Search

Objective. To elicit the barriers and facilitators experienced by social prescribing service providers when designing and delivering social prescribing services to support adult mental health. Design. Semistructured interviews were conducted with social prescribing service providers across England and Wales in the third sector. Data were analysed in accordance with the Theoretical Domains Framework (TDF) and Thematic Framework Analysis (TFA). Results. Twenty‐one providers (15 females and 6 males) from 17 social prescribing services agreed to participate. Nine analytical themes were identified across seven TDF domains associated with the design of services (e.g., skills and environmental context and resources). Thirteen analytical themes across nine TDF domains were associated with the delivery of services (e.g., beliefs about consequences and optimism). Key recommendations for future social prescribing services were increasing public knowledge of social prescribing; clearly communicating the role of a social prescriber to the public and professionals; providing training to providers on how to safely and effectively lived experiences; adopting a person‐centred approach, including use of person‐centred measures of mental health and well‐being; and strategies to address sustainability of social prescribing services. Conclusions. Service providers are an essential part of the design and delivery of social prescribing services. Person‐centred care, sustainable funding, and improved knowledge of social prescribing all warrant further research. Sustainable funding for social prescribing remains a salient policy‐level barrier. [ABSTRACT FROM AUTHOR]

SUMMARYA selection of summaries of post-medieval archaeological fieldwork carried out across Britain, Northern Ireland and Crown Dependencies in 2023 have been compiled for this annual round-up. These are indexed with thematic keywords. Formatting conventions and notes for future contributors are also outlined. [ABSTRACT FROM AUTHOR]

Background: Unicompartmental knee replacement (UKR) is an effective treatment for end-stage medial compartment osteoarthritis, but there can be problems with fixation. The cementless UKR was introduced to address this issue. It is unknown how its functional outcomes compare with those of the cemented version on a national scale. We performed a matched comparison of the clinical and functional outcomes of cementless and cemented UKRs. Methods: Using the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), 14,764 Oxford UKRs with linked data regarding patient-reported outcomes were identified. A total of 6,906 UKRs (3,453 cemented and 3,453 cementless) were propensity score matched on the basis of patient, surgical, and implant factors. Results: The 10-year cumulative implant survival rate was 93.0% (95% confidence interval [CI], 90.0% to 95.1%) for cementless UKRs and 91.3% (95% CI, 89.0% to 93.0%) for cemented UKRs. The cementless UKR group had a significantly lower revision risk (hazard ratio [HR], 0.74; p = 0.02). Subgroup analyses showed a stronger effect size (HR, 0.66) among UKRs performed by high-caseload surgeons (i.e., surgeons performing ‡30 UKRs/year). In the overall cohort, the postoperative Oxford Knee Score (OKS) in the cementless group (mean and standard deviation, 39.1 ± 8.7) was significantly higher (p = 0.001) than that in the cemented group (38.5 ± 8.6). The cementless group gained a mean of 17.6 ± 9.3 points in the OKS postoperatively and the cemented group gained 16.5 ± 9.6 points, with a difference of 1.1 points between the groups (p < 0.001). The difference in OKS points gained postoperatively was highest among UKRs performed by high-caseload surgeons, with the cementless group gaining 1.8 points more (p < 0.001) than the cemented group. Conclusions: The cementless UKR demonstrated better 10-year implant survival and postoperative functional outcomes than the cemented UKR. The difference was largest among UKRs performed by high-caseload surgeons, with the cementless fixation group having an HR for revision of 0.66 and an approximately 2-point greater improvement in the OKS compared with the cemented fixation group. [ABSTRACT FROM AUTHOR]

This article looks at the demographic contours and impact of the pestis secunda—the second wave of the Second Plague Pandemic—which ravaged England and Wales in 1361–62. The study is based on a rich corpus of statistical data deriving from manorial records—primarily court rolls, but also inquisitions postmortem and episcopal registers—on a national level. A close analysis of the data reveals that the wave in question tended to discriminate across regions, socioeconomic statuses, and genders. The study's findings are then considered within a wider context of ongoing historiographical debates related to the total size of the English population before and after the Black Death. It argues that the population size of England on the eve of the Black Death was higher than often argued, and that the impact of the pestis secunda was harsher than often assumed. The evidence suggests that it was the pestis secunda, rather than the Black Death, that had severe, long‐term demographic and socioeconomic repercussions for England and Wales. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand why demand for ambulances has increased in recent years • To reflect on why people experiencing mental health issues often contact emergency services • To learn how mental health professionals working within 999 call centres can help to reduce demand on emergency services. Demand for ambulances has increased significantly in recent years due, for example, to ongoing public health issues and lack of availability of alternative healthcare services. However, as demand increases, so too do ambulance waiting times, partly due to significant pressures on emergency departments (EDs) resulting in handover delays. People experiencing mental health distress who cannot access the care they need often contact ambulance services or present to the ED. Ambulance trusts across the UK are attempting to address this by employing mental health professionals (MHPs) in various capacities. In this article, the authors explore some of the issues related to mental health-related calls to 999 services. The authors then describe a service improvement initiative in Wales which involves MHPs working in 999 call centre clinical support desk services to improve the quality of care delivered to people with mental health issues and reduce demand on ambulance and ED services. [ABSTRACT FROM AUTHOR]

Policies aiming to restore ecosystems, achieve thriving fisheries and reverse biodiversity loss require knowledge of their former status and long‐term variation. As quantitative fish data is typically only available for recent decades long after changes may have occurred, a greater use of qualitative sources has been encouraged in marine historical ecology. We examined diverse historical information (including maritime history, fisheries reports, naturalists' accounts, recipes, nautical charts and newspapers) across a multi‐century time span (13th–20th century) for a wide range of species to document their long‐term trajectories in an understudied Northeast Atlantic ecosystem (Irish Sea coast of Wales). We find strong evidence of the loss of both a pelagic fishery for herring, which was of fundamental socio‐ecological importance since at least the 13th century, and the loss of significant multi‐species demersal and intertidal fisheries. Local, commercial and/or functional extinction has occurred for taxa spanning a wide range of diversity (crustacean, elasmobranchs, sturgeon, and teleosts), body size and ecological role, suggesting far‐reaching changes to food webs. This raises fundamental questions about the present‐day health and integrity of this coastal ecosystem and the long‐term viability of current fisheries which depend on a few shellfish species. Our century‐scale synthesis of qualitative data for multiple taxa allows the collective breadth of losses to be fully appreciated and may reduce the risk of 'shifting baselines'. Restoration to historical baselines may not be achievable, but our findings provide evidence of long‐term change relevant to policies for recovery, and prevention of further decline of fishes, fisheries and ecosystems. [ABSTRACT FROM AUTHOR]

