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Objective: Behavioral interventions targeting "free-living" physical activity (PA) and exercise that produce long-term glycemic control in adults with type 2 diabetes are warranted. However, little is known about how clinical teams should support adults with type 2 diabetes to achieve and sustain a physically active lifestyle.Research Design and Methods: We conducted a systematic review of randomized controlled trials (RCTs) (published up to January 2012) to establish the effect of behavioral interventions (compared with usual care) on free-living PA/exercise, HbA(1c), and BMI in adults with type 2 diabetes. Study characteristics, methodological quality, practical strategies for increasing PA/exercise (taxonomy of behavior change techniques), and treatment fidelity strategies were captured using a data extraction form.Results: Seventeen RCTs fulfilled the review criteria. Behavioural interventions showed statistically significant increases in objective (standardized mean difference [SMD] 0.45, 95% CI 0.21-0.68) and self-reported PA/exercise (SMD 0.79, 95% CI 0.59-0.98) including clinically significant improvements in HbA(1c) (weighted mean difference [WMD] -0.32%, 95% CI -0.44% to -0.21%) and BMI (WMD -1.05 kg/m(2), 95% CI -1.31 to -0.80). Few studies provided details of treatment fidelity strategies to monitor/improve provider training. Intervention features (e.g., specific behavior change techniques, interventions underpinned by behavior change theories/models, and use of ≥10 behaviour change techniques) moderated effectiveness of behavioral interventions.Conclusions: Behavioral interventions increased free-living PA/exercise and produced clinically significant improvements in long-term glucose control. Future studies should consider use of theory and multiple behavior change techniques associated with clinically significant improvements in HbA(1c), including structured training for care providers on the delivery of behavioural interventions. [ABSTRACT FROM AUTHOR]

Stage theories of health behavior change assume that individuals pass through qualitatively different stages on their way to the adoption of health behaviors. Three common stages (preintention, intention and action) can be defined by stage transitions included in current stage theories and supported by evidence. The present study examines whether transitions between these stages can be predicted by social cognition variables derived from prevailing health behavior theories. At two points in time, the motivation for interdental hygiene behaviors and oral self-care was assessed in 288 participants recruited in dental practices. Stage progression and regression over time were analyzed using discriminant function analysis. Progression from preintention to intention was predicted by action planning, whereas coping planning and self-efficacy predicted transitions from intention. Regression from action was predicted by self-efficacy. Results support the distinction of three common stages. Findings are discussed in terms of their contribution to health behavior theory. [ABSTRACT FROM AUTHOR]

Health behavior interventions may have different effects when targeting individuals at different stages of change. A 'motivation' stage, during which intentions are formed, has been distinguished from a 'volition' stage, implying that the latter requires self-regulatory effort in implementing and maintaining behavior. To test this stage assumption, an action control intervention (self-monitoring tool for dental flossing) matched to the volition stage and mismatched to the motivation stage was provided to 151 university students, with follow-up measures of action control and flossing after 2 and 6 weeks. Separate regression analyses for motivational and volitional participants indicated that only volitional participants benefited from the volitional intervention. This supports the usefulness of stage assumptions and the advantage of tailoring interventions to participants who reside either in the motivational or in the volitional stage. [ABSTRACT FROM AUTHOR]

Prevailing social cognition models consider behavioural intentions as immediate precursors of actions. This view ignores the role of more proximal self-regulatory processes, such as action control. The latter emerges after an intention has been formed and is supposed to maintain the level of intentions over time and to translate them into action. Three facets of action control were examined in terms of their predictive power for changes in intentions and for physical exercise: (a) awareness of standards, (b) self-monitoring, and (c) self-regulatory effort. A parsimonious 6-item instrument was administered to 122 cardiac patients at six weekly measurement points in time following rehabilitation. A distinction was made between the level of action control and the degree of change in action control, applying a latent growth model. While awareness of standards remained stable, the other two facets exhibited a linear change over the six-week period. Level and change were distinct predictors of physical exercise and changes in intentions. These findings emphasize the importance of self-regulatory mechanisms in the first weeks of trying to overcome a sedentary lifestyle. Action control may be a promising construct to narrow the intention-behaviour gap. [ABSTRACT FROM AUTHOR]

In cardiac rehabilitation programs, patients learn how to adopt a healthier lifestyle, including regular, strenuous physical activity. Long-term success is only modest despite good intentions. To improve exercise adherence, a 3-group experiment was designed that included innovative psychological interventions. All 3 groups underwent a standard care rehabilitation program. Patients in the 2 treatment groups were instructed not only to produce detailed action plans but also to develop barrier-focused mental strategies. On top of this, in 1 of these groups a weekly diary was kept for 6 weeks to increase a sense of action control. At the end of a standard cardiac rehabilitation program, 240 patients were randomly assigned to these treatment groups plus a standard care control group. Treatments resulted in more physical activity at follow-up and better adherence to recommended levels of exercise intensity. Moreover, self-regulatory skills such as planning and action control were improved by the treatments. Follow-up analyses demonstrated the mediating mechanisms of self-regulatory skills in the process of physical exercise maintenance. Findings imply that interventions targeting self-regulatory skills can enable post-rehabilitation patients to reduce behavioral risk factors and facilitate intended lifestyle changes. [ABSTRACT FROM AUTHOR]

