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Introduction The prevalence of adolescent e-cigarette use has increased markedly in recent years. Specifically, the prevalence of e-cigarette use over the past 30 days was higher than the prevalence of use of other tobacco products. However, there is no definitive data on e-cigarette use among adolescents, including a description of how e-cigarette use is part of a more widespread pattern of substance abuse. The objective of this study was to assess the prevalence of e-cigarette use in combination with tobacco, alcohol, or marijuana, and the risk of polysubstance use among a sample of Thai adolescents, analyzed by sociodemographic characteristics. Methods Data were extracted from the Bangkok Behavioral Surveillance Survey (BBSS) cross-sectional survey conducted in 2019. The survey used self-reports from a sample of adolescents aged 14-17 years in Bangkok (n=6167). Multinomial logistic regression was used to determine the status of poly drug use in combination with e-cigarettes. Results In all, 6.8% of adolescents in this sample reported having used e-cigarettes in the last 30 days. Among the students who used e-cigarettes, the majority (72.0%) reported using other substances along with e-cigarettes, and alcohol was the most common addictive substance used in combination with e-cigarette use. The use of e-cigarettes only and e-cigarettes in combination with other addictive substances (compared to the non-e-cigarette group) tended to be higher among male students, having low academic achievement, having a friend who smokes, being persuaded by a close friend, having ever had sex (OR: 1.48-3.70), and having close friends who drink alcohol (vs none) (OR=3.26). Conclusions Polysubstance use is highly prevalent among adolescents who use e-cigarettes. There should be extensive screening for e-cigarette consumption, including use of other addictive substances, especially alcohol. Early and comprehensive prevention efforts to reduce the use of e-cigarettes and other addictive substances can have a huge impact on the health of the adolescent population.

Definitions of drinker ‘categories’ (e.g., ‘light drinkers’) typically ignore the role of self-identification involved in drinking practices. To explore this, we presented self-identified ‘non’ or ‘light’ drinkers with official formal definitions of ‘light’ and ‘binge’ drinking as found in public health and academic research. A qualitative design was adopted. Semi-structured interviews with ten 18–27-year-old UK University students self-identifying as non-/light-drinkers were analysed using critical discourse analysis. A first data pattern saw participants working to defend and maintain self-identified ‘light drinker’ status in the face of contradictions to such claims. A second pattern involved participant challenges to the rigidity and legitimacy of formal drinking categories. A third pattern reflected participants' rhetorical work to hold at bay or reject disavowed and stigmatised drinking categories (e.g., ‘alcoholic’). Interviews suggested how formal definitions could create ideological dilemmas for participants, partly through investment in how formally defined drinker categories connected with recent personal drinking practices. Our data helps explain why units-based drinking guidelines may be poorly understood. More nuanced use of ‘drinker categories’ in units-based drinking guidelines could strengthen the visibility and credibility of alcohol health messages or could be drawn on in digital interventions designed to encourage moderate consumption behaviour by delivering personalised feedback.

Understanding of how time is experienced is essential when conducting qualitative research. Thisarticle explores how time seemingly stands still, speeds up, slows down, rewinds and fast-forwards forthe participants in our qualitative investigations. Drawing upon interview data with street homelesspeople in Moscow, Russia, this article examines the ways in which time is contextualized and used byresearch participants to make sense of their everyday experiences and important events in their lives.There is a tendency to understand time by measuring it, rather than seeing it as something withinwhich lived experience happens and qualitative research is carried out. Drawing on Bergson’sconception of time as duration, this article examines the ways in which time can be distinctively usedand understood within qualitative research.

Objective: Previous studies emphasise the negative psychological and physical consequences of Postnatal Depression (PND) on mothers and children’s health. In the UK, around 10-20% of women can be affected by perinatal mental health problems. Minority ethnic groups such as Black African mothers are considered to be at greater risk of developing PND and data estimates that immigrant mothers are twice more likely to develop PND than native mothers. The unique experiences and needs of this culturally diverse group remain little explored in the UK. To address this gap in the literature, this study aimed to explore the lived experiences of First-Generation Nigerian Mothers (FGNMs) who suffered PND, their coping behaviours and treatment experiences in the UK. \ud \ud Design: Six FGNMs with a previous diagnosis of PND and treatment experiences were purposefully recruited from GP practices and social groups attended by Nigerian mothers in the UK. Semi-structured interviews were analysed using Interpretative Phenomenological Analysis. \ud \ud Results: Three master and seven subordinate themes were identified: (i) Socio-cultural factors (Inter-generational transmission; cultural perceptions: shame and stigma; transitions: adjusting to a new culture); (ii) What about me? The neglected nurturer (experiences of treatment; pretending to be OK); and (iii) Loneliness and coping (lack of support from partner; self-reliance).\ud \ud Conclusions: The study provides evidence about the difficulties encountered by FGNMs in relation to PND, including socio-cultural factors, neglect from family and healthcare professionals, and self-reliance as a coping strategy. Contrary to reports suggesting that Black ethnic groups do not seek help for their mental health needs, participants’ accounts indicated that their attempts to engage with professionals were met with unsatisfactory responses. The findings of this study highlight the need to address barriers affecting access to services by fostering a patient-centred and culturally sensitive approach in healthcare teams to effectively engage mothers at an early stage in the detection pathway.

This evaluation study was commissioned by the Communications and Engagement team at the NHS North Central London Clinical Commissioning Group to assess the performance of the Winter Resilience Communications and Engagement campaign during the months of December 2021 and March 2022.\ud \ud The campaign aimed to deliver ‘an integrated system-wide communications and engagement programme to support residents, patients and health and care workers prepare for, and stay well this winter, reminding them that services are open and ready to provide care when needed and to access care in the right place at the right time’ (NCL CCG, 2021).\ud \ud The evaluation was conducted following the Evaluation Framework 2.0, with metrics for the 3 components of the Winter resilience campaign which sought to raise awareness, change behaviour intentions, and effect behaviour change. A mixed-methods complementarity study was used, combining quantitative and qualitative methods of data collection and analysis. We envision a three-stage process: 1) A baseline survey used as the control; 2) a modify repeat survey (post-campaign); 3) one-to-one interviews with staff involved in the delivery and with respondents to the final survey. Contextual data from NHS digital and GOV.UK were used to strengthen the evidence for the evaluation analysis.\ud \ud The evaluation makes recommendations directly relevant to the Communications and Engagement team as they prepare for the next Winter campaign. Recommendations focus on two main areas, campaign preparation and content, the latter is mapped against a diagnosis of behavioural components using the COM-B theoretical model and interventions informed by the Behaviour Change Wheel.

