Area Of North-East England Research Articles

Exploring what works well and less well in a community-based drop-in hub providing health and wellbeing services for people experiencing homelessness: a participatory action evaluation of service coordination

Abstract Background People experiencing homelessness often face obstacles accessing health and social care support. Challenges are further exacerbated when support provision for multiple unmet needs are not integrated or coordinated. To overcome these challenges, there has been growing attention on integrating and co-locating health and wellbeing services for people experiencing homelessness. In an urban area of North East England, a long-standing Hub or ‘drop-in centre’ offers a range of health and wellbeing support by bringing together the different health and care system agencies in one space. However, little is known about the perspectives of providers on what works well and less well in how the different services are coordinated. Methods Using a participatory action research approach, a qualitative service evaluation was undertaken between June and September 2023. Fourteen interviews were conducted with providers who work in a paid or voluntary capacity operating some of their service offerings or support in the Hub. Interview transcripts were analysed using inductive reflexive thematic analysis. Results Three themes were evident from the evaluation: 1) location and space matter, 2) co-location and relationships make a difference, and 3) service consistency and flexibility are paramount. Conclusion Co-locating support to cover the breadth of health and care needs has the potential to increase engagement and access for people experiencing homelessness, and to enhance trust with service users and between agencies. This model provides a unique example of co-location and integration of support, particularly with it being operated by a community housing organisation.

Wellbeing and religious community participation: Exploring resources for wellbeing in areas of socio‐economic deprivation in the United Kingdom

AbstractA decrease in wellbeing in the United Kingdom since the 2008 economic crisis has been compounded by the closure of community groups in socio‐economically deprived areas. This leaves churches as one of the few communal groups for fostering wellbeing, despite a dearth of research on religiosity and wellbeing in such areas. This article draws on semi‐structured interviews, supplemented with participant observations and ethnographic observations, to explore the social processes involved in shaping experiences of wellbeing amongst religious communities in socio‐economically deprived areas in North East England. It identifies the resources available for wellbeing and the points at which they are accessed. It also expands the existing conception of wellbeing by: (i) unpacking and refining a three‐tiered structure for understanding wellbeing; (ii) identifying a wellbeing paradox, whereby interpersonal vulnerability supports and undermines wellbeing; and (iii) mapping the relationships between the micro, meso and macro levels in shaping experiences of wellbeing, highlighting the need for more qualitative studies of subjective wellbeing. As it does so, this article offers practical insights that can guide those with pastoral responsibilities in areas of socio‐economic deprivation to foster higher levels of wellbeing in their communities.

MO350: Transfer Times for Renal Patients to a Tertiary Centre

BACKGROUND AND AIMSThe renal unit at Sunderland Royal Hospital (SRH) provides tertiary services to an area of North East England covering South Tyneside, Sunderland and County Durham. An AKI service was commenced in September 2020 at University Hospital North Durham (UHND), which is part of the County Durham and Darlington NHS Foundation Trust (CDDFT) with aims to improve recognition and treatment, support early discharge planning, and prevent severe injury for patients with AKI and renal conditions. The service comprises two specialist nurses and a team of consultant renal physicians providing in-reach at UHND across Monday–Friday 52 weeks/year, with over 700 patients seen within the first 12 months of operation.With the introduction of this service, we carried out a review of transfer times for patients requiring transfer from UHND to SRH for inpatient renal management. Delays in patient transfer between hospitals can result in deferred treatment and poor patient outcomes, hence the importance of analysing the benchmarking the first year's performance to inform future service development both regionally and nationally. With the use of this data, we hope to share our model with other teams and trusts with the goal of enhancing and streamlining the referral methods to renal services.METHODWe examined transfer data for 36 patients from CDDFT to the renal unit at SRH over a 12-month period from August 2020 to July 2021. This information looked at transfers from the time of consultant acceptance to the time of arrival on the ward and was compiled in conjunction with the AKI specialist nurses at CDDFT. Using the computer system and phone records, we were able to accurately document time of acceptance to time of arrival. Data was split into categories to enable further comparison; pre-June 2021 (when haematology patients were excluded from the inpatient ward at SRH due to protective isolation during COVID-19) increasing the availability of acute renal beds and June 2021 onwards. Additionally, we analysed patients with acute kidney injury versus those that were known to us with chronic kidney disease, and times by week days and where emergency cover is usual.RESULTSThe data showed a median time between acceptance and arrival for patients accepted pre-June 2021 of 8 h 7 min compared with 6 h 18 min from June 2021 onwards. Median time between acceptance and arrival of acute patients was 8 h 7 min compared with 6 h 35 min for chronic kidney disease patients. Acceptance and arrival times varied also depending on time of transfer; 6 h 29 min during working hours on a weekday, 9 h 23 min out-of-hours on a weekday and 8 h 48 min on a weekend. The overall median transfer time from acceptance to arrival across all categories was 7 h 38 min.CONCLUSIONCurrently, no standard national target exists for the transfer of patients to tertiary renal services, however there are ongoing discussions surrounding this and how it could be implemented. There are difficulties in compiling data to effect change in referral methods, in part due to the inter-trust movement of patients and challenges in coding; however, our initial findings support the positive impact of the AKI service at CDDFT and highlight the scope for further service development across the region. For example, in commissioning at software to streamline, process audit data using a web-based portal, accessible to all parties and extending nurse presence across 7 days due to the delayed times for weekend and evening transfers. Additionally, we were encouraged that our prevalent patients, usually dialysis recipients, experienced the shortest wait.FIGURE 1:Median Time Between Acceptance and Arrival Based on Time of Patient Transfer.

