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The article focuses on caring for patients with chronic mental illness. Such patients suffer from severe problems, such as aggression or socially unacceptable behavior. Problems are faced in the management of such patients, because community mental health centers don't give priority to their care service. In Newcastle, England, there is a unit for such aggressive patients. The unit consists of a consultant psychiatrist, a behavior therapist, and a clinical nurse specialist.

In their seminal paper 'Is our self nothing but reward', Northoff and Hayes (Biol Psychiatry 69(11):1019-1025, Northoff, Hayes, Biological Psychiatry 69(11):1019-1025, 2011) proposed three models of the relationship between self and reward and opened a continuing debate about how these different fields can be linked. To date, none of the proposed models received strong empirical support. The present study tested common and distinct effects of personal relevance and reward values by de-componenting different stages of perceptual decision making using a drift-diffusion approach. We employed a recently developed associative matching paradigm where participants (N = 40) formed mental associations between five geometric shapes and five labels referring personal relevance in the personal task, or five shape-label pairings with different reward values in the reward task and then performed a matching task by indicating whether a displayed shape-label pairing was correct or incorrect. We found that common effects of personal relevance and monetary reward were manifested in the facilitation of behavioural performance for high personal relevance and high reward value as socially important signals. The differential effects between personal and monetary relevance reflected non-decisional time in a perceptual decision process, and task-specific prioritization of stimuli. Our findings support the parallel processing model (Northoff & Hayes, Biol Psychiatry 69(11):1019-1025, Northoff, Hayes, Biological Psychiatry 69(11):1019-1025, 2011) and suggest that self-specific processing occurs in parallel with high reward processing. Limitations and further directions are discussed.

Background: Older people with multiple long-term conditions (multimorbidity) (MLTC-M) experience difficulties accessing and interacting with health and care services. Breakdowns in communication between patients and staff can threaten patient safety. To improve communication and reduce risks to patient safety in primary care, we developed an intervention: Safer Patients Empowered to Engage and Communicate about Health (SPEECH). SPEECH comprises a booklet for patients and an associated guide for staff. The booklet is designed to provide patients with information about staff and services, skills to prepare and explain, and confidence to speak up and ask. Methods: A single-arm mixed methods feasibility study with embedded process evaluation. General practices in the North West of England were recruited. Participating practices invited patients aged 65+ with MLTC-M who had an appointment scheduled during the study period. Patients were asked to complete questionnaires at baseline and follow-up (four to eight weeks after being sent the patient booklet), including the Consultation and Relational Empathy measure, Empowerment Scale, Multimorbidity Treatment Burden Questionnaire, and Primary Care Patient Measure of Safety. Staff completed questionnaires at the end of the study period. A sub-sample of patients and staff were interviewed about the study processes and intervention. Patients and the public were involved in all aspects of the study, from generation of the initial idea to interpretation of findings. Results: Our target of four general practices were recruited within 50 days of the study information being sent out. A fifth practice was recruited later to boost patient recruitment. We received expressions of interest from 55 patients (approx. 12% of those invited). Our target of 40 patient participants completed baseline questionnaires and were sent the SPEECH booklet. Of these, 38 (95%) completed follow-up. Patients found the intervention and study processes acceptable, and staff found the intervention acceptable and feasible to deliver. Conclusions: Our findings suggest the intervention is acceptable, and it would be feasible to deliver a trial to assess effectiveness. Prior to further evaluation, study processes and the intervention will be updated to incorporate suggestions from participants. Trial registration: The study was registered on the ISRCTN registry (ISRCTN13196605: https://doi.org/10.1186/ISRCTN13196605). [ABSTRACT FROM AUTHOR]

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

This paper presents a new approach for predicting human responses to emergency situations. The approach was developed for ergonomists working in emergency response preparedness. It involves presenting participants with a description of a hypothetical emergency scenario before asking them to describe how they would respond. This study builds upon previous investigations (Lawson et al., 2009a, 2009b; Lawson, 2011) which demonstrated significant associations between the predicted behaviour and that reported in a reference study of behaviour in real fires. This further work aimed to evaluate in greater detail the validity, reliability, resources and ethics of the approach. The results demonstrated significant relationships between the predicted behaviours and those from the reference study for both frequencies (r(s) = 0.572, N = 51, p < 0.001) and sequences (r(s) = 0.344, N = 40, p < 0.05) of behaviour. The approach is shown to be replicable and requires low resources. It does not present any notable risk of physical injury., (Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

The aim of the current paper was to examine externalizing and internalizing behaviors in adolescents with gender dysphoria. One hundred forty-one young people (84 natal females and 57 natal males, M age = 15.13, SD = 1.70) attending the Gender Identity Development Service in London completed the Youth Self Report form at the end of the assessment period (4 to 6 sessions). The main findings indicated that, overall, the adolescents showed significantly more internalizing than externalizing behaviors. Using cutoff points provided by Achenbach and Rescorla (2001), the mean internalizing score fell within the clinical range and the mean externalizing score within the normal range. There was also a significant positive relationship between these two behaviors both in the natal females and the natal males. The natal males presented with significantly more internalizing behaviors than the natal females; however, no significant difference was observed between the genders in terms of the number of externalizing behaviors and total problems. We discuss the implications of these findings with regard to clinical work. [ABSTRACT FROM AUTHOR]

Abstract: A travel plan is a package of measures implemented by an organisation to encourage people who travel to/from that organisation to do so by means other than driving alone by private car. This paper advances two principal arguments: firstly, that the planning system and maximum parking standards as part of it are the main factors leading to travel plan development in England today; and, secondly, that the difficulties of using the planning system in this way means that there is a risk that many of these travel plans are unlikely to have a great deal of influence on travel patterns, making it more unlikely that they will achieve the predicted impact on travel behaviour change, as contained in the important study and report “Smarter Choices” (). This paper presents results from a survey of planning and transport authorities in England, which obtained a 62% response rate from the 139 authorities contacted. It also uses the results of 18 interviews with local authority and Highways Agency staff involved in securing travel plans through the planning process. The survey found that the planning process (as opposed to voluntary efforts) is indeed the main means by which travel plans are now secured. In addition, maximum parking standards were shown to have a major influence on travel plan formation for organisations going through the planning process. There are however reasons to doubt that all of the travel plans secured through the planning process are effective. This is because: [•] Many local authorities use only planning conditions and not the more flexible (but complex) obligations which would allow more complex travel plans to be secured. [•] There is a lack of monitoring of travel plans in many authorities. [•] There is evidence that in many authority areas there are travel plans in breach of legal agreements, but these breaches are not enforced, reportedly due to a lack of monitoring, resources, and other organisational issues. The paper discusses the reasons for these findings and also makes a number of suggestions as to how the planning system could be improved as a means of securing travel plans. [Copyright &y& Elsevier]

