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Objectives: The aim of this study was to understand how people living with Parkinson's and healthcare professionals perceived their care management and interactions with health services were affected during the COVID‐19 pandemic. Background: During the COVID‐19 pandemic, many governments introduced restrictions and services that support Parkinson's care management had to cease or be delivered remotely. These changes may have had an impact on the well‐being of people living with Parkinson's. Methods: A qualitative exploratory UK study was carried out. Semi‐structured individual interviews with people living with Parkinson's and health professionals were recorded, transcribed verbatim and analysed using Braun´s and Clarke´s thematic analysis. Eleven patients and 10 health professionals were recruited between April and September 2020. The study was reported using the COREQ. Results: Two main themes were identified. In the first theme, many patients and professionals reported that the COVID‐19 pandemic made some people living with Parkinson's feel isolated and vulnerable due to disruptions to their social networks and usual activities related to Parkinson's disease care. However, other patients remained connected with their networks. In the second theme, patients and most professionals mentioned that some clinical practices were cancelled, delayed or transformed to remote consultation. Conclusion: The COVID‐19 restrictions had an impact on how people living with Parkinson's managed their care and in their interactions with healthcare services. Health professionals should assess the risk of vulnerability, social isolation, physical inactivity and confidence with remote consultations in people living with Parkinson's. This might inform a rethinking of existing clinical interactions with people living with Parkinson's towards a flexible, sustainable, person‐centred care model. Relevance to clinical practice: This study has shown that Parkinson's care management and interactions with healthcare services should provide personalised and flexible support. To meet this challenge, the design of the organisation of health services should include greater involvement of patients and person‐centred care models. [ABSTRACT FROM AUTHOR]

Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long‐term conditions such as Parkinson's disease. Objective: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. Methods: A mixed‐methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta‐ethnography approach was used to analyse and synthesize cross‐national findings. Results: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. Conclusions: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. Patient or Public Contribution: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings. [ABSTRACT FROM AUTHOR]

People with Parkinson's disease (PD) may find it difficult to identify and access the wide number of services they need and are entitled to along their complex PD journey. As part of the project OPTIM‐PARK – Optimisation of community resources and systems of support to enhance the process of living with Parkinson's Disease, document analysis was developed to create overviews of existing resources and systems of support in Denmark, Norway, Spain and the United Kingdom. Documents on community resources, policies, guidelines and professional recommendations were the main sources of information. They were sought systematically at official websites of the public sector (national and regional levels) and websites of non‐governmental organisations and scientific societies; searches were performed in October 2020 and updated in September 2021. A higher‐level cross‐national content analysis integrated all the country‐specific information. Data‐ and concept‐driven coding frames were developed; trial coding and peer review strengthened face validity and reliability. The analysis led to overviews of: (1) Key aims at patient and societal levels. (2) Key elements in form of professional approaches. (3) Community resources. (4) Legally anchored services. In general, clear descriptions of how to implement care pathways and tools to facilitate delivery were missing in the included documents, and pathways and guidelines did not include referral to general social support, social security support or labour and employment support. The results shed light on the complex support systems and resources and can inspire the planning of more comprehensive care pathways for people with PD and other long‐term conditions. [ABSTRACT FROM AUTHOR]

Several studies have suggested SARS‐CoV‐2 originated from a viral ancestor in bats, but whether transmission occurred directly or via an intermediary host to humans remains unknown. Concerns of spillover of SARS‐CoV‐2 into wild bat populations are hindering bat rehabilitation and conservation efforts in the United Kingdom and elsewhere. Current protocols state that animals cared for by individuals who have tested positive for SARS‐CoV‐2 cannot be released into the wild and must be isolated to reduce the risk of transmission to wild populations. Here, we propose a reverse transcription‐quantitative polymerase chain reaction (RT‐qPCR)‐based protocol for detection of SARS‐CoV‐2 in bats, using fecal sampling. Bats from the United Kingdom were tested following suspected exposure to SARS‐CoV‐2 and tested negative for the virus. With current UK and international legislation, the identification of SARS‐CoV‐2 infection in wild animals is becoming increasingly important, and protocols such as the one developed here will help improve understanding and mitigation of SARS‐CoV‐2 in the future. [ABSTRACT FROM AUTHOR]

Background: The reasons for acute hospital admissions among people with Parkinson's disease are well documented. However, understanding of crises that are managed in the community is comparatively lacking. Most existing literature on the causes of crisis for people with Parkinson's disease (PwP) uses hospital data and excludes the individual's own perspective on the crisis trigger and the impact of the crisis on their care needs. Objective: To identify the causes and impact of crises in both community and hospital settings, from a patient and carer perspective. Methods: A total of 550 UK-based PwP and carers completed a survey on (a) their own personal experiences of crisis, and (b) their general awareness of potential crisis triggers for PwP. Results: In addition to well-recognised causes of crisis such as falls, events less widely associated with crisis were identified, including difficulties with activities of daily living and carer absence. The less-recognised crisis triggers tended to be managed more frequently in the community. Many of these community-based crises had a greater impact on care needs than the better-known causes of crisis that more frequently required hospital care. PwP and carer responses indicated a good general knowledge of potential crisis triggers. PwP were more aware of mental health issues and carers were more aware of cognitive impairment and issues with medications. Conclusion: These findings could improve care of Parkinson's by increasing understanding of crisis events from the patient and carer perspective, identifying under-recognised crisis triggers, and informing strategies for best recording symptoms from PwP and carers. [ABSTRACT FROM AUTHOR]