Social prescribing during the COVID-19 pandemic: a qualitative study of service providers\u2019 and clients\u2019 experiences

BackgroundCOVID-19 public health restrictions, such as social distancing and self-isolation, have been particularly challenging for vulnerable people with health conditions and/or complex social needs. Link worker social prescribing is widespread in the UK and elsewhere and is regarded as having the potential to provide support to vulnerable people during the pandemic. This qualitative study explores accounts of how an existing social prescribing service adapted to meet clients’ needs in the first wave of the pandemic, and of how clients experienced these changes.MethodsData were collected in a deprived urban area of North East England via remote interviews with clients (n = 44), link workers (n = 5) and service provider managerial staff (n = 8) from May–September 2020. Thematic data analysis was conducted.ResultsThe research found that service providers quickly adapted to remote intervention delivery aiming to serve existing clients and other vulnerable groups. Service providers experienced improved access to some existing clients via telephone in the first months of remote delivery and in some cases were able to engage clients who had previously not attended appointments at GP surgeries. However, link workers also experienced challenges in building rapport with clients, engaging clients with the aims of the intervention and providing a service to digitally excluded people. Limited link worker capacity meant clients experienced variable contact with link workers with only some experiencing consistent support that was highly valued for helping to manage their conditions and mental wellbeing. Limited access to linked services also adversely affected clients. Clients living in less affluent circumstances and/or with worse health were more likely to experience negative impacts on their long-term condition. Some found their health and progress with social prescribing was ‘on hold’ or ‘going backwards’, which sometimes negatively affected their health.ConclusionsSocial prescribing offered valued support to some during the pandemic, but remote support sometimes had limited impact for clients and findings highlight the vulnerability of social prescribing’s success when linked services are disrupted. Findings also show the need for more to be done in the upscaling of social prescribing to provide support to digitally excluded populations.

What Influences Parents and Practitioners’ Decisions to Share Personal Information within an Early Help (Social Care) Context? Implications for Practice in Sharing Digital Data across Sectors

AbstractMeeting the multiple and often complex needs of families (children, young people and adults) within ‘Early Help’ support is dependent upon practitioners from different sectors sharing relevant and timely information, after gaining a family’s voluntary consent to share information. This article reports on qualitative one-to-one interviews with adults in families (n = 32), one mother/father dyad interview (n = 2) and focus groups with practitioners (n = 47) in five local authority areas in North East England receiving or providing Early Help support. We explored experiences of providing consent to share personal information and consider the usefulness of a digital health data system when providing Early Help support to families. Communication Privacy Management theory was used as a framework to analyse the data. Key themes in participants’ accounts include the degree of need for help and support; the importance of trusting relationships; stronger and structured joint working practices; and understanding how information is shared. This work provides insights into current information sharing practices for some of the most vulnerable families and the wider social contexts. It has implications for the usefulness of a digital data system that shares GP health data with Early Help services and suggests the role this could have in the parent–practitioner relationship.

Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness...

Link workers' perspectives on factors enabling and preventing client engagement with social prescribing.

For a social prescribing intervention to achieve its aims, clients must first be effectively engaged. A 'link worker' facilitating linkage between clients and community resources has been identified as a vital component of social prescribing. However, the mechanisms underpinning successful linkage remain underspecified. This qualitative study is the first to explore link workers' own definitions of their role in social prescribing and the skills and qualities identified by link workers themselves as necessary for effective client linkage. This study also explores 'threats' to successful linked social prescribing and the challenges link workers face in carrying out their work. Link workers in a social prescribing scheme in a socioeconomically deprived area of North East England were interviewed in two phases between June 2015 and August 2016. The first phase comprised five focus groups (n=15) and individual semi-structured interviews (n=15) conducted with each focus group participant. The follow-up phase comprised four focus groups (n=15). Thematic data analysis highlighted the importance of providing a holistic service focusing on the wider social determinants of health. Enabling client engagement required 'well-networked' link workers with the time and the personal skills required to develop a trusting relationship with clients while maintaining professional boundaries by fostering empowerment rather than dependency. Challenges to client engagement included: variation in the volume and suitability of primary-care referrals; difficulties balancing quality of intervention provision and meeting referral targets; and link workers' training inadequately preparing them for their complex and demanding role. At a broader level, public sector cuts negatively impacted upon link workers' ability to refer patients into suitable services due to unacceptably long waiting lists or service cutbacks. This study demonstrates that enabling client engagement in social prescribing requires skilled link workers supported by healthcare referrer 'buy-in' and with access to training tailored to what is a complex and demanding role.

Does domiciliary welfare rights advice improve health-related quality of life in independent-living, socio-economically disadvantaged people aged ≥60 years? Randomised controlled trial, economic and process evaluations in the North East of England.

BackgroundThere are major socio-economic gradients in health that could be influenced by increasing personal resources. Welfare rights advice can enhance resources but has not been rigorously evaluated for health-related impacts.MethodsRandomised, wait-list controlled trial with individual allocation, stratified by general practice, of welfare rights advice and assistance with benefit entitlements, delivered in participants’ homes by trained advisors. Control was usual care. Participants were volunteers sampled from among all those aged ≥60 years registered with general practices in socio-economically deprived areas of north east England. Outcomes at 24 months were: CASP-19 score (primary), a measure of health-related quality of life; changes in income, social and physical function, and cost-effectiveness (secondary). Intention to treat analysis compared outcomes using multiple regression, with adjustment for stratification and key covariates. Qualitative interviews with purposive samples from both trial arms were thematically analysed.FindingsOf 3912 individuals approached, 755 consented and were randomised (381 Intervention, 374 Control). Results refer to outcomes at 24 months, with data available on 562 (74.4%) participants. Intervention was received as intended by 335 (88%), with 84 (22%) awarded additional benefit entitlements; 46 did not receive any welfare rights advice, and none of these were awarded additional benefits. Mean CASP-19 scores were 42.9 (Intervention) and 42.4 (Control) (adjusted mean difference 0.3 [95%CI -0.8, 1.5]). There were no significant differences in secondary outcomes except Intervention participants reported receiving more care at home at 24m (53.7 (Intervention) vs 42.0 (Control) hours/week (adjusted mean difference 26.3 [95%CIs 0.8, 56.1]). Exploratory analyses did not support an intervention effect and economic evaluation suggested the intervention was unlikely to be cost-effective. Qualitative data from 50 interviews suggested there were improvements in quality of life among those receiving additional benefits.ConclusionsWe found no effects on health outcomes; fewer participants than anticipated received additional benefit entitlements, and participants were more affluent than expected. Our findings do not support delivery of domiciliary welfare rights advice to achieve the health outcomes assessed in this population. However, better intervention targeting may reveal worthwhile health impacts.