Drawing on ESRC-funded research this paper considers some characteristics of the policy process in schools using the construction of behaviour policy in four English secondary schools as a case in point. It argues that behavior policy, like other policies, is enacted in particular and distinct institutional contexts with their own histories; that behaviour policy at the school level is an ensemble of issues/fragments, principles, directives/imperatives and procedures/practices which are messy and complex; and that behaviour policy is very much a collective enterprise. This process of construction and enactment of policy draws upon a range of resources developed within contexts of recontextualisation and involves sophisticated interpretations and translations of policy texts into action. [ABSTRACT FROM AUTHOR]

Background English policy argues that people with intellectual disabilities should be supported in their local communities. There is considerable evidence that this aspiration is not being achieved. This paper seeks to look at the subsection of people with intellectual disabilities who have expensive care needs because of challenging behaviour, to identify the decision-making processes that have led to current service provision and expenditure and to suggest improvements. Materials and Methods We carried out a survey within five North London boroughs to investigate the characteristics of a cohort of people with intellectual disabilities and challenging behaviour in high-cost accommodation (over £70 000/annum). Postal questionnaires and face-to-face interviews were conducted with stakeholders with intellectual disabilities and patterns of current costs were estimated from existing data provided by the commissioning authorities in the five boroughs. Results Two hundred and five individuals with intellectual disabilities and challenging behaviour were identified. They were accommodated in placements provided by 97 separate providers, both in and out-of-area. Those more likely to be placed out-of-area were younger, had multiple health problems, significant challenging behaviour and mental health problems including autistic spectrum disorders. The local community intellectual disabilities teams identified a number of difficulties in meeting the needs of those service users. Conclusions Expenditure on all placements for service users with intellectual disabilities is significant. There is a notable lack of investment in local service development. A coherent approach is required, often across service boundaries. The authors suggest a model for targeted investment aimed at supporting effective local services, and reducing the need for and expense of out-of-area placements. [ABSTRACT FROM AUTHOR]

Driver headway has recently become an important question with much attention being given to unsafe headways or 'tailgating'. This paper reviews a series of recent studies undertaken at the University of Southampton, which have sought to measure and model distance keeping, demonstrating how following distance depends on a wide range of factors, some of which are only recently being explored. These include variations in following distance for any particular driver and the relationship with time to collision, variations in following distances of drivers of differing nationalities and the ability of the driver to 'read the road ahead', which may be affected by interaction with different vehicle types. It is demonstrated that providing clear unequivocal statements regarding car following and safety levels, even after such studies, is still far from straightforward. [ABSTRACT FROM AUTHOR]

Recent advances in medical technology enable many children with complex disabilities to survive into adulthood and to have certain expectations of life. One of these expectations is the continuity of specialist health care in an adult setting. This paper describes a new out-patient service which aims to provide optimum care, continuity and consistency of service for adults with spina bifida and/or hydrocephalus. The need for specialist health input into this service, in order to monitor the neurological, urological and psychosocial complications often associated with spina bifida and/or hydrocephalus is recognised. In one year (1992), 86 young adults with spina bifida and/or hydrocephalus attended for annual or more frequent assessment, either independently or with their families or carers. A variety of health and social problems were treated. In response to demand, a multi-disciplinary assessment unit, which includes the services of both medical and nursing specialists, occupational and physiotherapists, psychologists and access to specialist surgical opinions has recently opened at the Chelsea and Westminster Hospital. This new service attempts to meet some of the needs described in the outpatient audit. Adults with other disabilities are requesting to use this service. A longitudinal study to monitor quality, and outcome is indicated from this initial survey. [ABSTRACT FROM PUBLISHER]

Assessment of deaf children has found that their early understanding in science is behind that of their hearing peers. Research shows that parental attitudes and behaviours can affect educational outcomes but few studies have considered the effects of attitudes towards science on parent/child interactions in the home and thus, the effects on attainment. We studied whether caregiver participation in a pilot intervention would influence attitudes and reported behaviours towards science learning in the home. Method: Caregivers of deaf and hearing pre-school children (N = 18) completed a questionnaire at the start and end of a year-long intervention to determine whether there was a relationship between the level of engagement with the intervention and attitudes towards science both pre- and post-study. Findings: There was a significant positive shift in the amount of reported science talk between caregivers and their children. No relationship between engagement and attitudes was found. Conclusions: We propose that irrespective of group (control or intervention), participating in an intervention involving science talk led to a reported increase in science talk and a generally positive view of science across all groups. [ABSTRACT FROM AUTHOR]

This paper gives an overview of recent observation studies of coaching behaviour and the coaching relationship. It follows a keynote at the 2nd European Coaching Psychology Conference, December 2009, in London. Models influencing the research are drawn from studies of the behaviour of psychotherapists that help to understand the effects of therapeutic interventions. The background to the article is a process-theory of coaching. It reformulates and integrates general factors derived by Gassman and Grawe (2006) from behaviour observation studies. The process-theory assumes that the effects of coaching in general depend partly on seven hypothetical success factors of coaching behaviour that can be assessed by ratings of the observed behaviour of coaches: (1) Appreciation and emotional support of the client; (2) result-oriented problem reflection; (3) result-oriented self-reflection; (4) reflection and calibration of affects; (5) clarification of goals; (6) resource activation; and (7) support of transfer into practice. In a pilot study, trained observers rated the behaviour of coaches using video recordings of coaching sessions. The results show that outcome criteria can be predicted by specific success factors. To understand better how coaching works and how to improve coaching effectiveness, more research and multidisciplinary methods are recommended. [ABSTRACT FROM AUTHOR]

Comments on behaviour-based approaches to people with learning disabilities and challenging behaviour. Challenges facing positive behavioural support; Demands made on the Intensive Support Service in Hastings, England.