Objectives: To identify early nutritional risk in older populations, simple screening approaches are needed. This study aimed to compare nutrition risk scores, calculated from a short checklist, with diet quality and health outcomes, both at baseline and prospectively over a 2.5-year follow-up period; the association between baseline scores and risk of mortality over the follow-up period was assessed. Methods: The study included 86 community-dwelling older adults in Southampton, UK, recruited from outpatient clinics. At both assessments, hand grip strength was measured using a Jamar dynamometer. Diet was assessed using a short validated food frequency questionnaire; derived 'prudent' diet scores described diet quality. Body mass index (BMI) was calculated and weight loss was self-reported. Nutrition risk scores were calculated from a checklist adapted from the DETERMINE (range 0–17). Results: The mean age of participants at baseline (n = 86) was 78 (SD 8) years; half (53%) scored 'moderate' or 'high' nutritional risk, using the checklist adapted from DETERMINE. In cross-sectional analyses, after adjusting for age, sex and education, higher nutrition risk scores were associated with lower grip strength [difference in grip strength: − 0.09, 95% CI (− 0.17, − 0.02) SD per unit increase in nutrition risk score, p = 0.017] and poorer diet quality [prudent diet score: − 0.12, 95% CI (− 0.21, − 0.02) SD, p = 0.013]. The association with diet quality was robust to further adjustment for number of comorbidities, whereas the association with grip strength was attenuated. Nutrition risk scores were not related to reported weight loss or BMI at baseline. In longitudinal analyses there was an association between baseline nutrition risk score and lower grip strength at follow-up [fully-adjusted model: − 0.12, 95% CI (− 0.23, − 0.02) SD, p = 0.024]. Baseline nutrition risk score was also associated with greater risk of mortality [unadjusted hazard ratio per unit increase in score: 1.29 (1.01, 1.63), p = 0.039]; however, this association was attenuated after adjustment for sex and age. Conclusions: Cross-sectional associations between higher nutrition risk scores, assessed from a short checklist, and poorer diet quality suggest that this approach may hold promise as a simple way of screening older populations. Further larger prospective studies are needed to explore the predictive ability of this screening approach and its potential to detect nutritional risk in older adults. [ABSTRACT FROM AUTHOR]

Background: PDSAFE is an individually-tailored, physiotherapist-delivered, balance, strength and strategy training programme aimed at preventing falls among people with Parkinson's. We evaluated the cost-effectiveness of PDSAFE compared with usual care for people with Parkinson's at higher risk of falling, from a UK National Health Service and Personal Social Service perspective.Methods: Resource use and quality of life data (EQ-5D-3L) were collected from 238 participants randomised to the PDSAFE intervention and 236 participants randomised to control, at baseline, 3 months, 6 months (primary outcome), and 12 months. Adjusted cost and quality-adjusted life-years (QALYs) were estimated using generalised linear models and uncertainty estimated using a non-parametric bootstrap.Results: Over 6 months, the PDSAFE intervention was associated with an incremental cost of £925 (95% CI £428 to £1422) and a very small and statistically insignificant QALY gain of 0.008 (95% CI - 0.006 to 0.021). The resulting incremental cost-effectiveness ratio (ICER) was £120,659 per QALY and the probability of the intervention being cost-effective at a UK threshold of £30,000/QALY was less than 1%. The ICER varied substantially across subgroups although no subgroup had an ICER lower than the £30,000 threshold. The result was sensitive to the time horizon with the ICER reducing to £55,176 per QALY when adopting a 12-month time horizon and assuming a sustained treatment effect on QoL, nevertheless, the intervention was still not cost-effective according to the current UK threshold.Conclusions: Evidence from this trial suggests that the PDSAFE intervention is unlikely to be cost-effective at 6 months. The 12-month analysis suggested that the intervention became closer to being cost-effective if quality of life effects were sustained beyond the intervention period, however this would require confirmation. Further research, including qualitative studies, should be conducted to better understand the treatment effect of physiotherapy and its impact on quality of life in people with Parkinson's given existing mixed evidence on this topic.Trial Registration: ISRCTN48152791. Registered 17 April 2014. http://www.isrctn.com/ISRCTN48152791. [ABSTRACT FROM AUTHOR]