Devolution in the United Kingdom heralded a significant change in democratic arrangements including associated accountability mechanisms in the form of public accounts committees (PACs) in Scotland, Wales and Northern Ireland. This paper investigates whether devolved arrangements have resulted in enhanced accountability. Based on documentary sources, survey data, and interviews with key stakeholders, this study finds that all three jurisdictions have a high level of public accountability, with Wales being the most effective PAC. While there are significant differences in the information and discussion phases of the committees' work, all three regions have comparable outcomes as a result of their deliberations. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom. Aim: To explore adult intensive care nurses' decision‐making around the practice of GRV measurement to guide enteral feeding. Study Design: A cross‐sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales. Results: Two hundred and seventy‐three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4–6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision‐making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%). Conclusions: Factors affecting the nurses' decision‐making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols. Relevance to Clinical Practice: Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding. [ABSTRACT FROM AUTHOR]

The dominant arrangement for governance in many States which are party to international human rights treaties is decentralisation. This puts implementation of human rights in the hands of institutions which are geographically closer to intended beneficiaries. Decentralisation to different levels of government introduces complexity, risk and opportunity to the governance of human rights. In response, UN Treaty Monitoring Bodies focus on State responsibility for implementation of human rights. The Committee on the Rights of the Child has emphasised the State as the coordinating body responsible for children's rights under the UN Convention on the Rights of the Child (CRC). In this paper, Wales is used as an example of a jurisdiction where decentralisation is a feature of children's rights, which has enabled a progressive approach to implementation. It explains the principled Children's Rights Approach which provides public authorities in Wales with a coherent framework to give effect to international children's rights policy planning and service delivery. As the contours of decentralisation in Wales are typical of arrangements in many States parties to the CRC, insights from Wales will be transferable to other jurisdictions. This experience is also relevant to other areas of human rights implementation in the context of decentralisation. [ABSTRACT FROM AUTHOR]

As the Ministry of Justice looks to develop a 'new generation' of programmes to reduce reoffending, we reflect on what can be learnt from the only accredited domestic abuse programme in England and Wales, Building Better Relationships (BBR). Findings from an ethnographic study of BBR are situated within the Probation Inspectorate's recent inspection of domestic abuse work within the newly unified Probation Service which revealed a fractured and overstretched workforce. Our central argument is that if we are to avoid making matters worse, practitioners must be equipped with the time, supervision and skill needed to maintain something akin to a 'therapeutic alliance', that will endure in moments of crisis in their own lives as well as those of their clients. [ABSTRACT FROM AUTHOR]

The medium-term impact of emotional literacy support assistant (ELSA) intervention is unknown. Therefore, emotional literacy (EL) data were collected through intervention assessment records (IAR) and social and emotional support assessment (SESA) questionnaires from 18 children and young people (CYP) and 18 ELSAs and class teachers (CTs) jointly measuring the effect of a six-week intervention, employing a within-subjects design. Twelve primary schools, four secondary schools, one special school and one pupil referral unit (PRU) participated. A series of t-tests (95% CI) showed a significant positive impact on CYP's EL following six weeks of ELSA intervention with CYP, p <.001 (g = 0.57) and CT and ELSA perspective, p <.001, (g = 0.45), with no improvements for the control group. EL gains were maintained 10 weeks post intervention with CYP p <.001 (g = 0.57) and CT and ELSA perspective p <.001, (g = 0.35), thus providing tentative evidence for the impact of ELSA intervention in supporting CYP's EL that extends beyond a six-week interval time phase. Further research is suggested to build on the evidence base. [ABSTRACT FROM AUTHOR]

This paper addresses the research problem that arises from evidence that, despite supportive policy contexts, enactment of pedagogies that attend to young children's participation rights in classroom settings is highly variable. We report our exploration of the ways in which the child, and child participation are constructed in early education settings in Wales, where legislation and policy around children's rights has been a key feature of the Welsh Government agenda post‐devolution. Data were gathered via a qualitative online bilingual (English and Welsh) survey offered via email to teachers of children aged 3–7 in Wales. The overarching research question of the project was: How do teachers of children 3–7 years understand and enact the notion of participation as it relates to the children they teach? Data analysis focused on research participants' apparent constructions of the children they teach and their capabilities, and unpacked the ways in which these constructions relate to the reported opportunities for participation. The discussion is informed by the notion of the threshold concept, described by Meyer & Land as akin to a portal that opens new and previously inaccessible ways of thinking. We consider the extent to which the conceptual construction of the capable child maybe a threshold concept in shaping the realisation of children's participation rights in educative contexts. [ABSTRACT FROM AUTHOR]

Co‐production values lived experience as it promotes individuals as assets and offers insight where little is known about a problem. This paper critically considers the pragmatic approach to co‐design adopted in Wales with young people and parents affected by child criminal exploitation during the COVID‐19 pandemic. It suggests that combining co‐design with data collection facilitated the recruitment, sensitisation and facilitation of vulnerable groups. By placing informed consent at the forefront of co‐design, young people and parents decided how they wanted their voices heard. Further, combining data gathering with co‐design contextualised solution development within their lived experiences. However, embedding these solutions into policy and practice remains subject to existing power imbalances. [ABSTRACT FROM AUTHOR]

This paper investigates the level of LGBT+ representation among staff and students in higher education in England and Wales. We compare data from the 2021 England and Wales Census to Higher Education Statistics Agency (HESA) data. We find that LGBT+ people are more highly represented in higher education among all staff groups and students than in relevant comparator groups according to age and educational level in the general population. LGBT+ representation among students and STEM academics is modestly higher than the general population comparator group, while representation among non-STEM academics is substantially higher than one would expect from the general population comparator group. We found no statistically significant under-representation in any particular higher education institution. [ABSTRACT FROM AUTHOR]