Although some people may develop an intention to change their health behaviour, they might not take any action. This discrepancy has been labelled the 'intention-behaviour gap.' Detailed action planning, perceived self-efficacy, and self-regulatory strategies (action control) may mediate between intentions and behaviour. This was examined in a longitudinal sample of 307 cardiac rehabilitation patients who were encouraged to adopt or maintain regular exercise. At the first time point, the predictors of intention and intention itself were assessed. Two months and four months later, the mediators and outcomes were measured. Results confirmed that all the three factors (planning, maintenance self-efficacy, and action control) served to mediate between earlier exercise intentions and later physical activity, each of them making a unique contribution. The results have implications for research on the 'intention-behaviour gap,' and indicate that planning, maintenance self-efficacy and action control may be important volitional variables. [ABSTRACT FROM AUTHOR]

Background: People over the age of 70 carry the greatest burden of chronic disease, disability and health care use. Participation in physical activity is crucial for health, and walking accounts for much of the physical activity undertaken by sedentary individuals. Pedometers are a useful motivational tool to encourage increased walking and they are cheap and easy to use. The aim of this pilot study was to evaluate the feasibility of the use of pedometers plus a theory-based intervention to assist sedentary older women to accumulate increasing amounts of physical activity, mainly through walking.Methods: Female participants over the age of 70 were recruited from primary care and randomised to receive either pedometer plus a theory-based intervention or a theory-based intervention alone. The theory-based intervention consisted of motivational techniques, goal-setting, barrier identification and self-monitoring with pedometers and daily diaries. The pedometer group were further randomised to one of three target groups: a 10%, 15% or 20% monthly increase in step count to assess the achievability and acceptability of a range of targets. The primary outcome was change in daily activity levels measured by accelerometry. Secondary outcome measures were lower limb function, health related quality of life, anxiety and depression.Results: 54 participants were recruited into the study, with an average age of 76. There were 9 drop outs, 45 completing the study. All participants in the pedometer group found the pedometers easy to use and there was good compliance with diary keeping (96% in the pedometer group and 83% in the theory-based intervention alone group). There was a strong correlation (0.78) between accelerometry and pedometer step counts i.e. indicating that walking was the main physical activity amongst participants. There was a greater increase in activity (accelerometry) amongst those in the 20% target pedometer group compared to the other groups, although not reaching statistical significance (p = 0.192).Conclusion: We have demonstrated that it is feasible to use pedometers and provide theory-based advice to community dwelling sedentary older women to increase physical activity levels and a larger study is planned to investigate this further. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety problems are prevalent in childhood and, without intervention, can persist into adulthood. Effective evidence-based interventions for childhood anxiety disorders exist, specifically cognitive-behavioural therapy (CBT) in a range of formats. However, only a small proportion of children successfully access and receive treatment. Conducting mental health screening in schools and integrating evidence-based interventions for childhood anxiety problems may be an effective way to ensure support reaches children in need. The Identifying Child Anxiety Through Schools-Identification to Intervention (iCATS i2i) trial involves screening for childhood anxiety problems and offering a brief online parent-led CBT intervention. This paper presents the protocol for the process evaluation of the iCATS i2i trial, which aims to examine the implementation and acceptability of the study procedures, the mechanisms of change and whether any external factors had an impact on procedure engagement or delivery., Methods and Analysis: This process evaluation will use both quantitative and qualitative methods to evaluate the implementation and acceptability of and barriers/facilitators to engagement and delivery of the iCATS screening/intervention procedures. Quantitative data sources will include opt-out and completion rates of baseline measures and usage analytics extracted from the online intervention platform. Qualitative interviews will be conducted with children, parents, school staff, iCATS i2i clinicians and researchers delivering study procedures. The Medical Research Council framework for process evaluations will guide study design and analysis., Ethics and Dissemination: This study has received ethical approval from the University of Oxford Research Ethics Committee (R66068_RE003). Findings from the study will be disseminated via peer-reviewed publications in academic journals, conferences, digital and social media platforms and stakeholder meetings., Trial Registration: ISRCTN76119074., Competing Interests: Competing interests: TF's department receives funds from her advisory role at Place2Be, a third-sector organisation that provides mental health training and support to schools in the UK, and the rest of the authors declare no competing interest., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ.)

