfern O, Darbyshire JL, Griffiths P

Vital signs monitoring is key to identifying deteriorating hospital patients. However, adherence to monitoring protocols is limited, with observations frequently missed or delayed. Previous studies of interruptions and delays to vital signs observations have been descriptive, with none attempting to conceptualise the types of tasks that are prioritised over vital signs observations.

This paper aims to explore how nursing teams perform vital sign observations on acute hospital wards and conceptualises which types of work delay or interrupt them.

https://doi.org/10.1016/j.ijnurstu.2025.105018

February 2025

Collins P, Hopkins S, Milbourn H, Etkind SN

Older people often live with multiple serious illnesses and frailty with a reduced biological reserve. People living with frailty face an inherently uncertain future with the unpredictable dying trajectory of frailty being widely recognised. Uncertainty can also result from healthcare systems, from fragmented care due to multiple illnesses, or patchy communication between services. It can leave patients, carers and health professionals distressed and overwhelmed.

Advance care planning seeks to help individuals articulate their preferences and priorities for care in the face of an uncertain future . Advance care planning is thus intertwined with and inseparable from uncertainty, yet the relationship between the two is relatively under-recognised and under-investigated. The papers in this themed collection explore aspects of this relationship in the context of frailty. 

https://doi.org/10.1093/ageing/afae146

September 2024

Christie R, Sadler E, Sait M, Light K, Cox C, Board M, Thomas S, Walker DM, Allen-Pick M, Bradbury K, Murphy J

Globally, the prevalence of long-term conditions (LTCs) continues to rise. The impact of LTCs presents significant challenges for international health and social care systems and continues to be a leading cause of mortality. Despite this, digital health coaching interventions (DHCIs) appear to be a promising strategy for managing chronic disease. The aims of this systematic review and narrative synthesis were to explore the barriers and enablers for the use of DHCIs and to gather valuable information to inform the development of a new DHCI for LTC management.

https://doi.org/10.1177/20552076241302230

December 2024

Boateng I, Pascual CR, Grassby P, Asghar Z, Ibrahim K

Polypharmacy is commonly defined as the use of five or more medicines. Its prevalence among over 65-year-olds has been estimated between 17–52% . Medication non-adherence, cognitive impairment and Adverse Drug Reactions (ADRs) are associated with polypharmacy. The risk associated with ADRs increases as the number of medicines increase. Older patients are particularly susceptible to ADRs due to multiple comorbidities, a high prevalence of multiple medications and age-related changes in pharmacokinetics and pharmacodynamics activities.

Most of the research into polypharmacy has been done in over 65-year-olds and have sought to establish its relationship with sociodemographic and clinical factors . The findings have been inconsistent and in some comorbidity was poorly adjusted or not adjusted for. Participants from single centre settings were used by others and the short- and long-term effects of polypharmacy and mortality has only been estimated by one study. Misclassification of polypharmacy was also possible in some studies as it was only estimated at baseline. This poses a problem as new medicines can be prescribed, or existing medicines reduced during the follow up period. 

This study aims to address these gaps by estimating polypharmacy as the average number of medicines and determining its association with mortality, falls, ADRs and hospitalizations at one and five years in over 75-year-olds

https://doi.org/10.1371/journal.pone.0317907

February 2025

Citeroni-Clark NL, D'Angelo S, Crozier SR, Kermack A, Godfrey KM, Cooper C, Harvey NC, Moon RJ

Hypertensive disorders of pregnancy, including pregnancy-induced hypertension (PIH) and pre-eclampsia (PET) affect around 5–10% and 2–5% of all pregnancies, respectively. These conditions may have significant consequences for the mother, including maternal end-organ damage and death, and for the fetus, such as fetal growth restriction, preterm delivery and intrauterine death.

Several risk factors for hypertensive disorders of pregnancy have been identified, including a previous history or family history of PIH or PET, nulliparity, raised pre-pregnancy body mass index (BMI), multiple pregnancies, inter-pregnancy interval greater than 10 years, pre-existing renal disease and autoimmunity. However, the exact pathophysiologies of PIH and PET are not fully understood. 

Most recently, a potential role of the maternal cardiovascular system has also been proposed. This is in part due to the known increased risk for women with underlying hypertensive and cardiorenal disorders, in addition to greater circulating antiangiogenic factors associated with abnormal vascular function observed in both PIH and PET. An effect of maternal vitamin D status on the risk of PIH and PET has also been hypothesised due to the recognised role of vitamin D in immunological function and the possible impact of this on placental function. 

We hypothesised that vitamin D supplementation in pregnancy would lower maternal BP during pregnancy, and as a result would reduce the incidence of hypertensive disorders of pregnancy. We sought to examine this by integrating real-world BP data collected during pregnancy care with trial data within the MAVIDOS RCT of vitamin D supplementation in pregnancy.

https://doi.org/10.1007/s00404-025-07958-z

January 2024

Vingrys K, Hébert JR, Chen LW, Crozier S, Duijts L, Harvey NC, Jaddoe VWV, Kelleher C, McAuliffe FM, Polanska K, Suderman M, Jerzynska J, Bottai M, Segurado R, Phillips CM

Childhood adiposity and inflammation impact long-term health. However, associations between dietary inflammation and childhood adiposity are unclear. We investigated if more pro-inflammatory diets are associated with greater adiposity in early-, mid-, and late-childhood.

https://doi.org/10.1016/j.clnu.2024.12.023

January 2025

Austin   RC, Lunde Husebø AM, Wathne H, Storm M, Urstad KH, Morken I, Karlsen B

Chronic illness research has many challenges making research recruitment difficult. Despite reports of facilitators and barriers to research recruitment challenges remain. The reporting of research strategies and their impact on recruitment and subsequent randomised control trials is not sufficient. 

A newly developed chronic illness research recruitment taxonomy (CIRRT) details factors and elements observed to impact recruitment around the components of Project, People, and Place. This paper aims to use the chronic illness research recruitment taxonomy to report and evaluate the recruitment strategies, impact they had on recruitment, and alterations to an eHealth feasibility study.

https://doi.org/10.1016/j.conctc.2024.101420

January 2025

Stalpers D, Schoonhoven L, Dall'Ora C, Ball J, Griffiths P

In nursing, achieving adequate staffing levels to ensure high quality of care is a worldwide problem. The existing nursing shortages and the continuously increasing demand for highly skilled nurses lead to higher workloads for the already overburdened nursing workforce (Dall'Ora et al., 2022; Haddad et al., 2023). These challenges in the nursing field have driven a call for rigorous rethinking and redesigning of nursing care delivery (Griffiths and Dall'Ora, 2023; Geltmeyer et al., 2024).

In organising nursing care, currently the leading principle is to primarily consider nursing work a job that consists of a multitude of tasks that can be divided between staff (Sasso et al., 2017). However, this way of thinking partly ignores what nursing work entails; it does not fully acknowledge its multi-layered, holistic and therefore complex character.

In this paper, we aim to explore the potential of a new and less simplistic model for dividing nursing labour. We believe that, to capture the comprehensiveness of nursing work and its corresponding complexity, it is necessary to recognise that care delivery is not only about performing a discrete set of tasks. A defining factor in the daily work of nurses is the ‘entanglement’ of care activities. This refers to the fact that the work does not simply concern a series of tasks occurring in parallel, but that these activities are intertwined and bundled together. These activities are linked and cannot be separated without changing the nature of all activities involved.

https://doi.org/10.1016/j.ijnurstu.2025.104995

January 2025

Petty,   R, Agarwal V, Allison J, Bartolomeu-Pires S, Bartlett M, Boey T et al

Recruiting patients to clinical studies and ensuring participants complete them (known as “retention”) is challenging in Parkinson's disease (PD). If studies take longer this increases costs, and if the right people do not take part in studies this can mean that results may not be representative of the PD community. Our objective is to find out what effective strategies there are to support recruitment and retention to clinical research studies in PD. 

We reviewed literature within five study databases. We used the population, intervention, comparator, outcome and studies (PICOS) framework to create a search strategy based on our research question, and inclusion criteria for study selection. Important criteria were: (1) studies had to test a recruitment or retention strategy in a PD clinical research study, (2) studies had to provide evidence on how well the strategy worked. 

We found 4608 unique research papers, six of which described and evaluated recruitment strategies. No papers on retention strategies were found that met eligibility criteria. Successful recruitment strategies included digital marketing (n = 3), research registries (n = 3), supporting study sites (n = 1) and multiple sources to refer people with Parkinson's (PwP) to studies (n = 1). Recruitment of PwP from diverse backgrounds was enhanced by (1) online campaigns, (2) funders requesting that 10% of study participants come from diverse backgrounds 3) additional funding for research teams.

This scoping review identified methods that can be used to increase the rate and diversity of recruitment to PD clinical studies. Retention methodologies are under-researched.

https://doi.org/10.1177/1877718X241291986

January 2025

Pogson   CM, Austin R, Patel JP, Wheeler DC

Structured medication reviews (SMRs) were introduced into the National Health Service (NHS) Primary Care to support the delivery of the NHS Long-Term Plan for medicines optimization. SMRs improve the quality of care, reduce harm and offer value for money. However, evidence to support SMRs for patients with chronic kidney disease (CKD) stage G4-5D with elevated risk of cardiovascular disease and premature mortality is unknown. This scoping review aimed to assess the extent and nature of SMR research in the population of patients with CKD stage G4-5D

https://doi.org/10.1111/bcp.16363

December 2024

Campling N, Turnbull J, Richardson A, Voss S, Scott-Green J, Logan S, Latter S

Global demand for care during the last year of life (end-of-life) is rising and with shortfalls in community healthcare services, paramedics are increasingly called on to deliver this.

 Despite this growing demand on the paramedic workforce, little large-scale or detailed empirical research has evaluated current practice and paramedic experiences of attending this patient group. Therefore, as part of a wider study evaluating paramedic delivery of end-of-life care, a large-scale survey in England describing paramedics' current practice and experiences providing end-of-life care was undertaken.

https://doi.org/10.1186/s12904-024-01629-7

December 2024

Howes S, Stephenson A, Grimmett C, Argent R, Clarkson P, Khan A, Lait E, McDonough LR, Tanner G, McDonough SM

Given the well-accepted health benefits, it is important to identify scalable ways to support people with long-term conditions (LTCs) to remain physically active. This systematic review aimed to evaluate the effect of digital tools on the maintenance of physical activity (PA) amongst this population.

https://doi.org/10.1177/20552076241299864

December 2024

Pulman A, Fenge LA

Challenges with the retention of social workers have increased over the past ten years with links made to higher caseloads, increased stress, shrinking office space and hybridisation of work roles driven by both austerity and changes resulting from the coronavirus disease 2019 (COVID-19) pandemic. 