Feasibility of an incentive scheme to promote active travel to school: a pilot cluster randomised trial

BackgroundIn Great Britain, 19% of trips to primary school within 1 mile, and 62% within 1–2 miles, are by car. Active travel to school (ATS) offers a potential source of moderate-to-vigorous physical activity (MVPA). This study tested the feasibility of an intervention to promote ATS in 9–10 year olds and associated trial procedures.MethodsA parallel cluster randomised pilot trial was conducted over 9 weeks in two schools from a low-income area in northeast England. Measures included daily parental ATS reports (optionally by SMS) and child ATS reports, as well as accelerometry (ActiGraph GT3X+). At baseline, all children were asked to wear the accelerometer for the same week; in the post-randomisation phase, small subsamples were monitored each week. In the 2 weeks when a child wore the accelerometer, parents also reported the start and finish times of the journey to school. The intervention consisted of a lottery-based incentive scheme; every ATS day reported by the parent, whether by paper or SMS, corresponded to one ticket entered into a weekly £5 voucher draw. Before each draw session, the researcher prepared the tickets and placed them into an opaque bag, from which one was randomly picked by the teacher at the draw session.ResultsFour schools replied positively (3.3%, N = 123) and 29 participants were recruited in the two schools selected (33.0%, N = 88). Participant retention was 93.1%. Most materials were returned on time: accelerometers (81.9%), parental reports (82.1%) and child reports (97.9%). Draw sessions lasted on average 15.9 min (IQR 10–20) and overall session attendance was 94.5%. Parent-child report agreement regarding ATS was moderate (k = 0.53, CI 95% 0.45; 0.60). Differences in minutes of accelerometer-assessed MVPA between parent-reported ATS and non-ATS trips were assessed during two timeframes: during the journey to school based on the times reported by the parent (U = 390.5, p < 0.05, 2.46 (n = 99) vs 0.76 (n = 13)) and in the hour before classes (U = 665.5, p < 0.05, 4.99 (n = 104) vs 2.55 (n = 19)). Differences in MVPA minutes between child-reported ATS and non-ATS trips were also significant for each of the timeframes considered (U = 596.5, p < 0.05, 2.40 (n = 128) vs 0.81 (n = 15) and U = 955.0, p < 0.05, 4.99 (n = 146) vs 2.59 (n = 20), respectively).ConclusionsData suggest the feasibility of an ATS incentive scheme and of most trial procedures. School recruitment stood out as requiring further piloting.Trial registrationClinicalTrials.gov: NCT02282631. Registered 5th September 2014.

Productivity of the Black-legged Kittiwake Rissa tridactyla required to maintain numbers

ABSTRACTCapsule: To maintain the breeding numbers in Britain, Black-legged Kittiwakes Rissa tridactyla need to produce a mean of 0.8–1.5 fledged young per year.Aims: To obtain a new estimate for the number of young Kittiwakes fledged per pair required to maintain breeding numbers in Britain in the period 1985–2015 based on field data.Methods: The annual values of productivity in the River Tyne area of northeast England are compared with the long-term increases in numbers of breeding pairs in that area. Regressions between the annual productivity and the corresponding change in breeding numbers at 12 sites in Britain are used for the periods 1985–2000 and 15 sites for 2000–15.Results: A long series of records of the annual productivity of Kittiwakes, where breeding pairs increased progressively over 61 years, showed that an annual productivity of 1.5 young fledged per pair was an extremely rare event. Over the periods 1985–2000 and 2000–15 regressions of the change in breeding numbers against mean annual productivity for 15 sites indicated that about 0.8 fledglings per pair were needed to maintain breeding numbers and this value remained unchanged over the 30 years, suggesting that adult mortality rates had not changed over this period of time.Conclusion: The decline of Kittiwakes in Britain has occurred because fewer than 0.8 chicks per pair have been fledged at many sites in recent years. The mortality rate of adult Kittiwakes breeding in Britain 1985–2015 does not indicate an increase over time and so is unlikely to have been a major contributor to the decline in breeding numbers.

