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In the United Kingdom, the prevalence of children and young people (CYP) accessing acute paediatric inpatient care with mental health problems is increasing, with self-harm and eating disorders particularly prevalent. This study evaluated CYP experiences of being in receipt of acute paediatric inpatient care following either self-harm or crisis stemming from an eating disorder to inform domains for a person-centred outcome measure (PCOM). A series of stakeholder engagement events were conducted between April and July 2015 where creative approaches were used to explore stakeholder experiences of care and to identify outcome domains that were subsequently prioritised using a Nominal Group Technique. Data were analysed using inductive thematic approach, with significance scores calculated for domain statements. Ninety-six stakeholders (15 CYP, eight parents and carers, and 73 professionals) participated. Findings showed five priority PCOM domains: privacy and surveillance; holistic care; making choices, appropriate communication; working together to achieve care goals; and respect and empowerment. This single centre evaluation highlights the need for a PCOM to be developed for this patient group that comprehensively reflects stakeholders' expectations in order to inform improvements to quality of acute paediatric care., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Joseph Manning is currently funded through HEE NIHR ICA Clinical Lectureship and therefore the views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Dr Joanne Cooper is employed part-time by NHS England and NHS Improvement; therefore, the views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Green prescribing is gaining in popularity internationally for the promotion of mental wellbeing. However, the evidence base is limited, particularly in young pregnant women, a population with known risk factors for anxiety and depression. The aim of this mixed-methods study was to provide insights into the availability, processes, and suitability of nature-based interventions for young pregnant women. First, an online mapping survey of nature-based activities in the East Midlands region of the United Kingdom (UK) was undertaken. Second, focus groups ( n = 6) were conducted with nature activity providers and young mothers ( n = 11). This study found there were many diverse nature-based activities available to promote mental wellbeing. The organisational challenges highlighted include a lack of sufficient funding for service provision and disappointing experiences with some green prescribing programmes. The young women felt that nature-based activities helped to promote their mental wellbeing, and also offered an opportunity for social support. The facilitators, such as having detailed information and being accompanied to initial sessions to ease anxieties, were found to maximise the women's engagement with nature-based interventions. This study provides new perspectives on nature-based interventions from service providers and young women. Findings on the organisational barriers and facilitators to delivering interventions will inform the design of much needed future experimental research.

Background: Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures., Materials and Methods: A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches., Results: One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans., Conclusions: The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.

Background: This study is a secondary analysis of the trial by Callaghan et al. (2011), which reported higher antidepressant effects for preferred intensity (n = 19) vs. prescribed intensity (n = 19) exercise of three sessions/week over four weeks in depressed women. In particular, the present study sought to examine whether greater clinically significant individual change/recovery was observed in the preferred compared to the prescribed exercise group., Methods: The reliable change index and the C cutoff score criteria described by Jacobson and Truax (1991) were employed to determine clinical significance. These criteria examined if individual change in depression scores from pre- to post-intervention in the preferred intensity group were statistically significant beyond the standard error of difference derived from the active comparator prescribed group, and subsequently within a normal population range. Patients fulfilling the first or both criteria were classified as improved or recovered, respectively., Results: Post-intervention depression scores of six patients in the preferred intensity exercise group (32%) demonstrated statistically reliable improvement (p < 0.05) and recovery. Half of this subgroup started as moderately depressed. No patient demonstrated a reliable deterioration in depression. Due to a small sample size, it was impossible to determine whether patients on psychiatric medication or medication-free patients were equally benefited from preferred intensity exercise. Thirteen patients in the preferred intensity group (68%) displayed non-statistically significant change in post-intervention depression scores (p > 0.05), although eight of them showed a non-significant improvement in post-intervention depression scores and three could not technically show an improvement in depression due to floor effects (baseline depression within normal range)., Conclusions: Preferred intensity exercise of three sessions/week over four weeks led almost a third of the patients to record scores consistent with recovery from depression. Health professionals may consider that short-term preferred intensity exercise provides clinically significant antidepressant effects comparing favourably to exercise on prescription.

Background: There is very limited systematic analysis of the causes and consequences of maritime accidents across the whole passenger sector during the twentieth century either in United Kingdom (UK) or in other maritime nations, but some of the larger events have been the subject of detailed investigations that led to improved safety measures. In recent years, there has been increased attention to the analysis of passenger ship accidents, especially in relation to the two now dominant markets: vehicle/passenger ferries and cruise ships., Materials and Methods: Long-term trends since 1900 in passenger and crew deaths on UK seagoing pas- senger ships that have sustained a maritime accident, as defined by Lloyds Register, have been collated and analysed., Results: Over the course of the 20th century, there has been a continuous fall in the number of incidents and in their severity. This may be a reflection of improved vessel safety, however the scale and nature of UK passenger shipping has also changed markedly over the period., Conclusions: In addition to the reducing frequency of deaths it is apparent that the majority of fatalities in both crew and passengers came from a very small number of major events during the study period. Altho- ugh there has been no major disaster involving a UK passenger ship in the last 30 years, major casualties with heavy loss of life continue in the world passenger fleet, in recent years involving flags such as Greece, Indonesia, Italy, Panama and The Philippines.

Background: This study established trends in major infectious disease mortality in British merchant shipping from 1900 to 2010 as compared with the British male working population and the Royal Navy., Methods: A population mortality study of six infectious diseases using annual government mortality returns and death inquiry files for British merchant shipping and the Royal Navy, and official mortality data for the general male working aged population., Findings: Relative mortality risks for each disease were increased significantly in British merchant shipping when compared with the general population; malaria by 58.2 fold, yellow fever (6276), typhoid (9.5), cholera (1734), dysentery (20.6) and smallpox (142). For all six diseases combined, relative mortality risks were 21.5 compared with the general population and 3.5 compared with the Royal Navy. Mortality trend patterns varied between diseases, but reductions in mortality in British merchant shipping consistently lagged many years behind those in both the British general population and the Royal Navy., Conclusions: Merchant seamen were at far higher risk of death than probably any other occupational group of the population. Much of these excess risks came from exposure to infection in unhygienic and tropical ports, although some was a result of neglect of feasible preventative measures., (Copyright © 2016 Elsevier Ltd. All rights reserved.)