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The term 'left behind' has become common currency since the 2016 UK referendum vote to leave the European Union (EU). It is often used to describe areas of the country that have missed out on the economic prosperity from which others have benefited. Generally, however, the term tends to be loosely defined and applied. This paper describes research which hazards a more precise definition and a mapping of areas that might be accurately referred to as 'left behind', acknowledging that the phenomenon has a social and cultural, as well as an economic dimension. The research described in this paper was commissioned by Local Trust from OCSI. A new Community Needs Index (CNI) was developed for the project. This new index identifies wards in England that lack civic infrastructure (places for people to meet, green space and recreational opportunities), connectivity — physical and digital — and community engagement. The 206 wards which the research identifies as perhaps the most 'left behind' are both in the top 10 per cent of this new CNI and in the bottom, or most deprived, 10 per cent of the Index of Multiple Deprivation (IMD). The research finds that 'left behind' wards are concentrated in post-industrial and coastal areas, often housing estates on the peripheries of towns and cities. The residents of these areas have markedly worse socio-economic outcomes compared to those living in similarly deprived areas; they have fewer job opportunities, lower levels of educational attainment and poorer health. The research indicates the multidimensional nature of the problems in these neighbourhoods and suggests the value and importance of civic infrastructure, connectivity and community engagement as a protective factor which helps to guard against them becoming too entrenched or severe. Our experience of delivering the Big Local programme, and our assessment of the evidence from past local area initiatives, is that flexible, community-led solutions which build community confidence and capacity, and which create connections to opportunities in the wider geographical area, are key to improving 'left behind' areas and the quality of life of the people living in them. We argue, based on the evidence, that new government investment in neighbourhood regeneration is urgently needed. This should take the form of long-term funding focused on building hard and soft civic assets. It is our view that only through this approach will sustainable positive change be created in the areas that most need it. [ABSTRACT FROM AUTHOR]

This paper presents a descriptive analysis of the impact of tuition fee increases in England on the full‐degree mobility of undergraduate students from the European Union. First, we investigated whether the increase in tuition fees reduced the number of EU students in English higher education institutions. Our analysis shows that, on average, English universities suffered a sudden drop in EU enrolments in 2012/13 but recovered and then expanded their pre‐2012 enrolment levels in subsequent academic years. We observe that those English universities regarded as less prestigious experienced the sharpest decline and took longer to recover their pre‐2012 numbers. Second, we examined how changes in enrolment are associated with EU countries' macro‐level characteristics, using the push‐pull model framework. While there was a significant decrease in the number of students from Northern and Western European countries attending English universities after 2012, the tuition fee increase did not impact the number of students coming from Southern Europe. We found an association between EU countries' youth employment rates and higher education system characteristics with changes in enrolment in English universities. By examining the effect of changes in the tuition fee policy on international student mobility, our research provides new evidence on how tuition fee policies might change the behaviour of students. [ABSTRACT FROM AUTHOR]

Copyright of Comparative Maritime Law / Poredbeno Pomorsko Pravo is the property of Jadranski zavod HAZU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A new skills-based immigration system, with a preference for the highly-skilled, is central to UK policy debates in the Brexit context, arguably responding to majority public opinion on migration. Through qualitative fieldwork with British, Polish and Romanian citizens living in two local authorities in England, this paper shows what participants understand by 'low-skilled' and how there is broad support of those who 'contribute', but are 'controlled' at the same time. Migrants' narratives of downskilling also illustrate why the category of 'low-skilled' migration needs to be seen through a more critical lens in research and policymaking. [ABSTRACT FROM AUTHOR]

In 2008, the EU Innovation Partnership on Active and Healthy Ageing (EIP-AHA) set a target of an increase of two healthy life years by 2020. More recently, in 2018, the UK Government set a target to "ensure people can enjoy at least 5 extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest". This paper reviews the progress the EU member states have made towards meeting this target, and what the UK can learn from their experiences. I conclude that, although the EU target is likely to be reached, the gap in healthy life years between the member states has increased. Past trends in and projections of disability-free life expectancy in England suggest that it will be difficult to achieve an increase of five healthy and independent years of life by 2035. [ABSTRACT FROM AUTHOR]

