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The views of the children and young people experiencing Extended School Non‐Attendance difficulties are scarcely represented in the literature. This systematic literature review provides a much needed overview of the existing research evidence through a detailed synthesis of the lived experiences of persistently non‐attending young people, using a meta‐ethnographic approach. Ten qualitative, UK‐based papers were selected and analysed, each of which focused specifically on the direct views of school non‐attenders. Using Noblit and Hare's seven‐step approach, the analysis generated seven themes: (1) difficult relationships with peer group; (2) inconsistent relationships with and support from adults; (3) negative experiences of school transition; (4) negative experiences of learning in school; (5) emotional wellbeing and mental health needs; (6) others' negative perceptions of the individual's needs; (7) personal beliefs about attendance. Through reciprocal translation of these themes, the overarching higher‐order concept was developed relating to the impact of a sense of school belonging. The implications of this review include an enhanced emphasis on the need to gather young people's views early and to use their preferred terminology when discussing their difficulties. While outside the scope of this paper, further research should look to the translation into policy and practice in this area. [ABSTRACT FROM AUTHOR]

In this paper, we study the evolution of age‐group‐ and gender‐specific mortality and mortality inequality in England between 2003 and 2016, by comparing small geographic areas ranked by deprivation and grouped into bins of similar population size. We show that across all age groups, but especially in the older age groups (65+), there has been a clear and significant reduction in rates of mortality since 2003. In spite of these improvements, we continue to see significant inequalities in mortality across most age groups in 2016 and evidence of rising inequalities among women in the 65+ and men in the 80+ age groups. Furthermore, we see a striking stalling of the downwards trend in mortality and mortality inequality observed between 2003 and 2010 during the years of economic austerity in the aftermath of the 2008 financial crisis in England between 2010 and 2016. Analysis of specific causes of death among adults aged 20–79 allows us to examine the drivers and dynamics of these trends in more depth, as well as to consider scope for, and types of, interventions that would be appropriate at different ages. [ABSTRACT FROM AUTHOR]

This paper develops an intelligent real-time learning framework for the last-mile delivery of mobility as a service in city planning, based upon safe infrastructure use. Through a hybrid approach integrating statistics and supervised machine learning techniques, knowledge-driven solutions based on the specific user rather than generalized safe mobility practices are suggested. One of the most important aspects influencing transport mode and route selection, and safe infrastructure usage, i.e., the age of the user, is simulated. This is because this variable has been described in the literature as a significant variable. Nonetheless, few works deal with such modelling or the learning system. The learning system was applied in the Northumbria region of England's northeast as a case study. It comprised four building toolkits: (a) Input toolkit, (b) Safety Predictive toolkit, (c) Variable causation toolkit, and (d) Route choice toolkit. An accurate dynamic road safety model and understanding of the critical parameters influencing bicycle rider safety is created. The developed deep learning model's average distinguishing power to reliably predict the riskiest age group was 95%, with a standard deviation of 0.02, suggesting a good prediction accuracy across all age groups. According to the study's findings, different infrastructural networks represent varying risks to bicycle riders of different ages. The rider's age impacts how other road users engage with them. The regional diversity in trip intent and traffic flow conditions were significant elements influencing the safe use of infrastructure for a specific age group. The study's findings have the potential to considerably influence infrastructure route selection, modelling, and planning. The constructed model, which integrates the rider's fragility, sensitivity to externalities, and the varied safety impact dependent on its features, may even be used for the infrastructure still in the planning/design phase. It is envisaged that this research would aid in adopting sustainable (green) transportation options and the last-mile delivery of mobility as a service. Future work should aim to uncover the sensitivities of a rider from different countries and make a baseline comparison scenario. [ABSTRACT FROM AUTHOR]

This paper evaluates traineeships, a voluntary programme of work placement and preparation that aims to help young unemployed people in England compete for jobs and apprenticeships. Applying the method of local instrumental variables to administrative data, we estimate the marginal treatment effects on apprenticeship take‐up and employment. The heterogeneous impacts are then aggregated to form an estimate of the average impact of treatment for all participants. The results suggest that, among younger trainees, participation increases the probability of becoming an apprentice and that this holds across the distribution of unobserved heterogeneity. For older trainees, we find no significant effect on the probability of becoming an apprenticeship on average but some evidence of a negative effect among those more resistant to participating. We find no effects on employment for either age group. [ABSTRACT FROM AUTHOR]

In this short paper, I start with a case study – about how elementary school children in the early twentieth century in England understood their responsibilities vis-à-vis family (and school). This example provides a window into a past which deeply contrasts with present-day children's and adults' understandings and lives. I go on to consider (very briefly, for the field is vast) how ideas about childhood changed in the interwar years and how, since then, children have become locked into educational establishments – as well as into families. It seems to me that in these circumstances we are not used to thinking of children as thoughtful and active members of society. So it is no surprise to me that adults do not look to inter-relations with children as key variables towards understanding the social order. I note that my emphasis is on the UK, since I know most about that! [ABSTRACT FROM AUTHOR]

This article enquires about why some countries have specialised their further education provision more than others, focusing on three types of specialisation: by subject, by geographical area and by age group. The article proposes an analytical framework to understand the drivers for further education provider specialisation, based on four variables: inputs to the further education system, regulatory framework, demand and supporting clusters. It then applies this framework to review the experience of Germany, New Zealand and the Netherlands in recent years. Drawing on this review, the last section of the paper provides some lessons for England and issues for further debate. It is concluded that the model proposed helps to explain the evolution of provider specialisation in the countries covered and that the UK's current specialisation profile suggests that greater efforts should be made to increase geographical specialisation, whereas action in stimulating further specialisation by subject and age group should be subject to caveats. [ABSTRACT FROM AUTHOR]

Smoking has been identified as the second greatest risk factor for global death and disability and has impacts on the oral cavity from aesthetic changes to fatal diseases such as oral cancer. The paper presents a secondary analysis of the National Adult Dental Health Survey (2009). The analysis used descriptive statistics, bivariate analyses and logistic regression models to report the self-reported oral health status and dental attendance of smokers and non-smokers in England. Of the 9,657 participants, 21% reported they were currently smoking. When compared with smokers; non-smokers were more likely to report ‘good oral health’ (75% versus 57% respectively, p<0.05). Smokers were twice as likely to attend the dentist symptomatically (OR = 2.27, CI = 2.02–2.55) compared with non-smoker regardless the deprivation status. Smokers were more likely to attend symptomatically in the most deprived quintiles (OR = 1.99, CI = 1.57–2.52) and perceive they had poorer oral health (OR = 1.77, CI = 1.42–2.20). The present research is consistent with earlier sub-national research and should be considered when planning early diagnosis and management strategies for smoking-related conditions, considering the potential impact dental teams might have on smoking rates. [ABSTRACT FROM AUTHOR]

