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Introduction: The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self‐management of stoma‐related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Methods: Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self‐management intervention. Results: Nineteen young people, aged 19–33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty‐nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7‐point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Conclusions: Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self‐management resource for young people with an IBD stoma and have relevance for the clinical management of stoma‐related distress in this population. Patient or Public Contribution: Three patient contributors are co‐authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2‐h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self‐manage distress related to stoma surgery. [ABSTRACT FROM AUTHOR]

Introduction: Associations between structural inequalities and health are well established. However, there is limited work examining this link in relation to mental health, or that centres public perspectives. This study explores people's experience and sense‐making of inequality in their daily lives, with particular consideration of impacts on mental health. Methods: We conducted a peer research study. Participants had to live in one of two London Boroughs and have an interest in inequalities and mental health. Using social media, newsletters, local organisations and our peer researchers' contacts, we recruited 30 participants who took photos representing their experience of inequality and discussed them during semi‐structured interviews. Data were analysed using reflexive thematic analysis. Results: Three themes were identified in this study: (1) inequalities are unjust, multilayered and intertwined with mental health. Accounts demonstrated a deep understanding of inequalities and their link to mental health outcomes, describing inequalities as 'suffering' and 'not good for anyone'. Financial, housing, immigration and healthcare problems exacerbated poor mental health, with racism, gender‐based violence and job loss also contributing factors for both poor mental health and experiences of inequality; (2) inequalities exclude and have far‐reaching mental health consequences, impacting personal sense of belonging and perceived societal value and (3) moving forwards—addressing long‐standing inequality and poor public mental health necessitated coping and resilience strategies that are often unacknowledged and undervalued by support systems. Conclusion: Lived experience expertise was central in this study, creating an innovative methodological approach. To improve public mental health, we must address the everyday, painful structural inequalities experienced by many as commonplace and unfair. New policies and strategies must be found that involve communities, redistributing resources and power, building on a collective knowledge base, to coproduce actions combatting inequalities and improving population mental health. Patient or Public Contribution: This study was peer‐led, designed and carried out by researchers who had experiences of poor mental health. Six authors of the paper worked as peer researchers on this study. [ABSTRACT FROM AUTHOR]

Achieving successful multi‐stakeholder collaboration for sustainable outcomes is complex. This paper provides key principles for future co‐design projects aimed at fostering an inclusive approach to research. These have been developed based on a novel methodology that co‐designed the essential components of a long‐term, collaborative agreement for a nature recovery scheme in England. Using an assortment of iterative, deliberative participatory methods, this research engaged a wide variety of stakeholders to produce a template agreement for an agri‐environmental policy. We demonstrate that a flexible, highly reflective approach resulted in positive engagement with previously marginalised stakeholders. The approach also successfully navigated the unequal power dynamics seen both within and between groups. Finally, multiple feedback loops allowed participants to continually build on previous interactions as they developed and reviewed the agreement. By drawing out the complexities of the co‐design process, this paper explains how co‐design efforts can produce potentially transformative outputs. We hope that the principles introduced here offer a useful starting point for those planning to undertake multi‐stakeholder co‐design. [ABSTRACT FROM AUTHOR]

This paper examines three questions: (1) (How) Is democracy promoted in secondary schools in England? (2) How is the promotion of democracy understood in education and teacher education policy? and (3) To what extent does existing education policy benefit the promotion of democracy in schools in England? To explore these questions, we first discuss the policy landscape surrounding democratic education in England. We then outline our data collection and analysis methods, which comprised (a) the coding of ten different policy documents, including curriculum specifications, teaching standards and inspection frameworks, and (b) the utilisation of an original survey of more than 3000 teachers working in approximately 50% of all secondary schools in England. Together, our data allow us to raise three important points. First, education and teacher education policy neglects to specify 'how' democracy should be promoted and by 'whom'. Second, schools are offering scant provision of democratic education. Third, the majority of teachers feel fundamentally underprepared to teach democracy. We conclude this paper by arguing that, if policymakers do wish to promote democracy, there is a need for a cohesive policy and teacher education approach that guarantees democratic education for all. [ABSTRACT FROM AUTHOR]

Background: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. Aims: To compare the impact of standard parent‐based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. Methods and Procedures: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent‐based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20‐week period. Participants received one of two interventions: (1) Standard Care – indirect group PBI – (PBI) (2) Enhanced Care: indirect group enhanced PBI – (EPBI). Both standardised and non‐standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure – Speech & Language Therapy (PAM‐SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well‐being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. Outcomes and Results: One hundred fifty‐five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur‐Bates Communicative Development Inventories Sentence Length, from pre‐intervention to post‐intervention and 6 months post‐intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval –0.02 to 0.76), although wide variation was found. Conclusions and Implications: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject: Speech, language and communication needs (SLCN) have a knock‐on effect on emotional well‐being, school readiness, literacy and school attainment, putting children at increased risk of long‐term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge: Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work?: This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes. [ABSTRACT FROM AUTHOR]

We estimate the importance of local labour structure in the spread of COVID‐19 during the first year of the pandemic. We build a unique dataset across 6791 English neighbourhoods that distinguishes between people living (residents) and people working (workers) in a neighbourhood, and differentiate between jobs that can be done from home (homeworkers), jobs that likely continued on‐site (keyworkers), and non‐essential on‐site jobs. We find that a 10 percentage points increase in keyworker jobs among residents is associated with 3.15 more cases per 1000 (4.8% relative to the mean), while a 10 percentage points increase in homeworker jobs among residents is associated with a decrease of 7.74 cases per 1000 (11.8% relative to the mean). Results for the composition of workers show the same sign, but smaller magnitudes. A dynamic analysis of the monthly incidence of reported cases shows that these relationships are particularly strong during lockdown periods. These results are heterogeneous across neighbourhoods, with larger positive effect of keyworkers, and lower protective effect of homeworkers, in higher deprivation areas. We explore the role of occupation skill intensity in driving these neighbourhood differences. These findings highlight important asymmetries in the distributional impact of the policy response to COVID‐19. This paper is part of the Economica 100 Series. Economica, the LSE "house journal" is now 100 years old. To commemorate this achievement, we are publishing 100 papers by former students, as well as current and former faculty. Enrico Vanino is affiliated to the Department of Geography and Environment of the LSE. [ABSTRACT FROM AUTHOR]