This article argues that theories of economic development and productivity should move beyond the generally known factors and mechanisms of such development. It is theoretically proposed and empirically illustrated that differences in human behavior are significant deep-rooted causes of spatial economic and productivity disparities. The article examines the relationship between behavioral constructs and productivity using data for local areas across England. Measures of personality psychology and community culture (including both living culture and cultural heritage) are hypothesized to be related to activities impacting upon productivity performance at the local level. The analysis indicates that underlying human behavioral factors play a role in determining rates of productivity and levels of economic development in localities and regions. Culture and psychological traits, as manifested in the form of the psychocultural behavior of localities and regions, appear to shape their long-term development trajectories. Localities that have relatively atomized behavioral environments with high levels of individual commitment tend to enjoy productivity benefits. Similarly, places with high rates of cultural diversity and extravert individuals have relatively high rates of productivity. It is concluded that from a policy perspective, governments looking to level up local and regional economies should pay greater attention to understanding behavioral influences on productivity, especially related to strategies focused on behavioral nudges, institutional changes, and education systems. [ABSTRACT FROM AUTHOR]

The Mass-Observation Archive at the University of Sussex seeks to involve members of the British public in the recording of everyday life. A panel of several hundred correspondents responds regularly to open-ended 'directives' asking them to write about topics of contemporary interest. The April 1994 directive asked panel members to report their personal experiences of death and bereavement and to respond to questions about 'death and society'. A sample of 54 correspondents in the 65-80 age range (28 men and 26 women) was selected for detailed analysis of their personal experiences of death and bereavement and their views of changing societal attitudes towards death. Experiences of the Second World War appeared to have been of particular importance in shaping personal responses and attitudes towards death and dying. Religion also played a part, for both the religious and non-believers. While all correspondents acknowledged societal changes in behaviours and attitudes towards death in contemporary society as compared to their childhood, they varied in their assessment of these changes. Some welcomed new attitudes and behaviours, others saw them as generally bad and yet others liked some changes but disliked others. Correspondents did not generally describe any great personal fear of death, although there were concerns about the nature of their dying. However, neither were these older people ready to die; even those who accepted their nearness to death expressed the desire to continue living for as long as possible. The persistence of memory and loss is strikingly revealed by vivid accounts of deaths, bereavements and emotions that occurred in childhood, adolescence and young adulthood. [ABSTRACT FROM AUTHOR]

An argument for the political necessity, theoretical appropriateness, and methodological practicality of using recidivism as a measure of effectiveness in prison education programs is presented. Utilizing the experience of a current research project based in Canada and England, the paper explores issues of curriculum and pedagogy, the complexity of predicting behaviour, the utility and limitations of case studies, and 'scientific realist' evaluation methodology. [ABSTRACT FROM AUTHOR]

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The article presents the paper, the first of a series of reporting a five to fifteen year follow-up study of children with infantile psychoses, which attempts to provide a fairly detailed description of the children and their disorders in England. The group consisted of the 69 children who were all those who attended the Maudsley Hosspital between 1950 and 1958. The group is compared with a group of non-psychotic children who attended the same hospital at the same time, and who were individually matched for age, sex and intelligence levels.

• This study identifies the economic and societal drivers of engagement in agri-environmental schemes by UK dairy producers. • The use of a mixed-methodology allowed for an in-depth and detailed exploration of farmer behaviours. • The paper focused on the role of agri-environmental schemes on the future resilience of the dairy sector. • The study results will enable targeted policy development. • Improving communication and engagement with farmers will ensure greater levels of engagement with agri-environmental schemes. Livestock production is under increasing scrutiny regarding its impacts on the environment and its wider role in climate change. Consequently, there are a growing number of private agri-environmental schemes (AES) now operating alongside public AES that offer farmers economic rewards to maintain and enhance the environment. This study focused exclusively on a small number of commercial dairy producers located in the North West of England who were all suppliers of a global food producer and members of the producer's own private AES. The study explored the economic and societal drivers of adoption of agri-environmental behaviours and perceptions of the private processor AES. The study adopted a mixed-method approach. In Stage 1 a structured questionnaire was used to explore the role of an AES offered by the global food processor in the financial stability and environmental sustainability of dairy farms (n = 20). The survey sought to understand the range of interventions adopted, explore future adoption intentions and identify possible ways in which AESs could be extended. The results from the questionnaire were explored further in Stage 2, through qualitative in-depth interviews (n = 12). A thematic analysis approach was taken to describe the key themes that motivated farmer engagement in agri-environmental schemes. Overall, farmers felt that income from the private AES provided stability and resilience to their businesses, permitting them to have greater confidence in business planning and budgeting for the upcoming year. The majority of the farmers were not part of a public AES, but were already undertaking some agri-environmental behaviours and were motivated to join the private scheme primarily by financial incentives and by a desire to maintain the natural environment. A minority of respondents identified that the financial incentives offered had directly motivated a behaviour change. Decisions over which agri-environmental behaviours to adopt were driven by the existing animal management practices, geography and landscape of the farm. Farmers compared the private scheme favourably to available public AESs, which they perceived as more restrictive and providing insufficient reward for the "red tape" involved. In contrast, private scheme membership was perceived to have been beneficial for both their farm business and the local environment, and many reported personal satisfaction from engagement in agri-environmental behaviours. It is important that the design of future public AES does not "crowd out" private schemes, giving farmers increasing AES choice and increasing the overall amount of funding available for the delivery of public goods from agriculture. [ABSTRACT FROM AUTHOR]