The case of Charlie Gard sparked an ongoing public and academic debate whether in court decisions about medical treatment for children in England & Wales the best interests test should be replaced by a harm threshold. However, the literature has scantly considered (1) what the impact of such a replacement would be on future litigation and (2) how a harm threshold should be introduced: for triage or as standard for decision-making. This article directly addresses these gaps, by first analysing reported cases in England & Wales about medical treatment in the context of a S31 order, thus using a harm threshold for triage and second comparing court decisions about medical treatment for children in England & Wales based on the best interest test with Dutch and German case law using a harm threshold. The investigation found that whilst no substantial increase of parental discretion can be expected an introduction of a harm threshold for triage would change litigation. In particular, cases in which harm is limited, currently only heard when there are concerns about parental decision-making, may be denied a court hearing as might cases in which the child has lost their capacity to suffer. Applying a harm threshold for triage in decisions about withholding or withdrawing life-sustaining treatment might lead to a continuation of medical treatment that could be considered futile. [ABSTRACT FROM AUTHOR]

The eighteenth century saw antiquaries taking an increased interest in evidence arising from the Roman occupation of Britain. Sir Richard Colt Hoare explored Wales. From 1793 to 1804, his tours follow in the footsteps of Giraldus de Barri. His journals describing the Welsh tours are known, except for the year 1804. These have recently been uncovered at Stourhead. The 1804 tour was taken '[...] with a view to [...] exploring the Roman Roads and Stations through the Principality'. Colt Hoare's translation of the The Itinerary of Archbishop Baldwin Through Wales, a.d. MCLXXXVIII/by Giraldus de Barri; ..., followed in 1806. Comparison of Colt Hoare's journals with his translation of Giraldus' Latin text, which is mostly silent on the Romans, shows how he uses the translation to privilege his observations on Roman Wales. [ABSTRACT FROM AUTHOR]

Background Deaf and hard of hearing people persistently experience barriers accessing health services, largely due to ineffective communication systems, a lack of flexible booking arrangements, and a lack of Deaf awareness training for health professional staff. Methods Face to face focus groups were conducted with 66 Deaf and hard of hearing people in Deaf clubs across Wales, UK. Thematic analysis was undertaken. Results Responses identified from focus groups are reported as barriers faced using health services, improvements that would make a difference, impact of accessibility of health services, and a potential Sign language badge for healthcare staff. Conclusions Deaf people report that health professionals lack training on Deaf awareness and do not know how to communicate effectively with Deaf and hard of hearing people. Further research into Deaf awareness and training resources for health professionals are needed to establish what improves Deaf cultural competencies, and ultimately makes healthcare experiences more positive for people who are Deaf. [ABSTRACT FROM AUTHOR]

In 2015, the UK government placed teachers in England and Wales at the forefront of efforts to prevent radicalisation in young people. Radicalisation as a concept is complex and confusing, and addressing it in schools may be perceived as controversial. This article investigates how secondary school teachers and Prevent practitioners across England understand the concept of radicalisation in education and the impact of the Prevent Duty on teachers' professional role. Both groups are public service officials who work with or within secondary schools under different capacities. Thirteen teachers and fourteen Prevent practitioners were interviewed using semi-structured interviews, allowing for in-depth discussions. A thematic analysis approach was used to analyse and organise the data. The findings highlight discrepancies between teachers' and Prevent practitioners' understanding of radicalisation, due to different levels of knowledge, job expertise, personal interest, media exposure and training. This inquiry sheds light on how teachers' and Prevent practitioners' conceptualisation of radicalisation impacts the way they understand and comply with state policy – in this case, the Prevent Duty, within education. [ABSTRACT FROM AUTHOR]

Background: Physical, affective and behavioural symptoms associated with the menstrual cycle are commonplace. Adolescents with problematic symptoms have reported a negative impact on school attendance, behaviour and participation in physical activity. In the United Kingdom, evidence suggests that menstrual health education delivered by teachers focusses on menstrual cycle biology as opposed to management of menstruation and menstrual cycle related symptoms. Through obtaining the pupil voice, this study aimed to understand young people's perceptions and experiences of menstrual education in schools and their experiences of menstruating whilst at school, including within Physical Education. Methods: To address the aims, a qualitative descriptive study was conducted. Nine focus groups with female pupils (n = 48; ages 10–15 years) were completed across six school locations in England and Wales, including primary and secondary schools. A range of elements relating to the menstrual cycle, education at school and PE were discussed by pupils. Results: Four main themes were developed (a) Education preferences, (b) Period positive environments, (c) Personal experiences and (d) Impact on school. Similarities were reflected across focus groups in terms of current (lacking) education, lesson style and preferences, comfort of conversations, lack of school support and impact on school and PE. Conclusion: The findings highlight the lack of menstrual education received and subsequent impact of menstruation and menstrual-related symptoms in school and PE. The abundance of information requested by pupils highlights the deficit in understanding about how to manage periods in school and remain engaged in physical activity. Schools can utilise information from the current study to; create period positive environments; consider lesson content and format; and explore how to support girls to stay physically active in PE. Plain English Summary: Female pupils attending primary and secondary schools across England and Wales have shared their perceptions and experiences of school menstrual education, including perceived gaps in their own understanding. Pupils highlighted education was limited and sometimes no lessons were provided. Generally education focussed on the biology of the menstrual cycle rather than lived experiences and management solutions, as requested by pupils. Discussions also explored pupils' preferred learning style and environment for period education. A negative impact of the menstrual cycle on school was evident, especially within Physical Education (PE). The wider school environment, such as access to toilet facilties was repeatedly raised as an issue across all focus groups. The information collected highlights the lack of menstrual education received and subsequent impact of menstruation and menstrual-related symptoms in school and PE participation. The abundance of information requested by pupils highlights the deficit in information provided to young people to understand and manage periods in school. [ABSTRACT FROM AUTHOR]

