BackgroundMany emergency calls that are birth-related occur without complexity but in some cases difficult issues arise which require varying levels of assistance. Paramedics’ involvement in birth is infrequent, therefore the practical and cognitive skills required to manage these cases have the potential to atrophy over time, particularly in the absence of interventions aimed at reducing their decline. The aim of this study was to examine the knowledge, attitude and practice of paramedics in managing obstetric cases in order to identify areas that may require targeted in-service education to address knowledge deficit.MethodsWe have undertaken a cross-sectional study to explore the practices and learning needs of Registered Paramedics. Data were collected by a self-administered, anonymous and piloted Knowledge, Attitude and Practice (KAP) survey.ResultsFour hundred and thirty-five participants commenced the survey, however 264 (39%) completed it. The median age of participants was 32 years (IQR 17, min/max 22,64). There were 150 (56.8%) female respondents, 112 (42.4%) males, and <1% of survey participants preferred not to describe their gender identity, or to self-describe. 81.8% were Advanced Care Paramedics and 12.1% Critical Care Paramedics. The median number of self-reported births attended during their career was n=2.0 (min/max 0,65). Antenatal complications and trauma in pregnancy were self-reported as areas of weakness, this was consistent with assessed knowledge evaluated. Participants agreed that having a comprehensive understanding in managing obstetric emergencies was important and strongly agreed to the need for regular in-service education.ConclusionThis study revealed that of all domains tested few participants indicated an excellent level of obstetric knowledge. The provision of regular in-service training for the management of this type of emergency is valued by paramedics.

Current research recognises the role of parenthood in contributing to gender inequalities at work. Meanwhile, there is a growing interest in job quality. We contribute to both these debates by analysing differences in job quality by gender and parenthood status, using data from a nationally representative UK household survey. We develop a 12-indicator, multi-dimensional measure of job quality and use this to analyse the combination and distribution of job quality attributes by gender and parenthood status. Our analysis shows that women and mothers are under-represented in high quality jobs and over-represented in poor quality jobs. While some mothers sacrifice career prospects for flexibility, motherhood is not always associated with more flexibility, and job quality disadvantages are multi-faceted. Working part time is a strong driver of job quality differences, suggesting that reduced hours after motherhood impacts on job quality in addition to worsening women’s pay. Job quality gaps are larger for mothers of school-aged children, pointing to the additional constraints of managing work and childcare around the school day.

Complementary feeding is the process of introducing solid foods to milk-fed infants (also known as weaning). Current UK guidance states that complementary feeding should occur around 6 months but not before 4 months. This systematic review explores how parents in the UK, with an infant under 24 months of age, engage with sources of information and advice about complementary feeding. Engaging with sources of information can influence parents' feeding choices and so a better understanding of parents' information behaviours can improve service provisions. Six databases were searched, identifying 15 relevant qualitative studies with the predefined criteria. Data from each study were coded line by line allowing for a synthesis of higher analytical themes. Using thematic synthesis, four main themes were observed: (1) trust and rapport-parents valued information from a trusted source (2), accessibility-information needs were often time sensitive, and parents showed varying levels of understanding, (3) adapting feeding plans-often influenced by practicalities (4), being a good parent-feeding plans were changed to comply with societal ideas of 'good parenting'. Thereview concluded that parents receive information and advice about complementary feeding from multiple sources and are highly motivated to seek further information. The scope of this novel review explored the parental experience of finding, receiving and engaging with information sources and how this may or may not have influenced their feeding behaviours. Thereview has provided a new perspective to add to the growing body of literature that focuses on the experience of feeding an infant.

Human knowledge is growing exponentially, providing huge and sometimes contrasting evidence to support decision making in the realm of complex problems. To fight knowledge fragmentation, collective intelligence leverages groups of experts (possibly from diverse domains) that jointly provide solutions. However, to promote beneficial outcomes and avoid herding, it is necessary to (i) elicit diverse responses and (ii) suitably aggregate them in a collective solution. To this end, AI can help with dealing with large knowledge bases, as well as with reasoning on expert-provided knowledge to support decision-making. A hybrid human-artificial collective intelligence can leverage the complementarity of expert knowledge and machine processing to deal with complex problems. We discuss how such a hybrid human-artificial collective intelligence can be deployed to support decision processes, and we present case studies in two different domains: general medical diagnostics and climate change adaptation management.

Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme's impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making. The ActEarly meta-evaluation will follow and adapt the five iterative stages of the 'Evaluation of Programmes in Complex Adaptive Systems' (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model ("LifeSim") will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly's dynamic programme outputs at different system levels and measure the programme's system changes on early life health and well-being. This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose.

BackgroundOverconsumption is one of the most serious public health challenges in the UK and has been linked to increased consumption of food ordered through delivery platforms. This study tested whether repositioning foods and/or restaurant options in a simulated food delivery platform could help to reduce the energy content of users’ shopping basket.MethodsUK adult food delivery platform users (N = 9,003) selected a meal in a simulated platform. Participants were randomly allocated to a control condition (choices listed randomly) or to one of four intervention groups, (1) food options listed in ascending order of energy content, (2) restaurant options listed in ascending order of average energy content per main meal, (3) interventions 1 and 2 combined (4) interventions 1 and 2 combined, but food and restaurant options repositioned based on a kcal/price index to display options lower in energy but higher in price at the top. Gamma regressions assessed the impact of interventions on total energy content of baskets at checkout.ResultsThe energy content of participants’ baskets in the control condition was 1382 kcals. All interventions significantly reduced energy content of baskets: Compared to control, repositioning both foods and restaurants purely based on energy content of options resulted in the greatest effect (-209kcal; 95%CIs: -248,-168), followed by repositioning restaurants (-161kcal; 95%CIs: -201,-121), repositioning restaurants and foods based on a kcal/price index (-117kcals; 95%CI: -158,-74) and repositioning foods based on energy content (-88kcals; 95%CI: -130,-45). All interventions reduced the basket price compared to the control, except for the intervention repositioning restaurants and foods based on a kcal/price index, which increased the basket price.ConclusionsThis proof-of-concept study suggests repositioning lower-energy options more prominently may encourage lower energy food choices in online delivery platforms and can be implemented in a sustainable business model.

AbstractIntroductionLiving in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (&gt;20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme’s impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making.MethodsThe ActEarly meta-evaluation will follow and adapt the five iterative stages of the ‘Evaluation of Programmes in Complex Adaptive Systems’ (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model (“LifeSim”) will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly’s dynamic programme outputs at different system levels and measure the programme’s system changes on early life health and well-being.DiscussionThis meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS-framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose.

In this paper, we exploit a unique weekly longitudinal survey of adults in the UK purposefully collected to study consumption choices with respect to cultural content types during the first Covid-19 national lockdown (the “Great Lockdown”). We look for changes in the probability of consuming different cultural and creative types of content (Music, Movies, TV, Games, Books, Magazines and Audiobooks), as well as changes in the overall variety of consumption. We find that changes in consumption depend on the type of content. In particular, other things being equal, the likelihood of listening to Music and playing Games went up and the likelihood of reading Books went down. We find little statistically significant evidence of changes in the probability of consumption of the other types of content. We find that, while on average individuals increased the variety of their consumption, the statistical significance of this increase varied depending on the socio-demographic and economic characteristic of interest. In particular, we find evidence of an increase in the variety of consumption for those at the bottom of the distribution of socio-economic status, which speaks to the importance of access to culture and creativity during lockdown for this specific social class.