This article reports on findings from a study developed with two local authorities exploring retention in adult social care from the perspective of practitioners working in the South of England. A mixed methods approach was taken. A group of (n = 57) social workers at two local authorities completed an online survey and (n = 13) were interviewed in depth. A semi-structured interview schedule was constructed to collect expanded reflections on issues affecting retention. 

Several themes emerged concerning the differential impacts of the changing workplace post-COVID-19. These include increased stress and high caseloads and the potential negative impact of hotdesking and hybrid working on supervision and well-being. We discuss areas where changes might address some of the current concerns highlighted by participants, which may in turn exert a positive impact on retention.

https://doi.org/10.1093/bjsw/bcae120

JUly 2024

Holland E, Matthews K, Macdonald S, Ashworth M, Laidlaw L, Cheung KSY, Stannard S, Francis NA, Mair FS, Gooding C, Alwan NA, Fraser SDS

Multiple long-term conditions (MLTCs), living with two or more long-term conditions (LTCs), often termed multimorbidity, has a high and increasing prevalence globally with earlier age of onset in people living in deprived communities. A holistic understanding of the patient's perspective of the work associated with living with MLTCs is needed. This study aimed to synthesise qualitative evidence describing the experiences of people living with MLTCs (multimorbidity) and to develop a greater understanding of the effect on people's lives and ways in which living with MLTCs is 'burdensome' for people.

https://doi.org/10.1186/s12889-024-20763-8

December 2024

Stuber JM, Beulens JW, Ayala GX, Crozier SR, Dijkstra SC, Lin SF, Vogel C, Mackenbach JD

Healthy food nudges may be more, or especially, effective among groups experiencing socioeconomic disadvantage. We investigated the modifying role of socioeconomic and demographic characteristics in the effectiveness of nudge interventions targeting healthy foods in real-world grocery store settings on food purchasing patterns.

https://doi.org/10.1186/s12966-024-01687-3

December 2024

Schoenaker   D, Lovegrove E, Santer M, Matvienko-Sikar K, Carr H, Alwan NA, Kubelabo L,   Davies N, Godfrey KM

Preconception medical, behavioural and socioeconomic risk factors are common among people of reproductive age and can impact pregnancy and offspring outcomes. In line with clinical guidance, primary care practitioners are encouraged to support patients to manage and optimise their health prior to pregnancy. Due to barriers, including lack of time and resources, this support is not currently part of routine practice.

As a first step towards the co-development of practical and realistic best practice guidance, this study aims to achieve consensus on a list of priority risk factors that can be used in general practice to guide opportunistic preconception care for patients of reproductive age.

https://doi.org/10.1371/journal.pone.0311578

Novmber 2024

Taheem R, Woods-Townsend K, Lawrence W, Baird J, Godfrey KM, Chase D, Hanson MA

Local government is well placed to provide leadership for the national ambition in England to halve childhood obesity by 2030 and has delegated authority for many policies thought necessary for effective action. However, with currently constrained local government finances, resources may not be prioritized for the wide range of policies and interventions necessary. Thus, local political commitment is vital for directing local government investment to tackle the issue. This qualitative study investigated how political commitment has been demonstrated in local government, the strategies used to build such political commitment, and the role of the public health workforce.

https://doi.org/10.1177/15248399241294231

November 2024

Baird J, Dhuria P, Payne H, Crozier S, Lawrence W, Vogel C

Placement interventions, characterised by greater availability and more prominent positioning of healthy food products in supermarkets and other food stores, are associated with healthier patterns of purchasing and diet. The WRAPPED intervention study is a natural experiment that aims to evaluate a supermarket placement intervention to improve fruit and vegetable sales, household purchasing and the dietary quality of women and their children. Process evaluation, alongside the evaluation of outcomes, is essential to understand how interventions are implemented, under what circumstances they are effective, and their mechanisms of impact. This study aimed to assess the implementation of the WRAPPED placement intervention.

10.1186/s12966-024-01679-3

Novmeber 2024

Wang J, Goodfellow H, Walker S, Blandford A, Pfeffer P, Hurst JR, Sunkersing D, Bradbury K, Robson C, Henley W, Gomes M

Long COVID, as defined by the National Institute for Health and Care Excellence, refers to the persistence of symptoms lasting for at least 12 weeks following COVID-19 infection. It has been suggested that at least 1 in 10 patients who had COVID-19 experiences long COVID symptoms. By March 2024 (latest figures made available by the Office for National Statistics), an estimated 2 million people in the UK (3.3% of the population) reported experiencing symptoms consistent with long COVID. These symptoms have a particularly significant impact on the working-age population, leading to both absenteeism (productivity loss due to time off work) and presenteeism (lower productivity due to illness while working). It has been estimated that these productivity losses amounted to £5.7 billion in the UK between 2022 and 2023.

This paper reports on the trajectories of functional limitations, fatigue, health-related quality of life (HRQL) and societal costs within the first 6 months after registration in the Living With Covid Recovery programme. In addition, we investigate whether these trajectories differ according to patient characteristics or the extent of the individuals’ participation in the LWCR programme.

https://doi.org/10.1136/bmjopen-2024-088538

November 2024

Dhuria P, Muir S, Jenner S, Roe E, Lawrence W, Baird J, Vogel C

As part of the UK government's obesity strategy, the Food (Promotion and Placement) (England) Regulations 2021 were implemented in October 2022 to restrict the prominent placement of products high in fat, sugar, or salt (HFSS) in most retail settings. Local authority (LA) officers have been tasked with enforcement of these regulations. This qualitative study examined the perspectives of LA officers including, trading standards, environmental health, and public health officers to understand enforcement approaches and requirements to optimise business compliance with the regulations.

https://doi.org/10.1186/s12916-024-03720-5

November 2024

Sauerbier A, Bachon P, Ambrosio L, Loehrer PA, Rizos A, Jost ST, Gronostay A, Fink GR, Ashkan K, Nimsky C, Visser-Vandewalle V, Chaudhuri KR, Timmermann L, Martinez-Martin P, Dafsari HS; EUROPAR, the Non-Motor Parkinson’s Disease Research Group and the German Parkinson Society Non-Motor Symptoms Study Group

The effect of subthalamic stimulation (STN-DBS) on patients' personal satisfaction with life and their Parkinson's disease (PD) treatment is understudied, as is its correlation with quality of life (QoL). Therefore, we tested the hypothesis that STN-DBS for PD enhances satisfaction with life and treatment. In a prospective, multicenter study with a 6-month follow-up involving 121 patients, we measured the main outcomes using the Satisfaction with Life and Treatment Scale (SLTS-7)

https://doi.org/10.3390/jpm14101023

October 2024

Bartolomeu-pires   S, Kunkel D, Goodwin N, Dace S, Culliford D, Kipps C

Huntington's disease (HD) is among the most complex long-term neurological conditions, necessitating care and management from multiple partners within and beyond the health sector. However, there is a paucity of evidence describing how individuals receive this multifaceted care and whether current care provision adequately meets their needs. 

Our objective was to understand if current care provision is meeting the complex needs of people living with HD in England and assess their perceived need for integrated care.

https://doi.org/10.1177/18796397241288449

October 2024

Pulman A, Sloan H, Fenge L

Advocacy has been defined as promoting social inclusion, equality and social justice to empower people - principles closely associated with social work’s professional values. However, in-depth literature on advocacy and the current challenges it faces is sparse. 

Little is known about the day-to-day realities faced by advocates and the pressures they currently experience. This raises the question of who might advocate for the advocates themselves? This article reports on findings from a larger study to explore local recruitment and retention issues in adult social care from the perspective of different populations of interest in the South of England

https://doi.org/10.1080/09503153.2024.2410851

October 2024

Morgan SA, Scott S, Chandan J, Armitage R, Culliford D, Jolly K, McGovern R, McGovern W, Roy J, Thayakaran R, Young TA, Parkes J

Interventions related to the perpetration of Domestic Violence and Abuse (DVA) have gained traction over the past several years, in response to dissatisfaction by victims, an inadequate response from the criminal justice system, increased demand on police time and a lack of rehabilitative responses to the perpetration of domestic abuse. 

The CARA model is a conditional diversionary caution, offered by police for first time offenders of 'standard' or 'medium risk' domestic abuse, that engages perpetrators in awareness raising workshops and signposts them onto further services. Although quasi-experimental studies have indicated that CARA showed promise at reducing reoffending, the CARA model has yet to be evaluated nationally and there is no qualitative evidence related to understanding or learning about the lived experience of perpetrators and victims as they engage with the intervention.

https://doi.org/10.3310/nihropenres.13609.1

August 2024

Taylor EJ, Ziauddeen N, Berrington A, Godfrey KM, Alwan NA

Maternal preconception and pregnancy exposures have been linked to offspring adiposity. We aimed to quantify the effect of changes in maternal weight and smoking status between pregnancies on childhood overweight/obesity (≥ 85th centile) and obesity (≥ 95th centile) rates in second children.

https://doi.org/10.1371/journal.pone.0311677

October 2024

Smith A, Buchanan RM, Parkes J, Ibrahim K

The aim was to explore the views and attitudes of professionals, patients and the public to a role for community pharmacists in the identification of alcohol-related liver disease (ArLD).

Semi-structured interviews were conducted with a purposive sample of patients with ArLD, members of the public, pharmacy staff, and clinicians managing patients with ArLD across the Wessex region of south England. The interviews explored experiences of alcohol, ArLD and health advice in pharmacies and elicited views of what a pharmacist role in identifying ArLD could entail and factors influencing this. Transcripts were analysed using reflexive thematic analysis.

https://doi.org/10.1093/alcalc/agae069

September 2024

Stahacz C, Alwan NA, Taylor E, Smith D, Ziauddeen N

Households with children accessing food aid in high-income countries are often food insecure. We aimed to review the evidence on food aid interventions in households with children and impact on food insecurity, diet quality and mental health.

https://doi.org/10.1017/s1368980024001769

October 2024

Baz SA, Woodrow M, Clutterbuck D, Fang C, Mullard J, Banerjee A, Barley-McMullen S, Carpentieri J, Donskoy AL, Faux-Nightingale A, Lewis-Jackson S, O'Hara ME, Rai T, Sherwood O, Smyth N, Stanley K, Welsh V, Mir G, Alwan NA

Organised by the 'Qualitative Long Covid Network', a workshop for qualitative Long COVID (LC) researchers, LC charity representatives and people with LC took place in June 2023, where research on the intersectional inequalities affecting LC prevalence, recognition and care was shared and discussed.