Young unaccompanied asylum seekers have been portrayed as vulnerable, resilient or both. Those granted residency in Europe are offered support by health and social care systems, but once they leave the care system to make independent lives, what part can these services play? Our review of research with migrants who have been in care in Sweden and the United Kingdom found evidence of unmet need, but little research describing their own views of services. The limited published evidence, supplemented by interviews with care leavers in a UK inner city, suggests that in defining health needs, young people emphasise housing, education, employment and friendship over clinical or preventative services. Some felt well supported while others described feeling vulnerable, anxious, angry or sad. These experiences, if linked with the insensitivity of even one professional, could lower young people's expectations of healthcare to the extent that they avoided contact with service providers. In supporting young migrants' resilience to meet everyday challenges, friendly support from peers, carers and professionals was important. They needed determined advocacy at key moments. The different challenges for the Swedish and UK health and welfare systems along with the resilience/vulnerability trajectory are described. [ABSTRACT FROM AUTHOR]

Background Organisations in England's National Health Service (NHS) are required to have 'did not attend' (DNA) guidelines to help deal with the 'unseen child'. Aims To map DNA and associated guidelines in paediatric services, examine differences in safeguarding response and advice in the guidelines and explore the experience of guideline users. Methods A mapping approach was used to locate current DNA guidelines on English NHS organisations' websites. Analysis of the guidelines was supplemented with qualitative data from those who produce, monitor or use them. Results Fewer than 8% of English NHS organisations had up-to-date guidelines in the public domain, though a further 41% stated that they had a DNA/similar policy in place or had an out-of-date guideline on their website. Advice to healthcare providers about the steps to take when a child DNAs fell into five categories: reflection and review; direct interaction with the family; indirect interaction with the family; liaison with internal colleagues; and external referral. Interviews with eight individuals led to the identification of four themes. The management of information flows was central to the effective management of DNA. Respondents also reported seeking support and advice from others. While all respondents spoke about the importance of supporting the family, the child's needs were central to dealing with non-attendance, and respondents demonstrated awareness of wider risk discourses. Conclusions We consider the implications of the work and suggest that evidence-informed guidelines developed nationally but tailored to specific services might be helpful for providers and users alike. [ABSTRACT FROM AUTHOR]

Aim To investigate the chemotactic accuracy of peripheral blood neutrophils from patients with chronic periodontitis compared with matched healthy controls, before and after non-surgical periodontal therapy. Material & Methods Neutrophils were isolated from patients and controls ( n = 18) by density centrifugation. Using the Insall chamber and video microscopy, neutrophils were analysed for directional chemotaxis towards N-formyl-methionyl-leucyl-phenylalanine [fMLP (10 nM), or CXCL8 (200 ng/ml)]. Circular statistics were utilized for the analysis of cell movement. Results Prior to treatment, neutrophils from patients with chronic periodontitis had significantly reduced speed, velocity and chemotactic accuracy compared to healthy controls for both chemoattractants. Following periodontal treatment, patient neutrophils continued to display reduced speed in response to both chemoattractants. However, velocity and accuracy were normalized for the weak chemoattractant CXCL8 while they remained significantly reduced for fMLP. Conclusions Chronic periodontitis is associated with reduced neutrophil chemotaxis, and this is only partially restored by successful treatment. Dysfunctional neutrophil chemotaxis may predispose patients with periodontitis to their disease by increasing tissue transit times, thus exacerbating neutrophil-mediated collateral host tissue damage. [ABSTRACT FROM AUTHOR]

Background Parkinson's disease is a common movement disorder affecting approximately 127,000 people in the UK, with an estimated two thirds having speech-related problems. Currently there is no preferred approach to speech and language therapy within the NHS and there is little evidence for the effectiveness of standard NHS therapy or Lee Silverman voice treatment. This trial aims to investigate the feasibility and acceptability of randomizing people with Parkinson's disease-related speech or voice problems to Lee Silverman voice treatment or standard speech and language therapy compared to a no-intervention control. Methods/Design The PD COMM pilot is a three arm, assessor-blinded, randomized controlled trial. Randomization will be computer-generated with participants randomized at a ratio of 1:1:1. Participants randomized to intervention arms will be immediately referred to the appropriate speech and language therapist. The target population are patients with a confirmed diagnosis of idiopathic Parkinson's disease who have problems with their speech or voice. The Lee Silverman voice treatment intervention group will receive the standard regime of 16 sessions between 50 and 60 minutes in length over four weeks, with extra home practice. The standard speech and language therapy intervention group will receive a dose determined by patients' individual needs, but not exceeding eight weeks of treatment. The control group will receive standard care with no speech and language therapy input for at least six months postrandomization. Outcomes will be assessed at baseline (pre-randomization) and postrandomization at three, six, and 12 months. The outcome measures include patient-reported voice measures, quality of life, resource use, and assessor-rated speech recordings. The recruitment aim is at least 60 participants over 21 months from 11 sites, equating to at least 20 participants in each arm of the trial. This trial is ongoing and recruitment commenced in May 2012. Discussion This study will provide information on the feasibility and acceptability of randomizing participants to different speech and language therapies or control/deferred treatment. The findings relating to recruitment, treatment compliance, outcome measures, and effect size will inform a future phase III randomized controlled trial. [ABSTRACT FROM AUTHOR]

