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© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Adolescent dating and relationship violence is associated with health harms and is an important topic for sex education. School-based interventions addressing this have been effective in the USA, but schools in England confront pressures that might hinder implementation. We assessed the feasibility of, and contextual enablers/barriers to implementing Project Respect, a whole-school intervention. We conducted a pilot trial with process evaluation in six English secondary schools. Intervention comprised: training; policy-review; mapping and patrolling ‘hotspots’; parent information; help-seeking app; and a curriculum (including student-led campaigns) targeting dating violence. Process evaluation included assessments of fidelity and interviews with the trainer and school staff. Schools delivered training and lessons partially or completely and made parent and app information available. Two schools conducted policy reviews; none patrolled hotspots or implemented campaigns. Implementation was strengthened where staff saw dating violence as a priority. Delivery was undermined where staff were insufficiently involved, lacked time for planning or struggled to timetable lessons, and where new school challenges undermined engagement. School-based health interventions must work to build staff buy-in and ensure they do not overburden schools. Dating and relationship violence might best be addressed in this context as a broader aspect of sex education.

Background Previous studies linking social activity and disability have been limited by focussing on self-reported physical performance in older adults (>65). We examined whether social participation in mid-life is associated with objective and subjective measures of physical performance in older age. Methods Participants of the Medical Research Council National Survey of Health and Development reported their involvement in social activities at ages 43 and 60–64 years; frequency of such involvement was classified into thirds. Physical performance was measured at age 60–64 using: grip strength; standing balance; chair rises; timed get-up-and-go; self-reported physical function from the Short Form-36. Multivariable regression was used to examine longitudinal associations between social participation and each physical performance measure. We also investigated whether change in social participation between 43 and 60–64 was associated with each outcome. Results In fully adjusted models, higher frequency of social participation at 43 was associated with faster chair rise (1.42 repetitions/min, 95% CI 0.45–2.39) and timed get-up-and-go speed (2.47 cm/s, 95% CI 0.27–4.67) and lower likelihood of self-report limitations (OR of low physical function 0.67, 95% CI 0.50–0.91) at 60–64 compared with low frequency. Better performance in objectively measured outcomes was observed only if higher social participation persisted over time whereas lower odds of self-reported limitations were found in all groups when compared to those with persistently low participation (ORs 0.43–0.56, all P≤0.02). Conclusion Our findings suggest that associations between higher levels of social participation in mid-life and better physical performance exist only if this social participation persists through to older age.

Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.

Healthcare workers (HCWs) are at increased risk of exposure to\udrespiratory pathogens and may transmit infection to vulnerable\udpatients. This study summarises a recent systematic review, which\udaimed to assess evidence that influenza or pneumococcal\udvaccination of HCWs provides indirect protection for those patients\udmost at risk of severe or complicated acute respiratory infection. A\udnumber of healthcare databases and sources of grey literature were\udsearched using a predefined strategy, and citations screened for\udeligibility in accordance with specified inclusion criteria. Risk of bias\udwas assessed using validated tools and results summarised\udqualitatively. Twenty papers were included in the final review, all of\udwhich considered influenza vaccination of HCW. As such, planned\udsubanalysis of pneumococcal vaccination was discarded. The\udmajority of primary research studies included (11/14) were\udconducted in long-term care facilities, but there was marked\udheterogeneity in terms of the population, intervention/exposure and\udoutcomes considered. Consistency in the direction of effect was\udobserved across several different outcome measures, suggesting that\udinfluenza vaccination of HCWs is likely to offer some protection.\udFurther evidence is, however, required from acute care settings.

Background There is increasing emphasis on involving intended beneficiaries and other stakeholders in the development of public health interventions to maximise acceptability and remove barriers to adoption, implementation, and maintenance before costly implementation. Yet the processes whereby key actors are engaged in intervention development are rarely reported, and frameworks for carrying out such work remain limited. We outline our approach to involving stakeholders in the optimisation of two school-based relationships and sex education programmes (Project Respect and Positive Choices) and reflect on the challenges of co-producing with teachers, students, and other partners. Methods Systematic optimisation of both interventions involved a review of existing literature on effective approaches; consultation with staff and students on intervention content and delivery; drafting of intervention materials; further consultation with schools; and then intervention refinement in preparation for a pilot. Seven focus groups took place in southeast and southwest England involving 75 students aged 13–15 years and 22 school staff. A group of young people trained to advise on public health research were consulted on two occasions and a wide range of sexual health and sex education practitioners and policy makers shared their views at a stakeholder event. Findings Consultation provided useful insights to inform intervention adaption in relation to who should deliver the programmes in schools; whether lessons should be taught in single sex classes; the format that guidance and lesson plans should take; the relevance and acceptability to students and teachers; and the need for the flexibility for materials to adapt to different school contexts. Genuine consultation and incorporation of school stakeholder views was challenging where stakeholder availability was limited and intervention development and implementation timelines were tight. Challenges also arose in relation to the weight to give divergent opinions among stakeholders and between stakeholders and researchers. Interpretation Carrying out structured stakeholder engagement activities can yield valuable insights that can improve the applicability of interventions to local contexts before they are formally trialled. To genuinely engage stakeholders in intervention development requires sufficient time to both consult and adapt. In such consultations, it is important to attend not just to the voices of those who are the loudest and most powerful. Funding National Institute for Health Research (NIHR).