Copyright of Kwartalnik Neofilologiczny is the property of Polish Academy of Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]

Given the centrality of regions in social movements, politics and public administration, here we aim to quantitatively study regional identity, cross-region communication and sentiment. This paper presents a new methodology to study social interaction within and between social-geographic regions, and then applies the methodology to a case study of England and Wales. We use a social network, built from geo-located Twitter data, to identify contiguous geographical regions with a shared social identity and then investigate patterns of communication within and between them. In contrast to other approaches (e.g. using phone call data records or online friendship networks), use of Twitter data provides message contents as well as social connections. This allows us to investigate not only the volume of communication between locations, but also the sentiment and vocabulary used in the messages. For example, our case study shows: a significant dialect difference between England and Wales; that regions tend to be more positive about themselves than about others, with the South being more ‘self-regarding’ than the North; and that people talk politics much more between regions than within. This study demonstrates how social media can be used to quantify regional identity and inter-region communications and sentiment, exposing these previously hard-to-observe geographic concepts to analysis. [ABSTRACT FROM AUTHOR]

Earthworms are primary candidates for national soil health monitoring as they are ecosystem engineers that benefit both food production and ecosystem services associated with soil security. Supporting farmers to monitor soil health could help to achieve the policy aspiration of sustainable soils by 2030 in England; however, little is known about how to overcome participation barriers, appropriate methodologies (practical, cost-effective, usefulness) or training needs. This paper presents the results from a pilot #60minworms study which mobilised farmers to assess over >1300 ha farmland soils in spring 2018. The results interpretation framework is based on the presence of earthworms from each of the three ecological groups at each observation (20 x 20 cm x 20 cm pit) and spatially across a field (10 soil pits). Results showed that most fields have basic earthworm presence and abundance, but 42% fields may be over-worked as indicated by absence/rarity of epigeic and/or anecic earthworms. Tillage had a negative impact (p < 0.05) on earthworm populations and organic matter management did not mitigate tillage impacts. In terms of farmer participation, Twitter and Farmers Weekly magazine were highly effective channels for recruitment. Direct feedback from participants included excellent scores in trust, value and satisfaction of the protocol (e.g. 100% would do the test again) and 57% would use their worm survey results to change their soil management practices. A key training need in terms of earthworm identification skills was reported. The trade-off between data quality, participation rates and fieldwork costs suggests there is potential to streamline the protocol further to #30minworms (5 pits), incurring farmer fieldwork costs of approximately £1.48 ha-1. At national scales, £14 million pounds across 4.7 M ha-1 in fieldwork costs per survey could be saved by farmer participation. [ABSTRACT FROM AUTHOR]

Town and parish councils are the English government bodies closest to local people. Hierarchically, they are subordinate to both national and higher tier local governments (unitary, county and borough/district councils). Town councillors represent approximately 11,000,000 people; one-fifth of the population of England. Their mainly small towns will be affected by the COVID-19 pandemic and the United Kingdom's departure from the European Union ('Brexit'). To what extent is not known, but councillors will have roles to play in determining how their towns respond. This paper presents and discusses the views of 156 respondents to an online survey, some of whom were also interviewed. Councillors, town clerks, academics, and interested individuals with policy and practical experience of the sector contributed. Although respondents ' views differ (eg, as to whether town councils should have more powers), most believe they will have to do more. Indeed, they want to do more, especially in relation to planning, housing and transport. They are, however, uncertain about how to achieve their aims, given the constraints of time and resources on a mainly volunteer body, their partial dependence on higher-tier authorities, and the need for, as some strongly believe, effective monitoring of standards, performance, transparency, and accountability. [ABSTRACT FROM AUTHOR]