COVID-19 has transformed the British welfare state. The government has created millions of new beneficiaries, spent tens of billions of pounds it doesn't have and created a mountain of public debt. And yet, when the crisis has passed, we will be left with all the old problems of welfare and well-being which we have systematically failed to address over the past 50 years.\ud \ud In this book, Christopher Pierson argues that we need to think quite differently about how we can ensure our collective well-being in the future. To do this, he looks backwards to the welfare state's origins and development as well as forwards, unearthing some surprising solutions in unexpected places.

Coproduction is increasingly positioned as the gold standard for improving health engagement with marginalised groups. Yet little is known about how key factors such as power, position and culture impact success. Our research aims to identify the psychosocial factors and resources that enable successful coproduction between Black, Asian and other Minority communities and statutory agencies within a coproduction network for mental health services in London. Within our multi-site ethnography, 53 individuals completed: participatory learning appraisal (PLA) workshops, focus groups, and semi-structured interviews. Unstructured observations of network activities were also completed. Data were analysed using thematic network analysis.\ud \ud The findings highlight that coproduction is enabled by symbolic, relational and material resources. Resources are input before coproduction activities begin, within a newly conceptualised ‘phase zero’. Unconstrained by typical funding cycles, the phase shifts power, resources and relationships through recognising and addressing power asymmetries and histories of oppression facing marginalised groups. Implications for coproduction are discussed.

Objectives:\ud University students in the UK engage in relatively high alcohol consumption levels, yet young adults, including students, now drink less than previously and abstain more. Against this cultural backdrop, our objective was to further understanding of ‘maturing out’ of excessive drinking practices among students by focusing on drinking transitions that had taken place during university years. \ud \ud Design:\ud A qualitative interview study. Methods. Semi-structured interviews were conducted with ten 18-27-year-old UK undergraduate university students who self-identified as light or non-drinkers. Interviews were audio-recorded and anonymised interview transcripts were subjected to an experience-focused application of thematic analysis. \ud \ud Results:\ud Participants reported dilemmas involved in transitions from relatively high to low levels of alcohol consumption. One dilemma was characterised by managing to drink less (or nothing) without cutting off social options with university friends/peers. A second dilemma concerned not wishing to fully abandon the pleasures and increased social confidence that alcohol consumption could afford. Results also demonstrated that self-reported drinking could contradict participants’ self-defined ‘light drinker’ status. \ud \ud Conclusions:\ud This study reinforces the view that ‘maturing out’ involves more than simply having gained new responsibilities during young adulthood. Recognition of these dilemmatic features of drinking transitions could be drawn on in novel campus-based interventions. Such interventions may help strengthen realistic and sustainable moderate drinking by guiding students to anticipate potential difficulties involved in planned reductions in personal drinking but to foster students’ ability to view drinking choices as in transition rather than as permanent and enduring.

The objective of this review of reviews was to identify the potentially modifiable barriers and facilitators to physical activity in people with a musculoskeletal condition to influence intervention development.A rapid review of reviews.The Cochrane library and PubMed Central were searched for reviews using pre-defined search terms and relevant synonyms for "physical activity", "barriers" or "facilitators", and "musculoskeletal condition". The identified reviews were screened for inclusion by the principal investigator in line with recognised streamlining approaches for a rapid review. Only review papers investigating the barriers and facilitators to physical activity in adults with a musculoskeletal condition were included. A team of seven assessed the included reviews for identification of the barriers and facilitators to physical activity coded using the COM-B model of behaviour.503 reviews were identified with 12 included for analysis across a mix of conditions and designs (n = 2: qualitative; n = 6: quantitative; n = 4 mixed). A multitude of interrelated factors were identified across the COM-B components. The most prevalent factors included disease symptoms and physical function (physical capability), knowledge of the specific benefits of physical activity and knowing what to do (psychological capability), the accessibility of facilities and individualised programming (physical opportunity), tailored advice from healthcare professionals and peer support (social opportunity), beliefs about the benefits or harms of being active (reflective motivation) and having the self-efficacy to be active and experiencing positive emotions (automatic motivation).This review of reviews identified the complex nature of physical activity in people living with a musculoskeletal condition. The identified barriers and facilitators should be considered by intervention designers when developing behaviour change interventions for this population group.

To date, the controversy surrounding the unknown risks and consequences of heritable genome editing has grown, with such work raising biosafety and ethical concerns for future generations. However, the current guideline of global governance is limited. In the context of the new framework for the governance of human genome editing developed by the World Health Organization (WHO) committee, this paper presents further analysis by highlighting predicaments of governance on germline engineering that merit the most attention: (1) building a scientific culture informed by a broader set of values and considerations in the internal scientific community at large, such as codes of ethics, and education, in addition to awareness-raising measures; and (2) reflecting on and institutionalizing policies in grassroots practice according to local conditions in external governance, such as the experimentalist governance, which is a multi-layered model of governance that establishes an open-ended framework from the top and offers stakeholders the freedom of discussion. The key to achieving these goals is more democratic deliberation between the public and the inclusive engagement of the global scientific community, which has been extensively used in the Biological and Toxin Weapons Convention (BTWC). On a global scale, we believe that practicing heritable human genome editing in accordance with the WHO and BTWC appears to be a good choice.

Today healthcare globally is growing at a rapid pace and despite the huge technological advancement, healthcare still faces primitive challenges and hence results in the poor service and facility to the needy. Layout planning acts as one major reason which requires improvements for the effective and efficient working of the healthcare facilities. This research aims at optimizing several quantitative criteria related to economic, technology and society which are taken into consideration for the decision-making during the evaluation, analysing and selection of the best layout for an existing healthcare facility. Critical areas for the improvement were found out using statistical analysis based on a survey questionnaire and Apple’s layout procedure is utilised to design the different possible layouts for an efficient facility. The seven criteria namely inter-departmental satisfactory level, the average distance travelled and the average time required for staff flow, the average distance travelled and the average time required for patient flow, the average distance travelled and the average time required for material flow were taken into consideration. The ELECTRE methodology was used as multi-criteria decision making based on decided seven criteria for comparing the different layout by methodical and orderly thinking. First published online 23 November 2020

This article describes a pilot qualitative research study, exploring the impact of bereavement experiences, on pre-qualifying social work students in two UK Universities with diverse demographics. The research study took place in the context of general concern about the mental health of UK University students and suggests that social work students may be at particular risk of developing emotional wellbeing issues linked to bereavement. Interviews followed a free association narrative technique, with analysis of the data highlighting four main themes. Firstly, bereavement is associated with practical problems which may trigger wellbeing issues. Secondly, there is an increased need for specific bereavement training and support to be embedded within social work programmes, alongside skills and knowledge of cultural diversity and the part this plays in the bereavement process. Lastly, the study demonstrated that bereavement experiences are not isolated but linked to other losses and therefore students may need effective support to process these before they can effectively support others. The study appears to be distinctive in its focus on the impacts of bereavement on social work students and has significant implications for the ways in which students are supported by social work education programmes, as well as paving the way for further research in this area.