Vaccines against COVID-19 and influenza can reduce the adverse outcomes caused by infections during pregnancy, but vaccine uptake among pregnant women has been suboptimal. We examined the COVID-19 and influenza vaccine uptake and disparities in pregnant women during the COVID-19 pandemic to inform vaccination interventions. We used data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database in England and the Secure Anonymised Information Linkage Databank in Wales. The uptake of at least one dose of vaccine was 40.2% for COVID-19 and 41.8% for influenza among eligible pregnant women. We observed disparities in COVID-19 and influenza vaccine uptake, with socioeconomically deprived and ethnic minority groups showing lower vaccination rates. The suboptimal uptake of COVID-19 and influenza vaccines, especially in those from socioeconomically deprived backgrounds and Black, mixed or other ethnic groups, underscores the necessity for interventions to reduce vaccine hesitancy and enhance acceptance in pregnant women. [ABSTRACT FROM AUTHOR]

Increasing frailty or a medical crisis threatens older people's autonomy. Further threats may arise from adult children if such changes or events are perceived as permitting or signalling a need to assume greater control over their parent's life. In the context of reablement—a time‐limited intervention seeking to help older people regain their confidence and ability to live as independently as possible—this is observed in cases where adult children resist, or seek to sabotage, reablement. This runs counter to the notion of family being a valuable resource and partner to reablement services in achieving the desired outcomes. Notions of autonomy and legitimate authority, which often co‐occur in care relationships, provide a useful lens to understand this phenomenon. The aims of this study were to explore reablement staff's accounts of the ways adult children seek to assume control over their parents' reablement, and how they manage such situations. We undertook a secondary analysis of a qualitative dataset comprising transcripts of 11 focus groups with staff (n = 78) in five reablement services in England and Wales conducted for the purposes of a study investigating the factors affecting older people's engagement with reablement. Staff's accounts included descriptions of the different ways adult children can seek to exert control over the reablement process. Staff believed that, when aware this was happening, older people ceded control to their child(ren) because preserving the relationship with their child(ren) was a greater priority than maximising their independence. Staff's descriptions of the different strategies they used to protect family relationships whilst supporting the older person's autonomy shed light on the skills reablement staff require. Findings support person‐centred approaches to reablement which understand and respond to the wider family context. They also point to possible limitations or gaps in workforce training and supervision. [ABSTRACT FROM AUTHOR]

This paper employs data from the 2021 UK census to initially explore sub-state (English, Welsh) national identities among minority ethnic groups. This shows that these identities remain much more exclusive of people in minority groups than is a British identity, and that this exclusion is particularly marked with respect to English identity. The analysis then builds on this observation using similar data to examine English identification among the White British ‘majority’ in a ‘superdiverse’ city – London. Attributes which are typically shared by London boroughs in which identification as English deviates most from the national average, and multi-variable analysis which considers the ethnic structure of the borough in which an individual lives alongside other key factors (age, education, social class) suggest differences in identification between people living in boroughs that are characterised by more established and extensive ethnic diversity and those in boroughs transitioning from a previously more homogeneous (white) ethnic structure. In exploring how the articulation of a specific national identity might relate to ethnically-diverse or ‘superdiverse’ contexts, the paper uniquely contributes to recent research which calls for a stronger focus on how people who do not belong to migrant-minority groups might respond to living in such contexts. [ABSTRACT FROM AUTHOR]

Background and aims: On 1 May 2018, Scotland introduced minimum unit pricing (MUP), a strength‐based floor price below which alcohol cannot be sold, throughout all alcoholic beverages. The legislation necessitates an evaluation of its impact across a range of outcomes that will inform whether MUP will continue beyond its sixth year. We measured the impact of MUP on per‐adult alcohol sales (as a proxy for consumption) after 3 years of implementation. Design, setting and participants: Controlled interrupted time‐series regression was used to assess the impact of MUP on alcohol sales in Scotland after 3 years of implementation, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on‐trade alcohol sales (in off‐trade analyses) and substitution between drink categories (in drink category analyses) as covariates. Measurements: Weekly data were assessed on the volume of pure alcohol sold in Scotland and EW between January 2013 and May 2021, expressed as litres of pure alcohol per adult. The impact of MUP on total (on‐ and off‐trade combined), off‐trade and on‐trade alcohol sales was assessed separately. Results: The introduction of MUP in Scotland was associated with a 3.0% (95% confidence interval = 1.8−4.2%) net reduction in total alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. This reflects a 1.1% fall in Scotland in contrast to a 2.4% increase in EW. The reduction in total alcohol sales in Scotland was driven by reduced sales of beer, spirits, cider and perry. The reduction in total sales was due to reductions in sales of alcohol through the off‐trade. There was no evidence of any change in on‐trade alcohol sales. Conclusion: Minimum unit pricing has been effective in reducing population‐level alcohol sales in Scotland in the 3 years since implementation. [ABSTRACT FROM AUTHOR]

Tourism is an important and almost certainly increasing driver of anthropogenic climate change. However, intelligence on the total greenhouse gas emissions related to tourism trips – including travel to and from the destination – is limited, especially at sub-national destination scale. This paper uses an environmentally extended input-output approach to estimate the total greenhouse gas emissions consequent on inbound and domestic tourism trips in Wales, a region of the UK. We use the UN World Tourism Organisation (TSA) concept of visitors and trips to estimate the overall carbon footprint of tourism at around 3.4 megatons in 2019, 8.7% of total territorial emissions. We further compare these results with estimates for 2007 which suggests that there has been a modest reduction of under 2% per annum since 2007, but with significant data issues affecting comparability. Apparently slow progress in decarbonisation, including an increase in intercontinental visits to Wales over the period, suggest tourism here has not yet embarked upon a climate-responsible transformation. [ABSTRACT FROM AUTHOR]

Current police recruitment research is often focused on disproportionate outcomes based upon identity-based categories such as race, ethnicity, or gender. National government statistics and political discourse support this research agenda, indicating a significant recruitment gap in representation in England and Wales. This gap has resulted in the design and use of 'in-house' positive action initiatives for police recruitment, with little examination of their impact or otherwise. To understand this research gap, this paper applies a labour market lens to police recruitment. This study contributes to existing research by exploring how police recruits navigate the recruitment process using their social resources. It represents 27 in-depth, participant-led, long-form interviews within an English Constabulary, informed by the theory of Social Embeddedness. It explores how candidates who did not receive positive action navigated and perceived their recruitment process, whilst using their friends, family, and acquaintances for both instrumental and pastoral support. This is contrasted against those candidates that utilised positive action initiatives. The results illustrate developed social embeddedness within police recruitment in the researched constabulary. Recruits who drew heavily upon social contacts experienced instrumental and pastoral support throughout the recruitment process. Some stages of recruitment were more socially embedded than others, resulting in some specific, instrumental advantages. The nature of this social support evidences how disproportionality can be generated in police recruitment. Candidates using positive action initiatives experienced negative, pastoral social support, and temporal instrumental support – illuminating a very different journey during their presocialisation into policing. This finding underpins evidentially informed positive action interventions. [ABSTRACT FROM AUTHOR]