Domestic energy efficiency policy is potentially a means for reducing residential energy-related greenhouse gas (GHG) emissions and expenses for households in energy poverty. It has often been presented as an eco-social exemplar, for example in the European Union's Green Deal. The European Commission regards domestic energy efficiency improvements as the primary means for addressing energy poverty notwithstanding the 2022/23 energy crisis. However, the case for domestic energy efficiency improvement as a tool for achieving simultaneously social and environmental goals is often assumed rather than demonstrated. This article uses Mandelli's eco-social trilemma heuristic and the symbolic politics literature to surface the tensions involved in such processes, focusing on policy efforts in the England between 1997 and 2023 as a case study. England is a good case to consider because it has been regarded as a leader of energy poverty mitigation and its policy approach is similar to the European Commission's. The article details the main policy instruments used in England, assesses outputs and outcomes using official statistics, government and independent policy evaluations and the secondary literature, and details the main problems encountered in achieving environmental/social synergies. Based on this analysis, the article argues that English domestic energy efficiency policy has generally constituted a symbolic eco-social policy, particularly on the social side and since 2010. Highlighted by the 2022/23 energy crisis, domestic energy efficiency policy is best regarded as one component of a policy toolkit for reducing energy poverty, which at the least should also include targeted social protection. [ABSTRACT FROM AUTHOR]

Debates have persisted about the character of the East–West population flows that followed the EU expansions. Some of the discussions surround the extent to which the mobility has been temporal and hence how likely these migrants are to settle permanently or to stay for long periods in host countries. This paper enhances the understanding of such issues through examining survey data on 700 Polish recent migrants in seven English and Welsh towns and supplemented by an analysis of qualitative data. Three categories of migrants are initially identified on the basis of their intentions of stay in the UK. Multinomial logit models are then estimated to examine the characteristics of individuals in each category to establish the factors that influence migration strategies and changes in plans. Results indicate that although standard socio-economic characteristics tend to be insignificant, migration strategies and changes in intentions are affected by migrant's view of whether their job matches their expectations, the time of entry into the UK and remittances. Analysis of the qualitative information reinforces some of the key findings and also indicates the importance of migrants' ability to reference their experiences in two settings. [ABSTRACT FROM AUTHOR]

The development of functional economic areas and their relationship to governance has been attracting considerable attention. New forms of sub-regional governance have emerged that have been interpreted in a variety of ways. Within this context, a different approach to multiscalar governance linked to economic space is emerging at a European level in relation to the implementation of the Lisbon Treaty. This is embedding the principles of subsidiarity/territorial cohesion within member-states, and with sub-state scales of working being promulgated. This paper adds to existing discussions of city-regionalism by providing an alternative—yet fundamental—insight into these reform constructs within England in its relations with the EU. It explores: the role of economic spaces in the genealogy of rescaling tendencies; their co-option of governance as a ‘strategic’ mechanism for growth; and the emergent geo-politics associated with new sub-state governance structures and their effectiveness as intended ‘transitionary’ arrangements. [ABSTRACT FROM PUBLISHER]

Many academics ask 'How can I use my research to influence policy?'. In this paper, we draw on our first-hand experience as social researchers for the British Government to advise how academics can create and communicate research with policymakers. Specifically, we describe methods of communicating research to policymakers in relation to research we undertook to listen to farmers about their priorities for a new agricultural policy for England following the exit of the UK from the European Union. The main purpose of this research was to ensure farmers' voices were included in policy development and therefore communication of the research to policymakers was key. We reflect on the effectiveness of the communication methods we employed and summarise our learnings into four practical recommendations: (1) make research relevant to policymakers; (2) invest time to develop and maintain relationships with policymakers; (3) utilise 'windows of opportunity'; and (4) adapt presentation and communication styles to the audience. We consider that employing these recommendations will help to improve how evidence is communicated between academia and government and therefore the influence of evidence in decision-making processes. [ABSTRACT FROM AUTHOR]