A major national project, commissioned by Health Education England and delivered by the Social Care Institute for Excellence, in partnership with the British Association of Social Workers is currently studying digital capabilities across the social work profession. The project aims to chart the existing landscape and produce ethical guidance, together with a set of digital capabilities, which will map to existing frameworks. The initial Stakeholders’ Report, has important implications for social work education at all levels, as well as emphasising relationship and co-production as crucial values for digital design and delivery.\ud \ud This article responds to the initial outputs of this project, by describing the design and delivery of a mobile app created within a UK University Social Work Department, using a co-production model. The completed mobile app is cited as a key example within the Digital Capabilities for Social Work initial Stakeholder Report, which also emphasises the values which underpinned the app creation. The article is linked to a previous paper, describing original app development within social work education and forms part of a rapidly growing body of work, which attempts to address issues highlighted within the national Digital Capabilities project.

Numerous negative representations of youth emerged in the aftermath of the 2011 English riots. This article intends to fill a gap in the literature on the ‘riot-affected’ areas by looking at how youths from Tottenham (the North London constituency where a peaceful demonstration escalated into the English riots of 2011) deal with stereotypical and homogeneous portrayals put forward by the British mainstream news media and many government ministers. In drawing on an alternative conceptualisation of reflexivity that spells out how reflexive orientations relate to lived experiences, the article aims to open up novel pathways for understanding youth reflexivity in the context of being regularly subjected to negative representations. This is achieved by tying reflexive activity more closely to Alfred Schütz’s notion of ‘stock of knowledge’. The study applies qualitative methods to empirically address how a group of eighteen 15- to 25-year-olds from Tottenham reflexively negotiate the harmful consequences of stigmatised identities. The most striking conclusion to emerge from the data is that Tottenham’s young people embody a diverse range of youth identities and reflexive attitudes; a conclusion that flies in the face of the way in which much of the media depicted youths after the riots.

Aim: To evaluate a digital intervention to improve physical activity in people in the UK with a musculoskeletal condition delivered during movement restrictions brought about because of the COVID-19 pandemic. Method: Service evaluation data collected from 26,041 participants over 5 months was assessed against national datasets to understand the reach and representativeness of the digital physical activity intervention. Measures to restrict the movement and interaction of people were in place during these 5 months. Cross-sectional data from 2752 participants across different stages of the 12-week programme assessed levels of physical activity and the components of behaviour as defined by the COM-B model (Capability, Opportunity, Motivation = Behaviour). Regression analysis investigated the relationship between programme stage and physical activity and the components of behaviour. Results: In comparison to the UK population of people with a musculoskeletal condition, the intervention participants were over-represented by females, White, and inactive people. A cross-sectional analysis suggested that the number of participants regularly active increased by programme stage. Scores for the behavioural components of automatic and reflective motivation, physical and psychological capability, and physical opportunity were also improved by programme stage. Conclusion: The service evaluation suggests that the digital intervention, designed to improve physical activity in people with a musculoskeletal condition, could be beneficial during measures to restrict movement to slow the spread of infectious disease in those who are already motivated to become or stay active.

As coronavirus disease 2019 (COVID-19) pandemic unraveled, state-led preventative restrictions created a “new” normal through remote home-working. A long-planned follow-up qualitative research study on risk perceptions and experiences regarding Clay Ingestion among black African women during pregnancy, in London, was disrupted as England went into lockdown. Against this backdrop, we shifted to remote data collection which raised pertinent concerns around access to technology and participant digital skills. We share our experiences of navigating through remote fieldwork during the pandemic with black African mothers with caring responsibilities as well as the extra burden of homeschooling, the challenges we encountered and how we mitigate these and the lessons learnt. Thus, drawing from our remote qualitative research experiences, we refer to notable examples of challenges, mitigating strategies applied and potential lessons to inform future practice.

The position presented in this article draws on the professional insights of the authors, reflecting on issues of global political importance in culture and migration mental health. As institutional theory perspectives continue to develop, solutions to complex social problems such as racism require embodied knowledge if the lines of authority and basic occupational routines are to be meaningfully renegotiated. Embodied knowledge is socially situated and self-reflexive and reflects cumulative and marginalized experiences that contribute to a better understanding of institutional racism and the social construction of whiteness. The authors foreground the development of critical consciousness and emotional literacy in order to be more professionally competent in institutional contexts of mental health training, education and practice. To this end, elements of due process, transparency, inclusiveness, community engagement and accountability are at the center of a political and intellectual movement towards epistemological justice to promote antiracism and social justice in culture and migration mental health. The authors define decolonial intersectionality as a clear philosophical vision outlining how best to respond to those at risk of experiencing racism and the associated mental health burdens.

Terrorism is a universal enemy of mankind. North-eastern Nigeria has been facing terrorist activities perpetrated by Boko Haram in the past decade. Researches into this area are mostly based on anecdotal sources. However, building on existing works, this study explored the causes of Boko Haram, its sources of funds and arms, relationship with the other international terrorist groups and the localization of the group to only the North-east of Nigeria. It also investigated the effect of the group on Nigeria’s national development and examined the counter and anti-terrorism efforts of Nigeria's security forces and their efficacies. The study adopted a descriptive research design. Both primary and secondary data was used for the study. Primary data was collected using the quantitative method (validated questionnaire) and qualitative technique (In-depth Interview (IDI) and Key Informant Interview (KII). Employing the purposive sampling technique, the study involved 369 respondents (150) for the questionnaire survey while the rest (219) comprised respondents for the IDI and KII. Secondary data was extracted from Police case files (Document) involving Boko-Haram members in the police custody. Quantitative data collected was analyzed using descriptive and inferential statistics. The qualitative data was analyzed using content analysis and NVivo. The findings of the study revealed that Boko-Haram was not a result of politics but a multiplicity of poor socioeconomic factors with arms and funds sourced by direct criminal activities and dependence on foreign sources. Further findings suggested, that if anything, the Sect had links with other international terrorists group and localization more pronounced to the North-eastern Nigeria based on porous extensive borders and strong Islamic belief stemming from the frequent religious upsurge in the area. The impact of Boko-Haram on national development was negative as the insurgency affected food security, disrupted educational activities, scuttled industrial development, putting domestic and foreign investment in limbo. Specifically, the finding prefigured the anti and counter-terrorism strategies of the national security forces to be ineffective but now modified to include both soft and hard power approach. The study thus portrayed Boko-Haram as a domestic asymmetric conflict and a response mode to pains of frustration and poverty seething with strains of injustice, only to be addressed not by conventional warfare approach but using a combination of both kinetic and non-kinetic power strategies of the government.

This study explores historic class-based obstacles in the dispensation of secular pedagogy in the Bengal region with the objective of presenting a better understating of the present pedagogical positioning of the British Bangladeshi diaspora of Tower Hamlets. This study charts the visitation of symbolic violence in the historical development of pedagogy under colonial rule and continues into the East Pakistan period. Through the application of Pierre Bourdieu’s primary thinking tools the discussion asserts Muslim Bengalis were educationally marginalised by both colonialists and local elites in the realisation of human capital consumption.