Background: Despite the high prevalence of obesity in Germany, few effective political measures have been implemented to protect population health and improve the sustainability of food systems. One argument frequently raised against policy implementation is the lack of acceptability for policy measures in the German population., Aim: We aimed to evaluate the acceptability of policy measures currently discussed in Germany's national nutrition strategy and how perceived policy characteristics and participant characteristics influence policy acceptability., Method: We conducted an online survey with 2001 participants between 06.12.2023 and 05.01.2024, in which we collected data on perceived policy characteristics (acceptability, equity, societal and personal effectiveness), as well as participant values and beliefs., Results: Most policies were highly acceptable, with policies such as the introduction of free school lunches (84 % acceptability), the introduction of a ban on fast food advertising aimed at children (71 %) or a sugar tax (53 %) being acceptable to a majority of the sample. The least acceptable policy was the introduction of a tax on animal products (36 %). Logistic regression analyses showed that perceived equity and societal and personal effectiveness predicted policy acceptability. Likewise, environmental values and beliefs about state intervention of participants influenced policy acceptability., Conclusion: The high acceptability observed in this study suggests an opportunity for German policymakers to implement evidence-based and acceptable nutritional strategies to improve population health., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Optimizing vaccine uptake is a public health challenge that requires the implementation of effective strategies. The asymmetric dominance (or decoy) effect describes the increasing likelihood of selecting an option when a clearly inferior alternative is offered. Therefore, we aimed to test the impact of offering decoy alternatives-less convenient vaccination appointments-on vaccination intentions. Participants aged 18-33 years, residing in England, and initially not intending to get vaccinated, completed three online experiments. Participants were randomly assigned to either a control or an experimental condition in each experiment. The asymmetrically dominated options were: an appointment in two weeks at a distant location (experiment 1); a later time at the participant's local GP, pharmacy, or community centre (experiment 2); and a later time at a distant location (experiment 3). The primary outcome was vaccination intention, while secondary outcomes included an active interest in reading additional information about the vaccination procedure, perceived difficulty and cognitive effort. Initial analysis revealed no evidence of an asymmetric dominance effect. However, further subgroup analysis, supported by formative research, indicated that ensuring decoy alternatives are clearly perceived as inferior could enhance the effectiveness of this approach for certain individuals., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This research was approved by HSSREC (number 117/20–21) at the University of Warwick, and all methods were performed in accordance with the relevant guidelines and regulations. The study participants provided informed consent for their data to be used and published as part of this research project., (© 2024. The Author(s).)