‘Planning for uncertainty’: narratives on retirement transition experiences

ABSTRACTRetirement is a major life transition which is associated in public discourses with reduced economic productivity and a raft of personal vulnerabilities. Consequently, governmental, health and employment sectors have promoted ‘active’ planning of affordable and ‘healthy’ retirements. This study presents a qualitative exploration of retirement transition and preparation experiences among 52 men and women from rural and urban areas of North East England, United Kingdom. The sample was diverse in terms of social class, income level, health status and type of work exit. Health, finance, social relationships and third-age opportunities were required resources for a good transition into retirement, and a degree of planning was required to mobilise these resources. However, the degree of choice and control around the transition to retirement was highly variable and socially structured. Thenotionof planning was embedded as a normative practice, particularly in relation to finances, but the practice of planning was highly contingent primarily due to personal circumstances (ill-health, bereavement, relationships) and work exit (redundancy, work stress, changes to shift patterns or hours). The findings offer insights into the reasons why many people do not plan and indicate that many of the assumptions associated with retirement planning warrant further consideration both theoretically and practically.

The effectiveness of using the workplace to identify and address modifiable health risk factors in deprived populations

ObjectivesTo establish whether a programme of targeted health screening, with referral to appropriate interventions, offered to an employed but socioeconomically deprived group was effective in overcoming barriers to uptake of...

Children's Centres as spaces of interethnic encounter in North East England

This paper explores the role of Sure Start Children's Centres as spaces of encounter between new migrants to the UK and ‘White English’ residents in host communities. Children's Centres were selected as the context for the research because they serve people with common needs (families with pre-school children), and because building social capital and mutual support among parents is part of their core purpose (Department for Education. (2013). Sure Start Children's Centres: Statutory guidance for local authorities, commissioners of local health services and Jobcentre Plus. Retrieved from http://www.media.education.gov.uk/assets/files/pdf/s/childrens%20centre%20stat%20guidance%20april%202013.pdf). Drawing on data from semi-structured interviews conducted with service users from Black and Minority Ethnic backgrounds (recent migrants) and service users representing ‘the majority’ white population in two urban areas in North East England, it explores the role of ethnicity and other factors relating to migration in shaping encounters in these spaces, and considers the perceived benefits of these interactions. It finds that interethnic encounter in Children's Centres is often seen by new migrant parents/carers primarily as an opportunity to improve English language skills, meeting an additional need to that of local ‘indigenous’ parents/carers. It further found that new migrant parents/carers often perceived Children's Centres as an opportunity to experience a particular version of the local community, facilitating more predictable encounters than encounters in the wider host community.

Mobilizing Resources for Well-being: Implications for Developing Interventions in the Retirement Transition

Good health and well-being in later life are central issues for public health. Retirement presents an opportunity to intervene to improve health and well-being, as individuals may adjust associated lifestyle behaviors. However, there is little evidence about how well-being is experienced in the context of increasingly diverse retirement transitions. Our objectives were to explore (a) views on health and well-being through retirement transitions and (b) acceptability of intervening in this period. Qualitative study involving 48 workers/retirees, aged 53-77 years of diverse socioeconomic status, were recruited from urban and rural areas in North East England. Data were collected iteratively through focus groups (n = 6), individual interviews (n = 13), interviews with couples (n = 4), using the constant comparative method. Analysis was informed by theories of the Third Age and Sen's capabilities approach. Diverse retirement transitions were shaped by unanticipated events. Central to well-being was the "capability" to utilize resources to achieve desirable outcomes. Participants rejected a "later life" identity, associating it with decline, and an uncertain future. Lifestyle interventions that address challenges within the retirement transition may be acceptable. Inducements to change behavior based on possible long-term outcomes may be less appealing. Providing assistance to use resources to address personal goals may be central to effective interventions.

Achieving positive social outcomes through participatory urban wildlife conservation projects

Context As urbanisation continues to increase on a global scale, people are becoming increasingly distanced from nature. Fewer opportunities to encounter nature mean that the benefits of engaging with nature are often not realised by urban residents. In response to this, there is a growing number of initiatives that aim to connect people with nature, for the benefit of individuals, communities and nature conservation. However, in order to maximise these benefits, it is important to understand the potential transformative effects for participants, both on a personal level and in terms of wider impacts. Aims In this study, we evaluate the social outcomes of a participatory wildlife conservation project in an urban area in north-east England, using hedgehogs as the focal species. Methods Based on an approach of community volunteers working alongside scientific researchers in an evaluation of hedgehog urban habitat use, we examine the transformative effects of this involvement at the individual and community levels via qualitative semi-structured interviews with community volunteers. Key results Participants were motivated by personal wellbeing factors such as enjoying proximity to the study species, learning and social factors. Participation in the study itself indicates a degree of motivation for engaging with a study of this sort. Nevertheless, involvement in the study was a successful vehicle for increasing participants’ engagement with nature both during the study and potentially into the future, particularly in terms of biological recording and gardening for wildlife. Conclusions Participation in a wildlife study is a positive experience for many volunteers, leading to actual and potential changes in both personal and wider social outcomes. Implications Participatory initiatives such as the one described have an important role to play in signposting and supporting volunteers to follow future environmental aspirations and maximise the personal and social benefits associated with participation. This could be enhanced by ensuring that volunteering opportunities are linked in with pre-existing community-based networks that can act as advocates for environmental and wildlife conservation.