Mathematical and statistical models can be used to make predictions of how epidemics may progress in the near future and form a central part of outbreak mitigation and control. Renewal equation based models allow inference of epidemiological parameters from historical data and forecast future epidemic dynamics without requiring complex mechanistic assumptions. However, these models typically ignore interaction between age groups, partly due to challenges in parameterising a time varying interaction matrix. Social contact data collected regularly during the COVID-19 epidemic provide a means to inform interaction between age groups in real-time. We developed an age-specific forecasting framework and applied it to two age-stratified time-series: incidence of SARS-CoV-2 infection, estimated from a national infection and antibody prevalence survey; and, reported cases according to the UK national COVID-19 dashboard. Jointly fitting our model to social contact data from the CoMix study, we inferred a time-varying next generation matrix which we used to project infections and cases in the four weeks following each of 29 forecast dates between October 2020 and November 2021. We evaluated the forecasts using proper scoring rules and compared performance with three other models with alternative data and specifications alongside two naive baseline models. Overall, incorporating age interaction improved forecasts of infections and the CoMix-data-informed model was the best performing model at time horizons between two and four weeks. However, this was not true when forecasting cases. We found that age group interaction was most important for predicting cases in children and older adults. The contact-data-informed models performed best during the winter months of 2020–2021, but performed comparatively poorly in other periods. We highlight challenges regarding the incorporation of contact data in forecasting and offer proposals as to how to extend and adapt our approach, which may lead to more successful forecasts in future. Author summary: Short term epidemic forecasts help policy makers to plan and implement response activities. It can be useful to have such forecasts separately for different age groups, in order to reflect potential differences in transmission and incidence of infection between age groups as well as differences in risk of severe disease or death. A key challenge in developing age-specific models is understanding how different age-groups interact. We used data collected during a large-scale weekly survey of social contacts in the UK to inform this interaction in a model for short-term forecasts of COVID-19. To assess whether allowing interaction between age-groups and the use of contact data improved forecasts, we compared our forecasts to those from a set of models that either didn't use current contact data or treated each age group as a separate population. We found that including timely contact data improved predictions when forecasting two to four weeks into the future, but this improvement was not consistent throughout the epidemic. The best improvement was measured during a long national "lockdown". We also found that inclusion of age-group interaction and use of contact data were most important when forecasting infections in older adults and young children. [ABSTRACT FROM AUTHOR]

In an ageing society older people have a growing influence on politics in general, and potentially on the acceptability of road charging in particular. They face specific types of risk of transport-related social exclusion which may influence their views on charging, although there is also evidence to suggest that older people favour, more than any other age group, what is positively valued by society - a process known as 'pro-social value orientation'. Family and friends may also affect older people's considerations about their intentions and choices - thus the importance of studying the influence of 'social norms' on older people's attitudes to road charging. The paper develops our understanding of these issues, based on the findings of a quantitative survey conducted in Bristol, UK. Evidence indicates that the attitudes of older people to road charging do differ from those of younger people and that pro-social value orientations and social norms do contribute to the formation of these attitudes. It is concluded that the presence of pro-social attitude orientations assists in explaining why people assumed to be 'natural supporters' of charging schemes may hold negative attitudes, which underlines to scheme promoters the importance of understanding and overcoming strongly held, psychologically complex objections. [ABSTRACT FROM AUTHOR]

Background: Peer support interventions can improve carer wellbeing and interventions that engage both the carer and person with dementia can have significant mutual benefits. Existing research has been criticised for inadequate rigour of design or reporting. This paper describes the protocol for a complex trial that evaluates one-to-one peer support and a group reminiscence programme, both separately and together, in a factorial design.Design: A 2 × 2 factorial multi-site randomised controlled trial of individual peer support and group reminiscence interventions for family carers and people with dementia in community settings in England, addressing both effectiveness and cost-effectiveness.Discussion: The methods described in this protocol have implications for research into psychosocial interventions, particularly complex interventions seeking to test both individual and group approaches. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to investigate relationships between reported alcohol consumption and exposure to alcohol advertising. Design/methodology/approach - A survey of young people (17-21 years) was carried out in which they were questioned about their alcohol consumption habits, types of alcohol they consume, exposure to alcohol advertising, and a range of other factors linked to drinking (e.g. parental and peer groups alcohol-related behavior and attitudes). General alcohol consumption was measured within three time-frames: own lifetime, past year and past month. Findings - The results showed no significant relationships between exposure to any type of alcohol advertising (cinema, magazine, TV) and general alcohol consumption. Exposure to televised advertising for alcopops and for cider in each case emerged as a significant predictor of consumption of each of those types of alcohol. While there was no evidence that alcohol advertising plays a significant role in shaping general alcohol consumption among young people, it does seem to play a part in driving consumption of certain types of alcoholic beverage. Research limitations/implications - Self-completion questionnaires were used and the sample was based in central east England. Practical implications - The results can inform current debates about the role of advertising in young people's drinking. Originality/value - A wider range of alcohol-related consumption and alcohol advertising exposure behaviors was examined in this study than in most other published surveys that have investigated relationships between these classes of variables. [ABSTRACT FROM AUTHOR]

Background Few studies describe the epidemiology of childhood acute kidney injury (AKI) nationally. Laboratories in England are required to issue electronic (e-)alerts for AKI based on serum creatinine changes. This study describes a national cohort of children who received an AKI alert and their clinical course. Methods A cross-section of AKI episodes from 2017 are described. Hospital record linkage enabled description of AKI-associated hospitalizations including length of stay (LOS) and critical care requirement. Risk associations with critical care (hospitalized cohort) and 30-day mortality (total cohort) were examined using multivariable logistic regression. Results In 2017, 7788 children (52% male, median age 4.4 years, interquartile range 0.9–11.5 years) experienced 8927 AKI episodes; 8% occurred during birth admissions. Of 5582 children with hospitalized AKI, 25% required critical care. In children experiencing an AKI episode unrelated to their birth admission, Asian ethnicity, young (<1 year) or old (16–<18 years) age (reference 1–<5 years), and high peak AKI stage had higher odds of critical care. LOS was higher with peak AKI stage, irrespective of critical care admission. Overall, 30-day mortality rate was 3% (n =  251); youngest and oldest age groups, hospital-acquired AKI, higher peak stage and critical care requirement had higher odds of death. For children experiencing AKI alerts during their birth admission, no association was seen between higher peak AKI stage and critical care admission. Conclusions Risk associations for adverse AKI outcomes differed among children according to AKI type and whether hospitalization was related to birth. Understanding the factors driving AKI development and progression may help inform interventions to minimize morbidity. [ABSTRACT FROM AUTHOR]

Age identities are a product of negotiation between acquaintances and intimates. The negotiation takes place against a background of assumptions about appropriate ways of moving through the life span. This study of ageing in the context of an English church shows how organisational needs must be taken into account in understanding the ageing strategies of participants. The paper is based on fieldwork conducted in the south of England in 1985-6. The analysis draws on the literature of social gerontology which is mainly American. It is part of a larger ESRC-funded study of the social construction of old age in Britain. [ABSTRACT FROM AUTHOR]

Haemophagocytic lymphohistiocytosis (HLH) is a lethal syndrome of excessive immune activation. We undertook a nationwide study in England of all cases of HLH diagnosed between 2003 and 2018, using linked electronic health data from hospital admissions and death certification. We modelled interactions between demographics and comorbidities and estimated one-year survival by calendar year, age group, gender and comorbidity (haematological malignancy, auto-immune, other malignancy) using Cox regression. There were 1628 people with HLH identified. Overall, crude one-year survival was 50% (95% Confidence interval 48–53%) which varied substantially with age (0–4: 61%; 5–14: 76%; 15–54: 61%; > 55: 24% p < 0.01), sex (males, 46%, worse than females, 55% p < 0.01) and associated comorbidity (auto-immune, 69%, haematological malignancy 28%, any other malignancy, 37% p < 0.01). Those aged < 54 years had a threefold increased risk of death at 1-year amongst HLH associated with malignancy compared to auto-immune. However, predicted 1-year survival decreased markedly with age in those with auto-immune (age 0–14, 84%; 15–54, 73%; > 55, 27%) such that among those > 55 years, survival was as poor as for patients with haematological malignancy. One-year survival following a diagnosis of HLH varies considerably by age, gender and associated comorbidity. Survival was better in those with auto-immune diseases among the young and middle age groups compared to those with an underlying malignancy, whereas in older age groups survival was uniformly poor regardless of the underlying disease process. [ABSTRACT FROM AUTHOR]