Existing research on the social and cultural (S&C) values of treescapes tends to be limited in scope, for example to recreation, aesthetic or health values, and much is primarily qualitative, which provides rich detail but does not lend itself easily to incorporation into decision‐making. Having a way to quantify the range of S&C values associated with treescapes is important if decision‐makers are to effectively take these into account. This issue is particularly important currently with ambitious plans to increase tree cover alongside growing threats to treescapes from climate change and tree pests and diseases.This paper outlines the development of a new composite measure to quantify the S&C values associated with treescapes. The development of the measure resulted in a set of 19 statements across six categories of S&C value.We present results from using the measure in a survey with a representative sample of 5000 people across England together with the results of a factor analysis, which suggests a way to simplify the measure into five statements.We examine the measure through the lens of relational values and suggest that a majority of the values in our measure are relational.Policy implications. The composite measure can be used by decision‐makers looking to develop their evidence base regarding the value of treescapes in their area, or for exploring the impact of tree pests and diseases. It has already been used by more than one local authority in England. While data collection was limited to England, we suggest that the measure is applicable across a wider range of countries. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

Surprisingly little is known about the number and frequency level of words that beginner‐to‐low‐intermediate 16‐year‐old learners of French, German, and Spanish are expected to know when taking high‐stakes national exams in England. This study presents exploratory analyses of the lexical content of the listening and reading tests of these exams, a corpus totaling 116,647 running words. Specifically, it seeks to understand the number and frequency level of words that (a) this demographic seems to be expected to know and (b) could be needed for awarding organizations to create exams year‐on‐year. Key findings include that the proportion of low(er)‐frequency words in the corpus of exam papers seemed large, given the stage of the learners and the purpose of the assessments. Critically, these low(er)‐frequency words changed at a high rate between papers, likely incurring a heavy reliance on the lexical inferencing abilities of these relatively inexperienced language learners. The Challenge: Every year, approximately 250,000 16‐year‐olds in England sit high‐stakes exams in French, German, and Spanish. But how many and what kinds of words do these learners need to know to understand the listening and reading exam texts? And how often do these words change year‐on‐year? This article aims to address these questions by analyzing a corpus of exam papers. [ABSTRACT FROM AUTHOR]

Background: People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long‐term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout. Methods: This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically. Results: We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high‐risk situations, leading to hypervigilance and paternalistic approaches to care. Conclusion: The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden. Patient or Public Contribution: Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write‐up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors. [ABSTRACT FROM AUTHOR]

Accounting for the values placed on nature by the public is key to successful policies in reversing ongoing biodiversity declines. However, biodiversity values are rarely included in policy decisions, resulting in poorer outcomes for people and nature.Our paper addresses an important evidence gap related to the non‐availability of values for appraising large‐scale policies and investment programmes for species recovery and habitat improvement at the national level.We use a stated preference choice modelling approach to estimate household preferences and Willingness to Pay for species recovery and habitat improvement over a wide range of habitats in England.The framing of our stated preference study is crucial to the evidence we develop. Within the study, we define species recovery as incremental improvements to habitat quality and present respondents with choices between conservation policy options that improve different habitat types. We then use the response data to estimate values for habitat quality improvements, and the associated improvements to species presence and abundance. We are thus able to estimate economic benefits for 'wild species recovery' simultaneously across a wide range of habitat types.Willingness to pay values for habitat improvement was found to be highest for improvements from 'moderate' to 'full' species recovery by 2042; and for habitat types which have relatively low current extents in England, such as lowland fens.Policy Implications: biodiversity policy designers can make use of stated preference methods to guide decisions over which aspects of biodiversity targets to focus more resources on, since this enables policy to reflect public preferences, and thus engages higher public support for conservation. In our specific data and context, this implies prioritising the restoration of species recovery to high levels and focussing resources on scarcer rather than more abundant habitat types. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

Background: Globally, it is estimated that one in three adults live with two or more long‐term conditions (multiple long‐term conditions, MLTCs), that require self‐management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient‐healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self‐managing MLTCs, amongst people who experience socioeconomic deprivation. Methods: Semistructured one‐to‐one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Findings: Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self‐management, including social isolation, area‐based and economic exclusion, and health‐related stigma and (4) adapting self‐management strategies, including cost‐effective, and culturally/lifestyle appropriate strategies. Conclusions: Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self‐management of MLTCs are of great importance. Patient or Public Contribution: A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data. [ABSTRACT FROM AUTHOR]

Introduction: In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care. Methods: The paper uses thematic analysis of qualitative data from interviews with general practitioners and other healthcare professionals (HCPs, n = 33) in 19 practices in five PCNs, and their patients (n = 35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and 'working age' adults aged between 18 and 45 years. Findings: Patients and clinicians perceived changes to continuity in PCNs in our study. Larger‐scale care provision in PCNs required better care coordination and information‐sharing processes, aimed at improving care for 'vulnerable' patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine HCPs' ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes. Conclusions: New practitioners need to be effectively integrated to support effective team‐based care. However, for patients, especially those not deemed 'vulnerable', this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of the need for it as fluctuating and situational and by supporting clinicians to provide follow‐up care. Patient and Public Involvement (PPI): A PPI group was recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings. [ABSTRACT FROM AUTHOR]

This paper focuses on the use of emancipatory research principles in archival research and contends with the suitability of academic conventions that characterise ethical practice when the research goal is to elevate the voices of marginalised historical groups. Drawing on a case study of Le Court Cheshire Home, England (1948–1975) to address a critical gap in the literature, I highlight some ethical dilemmas I encountered when working at the nexus of historical geography and geographies of disability. This paper demonstrates what an emancipatory research approach means for an archival study of disability, using examples to illustrate how ethical decisions impacted all stages of the research design and the write‐up of findings. I argue that ethics should not be envisaged solely as an approval process completed at the project's outset. Rather, the explorative nature of archival research necessitates that ethics should be an iterative undertaking, with archival sources having the potential to shape both the content and conduct of the research. The paper uses a case study of Le Court Cheshire Home to explore research ethics and the applicability of emancipatory research principles for an archival study of disability. [ABSTRACT FROM AUTHOR]