The prevalence of pharmaceuticals and personal care products (PPCPs) in lotic habitats is increasing, with the main source of these contaminants being effluent from waste water treatment works (WwTW). There is still much uncertainty about the impacts of these PPCPs at environmentally relevant concentrations and their potential effects on aquatic ecology. Behaviour is a sensitive endpoint which can help evaluate possible population level effects from changes in physiology. This paper evaluates the effects of WwTW effluent on a range of behaviours in the freshwater invertebrate, Gammarus pulex. Effluent taken from the outflow of two WwTW in southern England was used in the study. Behavioural analyses, namely feeding rate, phototaxis, activity, velocity and precopula pairing, were measured in G. pulex following a period of one and three weeks after exposure to a 50% or 100% effluent and a control. Mortality remained very low throughout the 3 week experiment (0–10%, n = 20) and no significant changes in moulting frequency were observed (p > 0.05). No significant effects on feeding or velocity or phototaxis following 3 weeks of effluent exposures were observed (p > 0.05). However, significant reductions were observed in the overall activity over 3 weeks across which appeared to be exacerbated by exposure to effluents. Interestingly, males exposed for 3 weeks to WwTW effluent re-paired with unexposed females significantly faster (4-6x) than control animals. This result was consistent between the effluents taken from the two WwTW. The implications of these behavioural changes are currently unknown but highlight the need for a varied set of tools to study the behavioural changes in wildlife. Image 1 • Multiple behaviours in a freshwater amphipod studied following exposure to raw wastewater effluent. • No effects of effluent observed on mortality, moulting, velocity and phototaxis. • Significantly faster repairing times for precopular pairs indicating stimulation of reproduction. The effects of wastewater effluent on the multiple behaviours in the riverine amphipod, Gammarus pulex. Study surprisingly finds very little effects on activity-based behaviours but does find effects of reproductive behaviours. [ABSTRACT FROM AUTHOR]

Background: Outcomes following myocardial infarction (MI) are improved by uptake and maintenance of physical activity (PA), but little is understood regarding patients experience of maintaining an active lifestyle once immediate support, such as cardiac-rehabilitation (CR), has ended.Aim: The purpose of this study was to investigate MI survivors' attitude and appraisal towards PA and the perceived barriers, motivators and facilitators for maintaining PA long-term.Methods: Semi-structured interviews were carried out with 18 adults (mean age 60.5, range 37-73 years) from England and Scotland, who were a minimum of 5 months post-MI (mean 29 months, range 5-122 months). There were comparatively more male participants (n = 13, 72 %) than female (n = 5, 28 %). Overall 12 (67 %) participants had attended CR. The interviews were transcribed verbatim and thematic analysis was performed using qualitative data analysis software NVivo.Results: Data analysis indicated that the following four core themes influenced MI survivors' behaviour and attitude towards PA: (1) MI as a teachable moment for behaviour change, (2) affective response to MI: enjoyment versus fear, (3) cognitive response to MI: self-perception, attitude and self-efficacy, and (4) access to support and resources, including PA facilities and social support. Participants highlighted a lack of available guidance on maintaining PA behaviour change following CR and that advice on the frequency and intensity of exercise to follow was often unclear and confusing. Feelings of vulnerability and fear of overexertion were apparent, affecting participants self-efficacy to exercise.Conclusions: Current CR programmes fail to address PA belief systems and perceptions of self-efficacy to exercise. Interventions that address feelings of vulnerability and fear of overexertion may be beneficial. Providing ongoing PA advice and access to social support may facilitate patients to maintain changes in PA. [ABSTRACT FROM AUTHOR]

Background: Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery. Methods: The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13–17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness. Discussion: UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression. Trial registration: ISRCTN, ISRCTN66452702. Registered 9 April 2020. [ABSTRACT FROM AUTHOR]

Internationally and within England, there has been increasing focus upon perceived behaviour problems within schools. This study, which took place within a mainstream English secondary school, considered the interplay of the competing notions of exclusion and inclusion for children displaying challenging behaviour. The study used a mixed-methods approach combining quantitative data gathered on school referrals (temporary exclusions from lessons) and interviews with staff and students. This approach allowed both a consideration of trends within referrals and an analysis of how students displaying challenging behaviour are constructed within the discourse of the school. Findings showed that some groups were disproportionately affected by referrals. Within interviews, students and staff oscillated between individualising and contextualising the cause of challenging behaviour both blaming the student and seeing them as a victim of circumstance at the same time. Teachers indicated a greater willingness to change their practice and use a contextual approach to understanding pupils' behaviour when they felt they had been given a reason from the student's home life or background to do so. Recommendations are made for future research in the previously under-researched area of referrals and implications for practice are discussed to make schools more inclusive of students with challenging behaviour. [ABSTRACT FROM AUTHOR]

Background: The NHS Diabetes Prevention Programme (NHS-DPP) is a nine-month, group-based behavioural intervention for adults in England at risk of developing Type 2 diabetes. Four independent providers were commissioned to deliver versions of the NHS-DPP, in line with NHS England specifications. This observational study maps NHS-DPP delivery in routine practice against the NHS specification, and compares service delivery with observed patient experiences.Methods: Researchers observed service delivery across eight complete NHS-DPP courses (118 sessions, median 14 sessions per course), consenting 455 participants (36 staff, 398 patients, 21 accompanying persons). Key features of NHS-DPP delivery were described using the Template for Intervention Description and Replication (TIDieR) framework. Researchers wrote detailed field notes during each session, including observations of patient experience. Field notes were content analysed; instances of positive and negative experiences were labelled and grouped into categories. Researchers used a novel method of comparing observed patient experiences to variations in programme delivery.Results: Delivery broadly followed NHS England's specification and the plans set out by providers. Deviations included the scheduling and larger group sizes in some sessions. There was variation in the type and format of activities delivered by providers. Positive patient experiences included engagement, satisfaction with the programme, good within-group relationships and reported behavioural changes. Negative experiences included poor scheduling, large groups, and dissatisfaction with the venue. Where more interactive and visual activities were delivered in smaller groups of 10-15 people with good rapport, there were generally more instances of positive patient experiences, and where there were structural issues such as problems with the scheduling of sessions, poor venues and inadequate resources, there tended to be more negative patient experiences.Conclusions: Addressing issues that we have identified as being linked to negative experiences with the NHS-DPP could increase uptake, reduce patient drop-out and increase the overall effectiveness of the programme. In particular, modifying structural aspects of the NHS-DPP (e.g. reliable session scheduling, reducing group sizes, enough session resources) and increasing interaction appear particularly promising for improving these outcomes. [ABSTRACT FROM AUTHOR]