Background: Cancer-related fatigue (CRF) is the most prevalent, distressing, and quality of life disturbing symptom during and after cancer treatment for many cancer types including breast cancer. The experience and burden of this symptom can induce a cognitive bias towards fatigue or a fatigue-related self-image, which can further increase the fatigue symptoms and related behaviour. For this, a Cognitive Bias Modification (CBM) eHealth app (IVY) has been developed. The app aims to counter the fatigue-related self-image and to modify it towards vitality, which might translate to less experienced fatigue and more experienced vitality. This study aims to evaluate the feasibility of the IVY CBM training and the research design of a wait-list control trial. If feasibility is judged sufficient, the effectiveness of the CBM app will also be analyzed on (1) underlying mechanisms (cognitive fatigue bias), (2) symptom fatigue (self-reported fatigue and vitality), and (3) related behaviours (avoidance and all-or-nothing behaviour)., Methods: This feasibility study addresses individuals being treated for breast cancer receiving (neo)adjuvant treatment or metastatic care. The number of target participants is 120 (60 (neo)adjuvant, and 60 metastatic) patients. Both groups will be randomized with 30 people in the IVY treatment group and 30 people in the delayed treatment control group. All participants will receive the training via the IVY app, in which participants categorize words related to vitality with words related to 'I' and words related to fatigue with words related to 'other'. If feasibility is judged sufficient, the effects of the training will be explored on 3 levels: (1) self-identity bias, which will be measured with a short computer task based on the Implicit Association Test (IAT), (2) avoidance and all-or-nothing behaviour, and (3) fatigue and vitality levels, which will all be measured with questionnaires., Discussion: This study aims to evaluate the feasibility of a larger-scale multi-centre Randomized Controlled Trial (RCT) to investigate a novel eHealth application and, if possible, to give indications on the effectiveness of this intervention to counter fatigue in individuals with breast cancer. Using the IVY CBM app requires very little effort, both in time and cognitive load, which could be especially beneficial for fatigue symptoms., Trial Registration: Registered at the Open Science Framework (OSF; https://osf.io/e85g7/ ) on October 20, 2023., Competing Interests: Declarations. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Severe and multiple disadvantage (SMD) is the combined effect of experiencing homelessness, substance use and repeat offending. People experiencing SMD have high burden of physical and mental health issues. Oral health is one of the most common health problems in people experiencing SMD which interacts with substance use, smoking, and unhealthy diet to create a cycle of harm and disadvantage. However, burden of these conditions is worsened by poor access to health services. This study aimed to identify pathways to improve engagement and access to health interventions, for oral health, substance and alcohol use, smoking and diet., Methods: Using a qualitative methodology, interviews/focus groups were conducted with: (a) people experiencing SMD in Newcastle Upon Tyne/Gateshead; and (b) frontline staff, volunteer workers, policy makers and commissioners from London, Plymouth and Newcastle Upon Tyne/Gateshead. Data was analysed iteratively using thematic analysis., Results: Twenty-eight people experiencing SMD (age range: 27-65 years; 21% females) and 78 service providers (age range: 28-72 years, 63% females) were interviewed or included in focus groups. Data were organized into two overarching factors: barriers to accessing health interventions and improving access to health interventions. Barriers included: wider disadvantages of people experiencing SMD leading to low priority for support for oral health and associated health behaviours, psychosocial factors, waiting period and physical space. Factors that improved access to interventions included: positive relationships between service provider and person experiencing SMD, including a support worker, location of services and outreach services., Conclusions: The findings suggest the need for flexibility in offering services for oral health and related health behaviours for people experiencing SMD. Training health care providers and co-developing services with people with lived experience of SMD can help prevent (re)stigmatization. Systems-based approach to address factors on an environmental, organizational, inter-personal and individual level is needed. The results from this study could be extrapolated to other health intervention such as vaccinations and sexual and reproductive health., Competing Interests: The authors have declared that no competing interests exist. The funders had no role in the design of the study, in the collection, analysis, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results., (Copyright: © 2024 Jain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Patient complaints in healthcare settings can provide feedback for monitoring and improving healthcare services. Behavioural responses to complaints (e.g., talking or apologising to a patient) can influence the trajectory of a complaint for instance, whether a complaint is escalated or not. We aimed to explore healthcare professional (HCP) and service user (patient and carer) views on complaints' management and the perceived factors influencing responses to complaints within a healthcare setting by applying behavioural frameworks., Method: A qualitative study was conducted using online or phone-based interviews with eleven HCPs and seven patients or carers. All participants (N = 18) had experience responding to or submitting a formal