Background: When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non‐attendance or non‐adherence that are multifactorial and variable dependent on, for example, population and intervention. Aims: To identify rates of non‐attendance and non‐adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. Methods: Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self‐efficacy), personal circumstances (socio‐demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non‐attendance rates were identified via local health records and non‐adherence ascertained using a specific parent‐reported measure within the treatment experience domain. Results: Participants (N = 199) were predominantly mothers, and were ethnically and socio‐economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non‐attendance was 25% and the main predictors of non‐attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non‐adherence in this cohort was 26% with parental rating of the importance of a recommendation and self‐efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. Conclusions & Implications: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS: What is already known on the subject: It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge: This study identified rates of parental non‐attendance and non‐adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non‐attendance. What are the potential or actual clinical implications of this work?: This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities face health disparities, including in high‐income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010 (https://www.legislation.gov.uk/ukpga/2010/15/contents), the Mental Capacity Act 2005 (https://www.legislation.gov.uk/ukpga/2005/9/contents), and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally, the recent changes to healthcare organization in the UK, the COVID‐19 pandemic, and the implementation of the Valuing People white paper are discussed. [ABSTRACT FROM AUTHOR]

Climatic changes can cause unpredictability in flood regimes that traditional flood risk management (FRM) approaches may struggle with. Therefore, flood resilience is seen as a supplementation to these approaches, putting a larger emphasis on flood acceptance and minimising consequences. An (emergent) group contributing towards flood resilience is civil society. This paper examines how civil society contributions can be furthered and guided in the Netherlands as well as exploring potential limitations in doing so. To achieve this, England is used as a good practice example due to a more developed and defined role for civil society being present here. Data were collected on both actual (England and the Netherlands) and potential (The Netherlands) civil society contributions. These were compared to identify potential avenues for Dutch civil society contributions to flood resilience that can be further investigated. The research shows that the most promising avenues are improving advocacy from citizens, improving local flood awareness and developing relationships between FRM authorities and existing citizen groups that can be harnessed and mobilised to support flood resilience. Additionally, the research also provides insights into potential limitations for transferring resilience approaches from one context to another beyond the cases discussed in this publication. [ABSTRACT FROM AUTHOR]

Despite a history of critique, concentrated discussion and improved assessment processes, neglect continues to be a major challenge for child protection services. This paper draws on findings from a government‐commissioned analysis of 'serious case reviews' (SCRs) in England, arising from incidents of serious child abuse in 2017–2019. There were 235 cases, for which 166 final reports were available. Alongside a quantitative analysis of the whole cohort, we undertook an in‐depth qualitative analysis of 12 cases involving neglect. A key challenge in responding to neglect in its different forms is that it can be so widespread amongst families that practitioners no longer notice its severity or chronicity – it becomes normalised. In this paper we explore two dimensions of the 'paradox of neglect' where it seems to be everywhere and nowhere simultaneously. The first is that neglect is so closely bound up with the prevalence of poverty that little action is taken to address it. The second is that the overwhelming nature of neglect can blind practitioners to other forms of maltreatment that may also be present within a family. Practitioners, now more than ever, need to recognise the dimensions of this paradox to protect children from neglect. [ABSTRACT FROM AUTHOR]

There is a statutory duty for all practitioners to record information in child protection work in England. Case recording is a daily task for practitioners, yet an under-researched area of practice. This continuing professional development (CPD) paper will consider the context in which case recording takes place and highlight messages from child protection reviews and enquiries before exploring learning from contemporary research. The complexities of case recording will be considered and how practitioners can reflect upon and improve their daily case recording skills. Practitioners are encouraged to keep the child's views and experiences central and consider the long-term impact of case recording on adults who have experienced abuse and neglect in childhood. Key Practitioner Messages • Case recording is a complex and nuanced task, often missing the multiple perspectives inherent in a child's narrative. • The views, experiences and identity of individual children and young people can be lost in case recording, especially for very young children, older children and those in sibling groups. • Case recording has a support function for care experienced adults to understand their childhood histories, aiding recovery from abuse and neglect. [ABSTRACT FROM AUTHOR]

This paper explores public sentiment towards strike action among healthcare workers, as a result of their perceived inadequate pay. By analysing survey data collected in England between 2022 and 2023, the study focuses on NHS nurses and junior doctors, due to their critical role in delivering essential public services. Results indicate higher public support for strikes by nurses and junior doctors compared to other professions such as postal workers, teachers, rail workers, airport workers, civil servants and university lecturers. However, variation in support for strikes by healthcare workers is observed across societal segments. Significant disparities in support are linked to individual political affiliations, left–right ideological positions and trust in the NHS. In short, nonconservative voters, individuals leaning towards left‐wing politics and those with greater trust in the NHS demonstrate higher likelihoods of supporting strikes by health workers. These findings carry implications for future strike decisions and highlight specific target groups for enhanced communication efforts to garner increased public support. [ABSTRACT FROM AUTHOR]

Background: Developmental Language Disorder (DLD) impacts various aspects of children's language abilities, including the processing of inflectional morphology. Prior research suggests that children with DLD exhibit deficits in processing speed and sensitivity to grammatical inflections, yet the relationship between these deficits remains unclear. Aims: This study aimed to investigate the relationship between processing speed and sensitivity to inflectional morphology in children with DLD, focusing on their real‐time processing abilities in response to regular past tense, third person singular, and regular plural inflections at different rates of sentence articulation. Method: Eighteen children with DLD and 18 age‐matched controls underwent word monitoring tasks that assessed sensitivity to grammaticality of inflections in sentences presented at normal and slow rates of articulation. Results: At a normal rate of articulation, children with DLD demonstrated slower response times and reduced sensitivity to grammaticality across all inflections compared to controls. When the articulation rate was slowed, children with DLD showed improved sensitivity, particularly to regular plural and third person singular inflections, although deficits in processing the regular past tense persisted. Conclusions: The findings suggest a significant relationship between processing speed and inflectional morphology sensitivity in children with DLD. Slower articulation rates improved grammatical sensitivity for certain inflections, highlighting the potential of tailored interventions that consider processing speed limitations. Persistent difficulties with the regular past tense inflection indicate the need for targeted support for children with DLD in this area. WHAT THIS PAPER ADDS: What is already known on this subject: Children with Developmental Language Disorder (DLD) have a wide range of language difficulties, but deficits in inflectional morphology are regarded as a 'hallmark' of the disorder. Children with DLD are also very likely to show deficits in speed of processing, although it is not known if a 'slowness to process' can causally explain the language difficulties these children experience. What this study adds to existing knowledge: When grammatical sensitivity was measured using an online real‐time task, children with DLD showed widespread inflectional deficits when sentences were spoken at a normal conversational rate. When sentence articulation rate was slowed down, children with DLD were faster, more accurate and more sensitive to the grammaticality of constructions. However, deficits in the regular past tense remained persistent, even in this slow‐rate condition. What are the clinical implications of this work?: This study has implications for clinical and educational practices that work with children with DLD to improve their language skills. The findings of this study show that when children with DLD are given more time to process incoming information, their grammatical skills significantly improve. This study also shows that deficits in the regular past tense are persistent, and children are likely need extensive and intensive support with this particular grammatical feature. [ABSTRACT FROM AUTHOR]