Background: More deprived populations typically experience higher cancer incidence rates and smoking prevalence compared to less deprived populations. We calculated the proportion of cancer cases attributable to smoking by socio-economic deprivation in England and estimated the impact smoking has on the deprivation gap for cancer incidence. Methods: Data for cancer incidence (2013–2017), smoking prevalence (2003–2007) and population estimates (2013–2017) were split by sex, age-group and deprivation quintile. Relative risk estimates from meta-analyses were used to estimate the population attributable fraction (PAF) for 15 cancer types associated with smoking. The deprivation gap was calculated using age-specific incidence rates by deprivation quintile. Results: Smoking-related cancer PAFs in England are 2.2 times larger in the most deprived quintile compared to the least deprived quintile (from 9.7% to 21.1%). If everyone had the same smoking prevalence as the least deprived quintile, 20% of the deprivation gap in cancer incidence could have been prevented. If nobody smoked, 61% of the deprivation gap could have been prevented. Conclusions: The majority of the deprivation gap in cancer incidence could have been prevented in England between 2013–2017 if nobody had smoked. Policy makers should ensure that tobacco control policies reduce overall smoking prevalence by tackling smoking inequalities. [ABSTRACT FROM AUTHOR]

Background: Adult primary immune thrombocytopenia (ITP) is a rare bleeding disorder of unknown cause. Recent estimates of its incidence and trend over time were acquired for England. Method: The primary ITP population (using ICD 10 code D693 and excluding secondary ITP cases; positive predictive value: 82.6%) was sourced from NHS Digital inpatient and outpatient. Incidence rate (IR) for England and by age groups, sex, and regions were calculated and trends were assessed using average annual percent change (AAPC). Results: A total of 25 805 patients (mean age 59 years; females 57.8%) diagnosed between 2003 and 2014 was identified. IRs increased from 4.2/100 000 to 6.4/100 000 over this period (AAPC:4.3%). For all sex‐specific age groups, the IRs significantly increased over time, except 18–29 years males. The greatest increase was among females aged 30–39 (AAPC:8.7%). In contrast, among ≥70 years, ITP was more common in males (highest IR among ≥80 years males: 23.9/100 000). England's average annual IR was 6.1/100 000 for 2010–14. An estimated 2.5/100 000 (based on UKITP Registry data) was estimated to require 1st line treatment whereas 2.4/100 000 would have 1st and 2nd line treatments within 6 months from diagnosis. IRs for London and East Midlands were the highest (6.5/100 000). Conclusions: This study found a rising incidence of primary ITP, with sharp increases among young women and elderly men. These findings put in context the impact of ITP on patients' lives and the healthcare services in England, especially with 17%–50% who may develop chronic ITP and require long‐term care. [ABSTRACT FROM AUTHOR]

Objective: This study uses three linked datasets to provide an estimate of incidence of motor neuron disease (MND) in England from 1998 to 2019. Comparison is made to previous British studies. It examines age at diagnosis and ethnicity of those affected. Methods: The literature was searched for studies of MND incidence in Great Britain from 1995 to date. The QResearch and linked Hospital Episode Statistics and Death register databases were searched from 1998 to 2019 for cases of MND, and incidence calculated from 16.8 million adults and 112 million adult years of data. Results: We found 6437 adults with a diagnosis of MND giving an incidence of MND of 5.69/100,000 person years (95% CI 5.51–5.88); 6.57 (6.41–6.99) in men and 4.72 (4.49–4.97) in women when age-standardized to the 2011 UK population. The median age of diagnosis was 72 years. Peak incidence occurred in the 80–84 year age group in men and 75–79 in women. Age-standardized incidence was as high in Bangladeshi, Black Caribbean, Indian, other Asian and Pakistani people as in White people. Black African and Chinese people had a lower incidence. Conclusion: The use of three linked national datasets captured 33% more people than a primary care dataset alone. Patients were older than in previous studies and rates were high in all ethnic groups studied except Black African and Chinese people. We present the highest incidence of MND reported globally in the past 50 years. Methodological differences may in part explain differences with previous reports. The use of national datasets may have captured additional MND patients with serious comorbidities who have not seen a neurologist before death. A limitation of this approach is that unlike population registers, which minimize false positive diagnosis by neurologist review of each patient, we cannot review diagnosis for individuals as data are anonymized. [ABSTRACT FROM AUTHOR]

Background: Varicose vein (VV) treatments have changed significantly in recent years leading to potential disparities in service provision. The aim of this study was to examine the trends in VV treatment in England and to identify disparities in the provision of day-case and inpatient treatments related to deprivation, ethnicity, and other demographic, and geographical factors. Method: A population-based study using linked hospital episode statistics for England categorized VV procedures and compared population rates and procedure characteristics by ethnicity, deprivation quintile, and geographical area. Results: A total of 311 936 people had 389 592 VV procedures between 2006/07 and 2017/18, with a further 63 276 procedures between 2018/19 and 2020/21. Procedure rates have reduced in all but the oldest age groups, whereas endovenous procedures have risen to more than 60 per cent of the total in recent years. In younger age groups there was a 20-30 per cent reduction in procedure rates for the least-deprived compared with the most-deprived quintiles. Non-white ethnicity was associated with lower procedure rates. Large regional and local differences were identified in standardized rates of VV procedures. In the most recent 5-year interval, the North-East region had a three-fold higher rate than the South-East region with evidence of greater variation between commissioners in overall rates, the proportion of endovenous procedures, and policies regarding bilateral treatments. Conclusions: There are substantial geographical variations in the provision of treatment for VVs, which are not explained by demographic differences. These have persisted, despite the publication of guidelines from the National Institute for Health and Care Excellence, and many commissioners, and providers would seem to implement policies that are contrary to this guidance. Lower rates of procedures in less-deprived areas may reflect treatments carried out in private practice, which are not included in these data. [ABSTRACT FROM AUTHOR]

According to the Crime Survey for England and Wales, violence fell dramatically between 1995 and 2013/14. To improve understanding of the fall in violent crime, this study examines long-term crime trends in England and Wales over the past two decades, by scrutinizing the trends in (a) stranger and acquaintance violence, (b) severity of violence, (c) age groups, and (d) sexes. It draws on nationally representative, weighted data from the Crime Survey for England and Wales, and examines prevalence, incidence and crime concentration trends. The overall violence fall was driven by a decline in the victimization of young individuals and/or males perpetrated by acquaintances since 1995. Stranger and acquaintance violence followed different trajectories, with the former beginning to drop post 2003/4. Falls in both stranger and acquaintance violence incidence rates were led by a reduction in victims over time. Counting all incidents reported by the same victim (instead of capping at five incidents) significantly affects trends in stranger violence but not in acquaintance violence. In relation to the distributive justice within the crime drop, this study provides unique evidence of equitable falls in acquaintance violence but inequitable falls in stranger violence. These findings highlight the need to examine violence types separately and point to a number of areas for future research. [ABSTRACT FROM AUTHOR]

Background: Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all MI rates emerge from competing trends in risk factors and treatment. Materials and methods: microPRIME is a microsimulation of MI events within a sample of 114,000 agents representative of England. We simulate 37 annual time points from 1998 to 2035, where agents can have an MI event, die from an MI, or die from an unrelated cause. The probability of each event is a function of age, sex, BMI, blood pressure, cholesterol, smoking, diabetes and previous MI. This function does not change over time. Instead population-level changes in MI rates are due to competing trends in risk factors and treatment. Uncertainty estimates are based on 450 model runs that use parameters calibrated against external measures of MI rates between 1999 and 2011. Findings: Forecasted MI incidence rates fall for men and women of different age groups before plateauing in the mid 2020s. Age-standardised event rates show a similar pattern, with a non-significant upturn by 2035, larger for men than women. Prevalence in men decreases for the oldest age groups, with peaks of prevalence rates in 2019 for 85 and older at 25.8% (23.3–28.3). For women, prevalence rates are more stable. Prevalence in over 85s is estimated as 14.5% (12.6–16.5) in 2019, and then plateaus thereafter. Conclusion: We may see an increase in event rates from MI in England for men before 2035 but increases for women are unlikely. Prevalence rates may fall in older men, and are likely to remain stable in women over the next decade and a half. [ABSTRACT FROM AUTHOR]