complaint in secondary and tertiary public healthcare settings in the United Kingdom. The interviews were structured using the Capability-Opportunity-Motivation-Behaviour (COM-B) Model. We analysed the transcripts using inductive thematic analysis. Then, themes were deductively mapped onto the COM-B Model and the more granular Theoretical Domains Framework (TDF)., Results: Ten themes were generated from the analysis representing the influences on HCPs' responses to complaints from HCP and patient/carer perspectives. This included (with TDF/COM-B in brackets): 'Knowledge of complaint procedure' (Knowledge/Capability), 'Training and level of skill in complaints handling' (Skills/Capability), 'Regulation of emotions associated with complaints' (Behavioural regulation/Capability), 'Confidence in handling complaints' (Beliefs about capabilities/Motivation), 'Beliefs about the value of complaints' (Beliefs about consequences/Motivation) and 'Organisational culture regarding complaints' (Social influences/Opportunity). Staff highlighted strong support systems and open discussions as part of positive organisational cultures regarding complaints (Social influences/Opportunity), and a lack of certainty around when to treat issues raised by patients as a formal complaint or informal feedback (Knowledge/Capability)., Conclusion: Our study findings highlight the importance of strong support systems and organisational openness to patient feedback. These findings can be used to design targeted interventions to support more effective responses and enhance patient-centred approaches to complaints management in healthcare settings., Patient and Public Contribution: Patient and public involvement (PPI) was integral in this research. The NIHR PRU in Behavioural and Social Sciences had a dedicated PPI strategy group consisting of six external representatives from the patient and public community (Newcastle University, 2024). These six PPI members actively participated in shaping the research by reviewing and providing feedback on all questionnaire items before the data collection. They were actively involved in supporting participant recruitment by advertising this study on their PPI platform, The Voice R,1 and through their online social networks. During the analysis stages of the research, preliminary findings were discussed with the PPI group to support 'sense checking' and interpretation of the results., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background: Virtual wards (VWs) are being introduced within the National Health Service (NHS) in England as a new way of delivering care to patients who would otherwise be hospitalized. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their homes. Integrated care system commissioners are employees involved in the planning of, agreeing to, and monitoring of services within NHS England and have an important role in the adoption and implementation of VWs in clinical practice., Objective: This study aims to develop an understanding of the acceptability and feasibility of adopting and implementing VWs in England from integrated care system commissioners' perspectives, including the identification of barriers and facilitators to implementation., Methods: Qualitative semistructured interviews were conducted with 20 commissioners employed by NHS England (NHSE) in various geographic regions of England. Thematic analysis was conducted, structured using the framework approach, and informed by the Consolidated Framework for Implementation Research. The COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines were followed., Results: Four overarching themes were identified reflecting the acceptability and feasibility of key adoption and implementation processes: (1) assessing the need for VWs, (2) coordinating a system approach, (3) agreeing to Program Outcomes: NHSE Versus Organizational Goals, and (4) planning and adapting services. Commissioners expressed the need for system-level change in care provision within the NHS, with VWs perceived as a promising model that could reform patient-centered care. However, there was uncertainty over the financial sustainability of VWs, with questions raised as to whether they would be funded by the closure of hospital beds. There was also uncertainty over the extent to which VWs should be technology-enabled, and the specific ways technology may enhance condition-specific pathways. Differing interpretations of the NHSE instructions between different health care sectors and a lack of clarity in definitions, as well as use of hospital-centric language within national guidance, were considered hindrances to convening a system approach. Furthermore, narrow parameters of success measures in terms of goals and outcomes of VWs, unrealistic timescales for planning and delivery, lack of interoperability of technology and time-consuming procurement procedures, liability concerns, and patient suitability for technology-enabled home-based care were identified as barriers to implementation. Motivated and passionate clinical leads were considered key to successful implementation., Conclusions: VWs have the potential to reform patient-centered care in England and were considered a promising approach by commissioners in this study. However, there should be greater clarity over definitions and specifications for technology enablement and evidence provided about how technology can enhance patient care. The use of less hospital-centric language, a greater focus on patient-centered measures of success, and more time allowance to ensure the development of technology-enabled VW services that meet the needs of patients and staff could enhance adoption and implementation., (©Laura J McGowan, Fiona Graham, Jan Lecouturier, Louis Goffe, Carlos Echevarria, Michael P Kelly, Falko F Sniehotta. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.11.2024.)