Introduction: The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off‐premise locations. Comparisons are made between high‐income countries: Australia, New Zealand, England and Scotland, and across drinker‐types: high‐risk and lower‐risk. Methods: Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross‐national survey measures location and beverage‐specific alcohol consumption. The number of drinking occasions and mean consumption across on‐ and off‐premise locations and the proportion of drinking occasions that high‐ and lower‐risk drinkers had at on‐ and off‐premise locations was estimated for each country. Results: The majority of drinking occasions among high‐risk drinkers occurred at off‐premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High‐risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off‐premise locations compared to England and Scotland. Across all countries, high‐risk drinkers and lower‐risk drinkers consumed significantly larger quantities of alcohol per occasion at off‐premise locations compared to on‐premises locations. Finally, the majority of total alcohol consumed occurred at off‐premise locations across all countries for high‐ and lower‐risk drinkers. Discussion and Conclusions: As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off‐premise. [ABSTRACT FROM AUTHOR]

Primary school homework is a common practice internationally, historically viewed as an independent child activity, but more recently recognised as a family accomplishment. Parental involvement in homework has been principally discussed in relation to general and fixed typologies, with parent behaviours categorised into pre‐defined ‘types’. This paper challenges that framing by theorising homework as an interactional event. It illustrates that parental involvement is not simply determined by parents’ involvement ‘type’; rather, as an interactional exercise, homework is negotiated in‐the‐moment by parent and child, in linguistic, embodied and material ways. Based on a corpus of 74 video‐recorded homework sessions collected in England and Italy, and adopting discourse analysis, the article reveals that parents display their understanding of what counts as ‘appropriate involvement’ and, at the same time, locally negotiate this with their children, often adapting their involvement practices to meet children's explicit or implicit requests. We present this phenomenon as a ‘flexible line of involvement’ which can shift during each interaction, according to local negotiations embedded within the homework encounter. This shapes the unfolding event, as the parent's moment‐by‐moment responses to their child may result in them ‘crossing the line’. By demonstrating the locally negotiated fluidity of parental involvement, this article highlights the complexity of parent–child primary homework, moving beyond common assumptions that homework is either a lone child's activity, a task solely shaped by schools, or the result of fixed types of parental involvement. [ABSTRACT FROM AUTHOR]

This study provides a detailed picture of how the on‐going challenge of teacher shortages in England and Wales is driving the deployment of teaching assistants (TAs) to cover classes in place of teachers. Analyses of data from a survey of nearly 6000 TAs in mainstream and special schools found that TAs cover classes for up to 4 h a week, with one in four covering classes because schools do not have enough teachers and/or are unable to get external supply teachers. The conditions under which TAs cover classes are challenging and a cause of stress and anxiety. Unlike teachers, TAs cover classes without a lesson plan or support from another TA. The majority of TAs said that covering classes inevitably involves them having to teach pupils – despite national guidance stipulating that cover by TAs should not involve ‘active teaching’. Three in four TAs report that their own role is not covered when they cover for teachers. Being deployed to cover classes disrupts and diverts TAs from carrying out their regular duties of delivering curriculum interventions and providing classroom support. Consequently, TAs feel that undertaking cover negatively impacts the quality of learning and provision for pupils with additional needs, as well as their workload, wellbeing, sense of effectiveness and job satisfaction. The conclusion that TAs actively teach lessons to whole classes has potentially significant real‐world consequences and implications for policy and practice. This paper calls for an urgent policy response to what is, in essence, a troubling symptom of the current teacher recruitment and retention crisis. [ABSTRACT FROM AUTHOR]

This paper explores the role of family trajectories during childhood in explaining inequalities by maternal education in children's math and reading skills using harmonized, longitudinal, and nationally representative surveys, which follow children over the course of primary and lower secondary school in four high‐income countries (England, France, Germany, and the United States). As single parenthood and family transitions are more likely among less educated parents and are associated with fewer resources for children, we explore whether growing up outside a stable two‐parent family mediates educational inequalities in math and reading scores. Results show a strong educational gradient in family trajectories in the four countries, but this varies by child age and by country. Children who experience a family transition record lower test scores, although the magnitude differs by the type of postseparation arrangements. Overall, family trajectories are strongly associated with children's math and reading scores but, because of the importance of selectivity in family trajectories, they play only a modest role in explaining the skills gaps by maternal education, considerably less than determinants such as income. The penalties associated with not living within a stable two‐parent family are always larger in the United States and England than in France and Germany. [ABSTRACT FROM AUTHOR]

This article constitutes a 'reply and alternative' to two papers that appeared in a 2021 Special Issue of British Educational Research Journal. Both articles drew on theories of populism as a political logic to explain recent trends in England's education policy. I begin by highlighting how the contributors mobilise 'populist' political logics within their own 'anti‐populist' discourse. I then argue that the theory of epistemic communities, borrowed from the field of public policy analysis, offers an alternative interpretation of the dynamics described in (and exemplified by) the two articles. This alternative interpretation foregrounds the values, beliefs and policy enterprises of two rival communities that seek to influence education policy through the supply of expertise. I argue that attending to how these communities function helps explain how a new group of policy entrepreneurs has come to constitute an increasingly influential 'counter‐epistemic community' and established a mutually beneficial trade in legitimacy with English policy makers. To date, the theory of epistemic communities has been under‐utilised in the study of education policy, but applying the theory to education policy in England provides new insights into how these communities function when the nature of expertise is contested. England's educational policy context also exemplifies the importance of 'fit' between policy makers and experts' beliefs, and the role of policy makers in assembling and curating communities of experts. [ABSTRACT FROM AUTHOR]

Sociolinguistic research has demonstrated that 'urban contact dialects' tend to diffuse beyond the speech communities in which they first emerge. However, no research has attempted to explore the distribution of these varieties across an entire nation nor isolate the social mechanisms that propel their spread. In this paper, we use a corpus of 1.8 billion geo‐tagged tweets to explore the spread of Multicultural London English (MLE) lexis across the United Kingdom. We find evidence for the diffusion of MLE lexis from East and North London into other ethnically and culturally diverse urban centres across England, particularly those in the South (e.g. Luton), but find lower frequencies of MLE lexis in the North of England (e.g. Manchester), and in Scotland and Wales. Concluding, we emphasise the role of demographic similarity in the diffusion of linguistic innovations by demonstrating that this variety originated in London and diffused into other urban areas in England through the social networks of Black and Asian users. [ABSTRACT FROM AUTHOR]