The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups. In this retrospective cohort study, the authors investigate the risk of hospitalisation and death for all adults in England who tested positive for COVID-19 from October 2020–April 2021. They find that the risk of hospitalisation and death varied substantially over time after taking into account individual risk factors. [ABSTRACT FROM AUTHOR]

It is well known that children of immigrants experience inequality. Less is known about how inequalities compare across multiple life domains and multiple generations. We conduct a case study of England and Wales, focussing on children of Caribbean immigrants (the 'Windrush generation'). We use large-scale census data to compare inequalities across five domains of life—education, employment, occupation, housing, and health—separately for women and men across three distinct generations: the one-point-five generation, second-generation, and two-point-five generation. The children of the Windrush generation experience social inequality in all life domains, relative to comparable groups of the White British population, although there is considerable variation according to sex and generation. Men of all generations are uniformly disadvantaged; children of the Windrush are more disadvantaged if they belong to the two-point-five generation. Inequality is pervasive, persistent, and strongly indicative of segmented adaptation. [ABSTRACT FROM AUTHOR]

A plethora of research shows that income is an important factor in adult's life satisfaction, but research ascertaining its importance for children's life satisfaction is scant. Using a largescale nationally representative longitudinal survey with children aged 10–15, we estimate comprehensive life satisfaction models that account for heterogeneity in exogenous circumstances in children's lives, focussing on family income and material deprivation. We find empirical support for the hypothesis that children are more satisfied with their lives, the more income their family has and the less material deprivation they experience throughout their teens. There are, however, differences across age groups with children aged 12–15 experiencing greater life satisfaction losses on account of lower family material wellbeing than younger children. Overall, income effects for older children are small but statistically significant when accounting for unobserved individual differences. [ABSTRACT FROM AUTHOR]

In this paper we examine the fire injuries sustained by householders fighting accidental dwelling fires in Merseyside in the North West of England over the period 2006 to 2016. In particular, we examine the distribution of injuries sustained by householders fighting accidental dwelling fires by age, gender, and level of deprivation, the types of housing in which injuries related to householders fighting fires occurred, and the types of injuries associated with householders fighting such fires. Injuries sustained by householders fighting accidental dwelling fires made up a significant proportion (19.5%) of the overall set of fire injuries over the period studied. Overall, it appeared that males were twice as likely to be injured fighting an accidental dwelling fire compared to females, however, this ratio varied between different age groups. In addition, single occupancy housing appeared to be the most common housing type in which householders sustained injuries fighting accidental dwelling fires. There also appeared to be a strong link between level of deprivation and incidents of householders being injured fighting such fires. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is a common seasonal respiratory virus and an important cause of illness among infants, but the burden of RSV disease is not well described among the older population. The objective of this study was to estimate the age‐specific incidence of hospital admission among over 65 s due to respiratory illnesses attributable to RSV in England to inform optimal vaccine and therapeutic interventions. We used linear multiple regression to examine the effect of changes in weekly counts of respiratory pathogens on the weekly counts of respiratory hospital admissions. The study population was all patients aged 65 years or over admitted to English hospitals between 2nd August 2010 and 30th July 2017. RSV was estimated to account for a seasonal annual average of 71 (95% CI 52–90) respiratory admissions per 100 000 in adults age 65–74 and 251 (95% CI 186–316) admissions per 100,000 adults age 75+. Pneumococcus was the pathogen responsible for highest annual average respiratory admission with 448 (95% CI 310–587) admissions per 100,000 adults age 65–74 and 1010 (95% CI 527–1493) admissions per 100,000 adults aged 75+. This study shows that RSV continues to exert a significant burden of disease among older adults in England. These findings will support development of policy for the use of RSV therapeutics and vaccines in this age group. [ABSTRACT FROM AUTHOR]

Background Peer-marking has been suggested as a method to enhance self-directed learning and reflection, although whether this improves performance is unclear. This study evaluated the impact of peer-marking on examination performance and investigated its reliability and acceptability to students. Methods First-year medical students were randomised to peer-marking using a model answer or no intervention (control arm). Student scores were compared with tutor-marked scores. Two months later, students completed a summative assessment and performance was compared between students randomised to peer-marking and the control arm. A focus group was held with students in the intervention arm to capture their experiences and attitudes. Results A total of 289 of 568 students consented to participate and 147 were randomised to peer-marking (142 controls). Students randomised to peer-marking achieved marginally higher examination marks (1.5% difference, 95% CI −0.8% to 3.9%, P = 0.19) than controls (adjusting for year and in-course assessment), although this may have been due to chance. Students were harsher markers than the tutors. Focus group analysis suggested that students valued peer-marking, although concerns about passing judgement on a colleague's work were expressed. Conclusions Peer-marking did not have a substantial effect on examination performance, although a modest effect cannot be excluded. Students gained insight into examination technique but may not have gained deeper knowledge. Given its potential positive educational value, further work is required to understand how peer-marking can be used more effectively to enhance the learning experience. [ABSTRACT FROM AUTHOR]

Aim: The aim was to describe changes in incidence and mortality from colorectal cancer (CRC) in England by analysing data available from the National Cancer Registration and Analysis Service (NCRAS, 2001–2017). Methods: Data analysis was undertaken to interpret trends and patterns in age‐standardized incidence and death rates from CRC, including sub‐analyses by six age groups (0–24, 25–49, 50–59, 60–69, 70–79, 80+) and three sites of cancer—colonic, rectosigmoid and rectal. Results: Overall CRC incidence remained relatively stable—70.1 cases per 100 000 individuals (95% CI 69.3–71.0) in 2001 and 68.8 cases (95% CI 68.0–69.5) in 2017. Sub‐analysis demonstrates a quarter fewer incidence of rectosigmoid cancer (−27%). This is counterbalanced by a 3% rise in colon cancers. The age‐standardized incidence rate of CRC increased by 59% in the 25–49 age group. In the over 50s, CRC incidence remained stable, with reductions seen in rectosigmoid cancer (50–59 years, −19%; 60–69, −26%; 70–79, −39%; 80+, −27%). Overall, mortality improved (−18.7%), primarily as a result of the reduction in deaths from colon (−31.6%) and rectal cancers (−25.1%). Deaths from the small incident number of rectosigmoid cancers, however, demonstrated a significant increase overall (+166.7%). Grouped age‐standardized death rate analyses showed increasing death rates in the under 50s (+28.3%) compared to declining rates in the over 50s (−15.8%). Conclusions: There is a clear trend in increased incidence and mortality in individuals under 50 years old. There is also a trend to increased mortality from rectosigmoid cancer. These findings should have implications for national screening programme extension to under 50s and a call to arms for appropriate identification, staging and treatment of rectosigmoid cancers. [ABSTRACT FROM AUTHOR]

The time-varying reproduction number (Rt: the average number of secondary infections caused by each infected person) may be used to assess changes in transmission potential during an epidemic. While new infections are not usually observed directly, they can be estimated from data. However, data may be delayed and potentially biased. We investigated the sensitivity of Rt estimates to different data sources representing COVID-19 in England, and we explored how this sensitivity could track epidemic dynamics in population sub-groups. We sourced public data on test-positive cases, hospital admissions and deaths with confirmed COVID-19 in seven regions of England over March through August 2020. We estimated Rt using a model that mapped unobserved infections to each data source. We then compared differences in Rt with the demographic and social context of surveillance data over time. Our estimates of transmission potential varied for each data source, with the relative inconsistency of estimates varying across regions and over time. Rt estimates based on hospital admissions and deaths were more spatio-temporally synchronous than when compared to estimates from all test positives. We found these differences may be linked to biased representations of subpopulations in each data source. These included spatially clustered testing, and where outbreaks in hospitals, care homes, and young age groups reflected the link between age and severity of the disease. We highlight that policy makers could better target interventions by considering the source populations of Rt estimates. Further work should clarify the best way to combine and interpret Rt estimates from different data sources based on the desired use. [ABSTRACT FROM AUTHOR]