Practice-based education is an essential component of pre-registration physiotherapy programs, and there is a need for a contemporary review of practice-based educational experiences. The aim of this study was to explore physiotherapy practice educators' experiences of supporting learners to inform considerations for future workforce development. This was a mixed methods sequential explanatory study based in the United Kingdom (UK). Phase one of the study utilized an online survey disseminated via the Chartered Society of Physiotherapy (CSP) professional networks. Phase two consisted of three semi-structured focus group interviews with participants who expressed an interest via completion of the online survey. All were registered or associate CSP members who actively support practice-based education. A total of 208 participants completed the online survey and a sub-set of 15 participated in online focus groups. Quantitative survey data were analyzed using descriptive statistics. Initial thematic analysis of qualitative data from both phases was undertaken by one researcher. Subsequent analyses were carried out independently by the remaining research team, and comparisons were made to agree on codes, categories, and themes. The practice educator is vital in developing the future workforce (30%, n = 61, strongly agree). Identified challenges included supervising more than one learner (34%, n = 67 not at all experienced) and using technology to provide alternative placement models (45%, n = 87 not at all experienced). Practice educators need accessible opportunities for professional development. Practice-based education should be embedded as an integral component of all staff roles. A team approach is essential to developing the future physiotherapy workforce. [ABSTRACT FROM AUTHOR]

To describe the incidence and victim demographics of Welsh hospital admissions due to dog bites and strikes from 2014 to 2022. Descriptive analysis of Welsh hospital admissions data. Residents of Wales admitted to a Welsh National Health Service (NHS) hospital for a dog bite or strike, were identified using ICD-10 codes. The annual incidence of dog bite and strike admissions between 2014 and 2022 was calculated and stratified by child–adult status, sex, and Local Health Boards. Trends over time were analysed using the Chi-square test for trends. Hospital admissions due to dog bites and strikes have significantly increased from 16.3 per 100,000 to 23.7 per 100,000 population in 2022. This was driven by an increase in non-geriatric adults and an increase in three Local Health Boards. The Swansea Bay area has the highest incidence in Wales (56.1 admissions per 100,000). Wales has a higher incidence of dog bites and strikes than England or the Republic of Ireland. Work in the communities where incidence is exceptionally high is needed to understand the reasons behind having the highest incidence of dog bites in the British Isles and to establish the most efficacious methods for bite prevention. [ABSTRACT FROM AUTHOR]

Prominent ears (PEs) are the most frequent congenital external ear deformity, occurring in ∼5% of the population. Although the deformity does not usually cause functional difficulties, it can significantly affect the patient's psychological and social health. The authors aim to present the Welsh experience of pinnaplasty, reviewing our outcomes and complications. A retrospective cross-sectional study was performed of all patients undergoing pinnaplasty in Morriston Hospital, Swansea, Wales. We represent the tertiary plastic surgery referral unit across Wales. We included all patients undergoing pinnaplasty between 2015 and 2022 inclusive. We excluded patients undergoing revision procedures or those who had no follow-up. Over the 7-year period, 236 pinnaplasties were performed and 203 were included in the analysis. Ninety-six percent of cases were performed using a cartilage-sparing approach, which represents the mainstay in our unit. The mean follow-up length for our cases was 12 months. Revision procedures were required in 4% of cases. Three hematomas (1.5%) and one (0.5%) wound dehiscence due to infection were recorded and required a return to the operating room. Suture extrusion was noted in 5% of cases (10 patients); 4.5% (9) cases were affected by either hypertrophic or keloid scarring. Across the United Kingdom, cosmetic procedures have come under scrutiny, namely, because of a difficult economic climate. In the era of tight fiscal control in health care, it is pertinent to analyze the outcomes and performance metrics of our operations regularly, thus aiding in the development of an established evidence base to advocate for our respective patients. [ABSTRACT FROM AUTHOR]

Evidence on management of behavioral symptoms in motor neuron disease (MND) is lacking. The MiNDToolkit, an online psychoeducational platform, supports carers dealing with behavioral symptoms (BehSymp). The study objectives were to ascertain recruitment and retention rates, carer and healthcare professional (HCP) use of the platform, and completion of online assessments, to inform a full-scale trial. Design: Randomized, parallel, multi-center, feasibility trial. England and Wales, across diverse MND services; recruitment from July/21 to November/22; last participant follow-up in March/23. Carers of people with motor neuron disease (PwMND) with BehSymp, recruited through MND services. After confirming eligibility, participants completed screening and baseline assessments online via the MiNDToolkit platform and were randomized centrally in a 1:1 ratio to MiNDToolkit or control. MiNDToolkit offered tailored modules to carers for the 3-month study period. Carers in the intervention group could receive additional support from MiNDToolkit trained HCPs. The control group was offered access to the intervention at the end of the study. Data were collected on platform usage and psychosocial variables. One hundred and fifty-one carers from 11 sites were invited to join the study (letter, face-to-face); 30 were screened; 29 were randomized. Fifteen people were allocated to the control arm; 14 to intervention. Carers were mostly female; median age for was 62.5 (IQR: 58, 68; intervention) and 57 (IQR: 56, 70; controls). Study retention was high (24/29 = 82.76%); carers engaged with the platform on average 14 times (median (IQR):14.0 (10.0, 18.5)) during the study period. The MiNDToolkit study was feasible and well accepted by carers and trained HCPs. A definitive trial is warranted. [ABSTRACT FROM AUTHOR]