The following five themes are discussed: the unfairness of LC, difficulties in accessing care, mistrust of the healthcare system, a lack of understanding of LC and experiences of stigma and discrimination. Factors that widen or narrow inequalities related to LC were identified.

https://doi.org/10.1111/hex.70047

October 2024

Moon RJ, D' Angelo S, Curtis EM, Ward KA, Crozier SR, Schoenmakers I, Javaid MK, Bishop NJ, Godfrey KM, Cooper C, Harvey NC

Findings from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial demonstrated a positive effect of gestational cholecalciferol supplementation on offspring bone mineral density (BMD) at age 4 y. Demonstrating the persistence of this effect is important to understanding whether maternal vitamin D supplementation could be a useful public health strategy to improving bone health.

https://doi.org/10.1016/j.ajcnut.2024.09.014

September 2024

Living with long-term conditions: validation of a new instrument for family   caregivers in a Spanish-speaking population

Optimising the management of chronicity has been a global challenge for decades. Individuals with long-term conditions (LTCs) and their families live with them for years. Thus, it is necessary to include both of their perspectives in the management and adaptation of the interventions proposed. The psychometric properties of the living with LTCs scale from the perspective of the family caregiver are unknown. The objective of the present study is to describe the psychometric properties of the EC-PC-Fam in a Spanish-speaking population.

https://doi.org/10.1136/bmjopen-2024-088773

September 2024

Meredith P, Turner L, Saville C, Griffiths P

Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes.

A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions.

https://doi.org/10.1093/bjs/znae215

August 2024

At the Association of Cardiovascular Nursing & Allied Professions conference in June, Professor Tiny Jaarsma called for a pillar of self-care to be added to heart failure (HF) care guidelines. Taylor et al. agree that HF care needs an additional pillar and suggest cardiac rehabilitation. 

Currently, the HF pillars are focused on medications shown to improve the outcomes of people with heart failure with reduced ejection fraction (HFrEF), but other key non-pharmacological interventions are not considered. Also, the pillars of care do not provide guidance for people with heart failure with preserved ejection fraction (HFpEF), which represent 50% of the HF population. While these pillars focus on a single important aspect of care, they do not capture the totality of HF management or illness types. A focus on interventions to improve HF management is welcome but can obscure the challenges that treatment – as well as illness – impose on patients and their carers.

https://doi.org/10.5837/bjc.2024.005

February 2024

Moult A, McGrath C, Lippiett K, Coope C, Turner A, Chillcott S, Parton L, Holloway P, Dace S, Gibson A, Jinks C, Paskins Z, Portillo MC, Mann C, Dziedzic K

The aim of this project is to evaluate public contributors' experiences of their involvement in qualitative data analysis workshops during an on-going research project titled 'Personalised Primary care for Patients with Multiple long-term conditions'.

https://doi.org/10.1186/s40900-024-00628-5

September 2024

Murphy T, Culliford DJ, Hawley S, Johansen A, Whitehouse MR, Judge A, Matharu GS

Hip fractures are common and cause a huge socioeconomic burden to patients, their carers, and healthcare services worldwide. Our aim was to examine how much hip fracture numbers would be expected to rise over coming decades, simply as a consequence of the ageing of the population.

https://doi.org/10.1016/j.injury.2024.111863

September 2024

Myall M, Morgan S, Scott S

Domestic violence and abuse (DVA) is a significant public health and social care challenge worldwide, with a myriad of associated physical, mental health and social care consequences. Globally, it is estimated that one in three women and one in six men will experience DVA in their lifetime. Further, lifetime prevalence is anticipated to be particularly high in less developed countries and particularly problematic for under-represented groups or those already experiencing health inequalities.

DVA intersects cultural, religious, sex, gender, age and ethnic boundaries and can include physical, sexual, economic, psychological, emotional violence and/or abuse, as well as controlling, coercive, violent or threatening behaviour, between people who are, or who have been, intimate partners or family members.

The five papers in our Research Topic highlight the diversity and breadth of work undertaken in DVA and explore DVA experiences across and between multiple intersections that advance understanding of it as a global and intersectional issue.

https://doi.org/10.3389/frhs.2024.1465688

September 2024

Meredith SJ, Shepherd AI, Saynor ZL, Scott A, Gorczynski P, Perissiou M, Horne M, McNarry MA, Mackintosh KA, Witcher CSG

This study examines changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR).

This prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 ± 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis.

https://doi.org/10.1080/09638288.2024.2397086

September 2024

Sheppard S, Culliford D, Glen T, Lee S, Sheppard ZA, Porter S

The purpose of this paper is to describe the impacts of cancer treatment on sexual health in a sample of people who had been treated for mixed types of cancer; to describe discussions they had with professionals about sexual health that occurred during cancer care; and to consider the extent to which these discussions were sufficient to enable participants to give informed consent for the sexual side effect of cancer treatment.

https://doi.org/10.1016/j.ejon.2024.102669

August 2024

Forsyth F, Deaton C, Kalra PR, Green M, Harrison ME, Tavares S, Dirksen A, Kuhn I, Farquharson B, Austin RC

Heart failure with preserved ejection fraction (HFpEF) is increasing in incidence and is increasingly the most common heart failure (HF) diagnosis. Patients with HFpEF are often excluded from specialist HF services which has negative impacts on their healthcare experiences and health-related outcomes. As emerging evidence-based treatments are being incorporated into clinical guidelines, it is timely to focus on the management of this phenotype. 

This review aims to explore literature around care provision for HFpEF in the United Kingdom; to characterise and assess HFpEF care pathways against current standards, and to generate evidence to create an optimised framework of care.

https://doi.org/10.1093/eurjcn/zvae119

August 2024

Gavin JP, Clarkson P, Muckelt PE, Eckford R, Sadler E, McDonough S, Barker M

Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. 

Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active. We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity

https://doi.org/10.1371/journal.pone.0307493

August 2024

Prieto J, Wilson J, Tingle A, Cooper E, Handley M, Rycroft Malone J, Bostock J, Loveday H

Urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes. Our objective was to identify interventions for recognising and preventing UTI in older people living in care homes in the UK and explain the mechanisms by which they work, for whom and under what circumstances.

https://doi.org/10.1136/bmjqs-2023-016967

August 2024

Griffiths   P, Saville C, Ball J, Culliford D, Jones J, Lambert F, et al

Many studies show the adverse consequences of insufficient nurse staffing in hospitals, but safe and effective staffing is unlikely to be just about staff numbers. There are considerable areas of uncertainty, including whether temporary staff can safely make up shortfalls in permanent staff and whether using experienced staff can mitigate the effect of staff shortages.

The objective of this study is to explore the association of the composition of the nursing team with the risk of patient deaths.

https://doi.org/10.1001/jamanetworkopen.2024.28769

August 2024

Williams A, Alwan NA, Taylor E, Smith D, Ziauddeen N

Food insecurity is defined as not having safe and regular access to nutritious food to meet basic needs. This review aimed to systematically examine the evidence analysing the impacts of the COVID-19 pandemic on food insecurity and diet quality in households with children <18 years in high-income countries.

https://doi.org/10.1371/journal.pone.0308699

August 2024

Gafari O, Stokes M, Agyapong-Badu S, Alwan N, Calder PC, McDonough S et al

Physical activity and healthy eating are important for physical and mental health, yet long-standing inequalities constrain the ability of ethnic minorities in the United Kingdom (UK) to adopt these behaviours. Programmes aimed to improve these behaviours have also often not been engaged with by these communities. 

This study therefore aimed to: (1) identify the values underlying the physical activity and healthy eating behaviours of UK ethnic minorities and (2) explore how structural, socio-economic and environmental factors interact with these values to influence their physical activity and healthy eating behaviours. 

https://doi.org/10.1186/s12982-024-00163-4

July 2024

Strain   JDR, Welch L, Sadler E

The use of digital pain management interventions has grown since the Covid 19 pandemic. The aim of this study was to systematically review and synthesise evidence from qualitative studies regarding the experiences of individuals with chronic pain participating in digital pain management interventions in primary care and community settings.

https://doi.org/10.1371/journal.pone.0306455

July 2024

Schoenaker D, Gafari O, Taylor E, Hall J, Barker C, Jones B, Alwan NA, Watson D, Jacob CM, Barker M, Godfrey KM, Reason E, Forder F, Stephenson J

There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health.

https://doi.org/10.1111/hex.14181

August 2024

Schoenaker   D, Lovegrove EM, Cassinelli EH, Hall J, McGranahan   M, McGowan L et al

Background: Routine primary care data may be a valuable resource for preconception health research and informing provision of preconception care.

Aim: To review how primary care data could provide information on the prevalence of preconception indicators and examine associations with maternal and offspring health outcomes.

https://doi.org/10.1101/2024.02.05.24302342

July 2024

Smyth N, Ridge D, Kingstone T, Gopal DP, Alwan N, Wright A, Chaudhry A, Clark S, Band R, Chew-Graham CA

People from ethnic minority groups are disproportionately affected by COVID-19, are less likely to access primary healthcare and report dissatisfaction with healthcare. Whilst the prevalence of Long Covid in ethnic minority groups is unclear, these groups are under-represented in Long Covid specialist clinics and Long Covid lived experience research which informed the original Long Covid healthcare guidelines.

This study aims to understand lived experiences of Long Covid in people from ethnic minority groups.

https://doi.org/10.3399/bjgp.2023.0631

May 2024

Sait MI, Christie RA, Cox C, Board M, Thomas S, O'Sullivan C, Davies C, Walker DM, Vassallo M, Sadler EA, Allen-Pick M, Moore P, Bradbury K, Murphy J.

Multidomain interventions in older adults offer the best opportunity to prevent, delay or reverse existing symptoms in the earlier stages of frailty and improve independence but can be costly, and difficult to deliver at scale. However, digital health interventions enable personalised care and empowerment through self-management of long-term conditions, used at any time and when combined with health coaching offer the potential to enhance well-being and facilitate the achievement of health-related goals. 

We aim to evaluate the feasibility and acceptability of a digital health platform for long-term disease management combined with health coaching for people living with mild-moderate frailty, targeting self-identified goals-activity, nutrition, mood, enhancing social engagement and well-being.

https://doi.org/10.1136/bmjopen-2023-080480

May 2024

Serrano-Fuentes N, Rogers A, Portillo MC

Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change.

https://doi.org/10.1371/journal.pone.0302927

May 2024

Santonja-Ayuso   L, Corchón-Arreche S, Portillo MC

The family caregiver of a person with Alzheimer's disease still experiences, in most cases, negative consequences in their biopsychosocial environment, which are related to the acquisition of this role. 