Along the macro‐tidal (10.7 m tide range) SW Cumbria coast in situ rooted tree stumps are infrequently exposed below present‐day low Spring Tide elevations (≤−4.5 m OD). To date these remnants, we conducted a salvage operation at two sites on in situ rooted tree stumps exposed below the lowest tide levels; these sites are no longer exposed. We obtained four radiocarbon dates on these tree remnants and reference an earlier site recovered in 1972. One wood sample was identified as Quercus robur or Q. petraea, while samples from Haverigg and Kirby‐in‐Furness are tree Salix spp. The median group age for the rising relative sea level (RSL) that killed the trees was 8602 ± 243 bp cal a bp with an estimated Mean Tide Level (MTL) of ~≤−9 m. Evidence indicates that RSL rose ~10 m along this section of coast at a rate of between of between 18.5 and 8.7 mm a–1 until ~6800 cal a bp, or earlier, before the rate of global sea level rise fell below that of the local glacial isostatic recovery. The transgression is coeval with rapid collapse and deglaciation of the Laurentide Ice Sheet in Hudson's Bay and slightly lags the global Meltwater Pulse‐1C. [ABSTRACT FROM AUTHOR]

Background: Whilst eczema is a common inflammatory skin condition, we lack contemporary estimates of disease incidence and prevalence across the lifespan. Objective: To estimate the incidence and prevalence of eczema in children and adults in England and variation by sociodemographic factors (sex, socio‐economic status, ethnicity, and geography). Methods: We used the Royal College of General Practitioners Research and Surveillance Centre primary care research database of 3.85 million children and adults registered with participating general practitioner practices between 2009 and 2018 inclusive. Eczema incidence was defined as the first‐ever diagnosis of eczema recorded in the primary care record, and eczema prevalence was defined as fulfilment of criteria for active eczema (two eczema records appearing in the primary care record within any one‐year period). Results: Eczema incidence was highest in infants younger than 1 year (15.0 per 100 person‐years), lowest in adults aged 40–49 (0.35 p/100 person‐years), and increased from middle age to a second smaller peak in people 80 years or older (0.79 p/100 person‐years). Eczema prevalence was highest in children aged 2 (16.5%) and lowest in adults aged 30–39 (2.8%). Eczema incidence was higher in male infants (<2) and male adults older than 70; for all other ages, incidence was higher in females. Eczema was more common in Asian and black ethnic groups than in people of white ethnicity. Higher socio‐economic status was associated with a greater incidence of eczema in infants younger than 2, but the reverse was seen for all other age groups. Both incidence and prevalence of eczema were greater in urban settings and in North‐West England. Conclusions and Clinical Relevance: Eczema has a bimodal distribution across the lifespan. We observed differences in incidence and prevalence of eczema by ethnicity, geography, sex, and socio‐economic status, which varied in magnitude throughout life. [ABSTRACT FROM AUTHOR]

Infant facial features are typically perceived as "cute," provoking caretaking behaviours. Previous research has focused on adults' perceptions of baby cuteness, and examined how these perceptions are influenced by events of the adult reproductive lifespan, such as ovulation and menopause. However, globally, individuals of all ages, including pre‐pubertal children, provide notable proportions of infant care. In this study, we recruited participants in and around northern England, and tested 330 adults and 65 children aged 7–9 using a forced‐choice paradigm to assess preferences for infant facial cuteness in two stimulus sets and (as a control task) preferences for femininity in women's faces. We analysed the data with Hierarchical Bayesian Regression Models. The adults and children successfully identified infants who had been manipulated to appear cuter, although children's performance was poorer than adults' performance, and children reliably identified infant cuteness in only one of the two infant stimuli sets. Children chose the feminised over masculinised women's faces as more attractive, although again their performance was poorer than adults' performance. There was evidence for a female advantage in the tasks: girls performed better than boys when assessing the woman stimuli and one of the infant stimulus sets, and women performed better than men when assessing one of the infant stimulus sets. There was no evidence that cuteness judgements differed depending upon exposure to infants (children with siblings aged 0–2; adults with a baby caregiving role), or depending upon being just younger or older than the average age of menopause. Children and grandparents provide notable portions of infant caretaking globally, and cuteness perceptions could direct appropriate caregiving behaviour in these age groups, as well as in adults of reproductive age. [ABSTRACT FROM AUTHOR]

Background: Early studies of narcolepsy after AS03-adjuvanted pandemic A/H1N12009 vaccine (Pandemrix) could not define the duration of elevated risk post-vaccination nor the risk in children aged under 5 years who may not present until much older.Methods/findings: Clinical information and sleep test results, extracted from hospital notes at 3 large pediatric sleep centers in England between September 2017 and June 2018 for narcolepsy cases aged 4-19 years with symptom onset since January 2009, were reviewed by an expert panel to confirm the diagnosis. Vaccination histories were independently obtained from general practitioners (GPs). The odds of vaccination in narcolepsy cases compared with the age-matched English population was calculated after adjustment for clinical conditions that were indications for vaccination. GP questionnaires were returned for 242 of the 244 children with confirmed narcolepsy. Of these 5 were under 5 years, 118 were 5-11 years, and 119 were 12-19 years old at diagnosis; 39 were vaccinated with Pandemrix before onset. The odds ratio (OR) for onset at any time after vaccination was 1.94 (95% confidence interval [CI] 1.30-2.89), The elevated risk period was restricted to onsets within 12 months of vaccination (OR 6.65 [3.44-12.85]) and was highest within the first 6 months. After one year, ORs were not significantly different from 1 up to 8 years after vaccination. The ORs were similar in under five-year-olds and older ages. The estimated attributable risk was 1 in 34,500 doses. Our study is limited by including cases from only 3 sleep centers, who may differ from cases diagnosed in nonparticipating centers, and by imprecision in defining the centers' catchment population. The potential for biased recall of onset shortly after vaccination in cases aware of the association cannot be excluded.Conclusions: In this study, we found that vaccine-attributable cases have onset of narcolepsy within 12 months of Pandemrix vaccination. The attributable risk is higher than previously estimated in England because of identification of vaccine-attributable cases with late diagnoses. Absence of a compensatory drop in risk 1-8 years after vaccination suggests that Pandemrix does not trigger onsets in those in whom narcolepsy would have occurred later. [ABSTRACT FROM AUTHOR]

In the early 2000s, many police forces in England and Wales set up independent advisory groups (IAGs) following an inquiry into the flawed investigation of the murder of a black teenager, Stephen Lawrence, by London's Metropolitan Police. Members of IAGs were to act as critical friends of the police providing independent advice on policies, procedures and practices, thus ensuring that no section of their local community was disadvantaged through a lack of understanding, ignorance or mistaken beliefs. Based on a case study of an IAG in an English police force, this article reviews the operation of IAGs following the radical changes made to police governance by the introduction of directly elected police and crime commissioners (PCCs). Its main argument is that more thought needs to be given to the role of IAGs in this new landscape and urgent steps taken to clarify their relationships with police forces and PCCs. [ABSTRACT FROM AUTHOR]