This paper uses qualitative data from interviews with 118 young Londoners (age 12–18) to examine how the universal provision of free bus travel has affected young people’s independent mobility. Drawing on Sen’s capabilities approach, we argue that free bus travel enhanced young Londoners’ capabilities to shape their daily mobility, both directly by increasing financial access and indirectly by facilitating the acquisition of the necessary skills, travelling companions and confidence. These capabilities in turn extended both opportunity freedoms (e.g. facilitating non-‘necessary’ recreational and social trips) and process freedoms (e.g. feeling more independent by decreasing reliance on parents). Moreover, the universal nature of the entitlement rendered buses a socially inclusive way for groups to travel and spend time together, thereby enhancing group-level capabilities. We believe this attention to individual and group capabilities for self-determination provides the basis for a broader and more child-centred view of independent mobility than the typical research focus upon travelling without an adult and acquiring parental permissions. [ABSTRACT FROM AUTHOR]

This study contributes to the literature on mobility and wellbeing at older ages through an empirical exploration of the meanings of free bus travel for older citizens, addressing the meanings this holds for older people in urban settings, which have been under-researched. Taking London as a case study, where older citizens have free access to a relatively extensive public transport network through a Freedom Pass, we explore from a public health perspective the mechanisms that link this travel benefit to determinants of wellbeing. In addition to the ways in which the Freedom Pass enabled access to health-related goods and services, it provided less tangible benefits. Travelling by bus provided opportunities for meaningful social interaction; travelling as part of the ‘general public’ provided a sense of belonging and visibility in the public arena – a socially acceptable way of tackling chronic loneliness. The Freedom Pass was described not only as providing access to essential goods and services but also as a widely prized mechanism for participation in life in the city. We argue that the mechanisms linking mobility and wellbeing are culturally, materially and politically specific. Our data suggest that in contexts where good public transport is available as a right, and bus travel not stigmatised, it is experienced as a major contributor to wellbeing, rather than a transport choice of last resort. This has implications for other jurisdictions working on accessible transport for older citizens and, more broadly, improving the sustainability of cities. [ABSTRACT FROM PUBLISHER]

Introduction: sarcopenia is associated with adverse health outcomes. The aim of this study was to describe the prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) consensus definition.Methods: we applied the EWGSOP definition to 103 community-dwelling men participating in the Hertfordshire Sarcopenia Study (HSS) using both the lowest third of dual-energy X-ray absorptiometry (DXA) lean mass (LM) and the lowest third of skin-fold-based fat-free mass (FFM) as markers of low muscle mass. We also used the FFM approach among 765 male and 1,022 female participants in the Hertfordshire Cohort Study (HCS). Body size, physical performance and self-reported health were compared in participants with and without sarcopenia.Results: the prevalence of sarcopenia in HSS men (mean age 73 years) was 6.8% and 7.8% when using the lowest third of DXA LM and FFM, respectively. DXA LM and FFM were highly correlated (0.91, P < 0.001). The prevalence of sarcopenia among the HCS men and women (mean age 67 years) was 4.6% and 7.9%, respectively. HSS and HCS participants with sarcopenia were shorter, weighed less and had worse physical performance. HCS men and women with sarcopenia had poorer self-reported general health and physical functioning scores.Conclusions: this is one of the first studies to describe the prevalence of sarcopenia in UK community-dwelling older people. The EWGSOP consensus definition was of practical use for sarcopenia case finding. The next step is to use this consensus definition in other ageing cohorts and among older people in a range of health-care settings. [ABSTRACT FROM PUBLISHER]

Background: identification of patients at risk of prolonged hospital stay allows staff to target interventions, provide informed prognosis and manage healthcare resources. Admission grip strength is associated with discharge outcomes in acute hospital settings.Objective: to explore the relationship between grip strength and length of stay in older rehabilitation in-patients.Design: single-centre prospective cohort study.Setting: community hospital rehabilitation ward.Subjects: one hundred and ten patients aged 70 years and over.Methods: data on age, height, weight, body mass index (BMI), co-morbidities, medication, residence, grip strength, physical function, cognitive function, frailty, falls, discharge destination and length of stay were recorded.Results: higher grip strength was associated with reduced length of stay, characterised by an increased likelihood of discharge to usual residence among male rehabilitation in-patients (hazard ratio 1.09 (95% confidence interval 1.01, 1.17) per kilo increase in grip strength, P = 0.02) after adjustment for age and size.Conclusions: this is the first prospective study to show that stronger grip strength, particularly among male in-patients, is associated with a shorter length of stay in a rehabilitation ward. This is important because it demonstrates that grip strength can be discriminatory among frailer people. Further research into the clinical applications of grip strength measurement in rehabilitation settings is needed. [ABSTRACT FROM AUTHOR]