Following the call of the UK's Department for Environment, Food and Rural Affairs in its recent Water Efficiency and Behaviour Change Rapid Evidence Assessment 2018, this article seeks to understand the key barriers to effective information-based interventions to encourage household water efficiency in England and Wales and their implications. We review the evidence on information provision to conserve water in England and Wales. We then set out the current key barriers, highlight what might have contributed to the barriers and, based on learnings from the literature, clarify some underlying confusion and suggest ways to improve. [ABSTRACT FROM AUTHOR]

Background: Evidence indicates that early life is critical for determining future obesity risk. A sharper policy focus on pregnancy and early childhood could help improve obesity prevention efforts. This study aimed to systematically identify and categorise policy levers used in England with potential to influence early life course (pregnancy, 0–5 years) and identify how these interface with energy balance behaviours. The objective is to identify gaps and where further policy actions could most effectively focus. Methods: A behavioural science approach was taken using the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) framework. The key determinants of energy balance in the early years were identified from the Foresight Systems Map. Policy actions were scoped systematically from available literature, including any health or non-health policies which could impact on energy balance behaviours. Foresight variables and policy actions were considered in terms of COM-B and the BCW to determine approaches likely to be effective for obesity prevention and treatment. Existing policies were overlaid across the map of key risk factors to identify gaps in obesity prevention and treatment provision. Results: A wide range of policy actions were identified (n = 115) to address obesity-relevant risk factors. These were most commonly educational or guidelines relating to environmental restructuring (i.e. changing the physical or social context). Scope for strengthening policies relating to the food system (e.g. the market price of food) and psychological factors contributing to obesity were identified. Policies acted via all aspects of the COM-B model, but there was scope for improving policies to increase capability through skills acquisition and both reflective and automatic motivation. Conclusions: There is substantial policy activity to address early years obesity but much is focused on education. Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk. [ABSTRACT FROM AUTHOR]

Background: Young people in state care, often due to abuse or neglect, have a four-fold increased risk of drug and alcohol use compared to their peers. Aim: The SOLID study aimed to investigate the feasibility of a definitive randomised controlled trial, comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol), and improve mental health, in young people in care. Methods: We recruited young people in care aged 12–20 years, self-reporting substance use within the previous 12 months and residing in 1 of 6 participating local authority sites in the North East of England. Participants were randomised to either i. Motivational Enhancement Therapy (MET), ii. Social Behaviour and Network Therapy (SBNT) or iii. Control (usual care). All interventions were delivered by trained drug and alcohol workers. Follow-up data were collected 12 months post recruitment. Feasibility for trial progression was compared to pre-specified stop: go criteria (recruitment of 60% of eligible participants, 80% of participants attending 60% of offered sessions and retention of 70% of participants at 12 month follow up). Results: Of 1450 eligible participants, 860 (59%) were screened for drug and alcohol use by social workers, 211 (24.5%) met inclusion criteria for the trial and 112 young people (7.7%) consented and were randomised. Sixty of these 112 participants (54%) completed 12-month follow-up questionnaires. Only 15 out of the 76 (20%) participants allocated to an intervention arm attended any of the offered MET or SBNT sessions. Conclusion: By reference to pre-specified stop: go criteria it is not feasible to conduct a definitive trial for SOLID in its current format. Despite co-designing procedures with staff and young people in care, the screening, referral and treatment pathway did not work here. Future work may require dedicated clinically embedded research resource to evaluate effectiveness of new interventions in services. [ABSTRACT FROM AUTHOR]

Objectives This study explored how health behaviours were supported and changed in people with severe mental illness by primary health care professionals trained in delivering behaviour change techniques (BCTs) within a cardiovascular disease risk reducing intervention. Design Secondary qualitative analysis of 30 staff and patient interviews. Methods We mapped coded data to the BCT Taxonomy (version 1) to identify BCT application. Thematic analysis was conducted to explore the barriers and facilitators of supporting and changing health behaviours. Themes were then interpreted using the Capability, Opportunity, Motivation, and Behaviour model to gain greater explanation behind the processes. Results Twenty BCTs were identified. Staff and patients perceived that health behaviours were commonly affected by both automatic and reflective motivation, sometimes in turn affected by psychological capability, social, and physical opportunity. Staff and patients suggested that motivation was enhanced by both patient and staff ability to observe health benefits, in some cases patients' health knowledge, mental health status, and social support networks. It was suggested that engaging in/sustaining healthy behaviours was influenced by physical opportunities to engrain behaviours into routine. Conclusions According to staff and patients, health behaviour change in this population was driven by complex processes. It was suggested that capability, opportunity, and motivation were in some cases enhanced by BCTs, but variable. Behaviour change may be optimized by individualized behavioural assessments, identifying drivers of behaviour and applying a range of BCTs may help to target individual needs. Patient peer-led approaches, techniques to encourage awareness of visible success, and normalizing health behaviours may increase behaviour change. Statement of contribution What is already known on this subject? Poorer health behaviours may contribute to early mortality rates in people with severe mental illness. Health care professionals are encouraged to target the uptake of healthy behaviours, but there is limited guidance on how. The processes that cause or inhibit health behaviour change within interventions that use behaviour change techniques by health care practitioners are unclear. What does the study add? Staff and patients suggested that behaviour change techniques (BCTs) in some cases increased capability, opportunity, and motivation to engage in healthy behaviours, but in other cases had variable success. Staff and patients reported that in some cases, motivation impacted health behaviour change and was in turn affected by psychological capability, social, and physical opportunity. Individualized behavioural assessments, flexible approaches to BCT application, involvement from patient peer support and different ways of targeting patient motivation may help to increase healthy behaviour changes in this population. [ABSTRACT FROM AUTHOR]