Regular testing using rapid antigen lateral flow tests (LFTs) was an important prevention strategy during the COVID-19 pandemic. However, falsification of home LFTs was a concern. Using a large quota-representative sample of adults ( n  = 1295) in England, we conducted a vignette survey consisting of four hypothetical scenarios of LFT falsification behaviours (FBs) to examine whether prosocial personality traits were associated with attitudes towards and intentions for falsifying home LFTs during the pandemic. Results show that higher levels of affective empathy for people vulnerable to COVID-19 and Honesty-Humility from the HEXACO model of Personality are associated with non-acceptability of LFT FBs and intentions to not engage with them. However, affective empathy explained more of the variation compared to the facet-level measures of Honesty-Humility for both attitude and intention. Public health communications aimed at encouraging personal protective behaviours should consider the role of empathy and prosocial messages., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Understanding the behavioural factors influencing flu vaccination is crucial for mitigating seasonal infection outbreaks. This study utilised the Precaution Adoption Process Model (PAPM) to examine the public's decision-making about seasonal flu vaccination through an online cross-sectional survey with 2004 participants in England, UK. Results showed varying stages of decision-making: 7% in Stage 2 (unengaged), 10% in Stage 3 (undecided), 7% in Stage 4 (decided not to vaccinate), 39% in Stage 5 (decided to vaccinate) and 38% in Stage 6 (vaccinated). Regression modelling revealed factors common across stages and unique to certain stages, such as flu vaccination history distinguishing those who received the vaccine. Vaccine knowledge (Stage 2), perceived benefits (Stage 4), perceived control and fear of needles (Stage 5) were uniquely associated with specific PAPM stages. The study discusses policy implications for integrating these findings to improve flu vaccination uptake, highlighting the importance of tailored strategies based on decision-making stages., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Selenium has potential safeguarding properties against cognitive decline, because of its role in protecting DNA, proteins, and lipids in the brain from oxidative damage. However, acute and chronic overexposure to selenium can be neurotoxic., Objective: The aim of this analysis was to explore the association between selenium status [serum selenium and selenoprotein P (SELENOP) concentrations and glutathione peroxidase 3 (GPx3) activity] and cognitive function in 85-y olds living in Northeast England at baseline and ≤5 y of follow-up., Methods: Global cognitive performance was assessed in 755 participants from the Newcastle 85+ study using the standardized Mini-Mental State Examination and attention-specific cognition was assessed using composite scores derived from the Cognitive Drug Research System. Serum selenium, SELENOP, and GPx3 activity were measured at baseline by total reflection X-ray fluorescence, enzyme-linked immunosorbent assay, and coupled-enzyme reaction, respectively. Regression analyses explored linear and nonlinear associations between continuous values and tertiles of selenium status biomarkers, respectively, and cognitive function at baseline. Generalized linear mixed models explored associations between continuous values and tertiles of selenium status biomarkers, and global cognitive decline over 5 y, and attention-specific cognitive decline over 3 y., Results: Over 3 and 5 y, none of the selenium biomarkers were associated with the rate of cognitive decline. At baseline, in fully adjusted models, higher serum selenium was nonlinearly associated with global cognition (β = 0.05 ± 0.01, P = 0.387 linear, β = 0.04 ± 0.01, P = 0.002 nonlinear). SELENOP and GPx3 activity were not associated with any cognitive outcomes., Conclusions: There were no associations between selenium status and cognitive decline. However, serum selenium, but not SELENOP or GPx3 activity, was positively associated nonlinearly with global cognition at baseline. Furthermore, these associations were not evident during follow-up, potentially because of residual confounding and reverse causation., Competing Interests: Conflict of interest LS holds shares on selenOmed GmbH, a company involved in selenium status assessment. All other authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: UK local authority public health teams (LAPHT) supported delivery of the Covid-19 vaccination programme, particularly to disadvantaged populations. We explored the challenges encountered and lessons learnt by LAPHTs in tackling low Covid-19 vaccine uptake. The aim of this study was to understand what works, and how, in addressing local inequalities in relation to uptake of the Covid-19 vaccination with a view to generalising insights to building back fairer after the pandemic and into the future., Study Design: Qualitative., Method: We conducted in-depth on-line interviews with Directors of Public Health or their representatives from 21 English local authorities covering a total population of over 8 million people. Data were analysed thematically., Results: Accessing the requisite (and accurate) data, engaging with communities, and working with National Health Service (NHS) organisations presented challenges in delivering initiatives to improve vaccine uptake, particularly for disadvantaged groups. LAPHT's assets beneficial to the programme - in-depth knowledge and experience of their