This commentary responds to claims that research by Cheryl Thomas ‘shows’ no problem with rape myths in English and Welsh juries. We critique the claim on the basis of ambiguous survey design, a false distinction between ‘real’ jurors and other research participants, the conflation of attitudes in relation to abstract versus applied rape myths, and misleading interpretation of the data. Ultimately, we call for a balanced appraisal of individual studies by contextualising them against the wider literature.\ud \ud Key messages:\ud \ud Thomas (2020) argued that her research showed rape myths do not influence juries.\ud \ud We critique Thomas’ claim because the research was not designed to ask about influence on juries, there are several methodological limitations, and the data actually reveal ambivalence about rape myths on the part of many jurors.

The term ‘One Health’ was coined in 2003 to describe the interdependence of healthy ecosystems, animals and people, soon after the emergence of SARS broke out. The philosophy of One Health is now widely accepted by the international community, due to the COVID-19 pandemic, which was first reported in China, but its origin is far from certain.\ud \ud China has suffered two major pandemics during the 21st century. The ‘One Health’ philosophy and principals are dearly needed in China; therefore, it is critical to ensure a correct Chinese translation so that its holistic meaning could be fully grasped, and actions could be orchestrated across the globe.\ud \ud In China, two completely different Chinese characters are used as the translation of ‘One’ in One Health. Both sides have distinguished scholars from the field, and have reasonable arguments.\ud \ud The opportunities to contribute to Health at the ‘World’ scale, on the ‘International’ stage and with ‘Global’ spirit certainly sound inspirational especially for the young generations. But we argue that the acronym WIG (world, international, global) paints a more realistic picture of what is needed to be done. Under a wig in health salons, there is a hairless problem to be fixed. Under a wig in justice courts, there is a fairness problem to be tackled.

While the last decade has brought about a flourish of multi-disciplinary research on the topic of high street regeneration in general, the expansion of the cultural field of architectural production to the ‘unplanned’ public realm of the city has received little critical attention. Bringing together and juxtaposing the visual, social as well as semantic aspects of ‘distinctiveness’ in relation to high street regeneration, this paper aims to offer a starting point for a critical review of the architect’s evolving role in public realm renewal.

The COVID-19 virus pandemic has again demonstrated the devastating impact that a microbial pathogen can have on our health, society and economic systems. It necessitates a fundamental rethink of how the security of our societies can be better sustained. This rethinking will require many aspects of our security systems to be re-examined, but we concentrate here on the consequences of the rapid advances being made in the life and associated sciences. In this chapter, we will describe and analyse one of the most likely means by which the BTWC could be strengthened at the 9th Review Conference, namely: agreement of an International Aspirational Code of Conduct supported by mandatory biological security education for life and associated scientists. We conclude that a vigorous effort by civil society will be needed to assist the achievement of an agreement on this issue at the 9th Review Conference.

International audience; Research in social network analysis (SNA) faces unprecedented ethical challenges today due to both technological developments (‘big’ data) and a growing tendency toward institutionalization of ethics governance. We argue that a suitable response requires a more comprehensive approach to SNA ethics, and we identify two main paths toward this goal. First, we need to recognize the breadth of the subject, no longer limited to anonymity and consent. Second, we need to encourage the active participation and contribution of SNA scholars. We advocate a need for greater reflexivity at both individual and collective levels, whereby researchers can learn from their own and their peers’ experiences, and foster a more ethically ‘virtuous’ approach within the whole SNA community.

Aims\ud This paper reports the systematic development of a remote intervention delivered by the British Lung Foundation to support inactive people with chronic lung conditions to increase their physical activity levels, using the Behaviour Change Wheel (BCW).\ud \ud Method\ud An iterative approach was taken to intervention development guided by the eight steps outlined by the BCW and supported by a reviewing of the existing literature and stakeholder discussions. \ud \ud Results\ud The final intervention was designed to improve the capability, opportunity and motivation of inactive people with chronic lung conditions to increase their physical activity levels. The resulting intervention includes a 12-month telephone (health coaching) intervention, alongside the provision of printed and digital resources. The intervention incorporates the intervention functions of education, enablement, modelling, environmental restructuring, persuasion, and training, with service delivery supported by communications and marketing and the use of existing guidelines. The intervention incorporates twenty-eight Behaviour Change Techniques. \ud \ud Conclusions\ud The BCW enabled the systematic and comprehensive development of a multicomponent, remote intervention to increase physical activity in inactive people with chronic lung conditions. An assessment of the feasibility and potential impact of this new British Lung Foundation service is underway in England, to evaluate its impact on physical activity and the potential scalability.

It is nearly 60 years since the identification of the oestrogen hormone receptor (ER) in breast cancer, a discovery that radically transformed the clinical management of the disease. Hormonal therapy with anti-oestrogens (Tamoxifen and Aromatase inhibitors) antagonises ER function and became the mainstay treatment until today. Around 70% of breast tumours are classified as oestrogen dependent, yet the mechanism of action of other hormones in breast cancer growth both independently and interacting with ER as well as their targeted therapies have yet to find a place in the clinic. In this article, I critically review the scientific literature for the period 1960–2016 and examine the rise and persistence of the oestrogen hypothesis as well as the neglect of alternative hormonal explanations. By using Pierre Bourdieu’s concepts of the scientific field alongside feminist science scholars to explore the impact of gendered assumptions on science, the analysis provides insight into the dominant role of the oestrogen hypothesis and the struggles for legitimation of different alternative perspectives. I consider these alternative approaches as “internal” struggles for scientific authority, which are in turn, socially determined by “external” gender values that reinforce a binary arrangement of male/female bodies based on fixed molecular hormonal traits.

This article addresses recent debates relating to the measurement of domestic violence, and in particular the ‘domestic violent crime’ framework proposed by Sylvia Walby and colleagues. We argue for the utility of coercive control as a framework for measurement of domestic violence, and highlight what we see as misrepresentation of this concept in the work of Walby and colleagues. We also point to the limitations of traditional crime codes in capturing the range of abuse suffered by victims of coercive control, and question whether measuring physical assault is any more straightforward in sample surveys than measuring non-violent forms of coercion. We conclude by calling for greater attention to qualitative narratives and practice-based knowledge to ensure that measurement frameworks reflect the lived experiences of victim-survivors.