Background: Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours. Methods: Semi-structured individual interviews (n = 12) and focus groups (n = 3) were conducted with eight patients, four carers and 25 staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results: Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff–patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions: This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training. [ABSTRACT FROM AUTHOR]

Background: Reducing the need for antibiotics is crucial in addressing the global threat of antimicrobial resistance. Catheter-associated urinary tract infection (CAUTI) is one of the most frequent device-related infections that may be amenable to prevention. Interventions implemented nationally in England target behaviours related to catheter insertion, maintenance and removal, but the extent to which they target barriers to and facilitators of these behaviours is unclear. This strategic behavioural analysis applied behavioural science frameworks to (i) identify barriers to and facilitators of behaviours that lead to CAUTI (CAUTI-related behaviours) in primary, community and secondary care and nursing homes; (ii) describe the content of nationally adopted interventions; and (iii) assess the extent to which intervention content is theoretically congruent with barriers and facilitators.Methods: A mixed-methods, three-phased study: (1) systematic review of 25 studies to identify (i) behaviours relevant to CAUTI and (ii) barriers to and facilitators of CAUTI-related behaviours, classified using the COM-B model and Theoretical Domains Framework (TDF); (2) content analysis of nationally adopted CAUTI interventions in England identified through stakeholder consultation, classified using the Behaviour Change Wheel (BCW) and Behaviour Change Techniques Taxonomy (BCTTv1); and (3) findings from 1 and 2 were linked using matrices linking COM-B and TDF to BCW/BCTTv1 in order to signpost to intervention design and refinement.Results: The most frequently reported barriers to and facilitators of CAUTI-related behaviours related to 'environmental context and resources'; 'knowledge'; 'beliefs about consequences'; 'social influences'; 'memory, attention and decision processes'; and 'social professional role and identity.' Eleven interventions aiming to reduce CAUTI were identifed. Interventions were primarily guidelines and included on average 2.3 intervention functions (1-5) and six BCTs (2-11), most frequently 'education', 'training' and 'enablement.' The most frequently used BCT was 'information about health consequences' which was used in almost all interventions. Social professional role and identity and environmental context and resources were targeted least frequently with potentially relevant BCTs.Conclusions: Interventions incorporated half the potentially relevant content to target identifed barriers to and facilitators of CAUTI-related behaviours. There were missed opportunities for intervention as most focus on shaping knowledge rather than addressing motivational, social and environmental influences. This study suggests that targeting motivational, social and environmental influences may lead to more effective intervention design and refinement. [ABSTRACT FROM AUTHOR]

Background: The NHS Health Check Programme is a risk-reduction programme offered to all adults in England aged 40-74 years. Previous studies mainly focused on patient perspectives and programme delivery; however, delivery varies, and costs are substantial. We were therefore working with key stakeholders to develop and co-produce an NHS Health Check Programme modelling tool (workHORSE) for commissioners to quantify local effectiveness, cost-effectiveness, and equity. Here we report on Workshop 1, which specifically aimed to facilitate engagement with stakeholders; develop a shared understanding of current Health Check implementation; identify what is working well, less well, and future hopes; and explore features to include in the tool.Methods: This qualitative study identified key stakeholders across the UK via networking and snowball techniques. The stakeholders spanned local organisations (NHS commissioners, GPs, and academics), third sector and national organisations (Public Health England and The National Institute for Health and Care Excellence). We used the validated Hovmand "group model building" approach to engage stakeholders in a series of pre-piloted, structured, small group exercises. We then used Framework Analysis to analyse responses.Results: Fifteen stakeholders participated in workshop 1. Stakeholders identified continued financial and political support for the NHS Health Check Programme. However, many stakeholders highlighted issues concerning lack of data on processes and outcomes, variability in quality of delivery, and suboptimal public engagement. Stakeholders' hopes included maximising coverage, uptake, and referrals, and producing additional evidence on population health, equity, and economic impacts. Key model suggestions focused on developing good-practice template scenarios, analysis of broader prevention activities at local level, accessible local data, broader economic perspectives, and fit-for-purpose outputs.Conclusions: A shared understanding of current implementations of the NHS Health Check Programme was developed. Stakeholders demonstrated their commitment to the NHS Health Check Programme whilst highlighting the perceived requirements for enhancing the service and discussed how the modelling tool could be instrumental in this process. These suggestions for improvement informed subsequent workshops and model development. [ABSTRACT FROM AUTHOR]

Background: Despite the benefits of physical activity for walking ability, balance, and mood, less than 30% of stroke survivors engage in recommended levels of physical activity with high levels of sedentary behaviour observed. This study aims to assess the feasibility, acceptability and fidelity of a theory- and evidence-based multifaceted behaviour change intervention targeting free-living physical activity and sedentary behaviour after stroke. Methods: This study will be set in community stroke services in the North East of England and will assess the feasibility of a behaviour change intervention targeting free-living physical activity and sedentary behaviour of stroke survivors and consultation behaviour of the healthcare professionals to support stroke survivors to make these lifestyle changes. Up to 35 stroke survivors currently receiving stroke rehabilitation within the study catchment area with capacity and no contraindications to increasing physical activity/reducing sedentary behaviour will be recruited. Stroke survivors will receive a supported self-management physical activity/sedentary behaviour programme incorporating provision of information, goal setting, action planning, barrier identification, coping planning, self-monitoring and feedback on physical activity and sedentary behaviour. The programme will be supported by up to 12 healthcare professionals (HCPs) recruited from the community stroke services taking part in the study. The HCPs will deliver at least two face-to-face sessions (baseline, review and subsequent reviews if necessary) and provide a range of personalised tools to support each individual stroke survivor (e.g. workbook, self-monitoring tools, information on local resources). The consultation behaviour of the HCPs will be targeted via a training programme incorporating face-to-face training, a training manual and individual feedback on intervention programme delivery from the study research team. The feasibility, acceptability and fidelity of the study protocol will be assessed. Discussion: The most effective methods of supporting stroke survivors to alter physical activity and sedentary behaviour have yet to be established. This study will establish the feasibility of delivering a complex theory- and evidence-based intervention targeting the behaviour of both stroke survivors and HCPs and assess whether it is acceptable to the target populations. Findings will inform the iterative development of the intervention before a larger scale evaluation. Trial registration: Trial register: Trial identifier: ISRCTN35516780, date of registration: 24/10/2018 [ABSTRACT FROM AUTHOR]