communities and locality - were not considered in the national vaccination programme. Community engagement and relationships with local NHS featured heavily in the majority of LAPHTs responses to improving vaccine uptake rates., Conclusions: Incorporating local public health infrastructure, expertise and existing relationships into national vaccination planning during epidemics or pandemics is crucial. Community engagement and good relationships with NHS staff help to reach and serve disadvantaged populations. How these can be developed and maintained in the longer term without future investment was a concern. Future research should explore the design and implementation of PH and NHS joint service delivery models to tackle health inequalities, informed by experiences of the Covid-19 vaccination programme and with input from community partners., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Poor adherence to photoprotection in Xeroderma Pigmentosum (XP) increases morbidity and shortens lifespan due to skin cancers., Objective: To test a highly personalised intervention (XPAND) to reduce the dose of ultraviolet radiation (UVR) reaching the face in adults with XP, designed using known psychosocial determinants of poor photoprotection., Methods: A two-arm parallel group randomised controlled trial, including patients with sub-optimal photoprotection to receive XPAND or a delayed intervention control arm that received XPAND the following year. XPAND comprises seven one-to-one sessions targeting photoprotection barriers (e.g., misconceptions about UVR) supported by personalised text messages, activity sheets, and educational materials incorporating behaviour change techniques. The primary outcome, mean daily UVR dose-to-face across 21 days in June-July 2018, was calculated by combining UVR exposure at the wrist with a face photoprotection activity diary. Secondary outcomes were UVR dose-to-face across 21 days in August 2018, time spent outside, photoprotective measures used outside, mood, automaticity, confidence-to-photoprotect. Financial costs and quality-adjusted life years (QALYs) were calculated., Results: 16 patients were randomised, 13 provided sufficient data for primary outcome analysis. The XPAND group (n=8) had lower mean daily UVR dose-to-face [0.03 SED (SD 0.02] compared to control (n=7) [0.36 SED (SD 0.16)] (adjusted difference=-0.25, p<0.001, Hedge's g=2.2). No significant between-group differences were observed in time spent outside, photoprotection outside, mood, or confidence. The delayed intervention control showed improvements in UVR dose-to-face (adjusted difference=-0.05, Hedge's g=-0.1) , time outside (adjusted difference=-69.9, Hedge's g=-0.28), and photoprotection (adjusted difference=-0.23, Hedge's g=0.45), after receiving XPAND. XPAND was associated with lower treatment costs (£-2642; 95% CI: -£8715 to £3873) and fewer QALYs (-0.0141; 95% CI: -0.0369 to 0.0028)., Conclusions: XPAND was associated with a lower UVR dose-to-face in XP patients and was cost-effective., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Background: The path of a complaint and patient satisfaction with complaint resolution is often dependent on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs' responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints handling behaviours., Methods: A systematic literature review of UK published and unpublished (so-called grey literature) studies was conducted (PROSPERO registration: CRD42022301980). Five electronic databases [Scopus, MEDLINE/Ovid, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Health Management Information Consortium (HMIC)] were searched up to September 2021. Eligibility criteria included studies reporting primary data, conducted in secondary and tertiary care, written in English and published between 2001 and 2021 (studies from primary care, mental health, forensic, paediatric or dental care services were excluded). Extracted data included study characteristics, participant quotations from qualitative studies, results from questionnaire and survey studies, case studies reported in commentaries and descriptions, and summaries of results from reports. Data were synthesized narratively using inductive thematic analysis, followed by deductive mapping to the Theoretical Domains Framework (TDF)., Results: In all, 22 articles and three reports met the inclusion criteria. A total of 8 actors, 22 behaviours and 24 influences on behaviour were found. Key factors influencing effective handling of complaints included HCPs' knowledge of procedures, communication skills and training, available time and resources, inherent contradictions within the role, role authority, HCPs' beliefs about their ability to handle complaints, beliefs about the value of complaints, managerial and peer support and organizational culture and emotions. Themes mapped onto nine TDF domains: knowledge, skills, environmental context and resources, social/professional role and identity, social influences, beliefs about capability, intentions and beliefs about consequences and emotions. Recommendations were generated using the Behaviour Change Wheel approach., Conclusions: Through the application of behavioural science, we identified a wide range of individual, social/organizational and environmental influences on complaints handling. Our behavioural analysis informed recommendations for future intervention strategies, with particular emphasis on reframing and building on the positive aspects of complaints as an underutilized source of feedback at an individual and organizational level., (© 2024. The Author(s).)