This article considers the provision of modern foreign languages (MFL) in England since the 1970s in the context of wider curricular change and also taking into account Europe-wide developments in MFL. It charts the changes implemented over almost three decades to England's National Curriculum for MFL at secondary level (from ages 11 to 16) and highlights the significant role – particularly before 2010 – of Her Majesty's Inspectors of Schools (HMI) in evaluating curricular innovation and support for MFL teacher development. Perennial issues over this period include: the range of languages studied; the gender bias in the uptake of MFL; the low uptake of MFL after the age of 14; use of the target language and the role of grammar. The article highlights the limitations for MFL in England resulting from restricted time allocations; the lack of coherence and continuity in policy implementation; and the recent loss of support infrastructure for MFL teachers. Finally, the author reflects on the UK's participation in Council of Europe and European Union projects and the extent to which MFL in England has been influenced by these. [ABSTRACT FROM PUBLISHER]

Brexit, the withdrawal of the United Kingdom from the European Union, has offered the UK government a unique opportunity to fundamentally reform agricultural policy. In England, the new policy—called Environmental Land Management—will reward farmers for activities that produce environmental public goods, such as clean air and water and a thriving wildlife, and prevent environmental hazards. It could lead to the biggest changes in land management since the end of World War II. This photo essay and the process of making it contributes to a better understanding of how farmers feel about the changes underway. [ABSTRACT FROM AUTHOR]

Background: In assigning responsibility for obesity prevention a distinction may be drawn between who is responsible for the rise in obesity prevalence ('backward-looking responsibility'), and who is responsible for reducing it ('forward-looking responsibility'). Methods: We study how the two aspects of responsibility figure in the obesity policies of WHO (European Region), the EU and the Department of Health (England). Results: Responsibility for the emergence and reduction of obesity is assigned to both individuals and other actors to different degrees in the policies, combining an individual and a systemic view. The policies assign backward-looking responsibility to individuals, the social environment, the authorities and businesses. When it comes to forward-looking responsibility, individuals are expected to play a central role in reducing and preventing obesity, but other actors are also urged to act. WHO assigns to individuals the lowest degree of backward- and forward-looking responsibility, and the Department of Health (England) assigns them the highest degree of responsibility. Discussion: Differences in the assignment of backward- and above all forward-looking responsibility could be explained to some extent by the different roles of the three authorities making the plans. WHO is a UN agency with health as its goal, the EU is a liberal economic union with optimization of the internal European market as an important task, and England, as an independent sovereign country, has its own economic responsibilities. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Estimating ‘return on investment’ (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool ( http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. Methods: Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. Findings: Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single‐form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster‐acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face‐to‐face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self‐help materials (1%). There was insufficient evidence to obtain reliable, country‐specific estimates for interventions such as websites, smartphone applications and e‐cigarettes. Conclusions: Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions. [ABSTRACT FROM AUTHOR]

The past decade has been a dynamic one for biodiversity offsetting policy. Efforts to incorporate offsetting into the Convention on Biological Diversity as a compliance mechanism did not succeed. The expansion of offsetting outside of the Natura 2000 network in the European Union (EU), which looked all but inevitable in the early 2010s, was withdrawn in the face of unexpectedly strong opposition from environmental groups and the business sector. Highly publicised offsetting programmes in some EU countries have had mixed outcomes, and many observers describe offsetting as a failed policy. And yet four years of interviews and policy analysis in Brussels, Spain, and England suggest that reports of offsetting's death may be exaggerated. While the possibility of an overarching EU Directive aimed at harmonising offsetting policy and practice across the region's countries seems unlikely, in Spain, offsetting has returned to the national policy arena via adoption as an implementation tool within the national Green Infrastructure Strategy. Offsetting in England persists in a handful of counties as a locally situated development strategy, and seems to have returned at the national level despite its spectacular flame‐out in 2014. This is not, after all, a high‐profile failure of neoliberal environmental policy. Rather, we see offsetting's persistence as a result of policy refugia: the retreat to small but amenable jurisdictions where offsetting policies can wait out inclement policy conditions and then emerge to recolonise the policy landscape when conditions improve. Highly publicised offsetting programmes in some EU countries have had mixed outcomes, and many observers describe offsetting as a failed policy. However, our analysis of offset policy development in the EU, Spain, and England suggests that offsetting has not failed but persists as a result of policy refugia: it has retreated to small but amenable jurisdictions from which it can emerge to recolonise the policy landscape as conditions improve. [ABSTRACT FROM AUTHOR]