The purpose of this study is to introduce the SoI-EY framework and investigate infants' spontaneous musical behavior based on that framework. The SoI-EY framework is an instrument for investigating children's musical behavior and engagement. It was originally developed in England for children with learning difficulties, but a growing body of research using the SoI framework has been conducted throughout the world. SoI-EY was developed in order to explore the potential relevance for infants of so-called neurotypical musical development. We investigated three infants' musical behavior on the basis of that framework, gathering data by recording video over 13 weeks, then analyzed the total 1693 minutes of video. The frequency, average, and percentage of musical behavior were conducted based on three domains of the SoI-EY framework. We observed that Boy A ranged from Level 2 to Level 4 in the three domains, showing Level 2 overall, while boys B and C fit Level 2 in the reactive domain, and Levels 2 to 4 in the interactive and proactive domains. The results indicated that children of similar ages have different musical development levels, and that a child's environment, developmental level, and playmates can all influence the level of musical development. [ABSTRACT FROM AUTHOR]

Deep vein thromboses (DVTs) are common sequelae of injecting drugs into the groin. We explored meanings and experiences of DVTs in a group of 19 patients from the North East of England with a DVT and in treatment for opioid use. We report three themes: (a) DVT meaning making, (b) embodied experience, and (c) Stigma. Patients attributed DVTs to groin injecting, though thought other factors were also partially responsible. Medication performed both treatment and preventive functions. The most pertinent worry was amputation. Patients recognized stopping injecting as important, but it did not necessarily occur. Stigma resulted in delayed admission to hospital and feelings of isolation; support groups might alleviate the latter. Although groin injecting was undertaken partly to avoid the censure of being a drug user, ironically, a DVT led to long-standing stigmata that were discrediting signs of that exact status. [ABSTRACT FROM AUTHOR]

Internationally young people report experiencing sexual abuse and violence within schools. Developments within the field of adolescent sexual harm are increasingly recognising the need for ecological approaches to harm. Yet, to date, interventions with young people displaying harmful sexual behaviours have prioritised individual behaviours and characteristics over place-based interventions. This article presents empirical evidence from a mixed-methods study aimed at understanding the enablers and barriers to preventing and responding to harmful sexual behaviour in schools. Research was carried out in seven schools and four multi-agency partnerships in England, UK. Using evidence from focus groups, observations, case reviews and policy analysis the article outlines nine components that enable, or are barriers to, effective responses and interventions into harmful sexual behaviour in schools. The paper concludes that responses and interventions into harmful sexual behaviour must move beyond responding to individual behaviours to intervening within factors within schools themselves. [ABSTRACT FROM AUTHOR]

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

Background: Understanding the policy context and how policy is implemented at the local and clinical level is an important precursor to developing preventive strategies focusing on dementia risk reduction in primary healthcare settings.Objective: Using England as a case study, we review policies and strategies relevant to dementia prevention from the national to local level and how these are translated into primary healthcare services.Methods: We conducted a scoping review covering: 1) identification of national, regional, and local policies and strategies that include dementia prevention; 2) identification of national guidelines for implementing dementia prevention at the clinical level; and 3) evaluation of the implementation of these at the clinical level.Results: Dementia prevention is addressed in national policy, and this filters through to regional and local levels. Focus on dementia prevention is limited and variable. Reference to modifiable risk factors is associated with other non-communicable diseases, placing less emphasis on factors more dementia specific. Evidence of implementation of dementia prevention policies at the clinical level is limited and inconsistent. Available evidence suggests messages about dementia prevention may best be delivered through primary healthcare services such as the National Health Service (NHS) Health Check.Conclusion: The limitations identified in this review could be addressed through development of a national policy focused specifically on dementia prevention. This could provide a platform for increasing knowledge and understanding among the general population and healthcare professionals. It would be important for such a policy to cover the full range of modifiable risk factors relevant to dementia. [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]

Methods: A cross-sectional survey of men attending antenatal care with their partners at three London Maternity Units. We assessed level of pregnancy planning using the partner version of the London Measure of Unplanned Pregnancy (LMUP), preconception health behaviours, and whether they had sought information and health professional advice before conception. Main results: We recruited 573 men (91% response rate). Mean age was 34 years, 86% were in employment or full time education and 66% had a degree. Half were overweight or obese, 16% were still smoking and 79% had consumed alcohol in the three months before conception. Of 250 men answering questions about medication, a third were taking medication with potentially adverse effects on male reproductive health, while 23% reported taking pre-pregnancy vitamins. 46.9% had looked at information about pregnancy from a variety of sources, including online, before their partner became pregnant. Assessed by the LMUP, 74% of pregnancies were planned. Male 'planners' were more likely than other men to reduce smoking, reduce alcohol consumption and to eat more healthily in preparation for pregnancy. However, 57% took no action to improve their health. Significance of the findings: In a sample of relatively educated men accompanying their partners on an antenatal visit, nearly half had made at least one positive health behaviour change before pregnancy, but half were overweight or obese and a third were on medication that could impair male reproductive health. These findings, together with a high prevalence of alcohol consumption and smoking, indicate the need for greater paternal preconception health awareness and care. Innovative ways to promote positive messages about fatherhood, including medication review as part of preconception care, should be evaluated for impact on improving paternal reproductive health and pregnancy and neonatal outcomes. [ABSTRACT FROM AUTHOR]