This paper provides an analysis of working from home patterns in England using data from the 2021 Census to understand (1) how patterns of working from home (WFH) in England have shifted since the COVID‐19 pandemic and (2) whether human mobility indicators, specifically Google Community Mobility Reports, provide a reliable proxy for WFH patterns recorded by the 2021 Census, providing a formal evaluation of the reliability of such datasets, whose applications have grown exponentially over the COVID‐19 pandemic. We find that WFH patterns recorded by the 2021 Census were unique compared with previous UK censuses, reflecting an unprecedented increase likely caused by persistent changes to employment during the COVID‐19 pandemic, with a clear social gradient emerging across the country. We also find that Google mobility in 'Residential' and 'Workplace' settings provides a reliable measurement of the distribution of WFH populations across Local Authorities, with varying uncertainties for mobility indicators collected in different settings. These findings provide insights into the utility of such datasets to support population research in intercensal periods, where shifts may be occurring, but can be difficult to quantify empirically. [ABSTRACT FROM AUTHOR]

The publication of the 2021 Census data revealed that four English cities—Birmingham, Leicester, London and Manchester—are now 'no majority' cities, meaning that no ethnic group, including the White British, comprise a majority (more than half) of their populations. This paper explores the residential diversification of these cities to ask: whether that diversification is reflected in the average neighbourhood of all ethnic groups or just some; whether the decline in the number of White British means that 'enclaves' of other ethnic groups are emerging instead; whether the White British are avoiding living in diverse neighbourhoods; and whether a co‐occurrence of the diversification is that residential segregation between the White British and other groups is increasing within and beyond the boundaries of these cities. Using a harmonised set of cross‐census neighbourhoods to provide a consistent geography across the 2001, 2011 and 2021 censuses, the results show that the residential neighbourhoods of the four cities have increased their ethnic diversity for the average member of all ethnic groups. Despite some growth in the number of neighbourhoods where a group other than the White British form a majority, especially in Leicester, the overall conclusion is one of residential diversification happening alongside residential desegregation. [ABSTRACT FROM AUTHOR]

In January 2021, we assessed the implications of temporary regulations in the United Kingdom allowing pubs and restaurants to operate on a takeaway basis without instigating a change of use. Local authorities (LAs) across the North‐East of England were unaware of any data regarding the take‐up of these regulations, partially due to ongoing capacity issues; participants also raised health concerns around takeaway use increasing significantly. One year on, we repeated the study aiming to understand the impact of these regulations on the policy and practice of key professional groups. Specifically, we wanted to understand if LAs were still struggling with staff capacity to address the regulations, whether professionals still had public health trepidations, and if any unexpected changes had occurred across the local food environment because of the pandemic. We conversed with 16 public health professionals, planners and environmental health officers across seven LAs throughout the North‐East of England via focus groups and interviews. Data collated were analysed via an inductive and semantic, reflexive‐thematic approach. Through analysis of the data, three themes were generated and are discussed throughout: popular online delivery services as a mediator to increased takeaway usage; potential long‐term health implications and challenges; continued uncertainty regarding the temporary regulations. This paper highlights important changes to local food environments, which public health professionals should be aware of, so they are better equipped to tackle health inequalities across urban and sub‐urban areas. [ABSTRACT FROM AUTHOR]

Social workers routinely make judgements and decisions as part of their everyday practice. The nature and quality of these can have a significant and long‐lasting impact on the children and families concerned. In this paper, we present an analysis of more than 20 000 judgements (n = 21 193) made by social workers (n = 586) in relation to case vignettes, based on a series of anonymized referrals (n = 12) to social services in England. We do so to ascertain how accurately the social workers were able to predict subsequent actions, events and outcomes, and to calculate the ratio of true positives to false positives at various decision thresholds. We find that the social workers' predictions were more accurate than chance in relation to all but one of the referrals, albeit at the cost of a high rate of false positive errors. We consider these findings in relation to what appears to be a general lowering of the threshold for child protection interventions in England in recent years and in relation to who suffers the injustice of false positive errors in child and family social work. [ABSTRACT FROM AUTHOR]

This paper explores the explanatory models of mental challenges among Black Africans in England. It argues that understanding these models is critical for providing culturally appropriate care to this population. The study employed qualitative methodology, and interpretative phenomenological analysis (IPA). Twelve mental health service users who are living in England and self‐identified as first or second‐generation Black Africans were purposively selected. The data were gathered using face‐to‐face semistructured interviews. Data were manually analysed in accordance with IPA concepts of searching for common, unique and idiosyncratic themes across transcripts. The findings revealed three themes Black Africans associated to their explanatory model of mental health challenges: complexities of migration, African‐centred worldview and negative life experiences. To help alleviate the Eurocentric nature of mental health practice in England, it is hoped that this explanatory model will become an integral part of mental health practice in England and around the world. [ABSTRACT FROM AUTHOR]

The British Educational Research Association (BERA) has promulgated a concept of close‐to‐practice research that is seen as vital to defending and promoting education as an academic discipline. However, what is overlooked are the questions of what education is for and what educational practice is—questions that need to be addressed for any research aiming to understand and improve educational practice. Informed by Robin Alexander's conception of pedagogy, continental Pädagogik and Didaktik and Anglo‐American sources, this paper advances an alternative, different way of thinking about close‐to‐practice research and education as a discipline. It makes a case for education as a distinctive discipline directed towards the understanding and development of practice for the advancement of education. This discipline necessitates an educational and Didaktik way of thinking and theorising, centred on the questions of what education is for, what educational practice is and how practice is supported and developed. This way of thinking and theorising calls for three interrelated lines of research that are significant and matter to practice, particularly within the current context of the National Curriculum in England. [ABSTRACT FROM AUTHOR]