There is widespread evidence both of the exclusion of older people from clinical research, and of under-recruitment to clinical trials. This review and opinion piece provides practical advice to assist researchers both to adopt realistic, achievable recruitment rates and to increase the number of older people taking part in research. It analyses 14 consecutive recently published trials, providing the number needed to be screened to recruit one older participant (around 3:1), numbers excluded (up to 49%), drop out rates (5–37%) and whether the planned power was achieved. The value of planning and logistics are outlined, and approaches to optimising recruitment in hospital, primary care and care home settings are discussed, together with the challenges of involving older adults with mental incapacity and those from minority groups in research. The increasingly important task of engaging older members of the public and older patients in research is also discussed. Increasing the participation of older people in research will improve the generalisability of research findings and inform best practice in the clinical management of the growing older population. [ABSTRACT FROM PUBLISHER]

The article presents information on the National Resource Centre for Dance (NRCD) of the University of Surrey. It is said to be the only archive exclusively committed to collecting materials related to the history of dance in Great Britain. The archive includes personal papers, photographs, scrapbooks, periodicals and many forms of ephemera. It says that the oldest item it found was a book published in 1698 about the English stage. In 2008, the Arts and Humanities Research Council (AHRC) awarded the NRCD and University of Surrey with funds to conduct cataloguing, research and dissemination work on its collections during the early decades of the twentieth century.

Concerns remain that health and social care services often fail people dying of chronic illnesses other than those with cancer. British government policy aims to improve end-of-life care and to enable people to make choices about place of care near the end of life, with the assumption that home is often the preferred option. However, some elderly people may lack suitable social networks, family carers and other resources to remain at home. Community hospitals offer a potentially accessible resource for local provision of end-of-life care. They have the advantage of being located within easy reach for family members, are staffed by local people and in most of them, general practitioners can maintain continuity of care. This paper examines patients’ and family carers’ experiences of end-of-life care in community hospitals. In-depth organisational case studies were conducted in six community hospitals in the south of England. Interviews were undertaken with elderly patients dying of cancer and other advanced conditions ( n = 18) and their family carers ( n = 11). Qualitative analysis of transcribed interviews were undertaken, using the principles of grounded theory. Patients and family carers valued the flexibility, local nature (which facilitated visiting) and personal care afforded to them. Most participants regarded community hospitals as preferable to larger district general hospitals. Our research reveals that these participants regarded community hospitals as acceptable places for end-of-life care. Finally, we discuss the implications of our findings for improving end-of-life care. [ABSTRACT FROM AUTHOR]

In the UK there are concerns that, in certain groups of dying patients such as the old, those with non-cancer diagnoses and those in rural areas, the quality of care is unacceptably variable. There has been no systematic survey of the extent to which community hospitals provide general palliative care for such patients. Therefore, by means of a structured questionnaire we asked senior nurses/managers at all 478 community hospitals in the UK for information on staff expertise, facilities and specialist equipment, liaison arrangements with specialist palliative care providers, priorities, practice and policy in end-of-life care. Of the 346 hospitals (72%) that responded, only 28 were in urban areas. 73% of hospitals employed at least one nurse with additional training in palliative care, 72% had access to 24-hour specialist palliative care advice and 51% had separate overnight accommodation for relatives, but only 22% had designated palliative care beds. Most hospitals did not have written policies or guidelines for patient assessment or symptom control. These findings add to evidence that community hospitals represent an important resource to improve access to palliative care for groups that are currently under-served. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to identify what children and young people in a health district in a large urban area experience as positive - and not so positive - about their local health services, in the light of a growing expectation that users play a more central role in the design and delivery of services. Design A qualitative study incorporating a range of methods, including interviews, play techniques and a Web site. Setting Schools, nurseries, community groups, in- and outpatient settings in an inner London health authority. Participants Young people aged between 4 and 19 years, from community (n = 92) and clinical (n = 57) settings. This included 'hard-to-reach' children, including those leaving care, those in touch with the criminal justice system, asylum seekers, and those with learning disabilities. Results Alongside planning and environment issues, young people particularly emphasized the impact of communication and relationships with staff on their experience of health services. Discussion and conclusions Using a range of flexible and age- appropriate techniques, young people, even those as young as 4 or 5, are able to comment helpfully on their experiences of service provision. What children had to say is revealing but not astonishing to those working in the National Health Service (NHS). Clinicians and managers, to whom our findings were fed back, made this clear. If we have known for so long that the issues raised here are problems, why are we so poor at acting on this knowledge? The authors suggest four explanations. [ABSTRACT FROM AUTHOR]

This paper is intended as an aid to those researching the history of Quaker involvement in industry and commerce, with a regional focus on Yorkshire .A selection of archives of businesses founded and run by Quakers, as well as of family and personal papers of Friends in business are surveyed here. Both the historical context and a summary of the surviving sources are given for each collection surveyed, with details of where the material is held. Examples have been chosen to represent the Quaker contribution to particular trades and industries, and in some cases, to promote collections which have recently been catalogued or are little known. [ABSTRACT FROM AUTHOR]