Background: Young people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD.Methods: E-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018.Results: In Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a 'fad', which had begun to run its course.Conclusions: This study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital. [ABSTRACT FROM AUTHOR]

Social workers are increasingly globally mobile, pursuing employment opportunities that combine professional and lifestyle projects. Social work skills and practice are embedded in cultural, linguistic and nation-specific legislative competencies. The current article engages with the interplay of a fast-moving social work and immigration policy context and the role of inter-European social workers, using England as a case study of destination. Based on registration data of non-UK qualified social workers (2003–2017), a survey of 97 stakeholders from 27 European Union countries and focus group discussions, it investigates trends and challenges of transnational social workers (TSWs) in England. The findings highlight a dynamic process of social work education and immigration policy reforms during the past decade that was associated with a significant change in the volume and profile of TSWs registered to work in England. Data from European stakeholders further highlight two key findings: first, there is evidence of an increased role of inter-European social workers in most of Western European countries; second, the process of social work qualifications' recognition within Europe remains considerably variable. The implications of the findings are discussed within the context of continued inter-European policy and political changes. [ABSTRACT FROM AUTHOR]

Background/objectives: Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death. Design and setting: In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents' death. Measurements: Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis. Results: Nurses' response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9–27.2) in the Netherlands, 25.2% (18.3–33.6) in Belgium, 29.3% (16.9–45.8) in England, 33.7% (26.2–42.2) in Finland, 64.6% (52.0–75.4) in Italy and 79.1% (71.2–85.3) in Poland (p < 0.001). Opioid underuse was 57.2% (33.0–78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9–63.8) for pain and 37.4% (19.4–59.6) for both symptoms (p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20–0.54) when pain was assessed. Conclusion: Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders. [ABSTRACT FROM AUTHOR]

Objectives. To test the hypothesis that deaths of despair, a marker of social suffering, were associated with greater support for Brexit in the United Kingdom's 2016 European Union referendum. Methods. We used cross-local authority regression models of Brexit vote shares on changes in suicide and drug-related death rates before (2005–2007) and after the recession (2014–2016), adjusting for sociodemographic factors. The population comprised 345 local authorities in England and Wales. Results. Mortality rates were associated with voting patterns. An increase of 10 drug-related deaths per 100 000 was associated with a 15.25-percentage-point increase in Brexit votes (95% confidence interval [CI] = 10.27, 20.24), while an increase of 10 suicides per 100 000 was associated with a 9.97-percentage-point increase in vote shares for Brexit (95% CI = 6.25, 13.70). These results were substantially attenuated after we adjusted for education, and reduced to nonsignificance for drug mortality (b = 2.18; 95% CI = –0.21, 4.57) and suicide (b = 0.94; 95% CI = –0.32, 2.21) upon inclusion of other sociodemographic factors. Conclusions. Worsening mortality correlated with Brexit votes. These phenomena appear to share similar antecedents. A rise in such deaths may point to deeper social problems that could have political consequences. [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]

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]