This paper summarises work undertaken on behalf of the Environment Agency for England to quantify uncertainties resulting from internal exposures to a number of radionuclides considered significant because of their anthropogenic origin, namely: 238U, 226Ra, 239Pu, 241Am, 137Cs, 90Sr, 131I, 129I and 3H. Uncertainties in the biokinetic models that are used to calculate the retention and excretion of radionuclides are derived in order to calculate distributions of effective dose per unit intake following their inhalation or ingestion by members of the UK public. The central values and ranges of the distributions are used to inform the derivation of uncertainty factors (UFs) for the different dose coefficients, which can be used to assess reliability. These represent uncertainties inherent in the structures of the biokinetic models and their parameter values. The inferred UF values are typically around 2–3 for ingestion and 2–6 for inhalation for all age groups, and are comparable to UF values inferred from published studies. It is instructive to consider these ranges alongside the likely levels of exposure that are expected from the radionuclides considered (the microsievert range) and the dose limit of planned exposures for members of the public (1000 μSv). [ABSTRACT FROM AUTHOR]

Teachers in England are required to ensure that learners from the age of five are taught about algorithms and program design. Yet, there is evidence that despite teachers reporting that design is important, they are not converting this into classroom practice. This paper describes a survey study, in which we explored teachers' difficulties in using design. We surveyed 207 teachers asking them free-text questions on their use of design in teaching programming and their views of pupils' responses to using design. In the survey, we also investigated teachers' understanding of the term algorithm, an essential concept which may be a contributing factor in their difficulties with design. We provide underpinning data on the difficulties of using design that teachers of pupils aged from 5 to 11 years old (Grades K to 5) have in teaching programming. Difficulties with design identified include pupil resistance, a lack of time, a lack of pupil and teacher expertise, conflicting pedagogical choices and a general confusion over what an algorithm is. There were statistically significant differences in selection of the term 'algorithm' to describe programming artefacts whether a teacher was a specialist or a generalist, what training they had received on programming or design, the age group taught and programming language used. Teachers were more likely to call a complex code snippet an 'algorithm' than a simpler one and more likely to select the term to describe code snippets than a design artefact. We make suggestions of how to alleviate the problems including that teachers are introduced to the idea of ambiguous representations of algorithms and a process which refines the representation from ambiguous to unambiguous as the design progresses. • Pupils aged 5 to 11 are resistant to using design when programming. • Pupils aged 5 to 11 and their teachers lack expertise in program design. • Time constrains the teaching of design in programming lessons. • Conflicting pedagogy choices influence the teaching of design. • Teachers do not have shared understanding of the term algorithm. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to estimate incidence of self-harm presentations to hospitals and their associated hospital costs across England. Methods: We used individual patient data from the Multicentre Study of Self-harm in England of all self-harm presentations to the emergency departments of five general hospitals in Oxford, Manchester and Derby in 2013. We also obtained cost data for each self-harm presentation from the hospitals in Oxford and Derby, as well as population and geographical estimates from the Office for National Statistics. First, we estimated the rate of self-harm presentations by age and gender in the Multicentre Study and multiplied this with the respective populations to estimate the number of self-harm presentations by age and gender for each local Clinical Commissioning Group (CCG) area in England. Second, we performed a regression analysis on the cost data from Oxford and Derby to predict the hospital costs of self-harm in Manchester by age, gender, receipt of psychosocial assessment, hospital admission and type of self-harm. Third, the mean hospital cost per age year and gender were combined with the respective number of self-harm presentations to estimate the total hospital costs for each CCG in England. Sensitivity analysis was performed to address uncertainty in the results due to the extrapolation of self-harm incidence and cost from the Multicentre Study to England. Results: There were 228 075 estimated self-harm presentations (61% were female) by 159 857 patients in 2013 in England. The largest proportions of self-harm presentations were in the age group 40–49 years (30%) for men and 19–29 years (28%) for women. Associated hospital costs were approximately £128.6 (95% CI 117.8−140.9) million in 2013. The estimated incidence of self-harm and associated hospital costs were lower in the majority of English coastal areas compared to inland regions but the highest costs were in Greater London. Costs were also higher in more socio-economically deprived areas of the country compared with areas that are more affluent. The sensitivity analyses provided similar results. Conclusions: The results of this study highlight the extent, hospital costs and distribution of self-harm presentations to hospitals in England and identify potential sub-populations that might benefit from targeted actions to help prevent self-harm and assist those who have self-harmed. They can support national as well as local health stakeholders in allocating funds and prioritising interventions in areas with the greatest need for preventing and managing self-harm. [ABSTRACT FROM AUTHOR]

Background The objective of this study was to establish if renal transplant outcomes (graft and patient survival) for young adults in England were worse than for other age groups. Methods Outcomes for all renal transplant recipients in England (n  = 26 874) were collected from Hospital Episode Statistics and the Office for National Statistics databases over 12 years. Graft and patient outcomes, follow-up and admissions were studied for all patients, stratified by age bands. Results Young adults (14–23 years) had substantially greater likelihood [hazard ratio (HR) = 1.26, 95% confidence interval (CI) 1.10–1.19; P < 0.001] of kidney transplant failure than any other age band. They had a higher non-attendance rate for clinic appointments (1.6 versus 1.2/year; P < 0.001) and more emergency admissions post-transplantation (25% of young adults on average are admitted each year, compared with 15–20% of 34- to 43-year olds). Taking into account deprivation, ethnicity, transplant type and transplant centre, in the 14- to 23-year group, return to dialysis remained significantly worse than all other age bands (HR = 1.41, 95% CI 1.26–1.57). For the whole cohort, increasing deprivation related to poorer outcomes and black ethnicity was associated with poorer outcomes. However, neither ethnicity nor deprivation was over-represented in the young adult cohort. Conclusions Young adults who receive a kidney transplant have a significant increased likelihood of a return to dialysis in the first 10 years post-transplant when compared with those aged 34–43 years in multivariable analysis. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects. Additionally, multimorbidity is often negatively associated with participation in research cohorts. Therefore, we set out to identify clusters of multimorbidity patients and how they are differentially associated with mortality and service use across age groups in a population-representative sample.Methods: Linked primary and secondary care electronic health records contributed by 382 general practices in England to the Clinical Practice Research Datalink (CPRD) were used. The study included a representative set of multimorbid adults (18 years old or more, N = 113,211) with two or more long-term conditions (a total of 38 conditions were included). A random set of 80% of the multimorbid patients (N = 90,571) were stratified by age groups and clustered using latent class analysis. Consistency between obtained multimorbidity phenotypes, classification quality and associations with demographic characteristics and primary outcomes (GP consultations, hospitalisations, regular medications and mortality) was validated in the remaining 20% of multimorbid patients (N = 22,640).Results: We identified 20 patient clusters across four age strata. The clusters with the highest mortality comprised psychoactive substance and alcohol misuse (aged 18-64); coronary heart disease, depression and pain (aged 65-84); and coronary heart disease, heart failure and atrial fibrillation (aged 85+). The clusters with the highest service use coincided with those with the highest mortality for people aged over 65. For people aged 18-64, the cluster with the highest service use comprised depression, anxiety and pain. The majority of 85+-year-old multimorbid patients belonged to the cluster with the lowest service use and mortality for that age range. Pain featured in 13 clusters.Conclusions: This work has highlighted patterns of multimorbidity that have implications for health services. These include the importance of psychoactive substance and alcohol misuse in people under the age of 65, of co-morbid depression and coronary heart disease in people aged 65-84 and of cardiovascular disease in people aged 85+. [ABSTRACT FROM AUTHOR]