However, it has been observed that this fact is not universal in this type of population since benefits can be obtained in the act of caring through the development of resilience. Given this possibility and given that nurses are the health professionals who support people in this illness process, there is an urgent need to identify which non-pharmacological interventions could improve or promote resilience in family caregivers of people with Alzheimer's disease.

https://doi.org/10.3390/ijerph21040485

April 2024

Ambrosio   L, Faulkner J, Morris JH, Stuart B, Lambrick D, Compton E, Portillo MC

The objective of this study is to understand the physical activity and mental health of individuals living with long-term conditions during the COVID-19 pandemic.

It is a sequential explanatory mixed-methods study with two phases: phase 1: quantitative survey and phase 2: qualitative follow-up interviews.

https://doi.org/10.1136/bmjopen-2023-079852

April 2024

Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K

Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves.

The aimof this study is to improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions.

https://doi.org/10.3310/twdu4109

April 2024

Kilgour AHM, Rutherford M, Higson J, Meredith SJ, McNiff J, Mitchell S, Wijayendran A, Lim SER, Shenkin SD

Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years.

We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503)

https://doi.org/10.1093/ageing/afae080

April 2024

Clutterbuck   D, Ramasawmy M, Pantelic M, Hayer J, Begum F, Faghy   M et al

Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid.

 An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration.

https://doi.org/10.1111/hex.14037

April 2024

Michelle Myall, Sophia Taylor, Sally Wheelwright, Susi Lund

Domestic abuse is a global public health issue which impacts the health and wellbeing of victim-survivors and their families. 

While prevalence of domestic abuse is consistent amongst individuals and groups, some experience additional inequalities, vulnerabilities, and risk factors. This includes people living with life-limiting illnesses such as incurable cancer, neurological conditions and progressive heart, pulmonary, and renal conditions, who are at increased risk of domestic abuse because they are vulnerable, frail, isolated, and dependent on others. People with a life-limiting illness are more likely to spend long periods in the home, in close proximity to the perpetrator who may also be their caregiver, and experience multiple barriers to accessing and seeking support and may be less willing or able to escape the abusive situation. Lockdown and social isolation measures implemented to combat COVID-19 exacerbated the risk for those with a life-limiting illness experiencing domestic abuse. Existing patterns of abuse increased in terms of frequency and type.

To date, little is known about domestic abuse in the context of life-limiting illness, including the experiences and support needs of those affected; awareness, knowledge, and understanding of domestic abuse and life-limiting illness amongst health and care professionals and third sector organisations or their views and experiences of enquiring about, responding to, and supporting adults living with a life-limiting illness impacted by domestic abuse. This review has been undertaken as part of a wider study (DALLI) to coproduce a toolkit to enable hospice and palliative care practitioners to identify and respond to domestic abuse. The review is needed to inform understanding about the coexistence of domestic abuse and life-limiting illness, address gaps in academics and practitioners’ knowledge, and identify areas for further research.

https://doi.org/10.1155/2023/1841944

April 2023

Urquhart DS, Cunningham S, Taylor E, Vogiatzis I, Allen L, Lewis S, Neilson AR et al

Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The 'ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis' trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability.

https://doi.org/10.3310/nihropenres.13347.1

December 2022

Klepacz N, Wadey E, Griffiths P, Woodnutt S, Snowden J, Smith C et al

Demand for mental health services is high, but so are vacancy levels for registered nurses in mental health. To effectively address the workforce disparity, we need to engage with nurses to understand better the rewards and challenges of being part of the UK's mental health nursing workforce. The aim of the study set out in this protocol will be to identify modifiable workplace factors impacting nurses' work lives and wellbeing.

https://doi.org/10.12968/bjmh.2023.0037

February 2024

Turner LY, Saville C, Ball J, Culliford D, Dall'Ora C, Jones J et al

Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality. This study explores the relationship between staffing levels and readmission rates in maternity settings.

10.1136/bmjopen-2023-077710

April 2024

Remmington   C, Cameron L, Hanks F, Liang YH, Barrow L, Coxhead R et al

There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres.

The aim of this study is to describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs.

https://doi.org/10.1007/s11096-024-01719-9

April 2024

Turner  L, Ball J, Meredith P et al.

Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies.

https://doi.org/10.1186/s12913-024-10812-8

March 2024

Marín-Maicas   P, Portillo MC, Corchón S, Ambrosio L

Caring for people living with LTCs has a negative impact on the quality of life of caregivers, affecting their psychological, emotional, social, physical, and financial well-being. Evaluating how the family caregivers live with LTC can provide social health professionals with important information when planning interventions that favor better living . Therefore, it would be useful to have a tool available that allows for objectifying the degree to which people live with LTCs, for both the individuals affected by LTCs and the family caregiver. 

Presently, many scales exist that allow for measuring different concepts in family caregivers.However, although an instrument exists that measures the degree of living with LTC, according to the people with LTCs the “Living with Chronic Illness Scale” , no instrument was found that measures the degree of living with LTCs of family caregivers that includes all the dimensions that shape said process. This gap in the literature, in relation to measurement instruments that evaluate how the family caregiver experiences living with LTCs, is the common thread in this work. 

Based on an instrument created for people living with LTCs, an adaptation of this scale was planned to extend the reach of the instrument to family caregivers. Numerous recommendations exist on the process of adaptation of a scale to a context different from which it was created, but the available guides only refer to the methodological process for their transcultural adaptation, and especially to the guidelines established that allow the use of the scale in a language that is different from the one used for its creation. However, no specific system with the necessary methodological steps to be taken for the adaptation of the EC-PC to the family caregiver was found. 

Therefore, the aim of this study is to present a detailed description of the methodological process of adapting the EC-PC to the family caregiver (EC-PC-Family), providing transparency to the process followed to construct a robust instrument, to contribute towards filling the gap found in the scientific literature.

https://doi.org/10.3390/nursrep14010041

March 2024

Cox NJ

The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. 

This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.

https://doi.org/10.2147/cia.s431547

March 2024

Grant JE, Driessens C, Chamberlain SR

Data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder.

10.1097/WNF.0000000000000585

March 2024

Bradbury B, Chester H, Santer M, Morrison L, Fader M, Ward J, Manthorpe J, Murphy C

People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. 

This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home.

https://doi.org/10.1186/s12877-024-04830-8

March 2024

Moon RJ,   D'Angelo S, Crozier SR, Fernandes M, Fall C, Gale CR et al

Poor cognitive function and osteoporosis commonly co-exist in later life. In women, this is often attributed to post-menopausal estrogen loss. However, a common early life origin for these conditions and the associations between cognitive function and bone mineral density (BMD) in childhood have not previously been explored. We examined these relationships at age 6–7 years in the Southampton Women's Survey (SWS) mother-offspring cohort.

https://doi.org/10.1016/j.bone.2024.117067

March 2024

Ayoubkhani   D, Zaccardi F, Pouwels KB, Walker AS, Houston D, Alwan NA

Evidence on the long-term employment consequences of SARS-CoV-2 infection is lacking. We used data from a large, community-based sample in the UK to estimate associations between Long Covid and employment outcomes.

https://doi.org/10.1093/eurpub/ckae034

March 2024

Abowari-Sapeh   ME, Ackah JA, Murphy JL, Akudjedu TN

The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services.

https://doi.org/10.1016/j.jmir.2024.01.008

February 2024

Cox NJ,   Lim SE

Appetite loss or anorexia due to physiological, psychological and socioenvironmental effects of the aging process is termed the anorexia of aging.

The link between anorexia of aging and mortality has subsequently been established by a number of longitudinal studies across multiple settings.

Despite the association, clear interpretation of the mechanistic relationship between anorexia of aging and mortality, has been limited.

https://doi.org/10.1016/j.jnha.2024.100173

February 2024

Andina-Díaz   E, Welch L, Siles-González J, Serrano-Fuentes N, Gutiérrez-García AI,   Solano-Ruiz M

Objective: To assess nursing students' experiences of using photovoice as a pedagogical approach to active learning in the community.

Methods: A descriptive design with a cross-sectional mixed-method questionnaire was used with 108 students following an educational activity, in which their communities were photographed and the impact of the pandemic on vulnerable populations was reflected. Descriptive statistics and thematic analysis were used to analyze the data.

https://doi.org/10.1111/phn.13285

February 2024

Ejebu OZ, Turnbull J, Atherton I, Rafferty AM, Palmer B, Philippou J, Prichard J, Jamieson M, Rolewicz L, Williams M, Ball J

Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups.

https://doi.org/10.1136/bmjopen-2023-075066

February 2024

Hounkpatin HO, Roderick P, Harris S, Morris JE, Smith D, Walsh B, Roberts HC, Dambha-Miller H, Tan QY, Watson F, Fraser SD

Background: Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity.

Aim: To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity.

https://doi.org/10.3399/bjgp.2022.0103

October 2022

Wieruszewski PM, Leone M, Kaas-Hansen BS, Dugar S, Legrand M, McKenzie CA, Bissell Turpin BD, Messina A, Nasa P, Schorr CA, De Waele JJ, Khanna AK

Objectives: To provide guidance on the reporting of norepinephrine formulation labeling, reporting in publications, and use in clinical practice.

Design: Review and task force position statements with necessary guidance.

https://doi.org/10.1097/ccm.0000000000006176

January 2024

Bartolomeu Pires S,  Kunke Dl, Kipps   C, Goodwin N, Portillo MC

People living with long-term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions.

https://doi.org/10.1111/hex.13948

January 2024

Dall’Ora C, Ejebu OZ, Jones J, Griffiths P

Shifts of 12 hours or longer are common in nursing services within general hospital wards. Concerns have been raised about their safety, but previous research has mostly used staff-reported measures of quality and safety and has occurred in general hospital settings only. 

This study aims to measure the association between the use of 12+ hour shifts in nursing staff (including registered nurses, healthcare support workers or nursing assistants, and nursing associates) and the rate of patient incidents in mental health and community hospitals

https://doi.org/10.1155/2023/6626585

January 2024

Griffiths P, Turner L, Lown J, Sanders J

Birthrate Plus® is a widely used tool that informs decisions about the number of midwifery staff needed to provide safe and high quality care in maternity services. Evidence about the effectiveness, validity, reliability, and feasibility of tools such as this is needed.

https://doi.org/10.1016/j.wombi.2023.11.003

January 2024

Michopoulou S, Prosser A, Dickson J, Guy M, Teeling JL, Kipps C

Single photon emission tomography (SPECT) can detect early changes in brain perfusion to support the diagnosis of dementia. Inflammation is a driver for dementia progression and measures of inflammation may further support dementia diagnosis.

In this study, we assessed whether combining imaging with markers of inflammation improves prediction of the likelihood of Alzheimer's disease (AD).

https://doi.org/10.3233/jad-230726

January 2024

Ibrahim K, Weller S, Elvidge E, Tavener M

This article explores experiences of teaching qualitative research (QR) broadly, and qualitative methods (QM) more specifically in medicine, highlighting the challenges faced, and offering recommendations for overcoming them.

https://doi.org/10.1007/s10459-023-10224-z

May 2023

Grace J,   Nind M, de Haas C, Hope J.