Given the high prevalence of common mental disorders (CMDs) and individuals living alone in the United Kingdom, the goal of this study using English nationally representative data was to examine the association between living alone and CMDs, and to identify potential mediating factors of this association. The data were drawn from the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. CMDs were assessed using the Clinical Interview Schedule-Revised (CIS-R), a questionnaire focusing on past week neurotic symptoms. The presence of CMDs was defined as a CIS-R total score of 12 and above. Multivariable logistic regression and mediation analyses were conducted to analyze the association between living alone and CMDs, and to identify mediators in this association. The prevalence of CMDs was higher in individuals living alone than in those not living alone in all survey years. Multivariable analysis showed a positive association between living alone and CMDs in all survey years (1993: odds ratio [OR] = 1.69; 2000: OR = 1.63; and 2007: OR = 1.88). Overall, loneliness explained 84% of the living alone-CMD association. Living alone was positively associated with CMDs. Interventions addressing loneliness among individuals living alone may be particularly important for the mental wellbeing of this vulnerable population. [ABSTRACT FROM AUTHOR]

Objective: To explore pregnant women’s preferences for birth setting in England. Design: Labelled discrete choice experiment (DCE). Setting: Online survey. Sample: Pregnant women recruited through social media and an online panel. Methods: We developed a DCE to assess women’s preferences for four hypothetical birth settings based on seven attributes: reputation, continuity of care, distance from home, time to see a doctor, partner able to stay overnight, chance of straightforward birth and safety for baby. We used a mixed logit model, with setting modelled as an alternative-specific constant, and conducted a scenario analysis to evaluate the impact of changes in attribute levels on uptake of birth settings. Main outcome measures: Women’s preferences for birth setting. Results: 257 pregnant women completed the DCE. All birth setting attributes, except ‘time to see doctor’, were significant in women’s choice (p<0.05). There was significant heterogeneity in preferences for some attributes. Changes to levels for ‘safety for the baby’ and ‘partner able to stay overnight’ were associated with larger changes from baseline uptake of birth setting. If the preferences identified were translated into the real-world context up to a third of those who reported planning birth in an obstetric unit might choose a midwifery unit assuming universal access to all settings, and knowledge of the differences between settings. Conclusions: We found that ‘safety for the baby’, ‘chance of a straightforward birth’ and ‘can the woman’s partner stay overnight following birth’ were particularly important in women’s preferences for hypothetical birth setting. If all birth settings were available to women and they were aware of the differences between them, it is likely that more low risk women who currently plan birth in OUs might choose a midwifery unit. [ABSTRACT FROM AUTHOR]

Quantifying the value of investment in medical research can inform decision-making on the prioritisation of research programmes. Existing methodologies to estimate the rate of return of medical research are inappropriate for early-phase translational research due to censoring of health benefits and time lags. A strategy to improve the process of translational research for patient benefit has been initiated as part of the UK National Institute for Health Research (NIHR) investment in Biomedical Research Centres (BRCs) in England. By providing a platform for partnership between universities, NHS trusts and industry, successful BRCs should reduce time lags within translational research whilst also providing an impetus for local economic growth through industry collaboration. We present a novel contribution in the assessment of early-phase biomedical research by estimating the impact of the Oxford Biomedical Research Centre (OxBRC) on income and job creation following the initial NIHR investment. We adopt a macroeconomic assessment approach using Input-Output Analysis to estimate the value of medical research in terms of income and job creation during the early pathway towards translational biomedical research. Inter-industry linkages are assessed by building a model economy for the South East England region to estimate the return on investment of the OxBRC. The results from the input-output model estimate that the return on investment in biomedical research within the OxBRC is 46%. Each £1 invested in the OxBRC generates an additional £0.46 through income and job creation alone. Multiplicative employment effects following a marginal investment in the OxBRC of £98m during the period 2007-2017 result in an estimated additional 196 full time equivalent positions being created within the local economy on top of direct employment within OxBRC. Results from input-output analyses can be used to inform the prioritisation of biomedical research programmes when compared against national minimum thresholds of investment. [ABSTRACT FROM AUTHOR]