Introduction:\ud This study explored changes in therapeutic radiographers’ (TRs) self-reported knowledge and skills to engage in conversations about physical activity and diet with people living with and beyond cancer following completion of publicly available online courses.\ud \ud Methods:\ud Participants were randomly assigned to two of five online courses that aim to support health professionals to engage in conversations about physical activity and diet in the oncology setting. Participants rated their agreement with 18 statements related to the COM-B (capability, opportunity and motivation-behaviour) model components following completion of an online course on healthy diet (n = 16) and physical activity (n = 21). Semi-structured telephone interviews (n = 21) were also conducted. Analysis of the interviews was guided by the Theoretical Domains Framework.\ud \ud Results:\ud Overall, the online courses were acceptable and the TRs in this study self-reported improved COM to deliver advice on physical activity and diet. The inclusion of the evidence and scientific rationale on the benefits of diet and physical activity, and also guidance on how to start conversations with patients were highlighted as important features of the courses. Suggestions for adaptations to the nutrition courses included the need for content that accounts for the side effects cancer patients experience while undergoing treatment. To support the implementation of training and the delivery of advice on these topics, multi-disciplinary working, organisational support and guidance around professional role boundaries were highlighted as important.\ud \ud Conclusion:\ud Current publicly available online courses on physical activity and diet for oncology health professionals can reduce some barriers among TRs to providing advice to those living with and beyond cancer.\ud \ud Implications for practice:\ud Existing online training courses could be used to support TRs to deliver physical activity and dietary advice in practice. Findings show that these courses can be disseminated within radiotherapy departments. The results also highlight a number of important considerations for the implementation of brief health behaviour advice and online training interventions on physical activity and diet within cancer care.

This thesis explores media representations about ‘child sexual exploitation’ (CSE) and the ‘practice-based evidence’ of specialist practitioners from a feminist perspective. It considers how gender, power and other systems of social oppression relate to CSE. The study was conducted in two phases. \ud \ud The first phase was a frame analysis of newspaper articles published during two significant periods of increased awareness, policy and practice development in England. The periods chosen were 1997-99 and 2014-15. Newspaper articles were drawn from three national newspapers: The Times, Daily Mail and the Mirror. A total of 390 articles were analysed. The comparative approach highlighted some distinct changes in the way CSE is represented. In period one young women are represented as both victims and agents. In period two young women are more explicitly framed as ‘vulnerable’ and abused. The media construction of CSE victims as ‘vulnerable’ and ‘white’ are interrogated. It argues that an emphasis on ‘whiteness’ and ‘vulnerability’ obscures the socioeconomic position of the young women concerned. The analysis also reveals a change in the media’s focus on perpetrators, from their relative invisibility in period one to a racialised media template in period two.\ud \ud The second phase was qualitative interviews with 20 specialist practitioners. The analysis contributes to current debates about the language and terminology of ‘CSE’. It highlights the pragmatic and avoidant ‘uses’ of the term and suggests that while this acronym may generate resources and responses to young people, it sanitises young women’s experiences of rape. The way ‘CSE’ obscures the structural inequalities that underlie sexual exploitation and prostitution are explored. The final empirical chapter critiques the concepts of ‘grooming’ and ‘vulnerability’. It argues that these are individualising terms which obscure the gendered power dynamics and heteronormativity of the ‘grooming’ construct. The concept of ‘healthy relationships’ is also critiqued.

Self-isolation and quarantine measures were introduced by the UK Government on 12 March 2020 as part of the ‘delay’ phase to control the spread of SARS-CoV-2. Non-adherence to self-isolation for 7 days after the development of symptoms is considered suboptimal and little is known about adherence to quarantine for 14 days if a co-habitant developed symptoms. This study aims to analyse non-adherence behaviours to self-isolation and quarantine measures by identifying their potential psycho-social and demographic predictors and by exploring people’s accounts of their experiences with these measures. \ud \ud A mixed-methods convergent design was used, comprising an online survey (n = 681) completed by residents in six North London boroughs and qualitative interviews with a subsample of participants (n = 16). \ud \ud Findings identified not accessing community support, lack of control over leaving the house, and lack of perceived benefit and need to follow the rules as behaviours associated with non-adherence to quarantine (42.7%). Non-adherence to self-isolating measures (24.4%) was associated with individuals’ perceived lack of control over responsibilities, lack of control over leaving the house, uncertainty about symptoms experienced, lack of access to tests, and distrust in the Government. \ud \ud Adherence to self-isolation and quarantine could be improved through strengthening perceived benefit to self-isolate with messages emphasising its effectiveness, by implementing a two-way information system to support symptoms identification, and with Government-funded, locally supported packages at different levels (financial, food, and practical needs).

Background: \ud Mental health policy promoting the notion of self-management and the patient as the expert welcomed the advent of peer support (Watson, 2017; Gillard, 2019), which is now regarded as the fastest growing profession within mental health services (Rebeiro Gruhl et al., 2016). Research has noted the benefits of using peer support workers (PSWs) to encourage service user (SU) involvement by using their shared identity to improve mental health, well-being and confidence (Gillard et al., 2013; Simpson et al., 2018; Davidson et al., 2012). \ud \ud Rationale: \ud With increased numbers of PSWs employed within the NHS, it is essential to understand how PSWs develop/construct their occupational identity (OI). Employment has been shown to positively affect individuals well-being by affording them a sense of identity and purpose. How OI is experienced during development and then maintained will be the focus of this research. \ud \ud Methodology and main findings: \ud An Interpretative Phenomenological Analysis (IPA) was adopted for this research. Three superordinate themes were generated from the semi-structured interviews and analysis: 1) Symbiotic Green Shoots of Identity; 2) The Occupied Self; 3) A Limited and Limiting Role. The findings provide a timeline of how participants developed their OI, highlighting the life-changing events that led to a greater sense of self and a more meaningful life. By feeling accomplished at work, being future-orientated and having a solid OI provided participants with the motivation to spread their metaphorical wings and explore the transferability of their skills. However, despite participants significant experience of performing the role, they were met with a series of organisational hurdles that appeared to invalidate their OI outside of the originating organisation.

Despite vast research into police factual documentaries, little is known about the participant experience, especially how police themselves regard the construction of their visual images. More recently, questions have been raised about the performance of police as actors in observational documentaries and whether they take different police action or make different operational decisions when being filmed for fly-on-the-wall productions. Several critical incidents have occurred in the United States (US) while police were being filmed for crime shows, prompting people to ask: Does the presence of the camera change the way police work?\ud \ud As an officer of the NSW Police Force (NSWPF) and coordinator of the Film & Television Unit, I had insider access to conduct this research with police officers who had participated in the making of factual documentaries for the organisation. This enquiry represents the first study of its kind, in that all police officers were asked about their personal experiences of being filmed at work and having their images broadcast on prime-time television.\ud \ud The results were interesting and differed from information previously delivered by other researchers. My study shows that police do not change the way they work when in the presence of film crews. Of note was that the thoughts and opinions of officers from the NSWPF no longer correlated with those of officers who had undertaken similar studies in the US. NSWPF officers were not regular viewers of crime shows and those shows played no role in their desire to become police officers. \ud \ud Although police observational documentaries were found to accurately represent the role and function of police, officers believed that crime shows did not provide viewers with an accurate portrayal of the types of work undertaken by police. \ud \ud The overall view was that police duties had moved from making arrests to more of a role of community engagement. The outcome of the study suggests reviewing the format of police observational documentaries to better reflect the role and function of police in today’s society and not simply portray police work as entertainment.