This paper pursues the argument that finding a way for people with profound intellectual and multiple disabilities to belong in inclusive research requires starting from a deep knowledge of the people in question. This paper illustrates this idea in action showing what can be possible from building research around ‘being with’ people with profound intellectual disabilities, creating intersubjective knowledge together

https://doi.org/10.3390/socsci13010037

January 2024

Ambrosio   L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC

Objective: To present the psychometric properties of the living with long-term condition (LwLTCs) scale in an English-speaking population of people with different LTCs.

Design: An observational and cross-sectional study, with retest was conducted. Psychometric properties including feasibility, internal consistency, confirmatory factor analysis, reproducibility and content validity were tested.

https://doi.org/10.1136/bmjopen-2023-077978

January 2024

Taher R,   Gray D, Ramage J

Pseudomyxoma peritonei (PMP) is a form of peritoneal malignancy. It originates from a perforated appendiceal epithelial tumour. Patients with PMP experience various stressful and traumatic events including diagnosis with a rare disease, treatment with extensive and complex surgery, and long hospital stays. Currently, there is a scarcity of studies that primarily aim to assess the quality of life of patients with PMP, and there is no reviews or comprehensive understanding of the quality of life (QoL) issues faced by these patients. Even fewer studies have consulted with patients themselves. 

https://doi.org/10.1155/2024/8137209

January 2024

McKenzie   C, Spriet I, Hunfeld N

The intensive care unit (ICU) patient requires a plethora of disciplines to optimise care and clinical outcomes. Recently, the European Society of Intensive Care Medicine (ESICM) has given greater attention to ICU pharmacy professionals, i.e., the clinical pharmacist and pharmacy technician, and their integration into the ICU multidisciplinary (MDT) team. In this article, we describe ten reasons why ICU pharmacy professionals are vital for high-quality care in the ICU.

10.1007/s00134-023-07285-4

January 2024

Storm   M, Morken IM, Austin RC, Nordfonn O, Wathne HB, Urstad KH et al

Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care.

https://doi.org/10.1186/s12913-023-10508-5

January 2024

Bartolomeu-Pires S, Kunkel D, Kipps C, Goodwin N, Portillo MC

People living with long-term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions.

 https://doi.org/10.1111/hex.13948

January 2024

Inada-Kim M, Chmiel FP, Boniface M, et al

Objectives: To evaluate oxygen saturation and vital  signs measured in the community by emergency medical  services (EMS) as clinical markers of COVID-19-positive  patient deterioration

doi: 10.1136/bmjopen-2022-067378

January 2024

Emmanuel   T, Griffiths P, Lamas-Fernandez C, Ejebu OZ, Dall'Ora C

Aim: To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time.

Methods: We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis.

https://doi.org/10.1111/jocn.16974

December 2023

Wilson   MG, Bone JN, Slade LJ, Mistry HD, Singer J, Crozier SR

To examine the association with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit-to-visit BP variability (BPV), adjusted for BP level.

https://doi.org/10.1111/1471-0528.17724

December 2023

Driessens   C, Mills L, Patel R, Culliford D, Gbesemete D, Lee E et al

Early on in the COVID-19 pandemic, research highlighted the impact of the pandemic on the psychosocial wellbeing of children and young people (CYP). The long-term consequences of the pandemic on clinically vulnerable CYP is  however unclear. This study aims to describe the psychosocial experiences of immunosuppressed CYP while Britain moved from the COVID-19 pandemic to epidemic.

http://dx.doi.org/10.21203/rs.3.rs-2322586/v1

December 2023

Linceviciute S, Ambrosio L, Baldwin DS, Portillo MC

Social prescribing link workers interventions have been widely adopted within healthcare systems, particularly in the UK, to support a range of patients’ needs and to help improve condition management for those living with multiple long-term conditions. However, there is a lack of consistency in implementation and unclear guidance about how social prescribing link workers might address these needs, particularly in individuals living with physical and mental health long-term conditions who bear a greater burden of multifaceted everyday problems and health challenges. This review aimed to identify the existing ways in which link workers might support the needs of this group.

https://doi.org/10.1155/2023/7191247

December 2023

Harper RC, Sheppard S, Stewart C, Clark CJ

Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women.

We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care.

https://doi.org/10.2196/45947

December 2023

Zou M,   Northstone K, Leary S.

Later-eating rhythm (LER) refers to a later timing, greater energy intake, and higher meal frequency in the evening. The role of childhood LER in obesity development is emerging, but most evidence is cross-sectional. Cross-context comparison allows the improvement of causal inference in observational studies by comparing cohorts with different confounding structures. This method is applied to assess the causal effects of LER on adiposity, by exploring the likelihood of residual confounding due to socioeconomic status.

https://doi.org/10.1016/s0140-6736(23)02142-6

November 2023

Ziauddeen   N, Pantelic M, O'Hara ME, Hastie C, Alwan NA

A proportion of people infected with SARS-CoV-2 develop post-COVID-19 condition (also known as long COVID), a predominantly multisystem condition resulting in varying degrees of functional disability limiting day-to-day activities. We aimed to describe the impact of long COVID on work.

https://doi.org/10.1016/s0140-6736(23)02157-8

November 2023

Taylor   E, Ziauddeen N, Alwan NA, Smith D

Food membership clubs that charge a small fee for a set number of items are in place in Wessex to address food insecurity (inadequate reliable access to sufficient affordable, nutritious food). These clubs incorporate longer-term solutions such as budgeting support, benefit maximisation, and cooking skills. The Wessex DIET project was established to measure acceptability and impact of these clubs. Given the paucity of evidence on the prevalence of food insecurity in those accessing such clubs, we aimed to quantify food insecurity and assess diet quality and wellbeing at recruitment.

https://doi.org/10.1016/s0140-6736(23)02131-1

November 2023

Nixon C,   McKenzie C, Bourne RS

Intensive care unit (ICU) nurses have a pivotal role in delivering quality care for some of the sickest and most vulnerable patients in our hospitals. The direct patient care provided by ICU nurses affords a unique opportunity to influence the quality of care delivered. Delivering care that is safe is critical in the complex and dynamic environment of the ICU. Medication is the most common intervention that ICU patients receive. Medication errors (MEs) are numerous and contribute to worse ICU patient outcomes.

https://doi.org/10.1016/j.iccn.2023.103578

November 2023

Smith A,   Buchanan A, Parkes J, Stone H, Tan QY, Ibrahim K

Following increases in deaths due to alcohol during the COVID-19 pandemic, there have been renewed calls to increase resources in alcohol screening and brief intervention (SBI). Research has shown that community pharmacy could be a promising setting for SBI. This review aimed to investigate the barriers and facilitators to SBI delivery in community pharmacy to inform its further development.

https://doi.org/10.1093/ijpp/riad071

November 2023

Kemp I,   McKenzie C

“60% of the time, it works every time” stated the character Brian Fantana in the film Anchorman in (2004). In the previous issue of Intensive and Critical Care Nursing, Joan Rout and colleagues critically observed nursing practice in the preparation, double checking and administration of antimicrobials (in this case carbapenems) in the intensive care unit (ICU) and essentially asked “How well are we doing? Are we getting it right all the time, or just some of the time?” (Rout et al., 2023). The study outcomes report adherence to multiple steps that are intended to reduce the risk of errors associated with the preparation and administration of medication in the ICU. In the context of antimicrobials these processes, by design, endeavour to guarantee delivery of the correct drug at the correct dose, to the correct patient at the correct time i.e., antimicrobial stewardship.

doi:   10.1016/j.iccn.2023.103569

November 2023

McKenzie   C, Skrobik Y, Devlin JW

Maintaining comfort and analgesia is fundamental to providing adequate care in intensive care unit (ICU) patients. Pain assessment and its control remain the highest priorities and concerns among survivors of critical illness and their loved ones

DOI: 10.1007/s00134-023-07254-x

November 2023

Ambrosio   L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC

Background:

The English version of the living with long term conditions (LwLTCs) scale is a comprehensive person-centred measure that evaluates the complex process of living with long term conditions.

Objectives:

To present the psychometric properties of the LwLTCs scale in an English-speaking population in people with different long term conditions.

https://doi.org/10.1093/eurpub/ckad160.811

October 2023

Ambrosio   L, Faulkner J, Lambrick D, Morris J, Compton E, Portillo MC

Background:

During the COVID-19 pandemic the United Kingdom government released regular guidance on limiting the spread of COVID-19. People, including those with long term conditions, were told to use physical distancing, self-isolation and/or shielding during COVID-19 to protect themselves and others. A consequence of these interventions was to exacerbate poor lifestyle behaviours, namely less physical activity.

Objectives:

To propose recommendations to support and sustain their physical activity of people with long term conditions during and after COVID-19 or other pandemics.

https://doi.org/10.1093/eurpub/ckad160.1570

October 2023

Rumman   N, Fassad MR, Driessens C, Goggin P, Abdelrahman N, Adwan A, Albakri M,   Chopra J, Doherty R, Fashho B, Freke GM, Hasaballah A, Jackson CL, Mohamed   MA, Abu Nema R, Patel MP, Pengelly RJ, Qaaqour A, Rubbo B, Thomas NS,   Thompson J, Walker WT, Wheway G, Mitchison HM, Lucas JS.

Diagnostic testing for primary ciliary dyskinesia (PCD) started in 2013 in Palestine. We aimed to describe the diagnostic, genetic and clinical spectrum of the Palestinian PCD population.

doi:   10.1183/23120541.00714-2022.

April 2023

Sri   Ranjan Y, Ziauddeen N, Stuart B, Alwan NA, Cheong Y

Endometriosis is a chronic and debilitating condition which can affect the entire reproductive life course of women with a potentially detrimental effect on pregnancy. Pregnancy (and increasing parity) can affect endometriosis by modulating disease severity and suppressing symptoms. Multiparous women could be less likely to suffer from endometriosis-related pregnancy complications than primiparous women. We aimed to systematically review the evidence examining the role of parity in the relationship between pregnancy outcomes and endometriosis.

doi:   10.1530/RAF-22-0070

March 2023

Ziauddeen N, Jeffrey RF, Waiblinger D, Fraser SDS, Alwan NA, Yuen HM, Azad R, Mason D, Wright J, Coward RJM, Roderick PJ

Endstage kidney failure rates are higher in South Asians than in White Europeans. Low birth weight is associated with adult chronic kidney disease and is more common in South Asians. Foetal kidney size was smaller in South Asians in the Born in Bradford (BiB) birth cohort. 