England’s national Improving Access to Psychological Therapies (IAPT) programme advocates stepped care as its organizational delivery of psychological therapies to common mental health problems. There is limited evidence regarding the efficacy of stepped care as a service delivery model, heterogeneity of definition and differences in model implementation in both research and routine practice, hence outcome comparison in terms of effectiveness of model is difficult. Despite sound evidence of the efficacy of low intensity interventions there appears to be a perpetuation of the notion that severity and complexity should only be treated by a high intensity intervention through the continuation of a stratified care model. Yet no psychotherapy treatment is found to be more superior to another, and not enough is known about what works for whom to aid the matching of treatment decision. In the absence of understanding precise treatment factors optimal for recovery, it may be useful to better understand the impact of a service delivery model, and whether different models achieve different outcomes. This study aims to contribute to the discussion regarding the stepped care definition and delivery, and explores the impact on clinical outcomes where different types of stepped care have been implemented within the same service. An observational cohort study analysed retrospective data (n = 16,723) over a 4 year period, in a single IAPT service, where delivery changed from one type of stepped care model to another. We compared the outcomes of treatment completers with a stratified care model and a progression care model. We also explored the assumption that patients who score severe on psychological measures, and therefore are potentially complex, would achieve better outcomes in a stratified model. Outcomes in each model type were compared, alongside baseline factor variables. A significant association was observed between a recovery outcome and model type, with patients 1.5 times more likely to recover in the progression delivery model. The potential implications are that with a progression stepped care model of service delivery, more patients can be treated with a lower intensity intervention, even with initial severe presentations, ensuring that only those that need high intensity CBT or equivalent are stepped up. This could provide services with an effective clinical model that is efficient and potentially more cost effective. [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 Identifying ethnic inequalities in health requires data with sufficiently 'granular' (fine detailed) classifications of ethnicity to capture sub-group variation in healthcare use, risk factors and health behaviors. The Robert Wood Johnson Foundation (RWJF), in the USA, commissioned us to explore granular approaches to ethnicity data collection outside of the USA, commencing with the European Union. Methods We examined official data sources (population censuses/registers) within the EU-28 to determine the granularity of their approach to ethnicity. When ethnic information was not available, related variables were sought (e.g. country of birth). Results Within the EU-28, we found 55% of countries collected data on ethnicity. However, only 26% of these countries (England, Wales, Northern Ireland, Scotland, Republic of Ireland, Hungary, Poland and Slovakia) had a granular approach, with half of these being within the UK. Estonia, Lithuania, Croatia, Bulgaria, Republic of Cyprus and Slovenia collected one to six categories. A 'write-in' option only was found in Latvia, Romania and the Czech Republic. Forty-five percent of countries did not collect ethnicity data but collected other related variables. Conclusions (i) Although there is reasonable attention to the diversity of ethnic groups in data collection, a granular approach does not predominate within EU-28 classifications. (ii) Where ethnicity is collected, it is conceptualized in different ways and diverse terminology is used. (iii) A write-in option provides the most granular approach. (iv) Almost half of the countries did not collect data on ethnicity, but did collect related variables that could be used as a proxy. [ABSTRACT FROM AUTHOR]

Background: The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued. Objectives: To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes. Methods: A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes. Results: The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination. Conclusions: Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems. [ABSTRACT FROM AUTHOR]