Background: \ud People who are attracted to more than one gender are often grouped together in research under the bisexual umbrella (Flanders, 2017). This has been valuable when investigating issues potentially faced by these groups, such as erasure and poor health outcomes, as well as in the context of bisexual activism. However, grouping people under the bisexual umbrella may carry the risk of overlooking individual differences and findings suggest differences between bisexual and pansexual participants, suggesting a need for further knowledge about pansexuality. \ud \ud Aims: \ud This study aimed to gain a rich understanding of the ways in which pansexual people experience pansexuality. It also sought to contribute to the health professions by offering some insights into what may possibly be experienced by pansexual people. \ud \ud Methodology: \ud Semi structured interviews were completed with six pansexual people. The data was analysed using Interpretative Phenomenological Analysis (IPA) \ud \ud Findings: \ud Three superordinate themes (The pansexual label as an anchor; feeling ‘boxed in’; and a label that defies labels) and ten subthemes emerged. \ud \ud Conclusion: \ud The findings indicated the concept of feeling ‘boxed in’ as central to all of the superordinate themes in the study. A societal lack of awareness of both pansexual as an emerging, less ‘mainstream’ sexuality, and of gender identity outside the binary led to the strategic use of the bisexual label in order to manage stigma and invalidation. However, participants felt that the bisexual label was incongruent with their felt sense of identity because they favoured a label that explicitly acknowledged gender diversity. This led to a feeling of being erased. The current study provides a foundational knowledge of the under researched area of pansexuality. Future research could aim to further explore the impact of intersectionality, and experiences of healthcare settings for pansexual people.

Background To encourage people to lead healthier lifestyles, governments in many countries publish guidelines for alcohol intake, physical activity (PA), and fruit and vegetable (FV) intake. However, there is a need for better understanding of whether people understand such guidelines, consider them useful, and adhere to them. University students are a group worthy of attention because although they are less likely than older adults to exceed U.K. weekly alcohol intake guidelines or to be inactive, they are also less likely to meet FV consumption targets. Furthermore, because behavior during youth predicts adult behavior, it is important to identify influences on healthier behavior. Method An online survey was completed by 559 U.K. university students. Key outcome variables were knowledge of guidelines, motivation to adhere to them, and adherence to them. Results A total of 72% adhered to guidelines for alcohol intake, 58% for PA, and 20% for FV intake. Students generally had poor or moderate knowledge of guidelines, perceived them as only moderately useful, and were only moderately motivated to adhere to them. Greater motivation to adhere to guidelines was not significantly related to more accurate knowledge. However, it was related to greater familiarity, and perceiving guidelines as useful and realistic, and greater conscientiousness. Discussion There is a need to ensure that students understand the U.K. guidelines for alcohol intake, PA, and FV intake. However, simply increasing knowledge may not lead to greater adherence to the guidelines: There is also a need to focus on improving perceptions of how useful and realistic they are.

In many neoliberal economies, co-production is an increasingly popular way of generating public value, empowering citizens, and innovating public service delivery, and cuts to public sector budgets have seen it becoming more important as cash strapped public bodies strip back their services. However, its effectiveness as a means of inclusive engagement is unclear. This paper uses Bourdieu’s theory of practice to explore ethnographic data relating to the collaborative commissioning of a youth project on a South London housing estate and understand how effective the activities were at empowering people to take action. The study shows that although co-production has the potential to increase local involvement; the habitus of those with greater political, economic, and professional capital shaped the social space in which participation takes place. This habitus shaped how people should engage, causing some to disengage, limiting what outcomes were possible. Co-productive practices, such as the co-commissioning discussed in this paper, contain the promise of greater participation and empowerment. However, a lack of understanding of the power dynamics between those involved means the processes can be hierarchical and restricting, rather than increasing the participation of those whom such initiatives are meant to empower.

Lijun Shang, professor of biomedical science at London Metropolitan University's School of Human Sciences, tells Gwyn Winfield about their latest arms control report.

ObjectivesThe study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing.BackgroundIncidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content.DesignSystematic mapping study and analysis.Data sourcesEnglish-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo®and PubMed. Databases were searched from 1999 to 2019.Review methodsBroad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy.ResultsThe final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques).LimitationsMany interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records.ConclusionsStudies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways.Future workPrior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery.Study registrationThe study is registered as PROSPERO CRD42018086985.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.

The global 'lockdowns' and social distancing measures triggered by the COVID-19 pandemic have brought about unprecedented social changes, including the sudden, temporary closure of licensed venues and significant modifications to leisure and drinking practices. In this piece, we argue that these changes invite researchers to consider the short and longer-term consequences in terms of continuities and changes to the practices and symbolism of alcohol consumption both within and beyond domestic spaces. We do this by drawing on illustrations from our emergent qualitative research involving internet-mediated semi-structured interviews and focus groups with 20 participants from the UK (aged 26-65) concerning experiences of drinking in and beyond 'lockdown'. In sharing these early findings, we hope to highlight themes relevant to understanding drinking behaviour during the COVID-19 pandemic and to stimulate dialogue for immediate research priorities in this area. Key topic areas in our data appear to concern; variability in heavy/moderate/light/non-drinking practices while drinking at home, lockdown as an opportunity to reassess relationships with alcohol, and the symbolic role of alcohol in internet-mediated communications and interactions. Longstanding policymaker and practitioner concerns with managing public drinking and public order may have been unsettled by a growth in home-based drinking, although, as we argue, such changes were in motion before the global pandemic. We propose that a greater understanding of the challenges and opportunities the pandemic presents for (re)negotiating relationships with alcohol may offer wider lessons around how individuals and communities might be supported via innovative policy measures to change their relationships with alcohol both during and beyond lockdown.

Background/Aim: \ud The landmark referendum that occurred in the United Kingdom (UK) on 23rd June 2016 was poised to have considerable impact on the health and social care sector. The debate surrounding the referendum was dominated by the need to retain qualified healthcare professionals from the European Union (EU), and tended to overlook European migrants (EUMs) working in unqualified direct care roles. However, in the context of rapid population ageing and the increased prevalence of dementia, European migrant care workers (EUMCWs) have occupied a prominent role in meeting the longstanding recruitment and retention issues in social care sectors. This study sought to explore the impact of the referendum on EUMCWs’ sense of identity and wellbeing post-referendum, with an underlying aim to give voice to them in a time when their future rights are uncertain, an aim that is relevant to the ethos of counselling psychology (CoP).\ud \ud Method/Findings: \ud Interpretative phenomenological analysis (IPA) was utilised to explore the semi-structured interviews conducted with seven female EUMCWs aged 25-54. The analysis of verbatim data drawn from the interviews revealed three interconnected superordinate themes ‘being a EUMCW’, ‘the referendum’, and ‘the future?’, with ten sub-themes.\ud \ud Conclusion: \ud Despite recruitment issues in the social care sector reassuring some participants that they would be able to remain in the UK, the outcome and political handling of the vote inherently created a certain degree of uncertainty for participants, which impacted their sense of agency and belonging. Participants’ narratives were inconsistent, suggesting they drew on a number of strategies or combined strategies in an attempt to cope; therefore, the ways in which participants made sense of the referendum impacted their identities and wellbeing in various nuanced ways. These findings are discussed in relation to clinical implications for the field of CoP and beyond.