Objective: To assess the long-term impact of the increase in age-of-sale of cigarettes from 16 to 18 in England in October 2007.Methods: Data were collected between November 2006 and September 2018 on 252,601 participants taking part in a nationally representative survey of adults aged 16+ in England, the Smoking Toolkit Study (STS). We assessed the impact of the introduction of the increase in age-of-sale on prevalence of ever smoking, current smoking, and quit attempts, among 16-17 year olds compared with 18-24 year olds.Results: Following the increase in age-of-sale, there was a declining trend in ever smoking that was greater among 16-17 year olds than 18-24 year olds (OR 0.990 versus OR 0.993; p = 0.019). Data on current smoking were insensitive to detect a difference between the age groups in a step-level change or change in trend following the increase in age-of-sale (Bayes factors (BFs) 0.75 and 2.10). Data on quit attempts were also insensitive to detect a change in trend (BF 0.71), and despite a greater step-level decline among those aged 16-17 (OR 0.311 versus OR 0.547, p = 0.025), quit attempts remained higher among those aged 16-17. Secondary analysis indicated that post-policy change, trends in current and ever smoking were linear for 16-17 year olds but quadratic for 18-24 year olds (slowing decline).Conclusion: There is some evidence from an assessment of long-term trends in the Smoking Toolkit Study that the increase in legal age-of-sale of cigarettes in England was associated with a greater long-term decline in ever smoking among those aged 16-17 compared with those aged 18-24. [ABSTRACT FROM AUTHOR]

This comparative case study investigates the voluntary sector interface with criminal justice systems for youth and young adults in England/Wales and Finland. Methods included document review and stakeholder interviews. Across cases, key differences were found in the training of corrections and probation officers, funding sources and structures, and use of actuarial models and evidence. The organization of these relationships was also different for youth and young adult services, particularly in England/Wales where clear lines are drawn between age groups. The results contribute to an understanding of how system-level factors can drive relationships between the voluntary and criminal justice sectors. [ABSTRACT FROM AUTHOR]

Background: Over 2 million people in England were estimated to be eligible for bariatric surgery in 2006. In 2014, clinical guidelines were updated, widening potential eligibility, meanwhile, obesity prevalence rose. However, numbers receiving surgery decreased, and concerns exist of inequalities in access between population groups. This study is aimed at estimating the number of adults eligible for surgery in England and to compare demographics with those that receive surgery. Methods: BMI and comorbidity status were used to determine eligibility for bariatric surgery within participants of the 2014 Health Survey for England dataset (6938 adults), based on the National Institute of Health and Care Excellence guidelines. Results were scaled up using national population estimates. The demographics of eligible participants were compared against 2014/2015 hospital episode statistics for sex and age group using a chi-squared analysis. Results: Of the total population of England, 7.78% (95% CI 7.1–8.6%), or 3,623,505 people, could have been eligible for bariatric surgery in 2014; nearly a million more than if previous guidelines applied. Eligibility peaked at ages 45–54, with most in the 35–64 age group (58.9%). 58.4% of those eligible were women. Patients receiving surgery were far more likely to be female than male (76.1%) and the distribution skewed towards younger ages when compared with those eligible. Conclusion: Bariatric surgery may benefit many people in England; significant investment is required so that service provision is adequate for demand. Differences between demographics of those eligible and receiving surgery may be explainable; however, the potential health inequality should be investigated. [ABSTRACT FROM AUTHOR]

Research into experiences of social isolation and loneliness has predominantly focused on older adults, rhose post-retirement, as a significant at-risk group. Similarly, research exploring disability and loneliness has been associated with old age and conceptualised as an inevitable outcome of 'failing' health. This study seeks to conceptualise experiences of disability from a wider age group to understand if occurrences of social isolation and loneliness are commonplace. Fifteen qualitative biographical narrative interviews were completed by a Community Research Team, including 7 males and 8 females aged 32-89. A Disability Studies approach was applied to identify significant pathways from isolation into emotional loneliness, experienced by participants; fourteen of whom were affected by disability issues. Key risk factors were identified relating to disabled participants' experiences of 'loss'. Loss was associated with 'loss of ability', 'loss due to bereavement', 'loss of social connectivity' and 'loss of self-confidence'. Participants connected life events concerning loss with spending time alone, leading to feelings of emotional loneliness. The findings illustrate key risk factors in being alone during evenings and weekends, periods where disabled participants were most likely to experience subjective feelings of emotional loneliness. [ABSTRACT FROM AUTHOR]

Background: In October 2017, the United Kingdom Joint Committee on Vaccination and Immunisation (JCVI) recommended removal of one primary dose of the 13-valent pneumococcal conjugate vaccine (PCV13) from the existing 2+1 schedule (2, 4, 12 months). We conducted a mathematical modelling study to investigate the potential impact of a 1+1 (3, 12 month) schedule on invasive pneumococcal disease (IPD) and pneumococcal community-acquired pneumonia (CAP). Our results and those from a 1+1 immunogenicity study formed the key evidence reviewed by JCVI.Methods and Findings: We developed age-structured, dynamic, deterministic models of pneumococcal transmission in England and Wales to describe the impact on IPD of 7-valent PCV (PCV7; introduced in 2006) and PCV13 (introduced in 2010). Key transmission and vaccine parameters were estimated by fitting to carriage data from 2001/2002 and post-PCV IPD data to 2015, using vaccine coverage, mixing patterns between ages, and population data. We considered various models to investigate potential reasons for the rapid increase in non-PCV13 (non-vaccine serotype [NVT]) IPD cases since 2014. After searching a large parameter space, 500 parameter sets were identified with a likelihood statistically close to the maximum and these used to predict future cases (median, prediction range from 500 parameter sets). Our findings indicated that the emergence of individual NVTs with higher virulence resulting from ongoing replacement was likely responsible; the NVT increase was predicted to plateau from 2020. Long-term simulation results suggest that changing to a 1+1 schedule would have little overall impact, as the small increase in vaccine-type IPD would be offset by a reduction in NVT IPD. Our results were robust to changes in vaccine assumptions in a sensitivity analysis. Under the base case scenario, a change to a 1+1 schedule in 2018 was predicted to produce 31 (6, 76) additional IPD cases over five years and 83 (-10, 242) additional pneumococcal-CAP cases, with together 8 (-2, 24) additional deaths, none in children under 15 years. Long-term continuation with the 2+1 schedule, or changing to a 1+1, was predicted to sustain current reductions in IPD cases in under-64-year-olds, but cases in 65+-year-olds would continue to increase because of the effects of an aging population. Limitations of our model include difficulty in fitting to past trends in NVT IPD in some age groups and inherent uncertainty about future NVT behaviour, sparse data for defining the mixing matrix in 65+-year-olds, and the methodological challenge of defining uncertainty on predictions.Conclusions: Our findings suggest that, with the current mature status of the PCV programme in England and Wales, removing one primary dose in the first year of life would have little impact on IPD or pneumococcal CAP cases or associated deaths at any age. A reduction in the number of priming doses would improve programmatic efficiency and facilitate the introduction of new vaccines by reducing the number of coadministered vaccines given at 2 and 4 months of age in the current UK schedule. Our findings should not be applied to other settings with different pneumococcal epidemiology or with immature programmes and poor herd immunity. [ABSTRACT FROM AUTHOR]

Background: Funding shortages and an ageing population have increased pressures on state or insurance funded end of life care for older people. Across the world, policy debate has arisen about the potential role volunteers can play, working alongside health and social care professionals in the community to support and care for the ageing and dying. Aims: The authors examined self-reported levels of care for the elderly by the public in England, and public opinions of community volunteering concepts to care for the elderly at the end of life. In particular, claimed willingness to help and to be helped by local people was surveyed. Methods: A sample of 3,590 adults in England aged 45 or more from an online access panel responded to a questionnaire in late 2017. The survey data was weighted to be representative of the population within this age band. Key literature and formative qualitative research informed the design of the survey questionnaire, which was further refined after piloting. Results: Preferences for different models of community volunteering were elicited. There was a preference for ‘formal’ models with increased wariness of ‘informal’ features. Whilst 32% of adults said they ‘might join’ depending on whom the group helped, unsurprisingly more personal and demanding types of help significantly reduced the claimed willingness to help. Finally, willingness to help (or be helped) by local community carers or volunteers was regarded as less attractive than care being provided by personal family, close friends or indeed health and care professionals. Conclusion: Findings suggest that if community volunteering to care for elderly people at the end of life in England is to expand it may require considerable attention to the model including training for volunteers and protections for patients and volunteers as well as public education and promotion. Currently, in England, there is a clear preference for non-medical care to be delivered by close family or social care professionals, with volunteer community care regarded only as a back-up option. [ABSTRACT FROM AUTHOR]