Aim: To develop and explore the validity of a Patient Reported Experience Measure (PREM) for adult inpatient diabetes care. Method: 27 in‐depth interviews were conducted to inform the development of the 42‐item PREM which was cognitively tested with 10 people. A refined 38‐item PREM was piloted with 228 respondents completing a paper (n = 198) or online (n = 30) version. The performance of the PREM was evaluated by exploring (i) uptake/number of responses and (ii) survey validity by investigating whether the PREM data were of adequate quality and delivered useful information. Results: The PREM had low drop‐out or missing data rates suggesting it was appropriately constructed. Analysis of item frequencies and variances, and problem score calculations concluded that questions provided sufficient score differentiation. Conclusions: This new PREM allows for experiences of inpatient diabetes care to be measured, understood and reported on to help identify priority areas for improving care quality. [ABSTRACT FROM AUTHOR]

This paper examined relationships between area‐level deprivation, local authorities' social care expenditure and the rates of children entering care proceedings in England using a novel data linkage of de‐identified records provided by the Children and Family Court Advisory Service (Cafcass). Using structural equation modelling, the authors found strong positive relationships between socioeconomic area deprivation and high rates of children undergoing care proceedings in England between 2015 and 2019. Preventative social care expenditure is associated with lower child rates when adjusting for deprivation. Our findings suggest that deprived and underfunded local authorities respond to an increased need by prioritizing care arrangements. [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]

This paper sets out original findings from analyses of the English National Pupil Database of Key Stage 1 (KS1) attainment, to examine educational outcomes of children with Special Educational Needs and Disabilities (SEND). The schooling of these children has been entirely within the context of the current SEND system, defined by the 2014–2015 policy of the Children and Families Act and Code of Practice. With a strong focus on children's needs and outcomes, the policy intends to achieve high educational outcomes for children with SEND. Our new results show, however, that children with SEND are one of the most disadvantaged groups in education, and they are far less likely to meet expected learning standards than their peers at KS1. For instance, about 44%, 31% and 23% of children with SEND met the standards in phonics, reading and writing, respectively, compared to 88%, 83% and 78% of children with no SEND. Further, our spatial analysis shows for the first time that this disadvantage displays large spatial variability across Local Authorities: there is a postcode lottery in the education of children with SEND. The new findings provide strong evidence that the new SEND policy is failing many children with SEND, and that this performance varies markedly across space. This adds further weight and evidence to a growing recognition, even from government, that the SEND system needs to change, and that the ambitious aims of the transformation of education and care for children with SEND in 2014 and 2015 are not being realised. [ABSTRACT FROM AUTHOR]

Introduction: Consumer preferences should be important factors that are considered when developing health policies and interventions. This paper examines the prevalence of, and factors associated with, consumer preferences regarding smoking behaviour 1 to 2 years in the future. Methods: At least weekly cigarette smokers in the 2020 wave of the International Tobacco Control Four Country Smoking and Vaping Survey (USA, Canada, England and Australia) (N = 8642) were asked if they preferred to continue to smoke or to quit with or without an alternative nicotine product (ANP) over the next 1–2 years. Results: Country‐specific weighted data showed 21.5% preferred to continue smoking and 8.0% were uncertain, leaving 70.6% preferring to quit: 13.7% using an ANP and 56.9% completely quitting nicotine. Apart from interest in quitting, the main predictors of preferring to quit were history of vaping, being aged 55 and over, smoking weekly, worrying about smoking harms, regretting starting and believing vaping is less harmful relative to smoking. Among those preferring to quit, preferring to use ANPs in future was very strongly associated with current vaping (especially daily), being younger, living in England, reporting strong urges to smoke, believing vaping is much less harmful than smoking, and not strongly regretting starting to smoke, and not wanting to quit. Discussion and Conclusions: A significant minority of smokers preferred not to quit, at least in the next year or two. Both interest in quitting and preference for ANPs over complete cessation were associated with similar covariates, including interest in vaping. [ABSTRACT FROM AUTHOR]

There is growing recognition, in the UK and internationally, of the huge costs of recurrent appearances of parents in local authority care proceedings. This paper contributes to pressing policy and practice concerns to reduce recurrence. It presents qualitative longitudinal data from the first study of fathers' experiences of recurrent care proceedings in England. Demonstrating the emotional impact of repeat proceedings and successive loss of children on fathers, in terms of grief, loss and shame, we highlight the trauma and abuse in their developmental histories. We consider complex connections between anger and shame for these fathers, including within the arena of family justice. With the use of literature on complex trauma, shame and parental disengagement, we explore ideas for re‐framing fathers', and professionals', resistance to engagement and for better understanding fathers' intense emotions. We suggest that the link between shame and complex trauma and the value of shame reducing, dignity promoting practice in response provide a valuable way forward for working with fathers. As is recognized to be the case for mothers, without holistic, empathic interventions to address the vulnerabilities of such fathers, the risks for children, mothers and fathers are unlikely to reduce. [ABSTRACT FROM AUTHOR]

Background: Young people moving from adolescent secure hospitals to adult care present with multiple and complex needs which often remain unmet during transition periods. This paper delineates the process of developing and co‐producing the moving forward intervention (MFi), which aims to address the psychosocial needs of transitioning youth who have limited access to well‐researched and tailored service provisions. Method: An extensive search of the relevant literature was conducted to generate themes and guide the co‐production phase. Fourteen Advisory Group Meetings were held virtually during COVID‐19 to design the MFi module content with 17 keyworkers, 2 parents and 13 young people aged 17–18 years across six adolescent secure hospitals in England. Thematic analysis was used to reflect on the field notes discussed in the Advisory Groups. Results: Co‐produced themes from the literature and the Advisory Groups informed the development of the proposed intervention. Three overarching themes pertinent to expectations in adult services, improving communication gaps between services and facilitating the letting go period emerged from the co‐production phase. It was suggested the MFi is co‐delivered by a peer with lived experience to build trust and create hopefulness among young people. The importance of promoting graded transitions through standardised procedures was highlighted. Conclusions: The current findings promote evidence‐based initiatives and build robust practice frameworks that inform treatment and policy guidelines. The young people, parents and keyworkers found the MFi supportive and valued the co‐production experience. As such, co‐production has been a vital tool in promoting patient engagement and empowerment, and reducing service inequalities, especially in adolescent secure hospitals. [ABSTRACT FROM AUTHOR]