In criminal records, intentional manipulation of data is prevalent to create ambiguous identity and mislead authorities. Registering data electronically can result in misspelled data, variations in naming order, case sensitive data and inconsistencies in abbreviations and terminology. Therefore, trying to obtain the true identity (or identities) of a suspect can be a challenge for law enforcement agencies. We have developed a targeted approach to identity resolution which uses a rule-based scoring system on physical and official identity attributes and a graph-based analysis on social identity attributes to interrogate policing data and resolve whether a specific target is using multiple identities. The approach has been tested on an anonymized policing dataset, used in the SPIRIT project, funded by the European Union’s Horizon 2020. The dataset contains four ‘known’ identities using a total of five false identities. 23 targets were inputted into the methodology with no knowledge of how many or which had false identities. The rule-based scoring system ranked four of the five false identities with the joint highest score for the relevant target name with the remaining false identity holding the joint second highest score for its target. Moreover, when using graph analysis, 51 suspected false identities were found for the 23 targets with four of the five false identities linked through the crimes they had been involved in. Therefore, an identity resolution approach using both a rule-based scoring system and graph analysis, could be effective in facilitating the investigation process for law enforcement agencies and assisting them in finding criminals using false identities.

This thesis examines the UK‘s supposed victim-centred approach in developing its latest national anti-trafficking legislation - the Modern Slavery Act (MSA) 2015. Offering an original contribution to the knowledge base, it considers whether the UK‘s national legal framework is sufficiently equipped to protect women who are trafficked for the purposes of sexual exploitation and whether it meets international human rights standards.\ud \ud The thesis analyses the gradual development of international anti-trafficking law and policy, demonstrating the way in which this has influenced the UK‘s national resolve to address this complex phenomenon. It presents a critical legal analysis, comparing the MSA to the UN Palermo Protocol, the Council of Europe Convention on Action against Trafficking in Human Beings (ECAT), and EU instruments and policy positions. Original data, using mixed methods, has been collected from policy makers and lawyers, using surveys and in depth interviews. Key themes explored include the shift in language from human trafficking to modern slavery and its effect on legislative responses to human trafficking, and whether the MSA delivers sufficient protection to victims at the various stages of a case. The stages are victims‘ identification and the provision of long and short-term support, their protection as offenders and the protection of victims during their asylum applications and applications for discretionary leave to remain in the UK. Provisions for victim protection and support must be robust and clear in each stage of the legal process, if the protection offered by legislation is to be sufficient: a standard that this thesis suggests has not been met through development of the MSA.\ud \ud The thesis concludes that the MSA is flawed in a number of crucial ways. It does not fully comply with international standards, nor does it substantially advance victim protection because it continues to focus disproportionately on crime control within a policy context preoccupied with limiting irregular migration.

Recognised problem drinking is just the tip of the iceberg.

Background Alcohol interventions are important to the developing public health role of community pharmacies. The Medicines and Alcohol Consultation (MAC) is a new intervention, co-produced with community pharmacists (CPs) and patients, which involves a CP practice development programme designed to integrate discussion of alcohol within existing NHS medicine review services. We conducted a pilot trial of the MAC and its delivery to investigate all study procedures to inform progression to a definitive trial. Methods This cluster pilot RCT was conducted in 10 community pharmacies in Yorkshire, UK, with a CP from each who regularly conducted Medicine Use Review (MUR) and New Medicine Service (NMS) consultations. Randomisation was conducted using a secure remote randomisation service. Intervention CPs (n = 5) were trained to deliver the MAC in MUR/NMS consultations. Control CPs (n = 5) provided these services as usual. Consecutive MUR/NMS patients were asked by CPs to participate, screened for eligibility (consumption of alcohol at least twice per week), and baseline data collected for those eligible. A two-month follow-up telephone interview was conducted. Blinding of CPs was not possible, but patients were blinded to the alcohol focus of the trial. Primary outcomes were total weekly UK units (8 g of ethanol per unit) of alcohol consumption in the week prior to follow-up, and confidence in medications management. Trial procedures were assessed by recruitment, attrition, and follow-up rates. Results 260 patients were approached by CPs to take part in the trial, 68% (n = 178) were assessed for eligibility and 30% (n = 54) of these patients were eligible. Almost all eligible patients (n = 51; 94%) consented to participate, of whom 92% (n = 47) were followed-up at 2 months; alcohol consumption was lower in the intervention arm and confidence in medication management reduced slightly for both groups. Exploration of recall issues at follow-up showed a high level of agreement between a two-item quantity/frequency measure and 7-day guided recall of alcohol consumption. Conclusions The pilot trial demonstrates the feasibility of implementing the MAC in community pharmacy and trial recruitment and data collection procedures. However, decommissioning of MURs means that it is not possible to conduct a definitive trial of the intervention in this service. Trial registration ISRCTN57447996

Background On March 23, 2020, the government of the United Kingdom told the British people to stay home, an unprecedented request designed to limit the spread of the COVID-19 virus and stop the National Health Service from being overwhelmed. Methods This study undertook a cross-sectional design to survey a convenience sample of 681 residents of North London on their social distancing (SD) behaviours, demographics, housing situation, politics, psychology and social support using an online questionnaire. Logistic regression was used to measure the associations between these explanatory factors and non-adherence to all SD rules and intentional non-adherence to SD rules. Results The vast majority (92.8%) of participants did not adhere to all SD rules and nearly half (48.6%) engaged in intentional non-adherence of rules. The odds of not adhering to all SD rules increased if a participant was not identified as highly vulnerable to COVID-19 [OR = 4.5], had lower control over others’ distancing [OR = .724], had lower control over responsibilities for which coming into contact with others was unavoidable [OR = .642], and if SD behaviours were reported after lockdown was first relaxed [OR = .261]. The odds of intentionally not adhering to SD rules increased if a participant had a lower intention to socially distance [OR = .468], had lower control over others’ distancing [OR = .829], had a doctoral degree compared to a master’s degree [OR = .332], a professional qualification [OR = .307], a bachelor’s degree [OR = .361] or work-related qualification [OR = .174], voted for the UK Government compared to not voting for the Government [OR = .461], perceived higher normative pressure from neighbours [OR = 1.121] and had greater support from friends [OR = 1.465]. Conclusions Non-adherence to all SD rules had a stronger association with vulnerability to COVID-19 and control over SD, whereas intentional non-adherence had a stronger association with intention and anti-social psychological factors. It is recommended that people living in high-risk environments, such as those living in houses of multiple occupancy, should be specially supported when asked to stay at home, and public health messaging should emphasise shared responsibility and public consciousness.