Rate of Diabetic Vitrectomy in a Defined Geographical Part of North East England

Purpose: To assess the yearly incidence of vitrectomy for proliferative diabetic retinopathy (PDR) over an 11-year period, in a geographically defined part of North East England. The time period covered the introduction of diabetic retinopathy screening.Methods: All patients undergoing vitrectomy for diabetic retinopathy in the Sunderland and South Tyneside area were recorded from 2000 to 2010. Incidence rates of vitrectomy specifically for the complications of PDR for the observed diabetic population, the estimated diabetic population and the population with known PDR were calculated.Results: There was a gradual and significant decline in the vitrectomy rate from 157 (95% confidence interval, CI, 135–187) to 103 (95% CI 98–109) per 100,000 of the observed diabetic population in 2000 and 2010 respectively. The rate in the estimated diabetic population showed no significant change at 68 (95% CI 48–87) in 2002 and 77 (95% CI 55–103) in 2010. The rate in the PDR population, which comprised 2.4% of the known diabetic population in 2002 and 1.8% in 2010, declined significantly from 7.7% in 2002 to 5.7% in 2010.Conclusion: This study evaluated vitrectomy rates for PDR in an area of North East England. There were apparent declining rates of vitrectomy for PDR following the introduction of diabetic retinopathy screening but these have to be interpreted in the light of several confounding factors.

In whose interest? The dynamics of debt in poor households

This article examines the dynamics of credit and debt in low income households, drawing on an action research project with 24 households in the Teesside area of North East England. Despite crippling interest rates, high-cost credit sources (for example, doorstep lending, catalogue, rent-to-own and payday loan companies) are increasingly used by households that are excluded from mainstream financial services. The article discusses the range of credit sources used, reasons for reliance on high-cost credit and the exploitative practices of loan companies. It explores possible actions at household level through financial mentoring; the potential for developing alternative low-cost sources of credit; and campaigns for regulation of loan companies.

The economic impact of early intervention in psychosis services for children and adolescents

To develop and populate a plausible model of the impact of early intervention (EI) for children and adolescents with psychosis to estimate potential short-term health-related cost savings compared to generic Child and Adolescent Mental Health Services (CAMHS). A decision-tree-based model for EI in CAMHS was developed. The model was populated using data relating to the use of inpatient care and EI service activity for people aged under 18 from an area of North East England. Data were abstracted from the National Health Service clinical reporting systems for 2001-2008. Sensitivity analyses were performed to examine costs associated with the model under differing assumptions. EI delivered cost savings of £4814 per patient compared to care provided by generic CAMHS. Cost savings were predominantly a consequence of reduced length of hospital admissions for patients served by the EI team. The findings were robust to sensitivity analyses. These findings suggest that EI services for children and adolescents with psychosis provide potential direct health cost savings comparable to those observed for working-age adults.

Screening and brief alcohol intervention to prevent hazardous drinking in adolescents aged 14–15 years in a high-school setting (SIPS JR-HIGH): a feasibility pilot trial