When a pregnancy ends in England and Wales, statutory time away from paid employment is limited to circumstances where there is a live birth or stillbirth. Forms of leave, such as Maternity Leave or Paternity Leave, depend on parental status derived from the civil registration of a new person or a post‐viability stillbirth. Other early pregnancy endings, such as miscarriage or abortion, do not provide specific time off work after pregnancy. This paper uses the concept of reproductive governance to analyze current and shifting biopolitical truth discourses, strategies of intervention, and modes of subjectification around post‐pregnancy leaves. It shows how different inclusions and exclusions are generated by the classificatory boundaries which act as political technologies in this field. Contributing to an area that is under‐researched in the literature, we provide a review of post‐pregnancy statutory employment leave entitlements in this context. We then consider proposals for change presented in the United Kingdom political system in relation to more inclusive leave benefits offered by some employers and different pregnancy ending leaves offered in other jurisdictions. We argue that current arrangements and proposals do not adequately reflect the complexity and diversity of pregnancy endings. We conclude with a call to policymakers in all contexts to carefully assess the consequences of new ideas around leaves for pregnancy endings and to formulate inclusive and fair proposals for change. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]

Background: Socio-economic status (SES) is a powerful predictor of attainment. Research has identified multiple mechanisms that underpin the effect of SES on attainment. For example, self-regulation (processes through which individuals direct and control their attention, emotion and behaviour) has been identified as one mechanism mediating the SES attainment gap. However, previous studies have not directly tested the statistical pathways by which children from lower SES backgrounds develop low self-regulation skills and subsequently poor attainment at the end of primary school. Adding the home learning environment, which is associated with both SES and self-regulation, further fleshes out the longitudinal pathways., Aims: We propose and test a new model where the relationship between SES and school attainment is sequentially mediated by the family home learning environment and the child's self-regulation., Sample: This study uses the Effective Pre-school, Primary and Secondary Education data set to study 2311 English children., Methods: We measured SES (via socio-economic disadvantage) based on an index of low parental education, occupation and income at age 3+. The home learning environment was measured by the Home Learning Environment Index at age 3+; self-regulation was a teacher report on the Child Social Behaviour Questionnaire at age 4+ and attainment was measured via scores on national assessments of English and Maths at age 11., Results: Our measure of disadvantage predicted attainment. The home learning environment predicted children's self-regulation skills. The relationship between disadvantage and attainment was sequentially mediated by the home learning environment and self-regulation., Conclusions: These findings suggest that home learning environment and self-regulation may play a sequential role in perpetuating socio-economic disparities in education., (© 2023 The Authors. British Journal of Educational Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

This is a perspective from an Independent Advocate in England, United Kingdom on the importance of equality in the involuntary treatment of children and young people (CYP). The article highlights the need for safeguards when CYP require detention as part of their mental health care. The paper raises concern that CYP and their families who are less empowered to advocate for optimal care plans may be at risk of less satisfactory outcomes from mental health detention. It notes that CYP in the care system may be particularly vulnerable to such outcomes due to their lower levels empowerment. To mitigate this risk, services need to be proactive in reducing inequity arising from differential levels of empowerment among service users. This could be achieved by adopting strong participation and coproduction activities and ensuring access to Advocacy services for all CYP. [ABSTRACT FROM AUTHOR]

Aim: The British Isles have been worked for millennia to extract metal ores to feed industrial development, leaving a legacy of mine water pollution that continues to impact freshwater communities in many regions. Brown trout (Salmo trutta L.) have long been observed to persist in these metal‐impacted systems as apex predators, with previous studies showing a small number of impacted populations to be highly genetically divergent. We sought to understand the scale of genetic diversity across regions and the repeatability of genetic divergence in trout populations affected by metal pollution. Location: We examined four mine water‐impacted regions across the British Isles: west Wales, northeast England, southwest England and southeast Ireland. Methods: We employed a panel of 95 SNP loci to screen 1236 individuals from 71 sites representing paired metal‐impacted and clean sites from across the four regions. From these, we obtained diversity statistics, assessed genetic structuring of populations and modelled historical demographic scenarios to understand which factors most credibly explain genetic variation in divergent populations. Results: We evidenced hierarchical population structure in the regions studied, in line with expectations from phylogeographic history. However, in a hierarchical analysis of genetic structuring the first level of differentiation was driven by the divergence of the metal‐impacted trout of Cornwall in southwest England. Within regions we observed reduced genetic diversity and repeated patterns of local genetic sub‐structuring between paired samples from metal‐impacted and relatively clean sites. Demographic history analyses suggested the timing of these splits to be relatively recent and to be associated with periods of peak mining activity. Main conclusions: Our findings demonstrate distinct patterns of genetic isolation and reduced diversity arising from legacy pollution in freshwater ecosystems, with impacts being most apparent where both chemical pollution and physical barriers are present. Management should focus on the amelioration of mine water wash‐out and the removal of barriers to fish movement to safeguard genetic diversity in impacted populations. [ABSTRACT FROM AUTHOR]

Objectives: To explore the experiences, acceptability and utility of a decision aid for family carers of people with dementia towards the end of life. Methods: We conducted semi‐structured interviews with a sample of family carers enroled into a 6‐month feasibility study in England, sampling to gain a range of experiences and views, based on relationship to person they cared for (e.g., spouse, adult child), age, gender, and self‐reported use of the decision aid during the feasibility study. Interviews were conducted in March 2021–July 2021 and analysed using reflexive thematic analysis. We used COREQ checklist to report our methods and results. Results: Family carers found the decision aid acceptable, describing it as comprehensive, accessible with relevant information and its presentation enabled good engagement. Experiences of the decision aid covered four main themes which demonstrated the perceived acceptability and utility: 1. A source of support and reassurance; 2. Empowering conversations and confidence; 3. Including the person living with dementia; and 4. Breaking down complexity. Conclusions: An aid focussing on decisions about dementia end of life care supported family carers break down complex and emotive decisions, not only with making decisions in the moment but also in future planning. Patient or Public Contribution: Our three Patient and Public Involvement (PPI) members (all former family carers) were crucial throughout the wider study. PPI supported development of the topic guides, supported trialling the topic guide and interview procedures and finally supported the development of themes as part of the analysis. [ABSTRACT FROM AUTHOR]