This paper is intended as an aid to those researching the history of Quaker involvement in the peace movement in Britain. It surveys relevant primary sources in several key areas, namely records of the Society of Friends both nationally and in Yorkshire, personal papers of a sample of Yorkshire Quakers involved in peace work, and records of British peace associations. Both the historical context and a summary of the surviving sources are given for each collection surveyed, with details of where the material is held. [ABSTRACT FROM AUTHOR]

Drawing on a wider study of effectiveness in three models of day care, this paper explores the process and outcome of goal negotiation with older people in a day hospital, an outreach service and a day centre. Using qualitative data from interviews with day care attenders and focus groups with service providers, differing perspectives on goal setting and achievement are presented. It concludes with a brief discussion of this approach in the wider context of promoting older people's participation in decision-making in day care settings, where the espoused emphasis is on maintaining and maximising personal autonomy and independent living. [ABSTRACT FROM AUTHOR]

The main aim of this study was to compare EASY-Care data obtained during nurse-administered annual health checks in two populations of older people. A secondary aim was to determine whether a standardized assessment system administered as part of routine practice by a trained nurse during the over-75 health check could generate useful information for comparing population health and functional status of communitydwelling-older people. One hundred and seventy-nine elderly people (aged 75 years and over) from the Woodstock ward, Belfast, having relatively high deprivation; and 238 elderly people from south Hampshire, ranging from affluent wards in New Forest to inner city wards, were assessed using the EASY-Care assessment system as part of their annual health check. There was a high response rate to the standardized assessment in both populations (75% and 79%). Compared to people in south Hampshire, the people in Belfast had higher relative risk of having fair/poor self-rated health, and lower relative risk of having good/ sufficient accommodation and of having difficulty chewing. People in Belfast had a higher relative risk of being dependent for six of the seven IADL items and for continence of urine, bathing, grooming, use of the stairs and dressing among the ADL items. The results demonstrate the ability of data generated by assessment system to discriminate between populations of older people when used as part of routine practice. Differences in health and functional status may be associated with deprivation. Data collected during the annual health check about the health and functional status of older people could provide a useful adjunct to census and survey data to measure population needs and to support locality planning. [ABSTRACT FROM AUTHOR]

Deals with health inequalities in Great Britain. Impact of the social class differences on health; Link between poverty and ill-health; Correlation between income and health inequality; Objectives of the Health Action Zones.

This article looks into information resources regarding the histories of the miners' trade unions. The papers are dominated by the work which Robin Page Arnot undertook in writing the official history of the miners' trade unions in Great Britain. Amongst the earliest trade union records collected by Arnot is a volume of printed annual reports of the Amalgamated Association of Miners of West Bromwich. A similar depth of coverage is provided by Arnot's papers relating to the establishment of the Marx Memorial Library and his role in developing the institution as a center for Marxist education.

Background: West Nile virus (WNV) is a single-stranded RNA virus that can cause neurological disease in both humans and horses. Due to the movement of competent vectors and viraemic hosts, WNV has repeatedly emerged globally and more recently in western Europe. Within the UK, WNV is a notifiable disease in horses, and vaccines against the virus are commercially available. However, there has been no investigation into the seroprevalence of WNV in the UK equine population to determine the extent of vaccination or to provide evidence of recent infection. Methods: Equine serum samples were obtained from the Animal and Plant Health Agency's equine testing service between August and November 2019. A total of 988 serum samples were selected for horses resident in South East England. WNV seroprevalence was determined using two enzyme-linked immunosorbent assays (ELISAs) to detect total flavivirus antibodies and WNV-specific immunoglobulin M (IgM) antibodies. Positive IgM results were investigated by contacting the submitting veterinarian to establish the clinical history or evidence of prior vaccination of the horses in question. Results: Within the cohort, 274 samples tested positive for flavivirus antibodies, of which two subsequently tested positive for WNV-specific IgM antibodies. The follow-up investigation established that both horses had been vaccinated prior to serum samples being drawn, which resulted in an IgM-positive response. All the samples that tested positive by competition ELISA were from horses set to be exported to countries where WNV is endemic. Consequently, the positive results were likely due to previous vaccination. In contrast, 714 samples were seronegative, indicating that the majority of the UK equine population may be susceptible to WNV infection. Conclusions: There was no evidence for cryptic WNV infection in a cohort of horses sampled in England in 2019. All IgM-seropositive cases were due to vaccination; this should be noted for future epidemiological surveys in the event of a disease outbreak, as it is not possible to distinguish vaccinated from infected horses without knowledge of their clinical histories. [ABSTRACT FROM AUTHOR]

Editorial. Introduces several articles related to the history of the Quaker peace testimony in Great Britain. Ideas of the British peace movement covering the period 1730-1945; Interpretations of the peace testimony according to members of the York of Friends; Archive sources available for research into the history of Quaker pacifism.