Aim: To gain a better understanding of the complex relationships of different measures of social position, educational level and income with alcohol consumption in England. Method: Between March 2014 and April 2018 data were collected on n = 57,807 alcohol drinkers in England taking part in the Alcohol Toolkit Study (ATS). Respondents completed the AUDIT-C measure of frequency of alcohol consumption, amount consumed on a typical day and binge drinking frequency. The first two questions were used to derive a secondary measure of quantity: average weekly unit consumption. Socio-economic factors measured were: social-grade (based on occupation), employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each predictor taking account of high collinearity. Models were adjusted for age, gender and ethnicity. Results: The strongest predictor of frequency of alcohol consumption was social-grade. Those in the two lowest occupational categories of social grade (e.g. semi-skilled and unskilled manual workers, and unemployed, pensioners, casual workers) has fewer drinking occasions than those in professional-managerial occupations (β = -0.29, 95%CI -0.34 to -0.25; β = -0.31, 95%CI -0.33 to -0.29). The strongest predictor of consumed volume and binge drinking frequency was lower educational attainment: those whose highest qualification was an A-level (i.e. college/high school qualification) drank substantially more on a typical day (β = 0.28, 95%CI 0.25 to 0.31) and had a higher weekly unit intake (β = 3.55, 95%CI 3.04 to 4.05) than those with a university qualification. They also reported a higher frequency of binge drinking (β = 0.11, 95%CI 0.09 to 0.14). Housing tenure was a strong predictor of all drinking outcomes, while employment status and car ownership were the weakest predictors of most outcomes. Conclusion: Social-grade and educational attainment appear to be the strongest socioeconomic predictors of alcohol consumption indices in England, followed closely by housing tenure. Employment status and car ownership have the lowest predictive power. [ABSTRACT FROM AUTHOR]

The purpose of this article is to report on an ongoing suite of research that aims to develop a design‐led approach to help small and medium‐sized enterprises (SMEs) understand their innovation readiness. At present, a number of tools are available to organizations when carrying out an audit to determine their innovation readiness; however, none of these methodologies have been connected to the practice of design‐led innovation. This article begins to address this gap by presenting a review of a 12‐hour intervention carried out in collaboration with a fund‐management organization located in northeast England as part of a European Union–funded research and innovation program, Creative Fuse. The article utilizes a qualitative approach guided by case study principles, semi‐structured interviews, and action research to reflect on the proposed design‐led approach to assessing innovation readiness. Advantages and challenges to the approach are considered with the intention of developing a practical approach to assessing innovation readiness within SMEs, which builds on design principles in order to rapidly outline the opportunities and potential barriers facing organizations when it comes to identifying areas for future innovation. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) with antiretroviral medication is an effective, evidence-based option for HIV prevention. In England, issues of cost-effectiveness and of responsibility for commissioning prevention services have so far led National Health Service (NHS) England to decide not to commission PrEP. Given the significant lag between the awareness of PrEP efficacy and the opportunity to obtain PrEP through traditional health care routes, many gay and other men who have sex with men (MSM) have turned to ‘DIY PrEP’, purchasing generic formulations of PrEP for themselves on the internet or via other alternative routes. However, there is very little research on DIY PrEP practices and no qualitative study with DIY PrEP users in the UK. A formative qualitative study was conducted in 2017 to inform the development of an intervention (PrEP Club) to support DIY PrEP users and improve the safety and experience of this prevention strategy. Focus groups were held with 20 MSM who are based in London and are obtaining PrEP through means other than clinical trials, to explore their accounts of sourcing and using PrEP and the experiential meanings of these. In this article, we report findings from this first, formative study and present the different practices involved in finding out about PrEP, buying it and ascertaining legitimacy of sellers and products. We reflect on the uncertainties participants described related to actually using PrEP, including deciding on drug dosing and monitoring their health. Finally, we present the results of the discussions participants had about the kind of support they had received, the help they would have liked, and their views on proposed interventions to support DIY PrEP users, such as PrEP Club. [ABSTRACT FROM AUTHOR]

Background: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England.Method and Findings: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data.Conclusions: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status. [ABSTRACT FROM AUTHOR]

This article examines the 2011 England riots and seeks to place them in their recent comparative context. Briefly, it sets out a ‘life-cycle’ model for (historical and comparative) analysis, and then uses this as the basis for contrasting the English experience with the rioting witnessed in other European countries in recent times – in particular the riots in France in 2005 and in Sweden in 2013. Using a range of sources, the analysis identifies a number of similarities and differences between the aetiology, nature and aftermath of the riots in the different countries, and argues that this illustrates both the potential of comparative analysis and the importance of moving beyond an examination of their causes, to study riots ‘in the round’. [ABSTRACT FROM AUTHOR]