Background: Meals on Wheels (MoWs) could help adults with care and support needs continue living independently. However, many people are not aware that the service still exists in England, or that it could provide benefits beyond nutrition. Objective: Working with an existing advisory group of six people with lived experience of MoWs (an adult who uses MoWs and people who have referred a family member to MoWs), this work aimed to co‐produce knowledge translation resources (two infographics and a film) to raise awareness of MoWs and their benefits. Methods: Four participatory online workshops were held in May–July 2023, to establish perceived high‐priority themes from recent qualitative research that should be included in the resources, and preferences about message content, language, design, and how the resources should be disseminated. Findings: The most important perceived MoWs benefits that the group agreed should be included in the resources were: the importance of a nutritious meal that requires no preparation; the service's reliability/consistency; the importance of interactions in reducing social isolation, and; the ease to commence the service. The group highlighted the need for language to be nontechnical and invitational, and for images to relate to respective messages, and be inclusive of anyone who could benefit from MoWs. Several routes for dissemination were proposed, highlighting the need to disseminate to the NHS, social care organisations and community groups. Conclusion: These co‐produced resources could enhance adult social care delivery in England, as raising awareness of MoWs and their benefits could increase referral rates, so that more adults with care and support needs can benefit from the service. Patient or Public Contribution: An advisory group of people with lived experience of MoWs (users of the service and family referrers) participated in the workshops, extensively discussed the findings of earlier research, co‐produced the knowledge translation resources, and advised on the implications and future dissemination steps. The group also provided informal feedback on a draft of this manuscript. [ABSTRACT FROM AUTHOR]

Background: Disability is often an essentialised and oversimplified concept. We propose refining this while incorporating the multidimensional nature of disability by increasing the use of existing survey questions and their corresponding data to enrich, broaden and inform understandings of disability. Methods: We combined patient and public involvement and engagement (PPIE) with focus groups and concept mapping to collaboratively map disability survey questions into conceptual models of disability with six members of the public with lived experiences of disability. Results: Using reflexive thematic analysis, we identified three qualitative themes and eight subthemes through a series of four PPIE activities: (1) understanding concepts of disability based on individual experience, subthemes: 1.1—preference for the biopsychosocial model, 1.2—'Reviewing' instead of mapping survey questions and 1.3—comparing questions to real life; (2) consistency between understanding needs and implementing adjustments, subthemes: 2.1—connecting preparation and operation, 2.2—inclusivity and adjustments in activities and 2.3—feedback for improving activities and (3) real‐world applications—targeted awareness raising, subthemes: 3.1—who, where, what and how to share activity findings and results, 3.2—sharing with human resource and equality, diversity and inclusion professionals. Conclusion: Members of the public who collaborated in these activities felt empowered, engaged and supported throughout this study. This approach offers a model for other researchers to cede power to the public over the research aspects typically reserved for researchers. Patient or Public Contribution: We involved members of the public with lived experience throughout this study—co‐design, co‐facilitation, collaboratively mapping the disability or disability‐related survey questions into conceptual models of disability, evaluation of the activities, co‐analysis and co‐authorship. [ABSTRACT FROM AUTHOR]

Women with obesity during pregnancy are at increased risk of excessive gestational weight gain (GWG) and other maternal and infant adverse outcomes, which all potentially increase childhood obesity. This study explored infant weight outcomes for women with a body mass index (BMI) ≥ 35 kg/m² who were offered an antenatal healthy lifestyle service. A retrospective cohort study, including linking data from two separate health care Trusts, was undertaken. Data were collected from maternity records for women with a BMI ≥ 35 kg/m2 referred to an antenatal healthy lifestyle service from 2009 to 2015. The respective child's weight outcome data was additionally collected from health and National Child Measurement Programme records. Univariate logistic regression determined the odds of childhood overweight, obesity and severe obesity according to attendance at the antenatal healthy lifestyle service, GWG and sociodemographic characteristics. Factors significant (p < 0.05) within the univariate analysis were entered into multiple logistic regression models. Among women with a BMI ≥ 35 kg/m², 30.4% of their children were obese at school entry and 13.3% severely obese. Healthy lifestyle service attendance was not associated with childhood overweight or obesity at any point within the univariate analysis. At school age multiple regression analysis showed the odds of overweight and obesity increased with excessive GWG and the odds of obesity decreased with a parent in a professional occupation, additionally having a mother who smoked in pregnancy increased severe obesity. Women should be supported to optimise their BMI before pregnancy. Additionally, rather than exclusively focusing on changing an individual's behaviour, future interventions should consider external influences such as the woman's family, friends and sociodemographic background. Key messages: Among children born to women with a body mass index (BMI) ≥ 35 kg/m2 almost 50% were classified as overweight or obese at age 5. Of these, only 15.6% had been born large for gestational age.This brief antenatal healthy lifestyle intervention provided to mothers with obesity did not significantly reduce child's overweight or obesity.Demographic factors such as household occupation and maternal smoking during pregnancy were associated with long‐term childhood obesity.More emphasis is required on interventions that support women to optimise their BMI before pregnancy.Future interventions should consider external influences on the woman for example through a socioecological framework. [ABSTRACT FROM AUTHOR]

Background and Aim: Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. Methods: An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE‐ICP Collaboration. Findings: Twenty‐three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self‐doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. Conclusion: We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. Patient or Public Contribution: This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders. [ABSTRACT FROM AUTHOR]

Introduction: In the United Kingdom, fractures of the cervical dens process in older and/or frail patients are usually managed nonsurgically in a hard collar. However, hard collars can lead to complications and this management approach is now being questioned, with growing interest in maximising patients' short‐term quality‐of‐life. It is vital that patients' perspectives are considered; yet, there is a dearth of literature examining the aspect. To help inform wider decision‐making about use of collar/no collar management of dens fractures in older/frail people, we explored older/frail people's experience of the two management approaches and how they affected their perceived quality‐of‐life. Methods: We interviewed older and/or frail adults with a recent dens fracture (aged ≥65 years or with a clinical frailty score of ≥5) or their caregiver. Participants were recruited from both arms of a clinical trial comparing management using a hard collar for 12 weeks (SM) with early removal of the collar (ERC) and were interviewed following randomisation and again, 12–16 weeks later. Data were analysed using a framework approach. Results: Both participant groups (SM/ERC) reported substantial, negative quality‐of‐life (QoL) experiences, with the fall itself and lack of access to care services and information being frequent major contributory factors. Many negative experiences cut across both participant groups, including pain, fatigue, diminished autonomy and reduced involvement in personally meaningful activities. However, we identified some subtle, yet discernible, ways in which using SM/ERC reinforced or alleviated (negative) QoL impacts, with the perceived benefits/burdens to using SM/ERC varying between different individuals. Conclusion: Study findings can be used to support informed decision‐making about SM/ERC management of dens fractures in older/frail patients. Patient or Public Contribution: Public and patient involvement contributors were involved in the study design, development of interview topic guides and interpretation of study findings. [ABSTRACT FROM AUTHOR]