Aims: To explore adolescents’ experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care. Methods: In-depth semi-structured interviews with 27 adolescents (16 males; aged 14–17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis. Results: Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves. Conclusions: Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence. Trial registration: [ABSTRACT FROM AUTHOR]

Objective: To examine cross-sectional and prospective associations between perceived discrimination in daily life (based on a range of attributes), sexual orientation discrimination, and health and wellbeing in middle-aged and older lesbian, gay and bisexual (LGB) people. Methods: Data were from 304 LGB men and women aged 41–85 years participating in the English Longitudinal Study of Ageing. Perceived discrimination in daily life was reported in 2010/11. Participants could attribute their discrimination experience to characteristics including age, sex, race, physical disability, and sexual orientation. Self-rated health, limiting long-standing illness, depressive symptoms, quality of life, life satisfaction and loneliness were assessed in 2010/11 and 2016/17. Analyses adjusted for age, sex, ethnicity, partnership status and socioeconomic position. Results: Perceived discrimination in daily life was reported by 144 (47.4%) participants. Cross-sectionally, perceived discrimination in daily life was associated with increased odds of depressive symptoms (OR = 2.30, 95% CI 1.02 to 5.21), loneliness (OR = 3.37, 95% CI 1.60 to 7.10) and lower quality of life (B = -3.31, 95% CI -5.49 to -1.12). Prospectively, perceived discrimination in daily life was associated with increased odds of loneliness (OR = 3.12, 95% CI 1.08 to 8.99) and lower quality of life (B = -2.08, 95% CI -3.85 to -0.31) and life satisfaction (B = -1.92, 95% CI -3.44 to -0.39) over six-year follow-up. Effect sizes were consistently larger for participants who attributed experiences of discrimination to their sexual orientation compared with those who attributed experiences of discrimination to other reasons (e.g. age, sex, race). Conclusion: These results provide cross-sectional and prospective evidence of associations between perceived discrimination in daily life and health and wellbeing outcomes in middle-aged and older LGB adults in England. [ABSTRACT FROM AUTHOR]

Many disciplines of scholarship are interested in the Relative Age Effect (RAE), whereby age-banding confers advantages on older members of the cohort over younger ones. Most research does not test this relationship in a manner consistent with theory (which requires a decline in frequency across the cohort year), instead resorting to non-parametric, non-directional approaches. In this article, the authors address this disconnect, provide an overview of the benefits associated with Poisson regression modelling, and two managerially useful measures for quantifying RAE bias, namely the Indices of Discrimination and Wastage. In a tutorial-like exposition, applications and extensions of this approach are illustrated using data on professional soccer players competing in the top two tiers of the “Big Five” European football leagues in the search to identify paragon clubs, leagues, and countries from which others may learn to mitigate this form of age-discrimination in the talent identification process. As with OLS regression, Poisson regression may include more than one independent variable. In this way we test competing explanations of RAE; control for unwanted sources of covariation; model interaction effects (that different clubs and countries may not all be subject to RAE to the same degree); and test for non-monotonic versions of RAE suggested in the literature. [ABSTRACT FROM AUTHOR]

Background: Frail elderly people experience elevated mortality. However, no consensus exists on the definition of frailty, and many frailty scores have been developed. The main aim of this study was to compare the association between 35 frailty scores and incident cardiovascular disease (CVD), incident cancer, and all-cause mortality. Also, we aimed to assess whether frailty scores added predictive value to basic and adjusted models for these outcomes.Methods and Findings: Through a structured literature search, we identified 35 frailty scores that could be calculated at wave 2 of the English Longitudinal Study of Ageing (ELSA), an observational cohort study. We analysed data from 5,294 participants, 44.9% men, aged 60 years and over. We studied the association between each of the scores and the incidence of CVD, cancer, and all-cause mortality during a 7-year follow-up using Cox proportional hazard models at progressive levels of adjustment. We also examined the added predictive performance of each score on top of basic models using Harrell's C statistic. Using age of the participant as a timescale, in sex-adjusted models, hazard ratios (HRs) (95% confidence intervals) for all-cause mortality ranged from 2.4 (95% CI: 1.7-3.3) to 26.2 (95% CI: 15.4-44.5). In further adjusted models including smoking status and alcohol consumption, HR ranged from 2.3 (95% CI: 1.6-3.1) to 20.2 (95% CI: 11.8-34.5). In fully adjusted models including lifestyle and comorbidity, HR ranged from 0.9 (95% CI: 0.5-1.7) to 8.4 (95% CI: 4.9-14.4). HRs for CVD and cancer incidence in sex-adjusted models ranged from 1.2 (95% CI: 0.5-3.2) to 16.5 (95% CI: 7.8-35.0) and from 0.7 (95% CI: 0.4-1.2) to 2.4 (95% CI: 1.0-5.7), respectively. In sex- and age-adjusted models, all frailty scores showed significant added predictive performance for all-cause mortality, increasing the C statistic by up to 3%. None of the scores significantly improved basic prediction models for CVD or cancer. A source of bias could be the differences in mortality follow-up time compared to CVD/cancer, because the existence of informative censoring cannot be excluded.Conclusion: There is high variability in the strength of the association between frailty scores and 7-year all-cause mortality, incident CVD, and cancer. With regard to all-cause mortality, some scores give a modest improvement to the predictive ability. Our results show that certain scores clearly outperform others with regard to three important health outcomes in later life. Finally, we think that despite their limitations, the use of frailty scores to identify the elderly population at risk is still a useful measure, and the choice of a frailty score should balance feasibility with performance. [ABSTRACT FROM AUTHOR]

Background: Opportunistic chlamydia screening of <25 year-olds was nationally-implemented in England in 2008 but its impact on chlamydia transmission is poorly understood. We undertook a population-based seroprevalence study to explore the impact of screening on cumulative incidence of chlamydia, as measured by C.trachomatis-specific antibody. Methods: Anonymised sera from participants in the nationally-representative Health Surveys for England (HSE) were tested for C.trachomatis antibodies using two novel Pgp3 enzyme-linked immunosorbent assays (ELISAs) as a marker of past infection. Determinants of being seropositive were explored using logistic regression among 16–44 year-old women and men in 2010 and 2012 (years when sexual behaviour questions were included in the survey) (n = 1,402 women; 1,119 men). Seroprevalence trends among 16–24 year-old women (n = 3,361) were investigated over ten time points from 1994–2012. Results: In HSE2010/2012, Pgp3 seroprevalence among 16–44 year-olds was 24.4% (95%CI 22.0–27.1) in women and 13.9% (11.8–16.2) in men. Seroprevalence increased with age (up to 33.5% [27.5–40.2] in 30–34 year-old women, 18.7% [13.4–25.6] in 35–39 year-old men); years since first sex; number of lifetime sexual partners; and younger age at first sex. 76.7% of seropositive 16–24 year-olds had never been diagnosed with chlamydia. Among 16–24 year-old women, a non-significant decline in seroprevalence was observed from 2008–2012 (prevalence ratio per year: 0.94 [0.84–1.05]). Conclusion: Our application of Pgp3 ELISAs demonstrates a high lifetime risk of chlamydia infection among women and a large proportion of undiagnosed infections. A decrease in age-specific cumulative incidence following national implementation of opportunistic chlamydia screening has not yet been demonstrated. We propose these assays be used to assess impact of chlamydia control programmes. [ABSTRACT FROM AUTHOR]