BackgroundEarly and heavy drinking by young adolescents is linked to intellectual impairment, increased risk of injury, mental health issues, unprotected or regretted sexual experience, violence, and sometimes accidental death. Our aim was to assess the feasibility of delivering brief alcohol intervention in a school setting with adolescents aged 14–15 years; and to examine the acceptability of study measures to staff, young people, and parents, including take-up and follow-up rates. MethodsSeven schools across one geographical area in northeast England were recruited to this feasibility pilot trial. All schools within the study catchment area were judged eligible and approached to take part. Randomisation was done at the school level to reduce the chance of contamination. Allocation of schools to intervention was done by the study statistician, taking school size and socio-economic factors (proportion of free school meals) into account. Each school was randomly allocated to one of three groups: provision of an advice leaflet (control condition, two schools); a 30-min personalised session of structured advice delivered by the school learning mentor (level 1 condition, two schools); and a 60-min session with family members (level 2 condition, three schools). Trial participants were year 10 school pupils (aged 14–15 years) who screened positively for alcohol misuse with an alcohol screening questionnaire and who had consented to take part in the trial (n=181). Recruitment began on Jan 24, 2012, and finished on July 31, 2012. Statistical analyses were mainly descriptive, providing an estimate of eligibility, recruitment, intervention delivery, and retention rates in the study population. These key feasibility pilot trial parameters will inform the power calculation for a future definitive trial and confirm other aspects of trial design (particularly the acceptability of study processes and outcome measures to young people, their parents, teachers, and learning mentors). FindingsThis presentation focuses on the development of two manual-guided interventions for use with adolescents and parents, both of which encompass motivational interviewing principles and elements of the FRAMES approach to elicit behaviour change, which consists of the following elements: feedback, responsibility, advice, menu, empathy, and self-efficacy. Interventions were developed and piloted with young people and parents; training for learning mentors was divided into two half-day sessions. Each intervention used an A3-sized interactive document designed to promote a conversation about alcohol. The level 1 intervention was structured around a six-step method consisting of personalised feedback about drinking behaviour and advice about the health and social consequences of continued hazardous alcohol consumption. The level 2 intervention was structured around a four-step method designed to explore the young person's motivation to change their drinking behaviour and the family's motivation to facilitate and support change (appendix). InterpretationAlthough the use of brief interventions for adults is established in a health setting and there is evidence of their effectiveness in college and university students, very little work has been done in the UK to explore the early identification (screening) and brief intervention to reduce risky drinking in younger adolescents (aged 11–15 years), making a feasibility pilot study a necessary and important step of a definitive assessment. Results from this feasibility pilot trial will inform the development of a definitive randomised controlled trial to assess the effectiveness and cost-effectiveness of screening and brief alcohol intervention to reduce hazardous drinking in adolescents in a school setting. FundingThis project is funded by the National Institute for Health Research Public Health Research (NIHR PHR) programme (project number 10/3002/07).

Fractional urinary fluoride excretion of 6–7-year-old children attending schools in low-fluoride and naturally fluoridated areas in the UK

F is an important trace element for bones and teeth. The protective effect of F against dental caries is well established. Urine is the prime vehicle for the excretion of F from the body; however, the relationship between F intake and excretion is complex: the derived fractional urinary F excretion (FUFE) aids understanding of this in different age groups. The present study aimed to investigate the relationships between (1) total daily F intake (TDFI) and daily urinary F excretion (DUFE), and (2) TDFI and FUFE in 6-7-year-olds, recruited in low-F and naturally fluoridated (natural-F) areas in north-east England. TDFI from diet and toothbrushing and DUFE were assessed through F analysis of duplicate dietary plate, toothbrushing expectorate and urine samples using a F-ion-selective electrode. FUFE was calculated as the ratio between DUFE and TDFI. Pearson's correlation and regression analysis were used to investigate the relationship between TDFI and FUFE. A group of thirty-three children completed the study; twenty-one receiving low-F water (0·30 mg F/l) and twelve receiving natural-F water (1·06 mg F/l) at school. The mean TDFI was 0·076 (SD 0·038) and 0·038 (SD 0·027) mg/kg per d for the natural-F and low-F groups, respectively. The mean DUFE was 0·017 (SD 0·007) and 0·012 (SD 0·006) mg/kg per d for the natural-F and low-F groups, respectively. FUFE was lower in the natural-F group (30 %) compared with the low-F group (40 %). Pearson's correlation coefficient for (1) TDFI and DUFE was +0·22 (P= 0·22) and for (2) TDFI and FUFE was − 0·63 (P< 0·001). In conclusion, there was no correlation between TDFI and DUFE. However, there was a statistically significant negative correlation between FUFE and TDFI.