As part of BiB follow up, we aimed to investigate if there were ethnic differences in kidney function and blood pressure in early childhood and whether this was different by foetal kidney size.

10.12688/wellcomeopenres.17796.1

August 2023

Farrington   N, Richardson A, Bridges J

Tips and guidance on making cancer services

People with dementia have poorer cancer outcomes than those without, and are more likely to experience complications and poorer overall survival (McWilliams et al 2017). Few interventions are designed for older people with cancer and complex needs, such as those with dementia (Farrington et al 2022).

doi: 10.7748/cnp.21.5.22.s10

October 2023

May CR, Chew-Graham CA, Gallacher KI, Gravenhorst KC, Mair FS, Nolte E, Richardson A

Background: The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes.

Aims: With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia).

doi: 10.7748/cnp.21.5.22.s10

October 2023

Collaço N, Campion A, McNicholas R, Darlington AS

Purpose: Little is known about the impact of COVID-19 on children and young people (CYP) with hydrocephalus and their families. This study explored the experiences and support needs of CYP with hydrocephalus and parents who have a child with hydrocephalus during the COVID-19 pandemic.

Methods: CYP with hydrocephalus and parents of CYP with hydrocephalus in the United Kingdom completed an online survey with open and closed questions exploring experiences, information, support needs and decision making processes. Qualitative thematic content analysis and descriptive quantitative analyses were undertaken.

https://doi.org/10.1007/s00381-023-05980-7

May 2023

Borchert RJ, Azevedo T, Badhwar A, Bernal J, Betts M, Bruffaerts R, Burkhart MC, Dewachter I, Gellersen HM, Low A, Lourida I, Machado L, Madan CR, Malpetti M, Mejia J, Michopoulou S, Muñoz-Neira C, Pepys J, Peres M, Phillips V, Ramanan S, Tamburin S, Tantiangco HM, Thakur L, Tomassini A, Vipin A, Tang E, Newby D; Deep Dementia Phenotyping (DEMON) Network; Ranson JM, Llewellyn DJ, Veldsman M, Rittman T

Introduction: Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia.

Methods: We systematically reviewed studies reporting AI for neuroimaging in diagnosis and/or prognosis of cognitive neurodegenerative diseases.

https://doi.org/10.1002/alz.13412

August 2023

Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, Bakolis I, Sevdalis N, Sandall J, Soukup T, Corbett T, Gonçalves-Bradley DC, Walker DM

Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. 

Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co-ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well-being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co-ordinated care due to fragmented care systems.

Objectives: To assess the effects of case management for integrated care of older people living with frailty compared with usual care.

https://doi.org/10.1002/14651858.cd013088.pub2

May 2023

Almilaji O, Ayis S, Goubar A, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ

Purpose: To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery.

Methods: A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence.

https://doi.org/10.1016/j.physio.2023.03.002

September 2023

Adams J,   Jones GD, Sadler E, Guerra S, Sobolev B, Sackley C, Sheehan KJ.

Purpose: to investigate physiotherapists' perspectives of effective community provision following hip fracture.

Methods: qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented.

https://doi.org/10.1093/ageing/afad130

September 2023

Stannard   S, Berrington A, Paranjothy S, Owen R, Fraser S, Hoyle R et al

Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity.

https://doi.org/10.1177/26335565231193951

September 2023

Fraser SD, Stannard S, Holland S, Boniface M, Hoyle RB, Wilkinson R et al

Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as ‘early onset’). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled ‘MELD-B’ to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions.

https://doi.org/10.1177/26335565231204544

September 2023

Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K

A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate medications (deprescribing). Recent recommendations for effective deprescribing include shared-decision making and a multidisciplinary approach. Our aim was to understand when, why, and how interventions for medication review and deprescribing in primary care involving multidisciplinary teams (MDTs) work (or do not work) for older people.

https://doi.org/10.1186/s12877-023-04256-8

September 2023

Johnson L, Kirk H, Clark B, Heath S, Royse C, Adams C, Portillo MC

Systematically implementing personalised care has far reaching benefits to individuals, communities and health and social care systems. If done well, personalised care can result in better health outcomes and experiences, more efficient use of health services and reduced health inequalities. Despite these known benefits, implementation of personalised care has been slow. 

Evaluation is an important step towards achieving the ambition of universally delivered personalised care. There are currently few comprehensive assessments or tools that are designed to understand the implementation of personalised care at a service or system level, or the cultural, practical and behavioural factors influencing this. The aim of this paper is to describe the development and testing of a system-wide evaluation tool.

https://doi.org/10.1136/bmjoq-2023-002324

September 2023

Griffiths P, Saville C, Ball J, Dall'Ora C, Meredith P, Turner L, Jones J

Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals.

https://doi.org/10.1016/j.ijnurstu.2023.104601

September 2023

Stannard S, Berrington A, Paranjothy S, Owen R, Fraser S, Hoyle R, Boniface M, Wilkinson B, Akbari A, Batchelor S, Jones W, Ashworth M, Welch J, Mair FS, Alwan NA

Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity.

https://doi.org/10.1177/26335565231193951

September 2023

Almuhairi ES, Badejo M, Peer A, Pitkanen M, McKenzie CA

Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness.

https://doi.org/10.1177/08850666231199986

September 2023

Grove G, Ziauddeen N, Roderick P, Vassilev I, Appleton JV, Smith D, Alwan NA

A Childhood Obesity Risk Estimation tool (SLOPE CORE) has been developed based on prediction models using routinely available maternity and early childhood data to estimate risk of childhood obesity at 4-5 years. This study aims to test the feasibility, acceptability and usability of SLOPE CORE within an enhanced health visiting (EHV) service in the UK, as one context in which this tool could be utilised.

https://doi.org/10.1186/s12889-023-16500-2

September 2023

Shaw S, Muir S, Strömmer S, Crozier S, Cooper C, Smith D, Barker M, Vogel C

Factors from social and food environments can influence the food choices of adolescents in ways not experienced during childhood. Evidence suggests these two environments influence adolescents' food choices independently, but there is limited knowledge of how the interplay between these environments influence adolescents' diets. An enhanced understanding of this interplay surrounding adolescent food choice could aid the development of more nuanced interventions and policies. 

This qualitative study involved 13 online focus groups with adolescents (n = 45) aged 11-18 years, attending secondary school or college in England, UK. Data were analysed using thematic analysis. Social experiences which accompanied eating were perceived as more important than the food itself, and fast-food outlets were described as uniquely suited to facilitating these interactions. Young people wanted to spend their money on foods they considered worthwhile, but this did not always relate to the most affordable foods. Adolescents wanted to put little effort into making food decisions and appreciated factors that helped them make quick decisions such as prominent placement and eye-catching promotions on foods they wanted to buy. Chain food outlets were valued as they offered familiar and frequently advertised foods, which minimized the effort needed for food decisions. Adolescents' sense of autonomy underpinned all themes. 

Participants described having limited opportunities to make their own food choices and they did not want to waste these buying unappealing 'healthy' foods. Interventions and government policies should align with adolescents' experiences and values relating to food choice to ensure that they are effective with this important age group.

https://doi.org/10.1093/heapro/daad097

August 2023

Vester LB, Haahr A, Nielsen TL, Bartolomeu S, Portillo MC

Objective: To identify multi-sectoral integrated care initiatives for people with Parkinson's disease and caregivers.

Method: Following the Matrix Method we created a synthesis of literature across methodological approaches. The search was conducted in four databases until June 2022, and included studies focusing on multi-sectoral integrated care initiatives, and how they helped people with Parkinson's disease and caregivers in everyday living.

https://doi.org/10.1016/j.pec.2023.107931

August 2023

Meredith SJ, Cox NJ, Ibrahim K, Higson J, McNiff J, Mitchell S, Rutherford M, Wijayendran A, Shenkin SD, Kilgour AHM, Lim SER

Despite the advantages of physical activity (PA), older adults are often insufficiently active to maximise health. Understanding factors that influence PA engagement will support well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adults' engagement in PA.

https://doi.org/10.1093/ageing/afad145

August 2023

Collins P, Bridges J, Bartlett R

This is a methodological paper that aims to advance the conceptualisation of participatory research by focusing on the value of capturing and understanding movement as a vital means of communication for older people with dementia in a general hospital ward. Qualitative research involving people with dementia tends to be word-based and reliant upon verbal fluency. This article considers a method for capturing and understanding movement as a vital means of communication.

https://doi.org/10.1002/gps.5987

August 2023

Hesketh KR, Baird J, Crozier SR, Godfrey KM, Harvey NC, Cooper C, van Sluijs EMF

Purpose: To explore how activity behaviors before/during pregnancy relate to those in later parenthood, we assessed associations between sitting and moderate-/strenuous exercise before/during pregnancy, and sedentary time (SED) and moderate to vigorous physical activity (MVPA) 4-7 years postpartum ("later parenthood").

https://doi.org/10.1123/jpah.2022-0630

August 2023

Saynor ZL, Gruet M, McNarry MA, Button B, Morrison L, Wagner M, Sawyer A, Hebestreit H, Radtke T, Urquhart DS; European Cystic Fibrosis Society Exercise Working Group

Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. 

This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.

https://doi.org/10.1183/16000617.0029-2023

August 2023

Ziauddeen N, Roderick PJ, Santorelli G, Alwan NA

In England, 41% of children aged 10-11 years live with overweight or obesity. Identifying children at risk of developing overweight or obesity may help target early prevention interventions. We aimed to develop and externally validate prediction models of childhood overweight and obesity at age 10-11 years using routinely collected weight and height measurements at age 4-5 years and maternal and early-life health data.

https://doi.org/10.1038/s41366-023-01356-8

August 2023

Lim SER, Meredith SJ, Agnew S, Clift E, Ibrahim K, Roberts HC

Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs.

https://doi.org/10.1186/s12877-023-04184-7

July 2023

Alwan NA, Clutterbuck D, Pantelic M, Hayer J, Fisher L, Hishmeh L, Heightman M, Allsopp G, Wootton D, Khan A, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Smith K, Clarke R, Mcfarland S, Gabbay M, Banerjee A

Background and aim: Long Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups' experiences of Long Covid, and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area in London, United Kingdom to test the feasibility of a community-based approach of identifying Long Covid cases that have not been clinically diagnosed and have not been referred to Long Covid specialist services. We will explore the barriers to accessing recognition, care, and support, as well as experiences of stigma and perceived discrimination.

https://doi.org/10.1371/journal.pone.0284297

July 2023

Eadie R, McKenzie CA, Hadfield D, Kalk NJ, Bolesta S, Dempster M, McAuley DF, Blackwood B; UK ALERT-ICU study investigators

Background: Iatrogenic withdrawal syndrome, after exposure medication known to cause withdrawal is recognised, yet under described in adult intensive care.