Effective support of student teachers is critical to the teaching profession. This research involved student teachers and those who support student teachers on a new two-year Postgraduate teaching course. Using a range of data collection, including creative methods such as the use of artefacts, participants' interpretations of effective mentoring were explored. It is reported that it is important that mentors volunteer for, and proactively engage in their mentoring role. Also, that sufficient time is allocated to undertake mentoring responsibilities, which include frequent mentor meetings and professional learning. Key aspects identified for effective mentoring include the importance of a trusting relationship between the student teacher and mentor; nurturing student teacher self-reflection and ensuring that student teachers observe a range of teaching styles. The implications of the findings include the improvement and development of support materials for the programme's mentors along with sharing effective mentoring practice case studies, that showcase effective approaches in different school contexts. [ABSTRACT FROM AUTHOR]

The global spread of non-native species is leading to an increasing frequency of multiple co-occurring non-native species. We examined the co-occurrence of the bivalve mollusc Dreissena polymorpha (zebra mussel) with three Ponto-Caspian amphipods (Dikerogammarus villosus, Dikerogammarus haemobaphes, and Chelicorophium curvispinum) across England and Wales in association with in-situ substrate size. For all three amphipod species, substrate grain size where amphipods co-occurred with D. polymorpha was significantly finer than when recorded in isolation. Subsequently, we confirmed this via aquarium experiments. We examined the occurrence of D. villosus with D. polymorpha when present with cobbles, gravel, or sand from three population sources (co-location with abundant D. polymorpha populations, co-location with low populations, and naïve). Experiments demonstrated that D. villosus actively sought shelter on or near D. polymorpha, with their co-location being significantly more prevalent in finer grained substrates (sand > gravel > cobble). The strength of this co-location differed by population source, with those co-located with high D. polymorpha densities demonstrating a greater association. Our analyses and experiments indicate that D. polymorpha may facilitate Ponto-Caspian amphipod establishment in otherwise suboptimal locations, whereby mussel shells provide favourable structural habitat for the amphipods, analogous to the presence of coarse-grained benthic sediment. [ABSTRACT FROM AUTHOR]

Objectives Evidence suggests spouses influence each other's subjective views on aging. Aligned with the Theory of Dyadic Illness Management, we investigated for the first time similarities in felt age (how old people feel relative to their chronological age) between people with dementia and their spousal caregivers, and how each partner's felt age was related to psychological correlates in the other partner. Methods We used baseline (2014–2016) data from 1,001 people with dementia and their spousal caregivers who participated in the British Improving the experience of Dementia and Enhancing Active Life study. We ran linear regressions to analyze the extent to which the felt age of people with dementia and their caregivers were similar, and whether relationship quality was associated with the similarity. We utilized actor–partner interdependence models to analyze whether the felt age of people with dementia and their caregivers were associated with each other's well-being, satisfaction with life, and self-efficacy. Results The felt age of people with dementia was associated with the felt age of their caregivers (β = 0.10; p =.001). Caregivers and people with dementia reported a more similar felt age when caregivers rated the caregiving relationship more positively (β = 0.07; p =.04). Caregivers' felt age was associated with well-being (β = 0.07; p =.02) and satisfaction with life (β = 0.06; p =.04), but not with self-efficacy, in people with dementia. Discussion Felt age in caregivers and people with dementia may be interwoven, and important psychological variables in people with dementia are related to caregivers' felt age. Findings offer empirical evidence on dementia caregiving dynamics and how family relationships are related to views on aging. [ABSTRACT FROM AUTHOR]

Charity regulation is increasing internationally, leading to divergent views on what might constitute "better regulation." The purpose of a charity regulator and appropriate regulation may also be contested. Many modern charity regulators are required to maintain public trust and confidence in charities in order to bolster ongoing charity support from funders and the donating public. Nevertheless, public trust and confidence is precarious. At its nadir, in England and Wales "the person in the street" was deemed more trustworthy than charities, with donations diminishing in the current environment and the charity sector close to crisis. Further, charities contribute to crises when they incite negative media interest in their operations, fail to comply with regulatory filing deadlines, and/or manipulate their accounts. Charity regulators must maintain legitimacy within a changing regulatory space, despite often being resource‐constrained themselves. Yet, some suggest regulators could "do more" to increase sector‐wide resilience and to increase public trust and confidence. Hence, this raises the question of how charities should be regulated and whether (and how) a regulator could build resilience. We depict charity‐sector crises as a vehicular incident and ponder: should the regulator act as a "Guardian Angel" to prevent crises through interventions to build and maintain sectoral resilience, or should it appear postincident as a "Tow Truck" to clear the road for other traffic through closely bounded regulatory action focused on sanctions and deregistration. We address this question by analyzing publicly available regulatory data from the Charity Commission of England and Wales and semistructured interviews, which provide additional "behind the scenes" depth to our analysis and findings. We contribute to literature on charity regulation and expected regulatory responsibilities within a confined but permeable regulatory space. [ABSTRACT FROM AUTHOR]

Background: UK cancer mortality is worse than in many other high-income countries, partly because of diagnostic delays in primary care. Aim: To understand beliefs and behaviours of GPs, and systems of general practice teams, to inform the Think Cancer! intervention development. Design and setting: An embedded qualitative study guided by behaviour change models (COM-B [Capability, Opportunity, Motivation – Behaviour] and theoretical domains framework [TDF]) in primary care in Wales, UK. Method: Twenty qualitative, semi-structured telephone interviews with GPs were undertaken and four face-to-face focus groups held with practice teams. Framework analysis was used and results were mapped to multiple, overlapping components of COM-B and TDF. Results: Three themes illustrate complex, multilevel referral considerations facing GPs and practice teams; external influences and constraints; and the role of practice systems and culture. Tensions emerged between individual considerations of GPs (Capability and Motivation) and context-dependent external pressures (Opportunity). Detecting cancer was guided not only by external requirements, but also by motivational factors GPs described as part of their cancer diagnostics process. External influences on the diagnosis process often resulted from the primary–secondary care interface and social pressures. GPs adapted their behaviour to deal with this disconnect. Positive practice culture and supportive practice-based systems ameliorated these tensions and complexity. Conclusion: By exploring individual GP behaviours together with practice systems and culture we contribute new understanding about how cancer diagnosis operates in primary care and how delays can be improved. We highlight commonly overlooked dynamics and tensions that are experienced by GPs as a tension between individual decision making (Capability and Motivation) and external considerations, such as pressures in secondary care (Opportunity). [ABSTRACT FROM AUTHOR]