A letter to the editor is presented regarding the potential entry and transmission of Crimean Congo haemorrhagic fever (CCHF) virus in Great Britain.

The authors discuss a study which reviewed the emergence of Schmallenberg virus (SBV) in Great Britain and mainland European livestock, by Tarlinton and colleagues, published within the issue. They commend the researchers for demonstrating the relevance of scientific knowledge and resources, and of working together to address an outbreak. They also emphasize the role of disseminating peer-reviewed data relating to emerging diseases.

The authors reflect on the possible impact of changes to be made to pet movement rules in Great Britain on animal or public health. In an announcement made by the Department for Environment, Food and Rural Affairs (DEFRA) in June 2011, it says that the country is set to harmonise its rules with those of other member states of the European Union (EU). Under the new rules, dogs, cats and ferrets entering the country from EU member states and listed non-EU countries will no longer require a blood test to confirm seroconversion following rabies vaccination.

The article discusses how the British Department for Environment, Food and Rural Affairs (Defra) assesses the risks of exotic diseases in Great Britain. Defra's International Disease Monitoring team refers to reports from other organisations for monitoring risks and following emerging trends in diseases. To calculate risk, the team makes use of a decision matrix that include factors such as the disease's presence in the country of interest, transmission pathways, and mitigation measures in the country of origin.

Discusses the effectiveness of educational programs compared with traffic calming in reducing child traffic injuries in Great Britain. Influence of traffic calming measures on injuries; Objectives of the Children's Fund to reduce inequalities in child health; Availability of traffic safety education to children in primary schools.

Editorial. Presents guidelines on male and female sterilization from the Royal College of Obstetrics and Gynaecology in Great Britain. Rate of sterilization in the country; Details of the guidelines; Factors associated with increased sterilization rate.

The article focuses on the Taxi campaign of the Royal Association for Disability and Rehabilitation (RADAR) in Great Britain. The campaign is intended to offer accessible taxi policies to be introduced in all localities throughout the country. The author points out the inability of disabled people to access pubs, clubs and other public places because they face barriers like lack of personal support, difficulties with transport and a lack of respect and common courtesy.

The article reflects on a mixed-method project funded by the Teenage Pregnancy Unit and the Department of Health which draws on accounts of young people aged 15-18 from diverse ethnic groups in an urban multicultural area of East London describing their inclination (or otherwise) to talk with parents, other family members, and friends about sex and intimate relationships. The research indicated that Black African, Bangladeshi, Indian and Pakistani young people talked to a range of people for advice and support in addition to, or instead of parents.

Presented here is a record of plant-parasitic nematodes which were considered new or unusual in Great Britain during the period 1974-1976.

Since 2015, a multi-hazard partnership consisting of 4 UK Government science agencies and public sector organisations (Animal and Plant Health Agency, Public Health England, Met Office, British Geological Survey) has produced a weekly international overview of natural hazards for UK government departments. Aligning with the Sendai Framework, this novel, collaborative approach joins horizon-scanning scientists in order to anticipate and assess potential emerging international threats and their implications. The overall aim is to improve situational awareness of decision makers across government, allowing the UK government to be more anticipatory in its response to natural hazards and thus to reduce the impact(s) of future disasters on government resources and interests overseas. The International Forward Look (IFL) provides a weekly multi-hazard assessment of hydrometeorological, volcanic, animal, and human health events globally, with an emphasis on new, emerging or deteriorating situations. It predominately reports on current events and their potential evolution, as well as providing meteorological forecasts over the next 7 days. Each contributor scans and evaluates information from a wide range of UK and international sources, including authoritative information from mandated national, regional and global centres, and uses expert scientific knowledge to identify and assess events of interest/concern. The process has been designed to identify events, flag when they are worsening, identify inconsistencies in the evidence, determine where the impact of the hazard could be greatest, and identify potential cascading and interacting events (for instance where the meteorological forecast could interact with a health or volcanic event). Using a novel matrix, individual events are assigned a colour coded rating ranging from grey, through yellow, orange and red to communicate actual or potential increasing likelihood and/or impact. The final output is organised by region and includes two world maps, one highlighting noteworthy human, animal and meteorological events and the other details currently reported volcanoes. The individual entries include a brief summary of the hazard as well as an implications box for the science agencies to provide a more detailed analysis of the situation. The maps contain no political boundaries as the events of concern are observed from a regional perspective, but underlying information is given at a country level.Since its conception, the IFL has provided the UK government with situational awareness and informed response and resource allocation. Though challenges remain, such as the range of recipients and their knowledge and needs, the product is undergoing continual development through stakeholder consultation, with the aim of developing an open-access web-based platform. The value of the IFL is not just the end product and the regional non-political nature of the output, but also the building of organisational and individual relationships that provide a catalyst for innovation and more successful ways to assess risk from multiple natural hazards. [ABSTRACT FROM AUTHOR]

Genomic screening is routinely used to guide the treatment of cancer patients in many countries. However, several multi-layered factors make this effort difficult to deliver within a clinically relevant timeframe. Here we share the learnings from the CRUK-funded Stratified Medicine Programme for advanced NSCLC patients, which could be useful to better plan future studies., (© 2023. The Author(s).)