Aim: To investigate, opioid, sedation, and preadmission medication practice in critically ill adults with focus on aspects associated with iatrogenic withdrawal syndrome.

https://doi.org/10.1007/s11096-023-01614-9

July 2023

Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC

Introduction: Parkinson's disease is the second most prevalent neurodegenerative disease, affecting 10 million people worldwide. Health and social care professionals need to have personalised tools to evaluate the process of living with Parkinson's disease and consequently, plan individualised and targeted interventions. Recently, the English version of the Living with Long term conditions (LwLTCs) scale has been developed filling an important gap related to person-centred tools to evaluate the process of living with long term conditions among English-speaking population. However, no validation studies for testing its psychometric properties have been conducted.

Aim: To analyse the psychometric properties of the LwLTCs scale in a wide English-speaking population living with Parkinson's disease.

https://doi.org/10.1186/s12955-023-02154-6

July 2023

Ambrosio L, Morris J, Compton E, Portillo MC

Introduction: Regular physical activity is a strategy that is effective in the physical management of long term conditions. The COVID-19 pandemic, led to disruption of physical activity routines for many people with long term conditions. It is important, to understand the experiences of people with long term conditions regarding physical activity during COVID-19 to enable future identification of strategies to mitigate the impact of restrictions on health.

Objective: To explore perceptions and experiences of people with long term conditions of the impact of the UK Government physical distancing restrictions on their physical activity participation during the COVID-19 pandemic.

https://doi.org/10.1371/journal.pone.0285785

July 2023

Woodrow M, Carey C, Ziauddeen N, Thomas R, Akrami A, Lutje V, Greenwood DC, Alwan NA

Long COVID occurs in those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) whose symptoms persist or develop beyond the acute phase. We conducted a systematic review to determine the prevalence of persistent symptoms, functional disability, or pathological changes in adults or children at least 12 weeks postinfection.

https://doi.org/10.1093/ofid/ofad233

July 2023

Montague C, D'Angelo S, Harvey N, Vogel C, Baird J

Background: Previous studies of the UK Biobank have examined intake of single food items and their association with health outcomes. Our aim was to develop a dietary quality score and examine the relationship between this score and markers of cardiometabolic health.

Methods: Principal component analysis was performed on dietary data from UK Biobank participants. Linear regression was used to analyse the relationship between diet and cardiometabolic health.

https://doi.org/10.1093/pubmed/fdad103

July 2023

Belfrage SL, Husted M, Fraser S, Patel S, Faulkner JA

Aim: The aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents.

Methods: A systematic review of six databases - MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source - was conducted to identify relevant articles. Risk of bias was assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane collaboration risk of bias in non-randomised studies of interventions. The study findings were grouped and synthesised following the synthesis without meta-analysis framework.

https://doi.org/10.1177/17579139231180746

June 2023

Moult A, McGrath C, Lippiett K, Coope C, Chilcott S, Mann C, Evans N, Turner A, Dziedzic K, Portillo MC, Johnson R

Patient and public involvement (PPI) is increasingly seen as essential to health service research. There are strong moral and ethical arguments for good quality PPI. Despite the development of guidance aimed at addressing the inconsistent reporting of PPI activities within research, little progress has been made in documenting the steps taken to undertake PPI and how it influences the direction of a study. Without this information, there are minimal opportunities to share learnings across projects and strengthen future PPI practices. The aim of this paper is to present details on the processes and activities planned to integrate PPI into the qualitative research component of a mixed-methods, multi-site study evaluating the implementation of a smart template to promote personalised primary care for patients with multiple long-term conditions.

https://doi.org/10.1186/s40900-023-00440-7

June 2023

Walker S, Goodfellow H, Pookarnjanamorakot P, Murray E, Bindman J, Blandford A, Bradbury K, Cooper B, Hamilton FL, Hurst JR, Hylton H, Linke S, Pfeffer P, Ricketts W, Robson C, Stevenson FA, Sunkersing D, Wang J, Gomes M, Henley W, Collaboration LWCR

Objectives: To describe self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome (PCS). To assess the impact of symptoms on health-related quality of life (HRQoL) and patients' ability to work and undertake activities of daily living. 

https://doi.org/10.1136/bmjopen-2022-069217

June 2023

El-Heis S, Crozier SR, Harvey NC, Healy E, Godfrey KM

The risk of developing atopic eczema is influenced by various events pre-conception, during pregnancy, and throughout the neonatal period. Recent reports have suggested that early life exposure to microbiome altering medications, such as antibiotics and laxatives, could impact the risk of atopic eczema in infancy and childhood. For example, Lin et al., 2022, reported an increased risk of allergic disease in offspring whose mother used laxatives in pregnancy independent of laxative exposure in the offspring but no associations were found for maternal antibiotic use.

As the evidence on this topic is sparse, we aimed to examine whether maternal gestational exposure to antibiotics or laxatives were associated with the risk of atopic eczema in infancy as well as the link between offspring antibiotic exposure in the first 12 months of life and risk of infantile atopic eczema.

https://doi.org/10.1111/pai.13964

May 2023

Rubbo B,   Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P

Objectives: Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups.

https://doi.org/10.1136/bmjopen-2022-066702

May 2023

Pearce S, McKenzie C

In this issue of Intensive & Critical Care Nursing, David Jarrett and colleagues have published a notable study (Jarret et al., 2023). This prospective observational study elegantly describes one of the lesser appreciated challenges in administering the correct dose into our patients in the intensive care unit (ICU)

https://doi.org/10.1016/j.iccn.2023.103445

May 2023

Hjelle   EG, Rønn-Smidt H, Haahr A, Haavaag SB, Sørensen D, Navarta-Sánchez MV,   Portillo MC, Bragstad LK

Objectives: The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson`s disease (PD) in Denmark and Norway.

http://10.1177/17423953231174470

May 2023

Dall'Ora   C, Ejebu OZ, Ball J, Griffiths P

Background: Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested.

Aims: To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion.

https://doi.org/10.1093/occmed/kqad046

May 2023

Ankravs  MJ, McKenzie CA, Kenes MT

Delirium occurs in critical illness and is associated with poor clinical outcomes, having a longstanding impact on survivors. Understanding the complexity of delirium in critical illness and its deleterious outcome has expanded since early reports. Delirium is a culmination of predisposing and precipitating risk factors that result in a transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis. Because of its multifactorial nature, different clinical phenotypes, and potential neurobiological causes, a precise approach to reducing delirium in critical illness requires a broad understanding of its complexity. Refinement in the categorization of delirium subtypes or phenotypes (i.e., psychomotor classifications) requires attention. Recent advances in the association of clinical phenotypes with clinical outcomes expand our understanding and highlight potentially modifiable targets. Several delirium biomarkers in critical care have been examined, with disrupted functional connectivity being precise in detecting delirium. Recent advances reinforce delirium as an acute, and partially modifiable, brain dysfunction, and place emphasis on the importance of mechanistic pathways including cholinergic activity and glucose metabolism. Pharmacologic agents have been assessed in randomized controlled prevention and treatment trials, with a disappointing lack of efficacy. Antipsychotics remain widely used after "negative" trials, yet may have a role in specific subtypes. However, antipsychotics do not appear to improve clinical outcomes. Alpha-2 agonists perhaps hold greater potential for current use and future investigation. The role of thiamine appears promising, yet requires evidence. Looking forward, clinical pharmacists should prioritize the mitigation of predisposing and precipitating risk factors as able. Future research is needed within individual delirium psychomotor subtypes and clinical phenotypes to identify modifiable targets that hold the potential to improve not only delirium duration and severity, but long-term outcomes including cognitive impairment.

https://doi.org/10.1002/phar.2807

May 2023

Shaw S,   Barrett M, Shand C, Cooper C, Crozier S, Smith D, Barker M, Vogel C

Adolescence is a period of increased autonomy over decision-making, including food choices, and increased exposure to influences outside the home, including the food environment. This review aims to synthesize the evidence for the influence of community nutrition environments, spatial access to food outlets, and consumer nutrition environments, environments inside food outlets, on adolescent food purchasing and dietary behaviors in high-income countries. Six databases were searched for articles published before January 2023. Results were synthesized using a vote-counting technique and effect direction plots that record the direction of the effect in relation to the anticipated relationship with health. Thirty-four observational and two intervention studies met the inclusion criteria. In the 13 studies assessing adolescent exposure to healthy community nutrition environments, results did not show clear associations with dietary and purchasing outcomes. Thirty studies assessed adolescents' exposure to unhealthy community nutrition environments with the majority (n = 17/30, 57%) reporting results showing that greater exposure to food outlets classified as unhealthy was associated with less healthy food purchases and dietary intakes. Inconsistent results were observed across the seven studies investigating associations with the consumer environment. Further research in these areas, including more high-quality intervention studies, may help to develop policy strategies to improve adolescents' dietary behaviors.

https://doi.org/10.1111/obr.13569

Cameron   LK, Lumlertgul N, Bear DE, Cooney E, McKenzie C, Ostermann M

Micronutrients, principally vitamins and minerals, play an important role both in health and in disease. Parenteral micronutrient products are commonly prescribed for critically ill patients both in line with the terms of the product's license, and for other indications where there is an underpinning physiological rationale, or precedent, for their use but little evidence. This survey sought to understand United Kingdom (UK) prescribing practice in this area.

https://doi.org/10.1016/j.clnesp.2023.03.023

Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health 21, 30 (2023). https://doi.org/10.1186/s12960-023-00817-5

Published: 20 April 2023

DOI https://doi.org/10.1186/s12960-023-00817-5

Objectives

Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death.

Article Source: Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70)
Stannard S, Berrington A, Alwan NA (2023) Exploring the associations between number of children, multi-partner fertility

Background

Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)—defined as having biological children with more than one partner, with obesity at midlife

Article Source: The role of social networks in the self-management support for young women recently diagnosed with breast cancer
Vassilev I, Lin SX, Calman L, Turner J, Frankland J, et al. (2023) The role of social networks in the self-management support for young women recently diagnosed with breast cancer. PLOS ONE 18(4): e0282183. https://doi.org/10.1371/journal.pone.0282183

It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. 

This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016–2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. 

Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. 

Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. 

There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes

Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health21, 30 (2023). https://doi.org/10.1186/s12960-023-00817-5

Abstract

Objectives

Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death.

Methods

Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality.

Results

We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect.

Conclusions

Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies.

https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-023-00817-5

Farrington, N.,  Richardson, A., &  Bridges, J. (March 2023).

Aims
Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer.

Design
Secondary qualitative analysis of a focused ethnographic study.