ABSTRACTAgainst the backdrop of the Memorandum of Understanding (MoU) signed between the Welsh and Basque Governments in 2018, this article introduces a multiscalar and transdisciplinary social sciences action research framework that emerged from a workshop held in May 2023. The workshop engaged stakeholders from both sides and is part of the broader ongoing project. This project seeks to address the main research question, ‘How do small nations cooperate?’ through the exploration of transregional cooperation and mutual learning between Wales and the Basque Country. The structure of the article is as follows: First, it commences with an introduction defining ‘small nations’, presenting the main research question, articulating two related aims, outlining three primary methodological goals and providing a broad context for these two small nations within the framework of their MoU. Second, following a brief description of each small nation, the article concurrently develops the action research methodological framework while analysing findings stemming from workshop discussions between stakeholders of Wales and the Basque Country. They addressed three intertwined territorial scale challenges: Macro, examined through devolution and fiscal federalism perspectives; Meso, explored through social innovations in urban spaces in Cardiff (SPARK) and Bilbao (ASFabrik); and Micro, investigated through grassroots innovations. Finally, the article concludes with an action research and policy agenda. It suggests one operational research question per territorial scale as the conclusion of this article, offering a response to the main research question. The conclusion acknowledges limitations and outlines future research and policy pathways for this ongoing project.

Against the backdrop of what seems like a perpetual cycle of crisis for policing in modern day England and Wales, this introduction synthesises some of the core challenges facing the police. A catalogue of crimes committed by serving officers, missed opportunities for reform, and a scathing review of the internal culture of the Metropolitan Police culminating in a recommendation for a ‘complete overhaul’, might initially leave some readers with the view that there is little hope for fixing an outdated and buckling police service. Yet this collection of articles, authored by academic experts, senior police—both current and former—and commentators, not only summarises some of the problems facing policing as the new Government beds in. The contributions also brim with a diverse set of ideas for changing policing for the better and rebuilding trust and confidence. We conclude with the idea that a fundamental review and reconceptualization of the police role, of the type that might be provided by a Royal Commission, is needed if we are to meet the challenges that lie ahead. [ABSTRACT FROM AUTHOR]

Despite over two decades of research, initial teacher education (ITE) partnerships remain problematic. Our study explores the development of a mandated ITE university–school partnership in Wales amidst significant educational reform. Through qualitative research, involving focus groups with 47 teacher educators from a university and 15 schools, we investigate their perceptions and experiences, focusing on shifts in professional roles and responsibilities. Our findings reveal disparities in the impact on the staff, including differences in changes to their roles and responsibilities, perceptions and experiences of agency and in the emotional effort required in the change process. We contend these findings have implications for all stakeholders involved in development of university–school ITE partnerships. In particular, the need for support for the development of individual and joint agency for all staff involved in partnership-building efforts. By shedding light on the complexities involved, we offer valuable insights for practitioners and researchers engaged in similar initiatives. [ABSTRACT FROM AUTHOR]

This article revisits the concept of police culture and its explanatory value in understanding the recent scandals that have rocked policing in England and Wales. It focusses on concerns around the prevalence of sexism and violence against women and girls (VAWG) within policing and explores whether an increase in the diversity of police officers has pushed aspects of police culture into specific specialist and less visible areas of policing. The article suggests that any attempts at substantive police reform need to consider radical organisational and structural change, including a new narrative for British policing. Such a narrative needs political and social support and will require wider engagement beyond internally focussed police discussions. [ABSTRACT FROM AUTHOR]

Welsh and coal heritage may seem synonymous in the context of Welsh identities. One of seven national museums, Big Pit and its associated memory work reflect and shape the intertwined dynamic discourses of Wales and coal for visitors. We explore these discourses through a mixed methodology, highlighting the changing and transcalar nature of Wales itself, particularly the devolution of the tourism, heritage, and culture sector in 1997 from the UK Government to the Welsh Government. How have the discourses of National Museum Wales and Big Pit shifted in conjunction with devolutionary power transfers? This paper reflects upon the complicated and fluid discourses of Welshness within the museum's landscapes. Migration, the dialectic of capital industrialization, and the romanticization of the banal activity of work are all central to these discourses at the Big Pit. Transcalar relationships of tourism and heritage fuel and challenge these discourses as the Big Pit sits on the edge of a UK National Park, on the European Route of Industrial Heritage, and as a central institution of the Blaenavon Industrial Landscape UNESCO World Heritage Site. These interscalar and geopolitical relationships of memory, heritage, and tourism emerge from our multisensory analysis and speak to questions echoing across the United Kingdom and other multi-nation states navigating spatial and temporal shifts in the geopolitics of their tourism sectors. All industrial heritage sites navigate national identities in overt and covert ways. The relationships between resources, heritage sites, the state, and visitors shape the landscapes of industrial heritage sites and their embeddedness into community and national narratives. As Big Pit has transitioned from a small industrial heritage site managed by the UK-overseen National Museum of Wales towards a major tourist attraction and equal member of the seven-site Welsh-overseen National Museum Wales, we identify geopolitical shifts in coal and national heritage. [ABSTRACT FROM AUTHOR]

Introduction: Early-life medical and surgical interventions in babies born preterm and/or with surgical conditions influence later life health and educational outcomes. Obtaining long-term outcomes post-discharge to evaluate the impact of interventions is complex, expensive, and burdensome to families. Linkage of routinely collected data offers a feasible and cost-effective solution. The NeoWONDER research programme aims to describe the short and long-term health and educational outcomes for babies born preterm and/or with surgical conditions and evaluate the impact of neonatal care and interventions on later health and educational outcomes. Methods and analysis: We will include babies who received care in neonatal units in England and Wales, born between 2007–2020 with a gestational age below 32 weeks (approximately 100,000), and/or born between 2012–2020 (all gestations) with any of six surgical conditions: necrotising enterocolitis, Hirschsprung's disease, gastroschisis, oesophageal atresia, congenital diaphragmatic hernia, and posterior urethral valves (approximately 8,000). A detailed list of surgical condition codes is shown in S3 File. We will obtain long-term health and education outcomes through linkage of the National Neonatal Research Database, which contains routine data for all babies admitted to NHS neonatal units, to other existing health and educational datasets. For England, these are: Hospital Episode Statistics, the Office for National Statistics, Mental Health Services Dataset, Paediatric Intensive Care Audit Network, National Pupil Database; and for Wales, the Secure Anonymised Information Linkage databank. Analysis will be undertaken on de-identified linked datasets. Outcomes of interest for health include mortality, hospital admissions, diagnoses indicative of neurodisability and/or chronic illness, health care utilisation; and for education are attainment (using national curriculum assessments), school absence and special educational needs status. [ABSTRACT FROM AUTHOR]