Background As people live longer, their risk of disability increases. Disability affects quality of life and increases health and social care costs. Preventing or delaying disability is therefore an important objective, and identifying an effective intervention could improve the lives of many older people. Observational and interventional evidence suggests that physical activity may reduce the risk of age-related disability, as assessed by physical performance measures. However it is unclear what approach is the most cost-effective intervention in changing long-term physical activity behaviour in older adults. A new theory-driven behavioural intervention has been developed, with the aim of increasing physical activity in the everyday lives of older adults at risk of disability. This pilot study tests the feasibility and acceptability of delivering this intervention to older adults. Methods/Design A randomised controlled trial (RCT) design will be used in the pilot study. Sixty patients aged 65 years and older will be recruited from primary care practices. Patients will be eligible to participate if they are inactive, not disabled at baseline, are at risk of developing disability in the future (Short Physical Performance Battery score

It has become increasingly common for UK patients to travel to malarial regions: in 2004 over 2.5 million visits were made by UK individuals to countries in which malaria is endemic, representing a 300% increase since 1987.1 Malaria prophylaxis routinely provided in general practice comprises atovaquone–proguanil, mefloquine, doxycycline, or chloroquine plus proguanil. This article describes two cases of malaria that presented 8 months after foreign travel, despite adherence to antimalarial prophylaxis. Two 16-year-old boys presented to the same UK hospital during the same week. Both had a 2-week history of unexplained fever and myalgia. They had travelled together to a malarious area of Kenya for a fortnight 8 months previously on a school trip, and had shared a tent. Both pupils reported adherence to a complete course of atovaquone–proguanil (Malarone®, GSK) on this trip, and had not been to any other malarious regions subsequently. Neither patient reported symptoms at the time of the trip or on initial return to the UK; nor were any other pupils or staff member on the …

Previous studies suggest that physical activity may be protective for dementia and cognitive impairment. We report findings comparing leisure-time and work-related physical activity from the Caerphilly Prospective study (CaPS) with dementia and cognitive impairment not dementia (CIND) after around 16 years of follow-up. We synthesized our results with a meta-analysis specifically testing if length of follow-up was associated with the size of any association. Age-adjusted models found no real association with dementia, and if anything increased risk for CIND (odds ratio (OR) highest versus lowest tertile 2.61, 95% CI 1.58 to 4.31), though this was attenuated after adjustment for other confounders (OR highest versus lowest tertile 1.38, 95% CI 0.78 to 2.44). There was no evidence that this differed by type (vascular versus non-vascular) of cognitive disease. Meta-analysis of other published effect estimates showed a protective effect of physical activity on cognitive impairment (OR 0.66, 95% CI 0.52 to 0.85) but with significant heterogeneity which was partially explained by length of follow up (p = 0.03). A protective association was also seen for dementia (OR 0.78, 95% CI 0.65, 0.94), which did not appear to be related to follow-up length but there was evidence of small study bias (p = 0.002) suggesting an absence of small null studies. The apparent protective effects of physical activity on cognitive health may partially reflect reverse causation and current estimates may be overly optimistic in terms of cognitive benefits.

Background Whilst there have been several robust reviews of the quantitative literature surrounding physical activity in older adults, less has been published on the qualitative literature in this field. Qualitative data can be of great value to researchers designing interventions as it can lead to greater insight into how individuals understand the social world and how they conceptualise and understand health messages. This can be used to aid selection of the theoretical elements of an intervention and to design specific components. Previous qualitative syntheses in this field have been limited in scope or methodology, or have comprised a narrative review of the quantitative and qualitative literature. It is therefore clear that there is a need for a thorough, rigorous, and interpretive synthesis of the qualitative literature surrounding older adults and physical activity. Methods The electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and Web of Science were systematically searched for qualitative studies with adults aged 50 years and over on physical activity. Following title/abstract and full-text screening, eligible papers were included in the final synthesis. Findings from all papers were coded and descriptive themes constructed. We attempted a meta-ethnographic approach, aiming to go beyond the findings of the primary studies to generate third order interpretations about older adults’ accounts of physical activity. Results After de-duplication, 5038 titles were retrieved from the database search. All retrieved papers were screened by title and abstract, and a random sample of 10% were double-screened (kappa score for agreement 0.74; strong agreement). 380 papers were subject to full-text screening, and of these 66 papers met the inclusion criteria. The findings from the included papers were subject to in-depth, line-by-line coding. Studies varied greatly in methodological and analytical quality. Descriptive themes, including for example ideas on mortality, life as purposeful, and concept of self, were constructed from the studies, and studies were translated into one another to generate additional understandings on the topic. Discussion We will present details of the results of our meta-ethnography, and we shall discuss our conclusions on the value of this exercise in this topic area.