We report results of surveillance between June and mid-September 2022 of pet animals living in households of confirmed human monkeypox (MPX) cases. Since surveillance commenced, 154 animals from 40 households with a confirmed human MPX case were reported to the United Kingdom Animal and Plant Health Agency. No animals with clinical signs of MPX were identified. While a risk of transmission exists to pets from owners with a confirmed MPX virus infection, we assess this risk to be low.

In early 2019, four stallions in the south of England tested positive for equine viral arteritis following routine prebreeding screening. Here, a team from Defra and the APHA describe the epidemiological investigation that was carried out to determine the origin of infection and the potential for its transmission across the country., (British Veterinary Association.)

Young unaccompanied asylum seekers have been portrayed as vulnerable, resilient or both. Those granted residency in Europe are offered support by health and social care systems, but once they leave the care system to make independent lives, what part can these services play? Our review of research with migrants who have been in care in Sweden and the United Kingdom found evidence of unmet need, but little research describing their own views of services. The limited published evidence, supplemented by interviews with care leavers in a UK inner city, suggests that in defining health needs, young people emphasise housing, education, employment and friendship over clinical or preventative services. Some felt well supported while others described feeling vulnerable, anxious, angry or sad. These experiences, if linked with the insensitivity of even one professional, could lower young people's expectations of healthcare to the extent that they avoided contact with service providers. In supporting young migrants' resilience to meet everyday challenges, friendly support from peers, carers and professionals was important. They needed determined advocacy at key moments. The different challenges for the Swedish and UK health and welfare systems along with the resilience/vulnerability trajectory are described.

Academic geriatric medicine activity lags behind the scale of clinical activity in the specialty. A meeting of UK academic geriatricians was convened in March 2018 to consider causes and solutions to this problem. The meeting highlighted a lack of research-active clinicians, a perception that research is not central to the practice of geriatric medicine and a failure to translate discovery science to clinical studies. Solutions proposed included better support for early-career clinical researchers, schemes to encourage non-University clinicians to be research-active, wider collaboration with organ specialists to broaden the funding envelope, and the need to co-produce research programmes with end-users. Solutions to grow academic geriatric medicine are essential if we are to provide the best care for the growing older population., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Providing universal health coverage (UHC) through better maternal, neonatal, child and adolescent health (MNCAH) can benefit both parties through North-South research collaborations. This paper describes lessons learned from bringing together early career researchers, tutors, consultants and mentors from the United Kingdom, Kenya, and South Africa to work in multi-disciplinary teams in a capacity-building workshop in Johannesburg, co-ordinated by senior researchers from the three partner countries. We recruited early career researchers and research users from a range of sectors and institutions in the participating countries and offered networking sessions, plenary lectures, group activities and discussions. To encourage bonding and accommodate cross-cultural and cross-disciplinary partners, we asked participants to respond to questions relating to research priorities and interventions in order to allocate them into multidisciplinary and cross-country teams. A follow up meeting took place in London six months later. Over the five day initial workshop, discussions informed the development of four draft research proposals. Intellectual collaboration, friendship and respect were engendered to sustain future collaborations, and we were able to identify factors which might assist capacity-building funders and organizers in future. This was a modestly funded brief intervention, with a follow-up made possible through the careful stewardship of resources and volunteerism. Having low and middle-income countries in the driving seat was a major benefit but not without logistic and financial challenges. Lessons learned and follow-up are described along with recommendations for future funding of partnerships schemes., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Objectives: (1) To explore sexual behaviour and relationships amongst Black and minority ethnic (BME) teenagers in East London. (2) To examine how these relationships are shaped by culture, gender, peer norms and religion. (3) To describe the implications for sexual health policy and practice in urban, multicultural areas., Design: This report draws primarily on the qualitative arm of a mixed methods study which collected data from 126 young people, aged 15-18, largely through focus groups in the London boroughs of Hackney, Newham and Tower Hamlets., Results: Previous research has reported culture influencing the patterning of risk/protection amongst BME groups. Our data suggest that this is mediated by gender, religion and youth. Religion reportedly influenced young women's sexual behaviour in multiple ways. Young people described gendered norms in meeting and flirting with partners, and the role of mobile phones and peer pressure., Conclusion: Our paper suggests culture, gender, religion and youth influence BME teenagers in aspects of sexual relationships, and that these social markers may have different contextual meanings for individuals. The multiplicity of factors affecting attitudes/behaviour requires a range of contraceptive, counselling, screening and sex education services available for all teenagers, although delivery patterns may differ in response to differing needs.