To understand whether people attending sexual health (SH) clinics are willing to participate in a brief behavioural change intervention (BBCI) to reduce the likelihood of future sexually transmitted infections (STIs) and to understand their preferences for different service designs, we conducted a discrete choice experiment (DCE) with young heterosexual adults (aged 16-25 years), and men who have sex with men (MSM) aged 16 or above, attending SH clinics in England. Data from 368 participants showed that people particularly valued BBCIs that involved talking (OR 1.45; 95%CI 1.35, 1.57 compared with an 'email or text'-based BBCIs), preferably with a health care professional rather than a peer. Findings also showed that 26% of respondents preferred 'email/texts' to all other options; the remaining 14% preferred not to participate in any of the offered BBCIs. These results suggest that most people attending SH clinics in England are likely to participate in a BBCI if offered, but the type/format of the BBCI is likely to be the single important determinant of uptake rather than characteristics such as the length and the number of sessions. Moreover, participants generally favoured 'talking'-based options rather than digital alternatives, which are likely to require the most resources to implement. [ABSTRACT FROM AUTHOR]

The ageing of the ethnic minority population in Britain has led to a more ethnically diverse older client group for social care services than has ever been the case. This article focuses on the issue of how social care staff in England experience working across differences of culture, ethnicity, religion, and language. First, the article critically discusses the concept of cultural competence. Then, it reports on the perspectives of social care staff on their attempts to work in a culturally competent way. Individual in-depth qualitative interviews were carried out with 39 social care practitioners, and thematically analysed. Themes related to professional competence, appropriate behaviour, and training needs. Some practitioners felt unable to perform to their accustomed skill level when working across diversity, which has implications for the quality of care provided and job satisfaction. Other practitioners were confident in working across diversity. The key difference between these practitioners was a degree of cultural reflexivity. Recommendations for training are provided. [ABSTRACT FROM AUTHOR]

Objectives: There is considerable public health concern about the combining of sex and illicit drugs (chemsex) among gay men. With a view to inform supportive therapeutic and clinical interventions, we sought to examine the motivations for engaging in chemsex among gay men living in South London.Methods: Community advertising recruited 30 gay men for qualitative semi-structured interview. Aged between 21 and 53 years, all lived in South London in the boroughs of Lambeth, Southwark and Lewisham and all had combined crystal methamphetamine, mephedrone and/or γ-hydroxybutyric acid/γ-butyrolactone with sex in the past 12 months. Transcripts were subjected to a thematic analysis.Results: We broadly distinguished two groups of reasons for combining sex and drugs, within which we described eight distinct motivations. The first major group of motivations for combining drugs with sex was that drugs provide the means by which men can have the sex they desire by increasing libido, confidence, disinhibition and stamina. The second major group of motivations for chemsex was that drugs enhance the qualities of the sex that men value. Drugs made other men seem more attractive, increased physical sensations, intensified perceptions of intimacy and facilitated a sense of sexual adventure.Conclusion: Analysis revealed that sexualised drug use provides both motivation and capability to engage in the kinds of sex that some gay men value: sex that explores and celebrates adventurism. Those services providing (talking) interventions to men engaging in chemsex should consider these benefits of sexualised drug use alongside the harms arising. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption. Method: Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so. Results: Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn’t know why they were cutting down (β -0.25, p<0.05). Conclusions: Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking. [ABSTRACT FROM AUTHOR]

Background: It is estimated that approximately 40% of all cases of cancer are attributable to lifestyle factors. Providing people with personalised information about their future risk of cancer may help promote behaviour change.Aim: To explore the views of health professionals on incorporating personalised cancer risk information, based on lifestyle factors, into general practice.Design and Setting: Qualitative study using data from six focus groups with a total of 24 general practice health professionals from the NHS Nene Clinical Commissioning Group in England.Method: The focus groups were guided by a schedule covering current provision of lifestyle advice relating to cancer and views on incorporating personalised cancer risk information. Data were audiotaped, transcribed verbatim, and then analysed using thematic analysis.Results: Providing lifestyle advice was viewed as a core activity within general practice but the influence of lifestyle on cancer risk was rarely discussed. The word 'cancer' was seen as a potentially powerful motivator for lifestyle change but the fact that it could generate health anxiety was also recognised. Most focus group participants felt that a numerical risk estimate was more likely to influence behaviour than generic advice. All felt that general practice should provide this information, but there was a clear need for additional resources for it to be offered widely.Conclusion: Study participants were in support of providing personalised cancer risk information in general practice. The findings highlight a number of potential benefits and challenges that will inform the future development of interventions in general practice to promote behaviour change for cancer prevention. [ABSTRACT FROM AUTHOR]

Background: This 7 year NIHR programme [2011-2018] tests the primary hypothesis that the NDPS diet and physical activity intervention will reduce the risk of transition to type 2 diabetes (T2DM) in groups at high risk of Type 2 diabetes. The NDPS programme recognizes the need to reduce intervention costs through group delivery and the use of lay mentors with T2DM, the realities of normal primary care, and the complexity of the current glycaemic categorisation of T2DM risk.Methods: NDPS identifies people at highest risk of T2DM on the databases of 135 general practices in the East of England for further screening with ab fasting plasma glucose and glycosylated haemoglobin [HbA1c]. Those with an elevated fasting plasma glucose [impaired fasting glucose or IFG] with or without an elevated HbA1c [non -diabetic hyperglycaemia; NDH] are randomised into three treatment arms: a control arm receiving no trial intervention, an arm receiving an intensive bespoke group-based diet and physical activity intervention, and an arm receiving the same intervention with enhanced support from people with T2DM trained as diabetes prevention mentors [DPM]. The primary end point is cumulative transition rates to T2DM between the two intervention groups, and between each intervention group and the control group at 46 months. Participants with screen detected T2DM are randomized into an equivalent prospective controlled trial with the same intervention and control arms with glycaemic control [HbA1c] at 46 months as the primary end point. Participants with NDH and a normal fasting plasma glucose are randomised into an equivalent prospective controlled intervention trial with follow up for 40 months. The intervention comprises six education sessions for the first 12 weeks and then up to 15 maintenance sessions until intervention end, all delivered in groups, with additional support from a DPM in one treatment arm.Discussion: The NDPS programme reports in 2018 and will provide trial outcome data for a group delivered diabetes prevention intervention, supported by lay mentors with T2DM, with intervention in multiple at risk glycaemic categories, and that takes into account the realities of normal clinical practice.Trial Registration: ISRCTN34805606 (Retrospectively registered 16.3.16). [ABSTRACT FROM AUTHOR]