Data Sources
In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison.

Results
The principal theme was balance, encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals.

Conclusion
The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making.

https://doi.org/10.1111/jan.15629

Fearn S, Bartolomeu Pires S, Agarwal V, Roberts HC, Spreadbury J, Kipps C.

21 June 2021

Background: The reasons for acute hospital admissions among people with Parkinson's disease are well documented. However, understanding of crises that are managed in the community is comparatively lacking. Most existing literature on the causes of crisis for people with Parkinson's disease (PwP) uses hospital data and excludes the individual's own perspective on the crisis trigger and the impact of the crisis on their care needs.

Objective: To identify the causes and impact of crises in both community and hospital settings, from a patient and carer perspective.

Methods: A total of 550 UK-based PwP and carers completed a survey on (a) their own personal experiences of crisis, and (b) their general awareness of potential crisis triggers for PwP.

Results: In addition to well-recognised causes of crisis such as falls, events less widely associated with crisis were identified, including difficulties with activities of daily living and carer absence. The less-recognised crisis triggers tended to be managed more frequently in the community. Many of these community-based crises had a greater impact on care needs than the better-known causes of crisis that more frequently required hospital care. PwP and carer responses indicated a good general knowledge of potential crisis triggers. PwP were more aware of mental health issues and carers were more aware of cognitive impairment and issues with medications.

Conclusion: These findings could improve care of Parkinson's by increasing understanding of crisis events from the patient and carer perspective, identifying under-recognised crisis triggers, and informing strategies for best recording symptoms from PwP and carers.

https://pubmed.ncbi.nlm.nih.gov/34250952/

Qian Yue Tan , Helen C. Roberts, Simon D. S. Fraser, Khaled Amar, Kinda Ibrahim

March 30, 2023

Background

People with long-term conditions must complete many healthcare tasks such as take medications, attend appointments, and change their lifestyle. This treatment burden and ability to manage it (capacity) is not well-researched in Parkinson’s disease.

Objective

To explore and identify potentially modifiable factors contributing to treatment burden and capacity in people with Parkinson’s disease and caregivers.

Methods

Semi-structured interviews with nine people with Parkinson’s disease and eight caregivers recruited from Parkinson’s disease clinics in England (ages 59–84 years, duration of Parkinson’s disease diagnosis 1–17 years, Hoehn and Yahr (severity of Parkinson’s disease) stages 1–4) were conducted. Interviews were recorded and analyzed thematically.

Results

Four themes of treatment burden with modifiable factors were identified: 1) Challenges with appointments and healthcare access: organizing appointments, seeking help and advice, interactions with healthcare professionals, and caregiver role during appointments; 2) Issues obtaining satisfactory information: sourcing and understanding information, and satisfaction with information provision; 3) Managing medications: getting prescriptions right, organizing polypharmacy, and autonomy to adjust treatments; and 4) Lifestyle changes: exercise, dietary changes, and financial expenses. Aspects of capacity included access to car and technology, health literacy, financial capacity, physical and mental ability, personal attributes and life circumstances, and support from social networks.

Conclusions

There are potentially modifiable factors of treatment burden including addressing the frequency of appointments, improving healthcare interactions and continuity of care, improving health literacy and information provision, and reducing polypharmacy. Some changes could be implemented at individual and system levels to reduce treatment burden for people with Parkinson’s and their caregivers. Recognition of these by healthcare professionals and adopting a patient-centered approach may improve health outcomes in Parkinson’s disease.

Nida Ziauddeen,, Paul J. Roderick, Gillian Santorelli, John Wright, Nisreen A. Alwan

June 2022

Abstract

Tackling the childhood obesity epidemic can potentially be facilitated by risk-stratifying families at an early-stage to receive prevention interventions and extra support. Using data from the Born in Bradford (BiB) cohort, this analysis aimed to externally validate prediction models for childhood overweight and obesity developed as part of the Studying Lifecourse Obesity PrEdictors (SLOPE) study in Hampshire. BiB is a longitudinal multi-ethnic birth cohort study which recruited women at around 28 weeks gestation between 2007 and 2010 in Bradford. The outcome was body mass index (BMI) ≥91st centile for overweight/obesity at 4–5 years. Discrimination was assessed using the area under the receiver operating curve (AUC). Calibration was assessed for each tenth of predicted risk by calculating the ratio of predicted to observed risk and plotting observed proportions versus predicted probabilities. Data were available for 8003 children. The AUC on external validation was comparable to that on development at all stages (early pregnancy, birth, ~1 year and ~2 years). The AUC on external validation ranged between 0.64 (95% confidence interval (CI) 0.62 to 0.66) at early pregnancy and 0.82 (95% CI 0.81 to 0.84) at ~2 years compared to 0.66 (95% CI 0.65 to 0.67) and 0.83 (95% CI 0.82 to 0.84) on model development in SLOPE. Calibration was better in the later model stages (early life ~1 year and ~2 years). The SLOPE models developed for predicting childhood overweight and obesity risk performed well on external validation in a UK birth cohort with a different geographical location and ethnic composition.

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000258

Moon RJ, D'Angelo S, Holroyd CR, Crozier SR, Godfrey KM, Davies JH, Cooper C, Harvey NC.

Context: Children born to parents who are overweight or obese have a high risk of adult obesity, but it is unclear if transgenerational associations relating to unfavorable body composition differ by parent.

Objective: To examine differential mother-offspring and father-offspring associations in body composition in early childhood.

Methods: A total of 240 mother-father-offspring trios from a prospective UK population-based pre-birth cohort (Southampton Women's Survey) were included for anthropometry and dual-energy x-ray absorptiometry assessment of whole-body-less-head body composition in the offspring at 3 different ages (4, 6-7, and 8-9 years) and in the mother and father at the 8- to 9-year offspring visit. Associations were assessed using linear regression adjusting for the other parent.

Results: Positive associations between mother-daughter body mass index (BMI) and fat mass were observed at ages 6 to 7 (BMI: β = .29 SD/SD, 95% CI = .10, .48; fat mass β = .27 SD/SD, 95% CI = .05, .48) and 8 to 9 years (BMI: β = .33 SD/SD, 95% CI = .13, .54; fat mass β = .31 SD/SD, 95% CI = .12, .49), with similar associations at age 4 years but bounding the 95% CI. The mother-son, father-son, and father-daughter associations for BMI and fat mass were weaker at each of the ages studied.

Conclusion: A strong association between the fat mass of mothers and their daughters but not their sons was observed. In contrast, father-offspring body composition associations were not evident. The dimorphic parent-offspring effects suggest particular attention should be given to early prevention of unfavorable body composition in girls born to mothers with excess adiposity.

Corine Driessens, Lynne Mills, Ravin Patel, David Culliford, Diane Gbesemete, Emma Lee, Meera Shaunak, Harry Chappell, Saul N. Faust, Hans de Graaf,

Abstract: The COVID-19 pandemic has proved unique in both its unpredictability and the extent to which it has continued to impact on daily life since March 2020. Among the immunosuppressed population the challenges of the COVID-19 pandemic are cumulative to the ever-present challenges of living with a long-term condition. This prospective longitudinal study explored patterns of concern experienced by 467 British parents caring for an immunosuppressed child during the first 2 years of the COVID-19 pandemic and related this to parental mental wellbeing. Most parents slowly adapted or were resilient to the ever-changing stressors of the COVID-19 pandemic. However, 12% experienced high levels of concern throughout the first 2 years of the pandemic. This group was also more likely to report emotional mental health problems towards the end of this period. The experience of emotional mental health problems among parents caring for an immunosuppressed child was related to low household income, single parenting, difficult access to greenspace, and higher level of exposure to COVID positive cases and COVID restrictions (North of England). Parents reported that optimism, reduction of isolation, and support promoted coping and management of the challenges of the COVID-19 pandemic. More reliable COVID information and periodic medical-condition-specific guidance would have been appreciated. These findings can increase clinical awareness of high-risk parental groups and make an important contribution to the planning of appropriate targeted psychological family interventions.

Miriam Avery BN (Hons), PhD, Greta Westwood CBE, RN, PhD, MSc, Alison Richardson BN (Hons), MSc, PhD, PGDip, ED, RN

Published: 28 January 2021

Abstract

Aims and Objectives

This study aimed to understand the routes by which nurses, midwives and allied health professionals (NMAHPs) pursue and sustain a research career and the enablers and barriers to career progression.

Background
Robust evidence is central to practice and professional decision making of NMAHPs, with generation and translation of research arguably best led by those clinically active. Whilst countries like the UK and USA have fellowship schemes to support research career development, anecdotal reports suggest barriers exist in translating these opportunities into sustainable clinical academic careers.

External web link - https://onlinelibrary.wiley.com/doi/10.1111/jocn.15673

Article published in The Guardian newspaper  on 14th January 2021(Kellyn Lee) 

External web link - https://www.theguardian.com/society/2021/jan/14/everyday-objects-people-with-dementia-quality-of-life-care-homes

CRN Vision Magazine (July 2020)

External web link - https://mcusercontent.com/1100bd355403b33d410f8067a/files/138916b8-e47e-4f82-ab0e-0f804c034ff4/CRN_Wessex_VISION_magazine_Summer_2020_Final.pdf

Tan QY, Lim SER, Cox NJ, Roberts HC.(December 2019)

Pulse Magazine

External web link - https://www.pulsetoday.co.uk/clinical-feature/clinical-areas/elderly-care/ten-top-tips-on-frailty-in-general-practice/?cmpredirect

Michelle Myall, Carl May, Alison Richardson, Sarah Bogle, Natasha Campling, Sally Dace and Susi Lund – August 2020

Abstract

Purpose – The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

External web link - https://www.emerald.com/insight/content/doi/10.1108/JHOM-06-2020-0240/full/pdf?title=creating-pre-conditions-for-change-in-clinical-practice-the-influence-of-interactions-between-multiple-contexts-and-human-agency

Matt Johnson, Lucy Rigge, David Culliford, Lynn Josephs, Mike Thomas, Tom Wilkinson - december 4 2019

ABSTRACT

Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year.

External web link - https://www.nature.com/articles/s41533-019-0154-6

Yincent Tse, Anne-Sophie E. Darlington, Kay Tyerman, Dean Wallace, Tanya Pankhurst, Sofia Chantziara, David Culliford, Alejandra Recio-Saucedo & Arvind Nagra 

Background

During the initial COVID-19 pandemic, young United Kingdom (UK) kidney patients underwent lockdown and those with increased vulnerabilities socially isolated or ‘shielded’ at home. The experiences, information needs, decision-making and support needs of children and young adult (CYA) patients or their parents during this period is not well known.

External web link - https://link.springer.com/article/10.1007/s00467-021-05041-8