Despite self-isolation, social distancing and NHS work during the COVID-19 pandemic, Sandra Denicke-Polcher and Anna Lawin-O’Brien found a way to make a joyous difference, connecting the community with healthcare providers on the shop floor. The article describes an initiative to provide face masks for NHS and key workers by connecting a community of home makers throughout the UK, with benefits to both, makers and receivers.

BackgroundPeer support groups have proliferated since the 1960s, providing safe, informal environments where peers share experiences and information. A common model is for those who have progressed further along a care pathway or in dealing with a particular medical condition or psycho-social problem, to encourage those at an earlier stage of recovery, either within a group or one to one. Online support now co-exists with face to face models, providing an additional resource for those with digital access and competence.The paradigm of health care has moved towards the incorporation of health promotion, patient empowerment, self-management and community engagement. This has led to a broadening of activities and roles within health systems. The role of peer supporter has been incorporated in a range of behaviour change interventions promoting engagement and adherence. Increasingly these are delivered online. While this aims to extend their reach, it leaves those without digital access at a disadvantage in terms of the ability to make use of online health resources.Main textThough peer support has been used to maintain adherence to online programmes, its potential in assisting with access and thus widening participation has remained unknown.We successfully piloted the use of a paid peer supporter to help men without experience of IT to take part in an online intervention involving a prostate specific holistic needs assessment. Lessons were learnt in relation to training needs and support for the supporter and around data security, confidentiality and safeguarding.Alternative models of voluntary peer support maybe appropriate, particularly in the implementation phase of an intervention and require exploration. A framework for best practice in relation to Digital Health interventions is needed to guide future development of the role.ConclusionHealth services are predicted to increasingly rely on digital technologies over the next decade. Research into the impact of these technologies must include participants’ representative of the entire population. Efforts are needed to include those who are currently underrepresented in research such as the elderly and other disadvantaged groups. Innovative designs involving peer support in a research project may be valuable in addressing the current barriers to participation.

Findings from this qualitative audit conducted in a North London Borough among Black African women show that clay ingestion during pregnancy is a cultural phenomenon embedded in indigenous knowledge (IK). Reasons for clay ingestion include curbing morning sickness, nausea, satisfying cravings, “mineral deficiency” and other life sustaining beliefs. However, Public Health practitioners' top down approach and response which considers the practice as “dangerous” and potentially harmful to the health of the woman and unborn child with midwives and General Practitioner doctors called upon to discourage it, risks alienating the target population. Furthermore, within such a top down framework, opportunities to integrate biomedical science and indigenous knowledge systems are potentially missed. The use of culturally sensitive Public health interventions which consider a community approach, while attempting to integrate these two knowledge systems through further research is likely to bear more fruits.

Background: \ud Carers who identify as ‘Black’ are a group that is thought to experience exclusion and marginalisation within existing services (JCPMH, 2014). Whilst, there is some research that explores caregiving attitudes, experiences and needs of BME family carers, it is documented that little is known about knowledge or awareness and uptake of counselling services. Further it has been empirically noted that individuals from BME groups are less likely to access counselling services than White British people. This would suggest that this is an underrepresented area of research, particularly within the UK. Thus, the present study is concerned with the experience of Black carers with a focus on wellbeing and how they ‘cope’ in relation to their caring role.\ud \ud Method: \ud Semi-structured interviews were conducted with a purposive sample of six carers who identified as Black. Participants accounts of their lived experiences were recorded, verbatim transcribed and analysed using Interpretive Phenomenological Analysis (IPA).\ud \ud Results: \ud Three themes were identified: ‘Being a carer’, ‘Being Black’ and ‘Being a Black Carer’. Although, separate from each other each theme is all part of the repertoire highlighting that although they are different from each other, they are also related to each other. These master themes are not opposites, but different yet integrated parts of Carers who identify as ‘Black’.\ud \ud Conclusion: \ud The findings indicated that the experience of wellbeing for Black carers is predominantly influenced by cultural identity and perceptions. This research supports existing literature on carers who identify as Black. The findings of this research offer some useful implications for practice and service provision. Seeking to understand what constitutes and contributes to the experiences of carers who identify as Black.

When Andreas Lubitz crashed German wings flight 9525 killing all on board, the event refocused public attention on Pilot Suicide Using Aircraft accidents or (PSUA), the term used throughout this thesis.\ud \ud The Lubitz event led to the introduction of procedures that called for an in-flight minimum of two crew members in the cockpit and pilots psychometric testing. However, the new measures were not flawless. A terrorist posing as a cabin crew could easily access the cockpit, and the still debated effectiveness of psychometric screening.\ud \ud To prevent another PSUA, the research reviewed relevant events that lead into a potential or actual PSUA and the triggering factors behind it. The research also examines existing measures and related literature covering suicide, psychology, terrorism, aviation security and international organisations views. The available information was widely scattered and heavily cluttered. Hence, it was decided to compile an academically accredited and professionally filtered reference that lists relevant events, establish PSUA triggering factors, identify an effective mitigation and immediately bridge the current measures identified gaps.\ud \ud The research findings, short and long term recommendations are backed up by the author's 30 years of aviation experience and are validated by recognised aviation experts. To address PSUA risk; the research suggests to temporarily maintain the "two in the flight deck" procedure, subject to reducing cabin crew risk by limiting in-flight cockpit access to the two senior cabin crews and immediately implementing the research gap bridging recommendations in term of crew specific procedures and training.\ud \ud PSUA long term solution is achieved by addressing the personal factor, that could reduce the risk by 50% through the combination of the following measures: enhanced crew security background checks, enhanced psychometric screening by an aviation experienced company psychiatrist, awareness campaigns and effective crew support programs, along with job security campaigns, real just culture implementation and suicidal behaviour recognition training.

Enteral feeding is defined as the intake of food directly into the gastrointestinal (GI) tract. Enteral feeding tubes can also be used to administer medicines. Patients who may require enteral feeding include those who are unconscious, or those with neurological swallowing disorders, upper GI obstruction, GI dysfunction or malabsorption. There are several routes that can be used for enteral feeding including gastrostomy, post-pyloric, nasogastric, continuous pump and bolus feeding. When undertaking enteral feeding, nurses and other healthcare professionals should be aware of the potential complications such as tube blockage and infection. This article examines the various enteral feeding routes, discusses the administration of medicines, and details the common complications associated with enteral feeding. [Abstract copyright: © 2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.]