In this paper, I argue that a new term, ‘thematic discretion’, can help us understand police decision-making in cases of youth image-based sexual abuse (YIBSA). YIBSA can be defined as harmful image-sharing practices amongst young people, inclusive of the non-consensual sharing of private sexual images, upskirting and cyberflashing, alongside other actions. I will be drawing on findings from a doctoral research project investigating YIBSA, which utilised a mixed methods approach, comprising of quantitative analysis of freedom of information requests from 40 police forces in England and Wales, as well as 26 qualitative interviews with police and non-police practitioners, also based within England and Wales. Research findings established that YIBSA is highly complicated, and as a result, police officers utilised discretion at a considerable rate, alongside crafting their own guidelines to direct their decision-making, which is argued to be steeped in sexist and victim-blaming narratives. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact Reporting Method Patient or Public Contribution To explore the challenges experienced by Executive Nurse Directors during the COVID‐19 pandemic, and to inform future nursing leadership strategies.A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales.Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi‐structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis.Executive Nurse Directors played a critical role during the COVID‐19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision‐making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision‐making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision‐making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high‐level decision‐making role, protecting staff from burnout and understanding the long‐term implications of pandemic work for nurse leaders.Future strategies for nursing leadership during public health, national and global emergencies are recommended.This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID‐19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership.The study adhered to the Consolidated Criteria for Reporting Qualitative Research.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Purpose: Despite a known risk of cellulitis recurrence, the management of the wider impact and risk factors has been neglected. The innovative National Cellulitis Improvement Programme (NCIP) addresses this by providing evidence-based and individualised care to improve patient reported outcomes and reduce the risk of recurrence. The aim of this paper is to examine the longer-term impact of cellulitis and to identify a suitable and clinically relevant Patient Reported Outcome Measure (PROM). Methods: A review of existing cellulitis-specific PROMs was undertaken, alongside literature detailing the patient-focused impact of cellulitis, to identify a suitable PROM for clinical use. A group of expert therapists and patient representatives (n = 14) shared their individual and collective experiences over a series of events to discuss and debate the impact of cellulitis and review available PROMs. CELLUPROM© is introduced with anonymised PROM data and case study information reported to establish the impact of CELLUPROM© within usual NCIP care. Results: No cellulitis-specific PROMs were identified. Literature focused on the signs and symptoms of an acute episode of cellulitis, with outcome measures primarily used to evidence the impact of an intervention. An enduring physical, social and emotional impact of cellulitis was identified in this study, providing the basis for the new cellulitis-specific PROM (CELLUPROM©), which has been implemented with good effect in clinical care. Conclusion: This study has highlighted the lasting impact of cellulitis. Using CELLUPROM© within the risk-reduction NCIP has helped develop Value-Based Healthcare and support programme evaluation. [ABSTRACT FROM AUTHOR]

Aim(s) Background Design Methods Discussion/Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution The aim of this study is to understand factors that challenge retention and support nurses to stay in general practice.One in four general practice nurse positions in England expected to be left unfilled within the next 10 years. Cultural and structural issues associated with working in general practice have been linked with nurses leaving general practice, re‐evaluating their professional futures, adjusting work‐life balance and bringing forward retirement. This has implications for the future of the general practice nursing workforce and patient care more broadly.Exploratory qualitative interview study funded by the General Nursing Council Trust for England and Wales. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained in September 2023. The study will be conducted between September 2023 and August 2024.Qualitative interviews will be conducted with a range of nurses working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment will be via professional and social media networks and snowballing techniques. We aim to purposively recruit 30–40 participants for maximum variation. Cultural and structural influences which may contribute to retention decisions will be explored. Data will be analysed following framework analysis.This study will explore how underpinning cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention.By exploring factors that support or discourage nurses to remain in general practice, retention strategies can be better planned on order to address the general practice nursing workforce crisis.What problem did the study address? This study will address the retention crisis in nursing in general practice by exploring how cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention.Where and on whom will the research have an impact? From the study findings, recommendations will be developed to inform future policy and practice. Key factors to address attrition will be generated to support employers and policy makers in future primary care workforce planning, as well as supporting nurses, at an individual level, in negotiating their roles in practice.Standards for Reporting Qualitative Research (O'Brien et al., 2014).As this is a workforce study protocol, there is no patient or public contribution. [ABSTRACT FROM AUTHOR]

Background The indirect impact of the coronavirus disease 2019 pandemic on healthcare services was studied by assessing changes in the trend of the time to first treatment for women 18 or older who were diagnosed and treated for breast cancer between 2017 and 2021. Methods An observational retrospective longitudinal study based on aggregated data from four European Union (EU) countries/regions investigating the time it took to receive breast cancer treatment. We compiled outputs from a federated analysis to detect structural breakpoints, confirming the empirical breakpoints by differences between the trends observed and forecasted after March 2020. Finally, we built several segmented regressions to explore the association of contextual factors with the observed changes in treatment delays. Results We observed empirical structural breakpoints on the monthly median time to surgery trend in Aragon (ranging from 9.20 to 17.38 days), Marche (from 37.17 to 42.04 days) and Wales (from 28.67 to 35.08 days). On the contrary, no empirical structural breakpoints were observed in Belgium (ranging from 21.25 to 23.95 days) after the pandemic's beginning. Furthermore, we confirmed statistically significant differences between the observed trend and the forecasts for Aragon and Wales. Finally, we found the interaction between the region and the pandemic's start (before/after March 2020) significantly associated with the trend of delayed breast cancer treatment at the population level. Conclusions Although they were not clinically relevant, only Aragon and Wales showed significant differences with expected delays after March 2020. However, experiences differed between countries/regions, pointing to structural factors other than the pandemic. [ABSTRACT FROM AUTHOR]