Areas Of England Research Articles

Bringing lay knowledge into place-making? A critical exploration of community review panels in London and Southeast England

ABSTRACT This article serves as the first academic inquiry into the establishment and functioning of community review panels (CRPs) in England. CRPs are an innovation in public participation in planning. The first CRP was established in 2018 to operate within the boundaries of the Old Oak and Park Royal Development Corporation (OPDC) in West London. It was set up to mirror the workings of a Design Review Panel, with people selected to serve on the CRP for their local knowledge and ability to participate in substantive discussions. CRPs are now active in six areas of London and Southeast England, predominantly in locations experiencing significant development or regeneration. The article is based on analysis of primary interview and observation data, grey literature on CRPs, and a review of academic and policy debates on public participation and lay knowledge. It explores the potential for CRPs to provide meaningful input into planning and place-making. It concludes that well-managed panels can make meaningful contributions to the development control process, but could be more effectively employed in broader place-making. Both outcomes are contingent on local planners' willingness and ability to serve as brokers of different types of knowledge, testing lay and expert perspectives alongside each other.

Identifying employee, workplace and population characteristics associated with COVID-19 outbreaks in the workplace: a population-based study

ObjectivesTo identify risk factors that contribute to outbreaks of COVID-19 in the workplace and quantify their effect on outbreak risk.MethodsWe identified outbreaks of COVID-19 cases in the workplace and investigated...

“I Prefer Eating Less Than Eating Healthy”: Drivers of Food Choice in a Sample of Muslim Adolescents

Adolescence is a time of significant change which is experienced differently across sociocultural contexts. Understanding drivers of food practice in adolescence is vital as these impact future health outcomes and can drive health inequality. This study investigates drivers of food choice in predominantly British–Asian, Muslim adolescents living in a deprived urban area of England. It identifies dominant drivers of food choice and their impact on health and wellbeing, and explores how Muslim adolescents from a low socioeconomic, British–Asian group understand and action autonomy in their food practices. PhotoVoice, a focussed ethnographical methodology where participants reflect on lived experience, was used to address the study aim. Participants (n = 21) were secondary school pupils aged 14–15 years, recruited from a school situated in an area of deprivation. Four overarching themes were developed from the qualitative data framework analysis: (1) food preference and other determinants of food choice; (2) concept, understanding and importance of health; (3) developing autonomy, skills, and independence; and (4) role of community, friends, and family in food practices. The adolescents were developing autonomy in relation to their food practices, whilst navigating a complex web of factors which were, in part, determined by their social class location and demographics. Participants understood the constituents of healthy eating. However, there was a perceived “effort” of being healthy, including additional time for preparing healthier food and sacrificing taste preferences. Parents, friends, and schools highly influence food choices, with adolescents preferring a broad palate of takeaway and convenience foods and would prefer to eat less of these “unhealthy” options than eat healthily.

The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England - CORRIGENDUM.

The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England - CORRIGENDUM.

The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England.

High-quality evidence is lacking for the impact on healthcare utilisation of short-stay alternatives to psychiatric inpatient services for people experiencing acute and/or complex mental health crises (known in England as psychiatric decision units [PDUs]). We assessed the extent to which changes in psychiatric hospital and emergency department (ED) activity were explained by implementation of PDUs in England using a quasi-experimental approach. We conducted an interrupted time series (ITS) analysis of weekly aggregated data pre- and post-PDU implementation in one rural and two urban sites using segmented regression, adjusting for temporal and seasonal trends. Primary outcomes were changes in the number of voluntary inpatient admissions to (acute) adult psychiatric wards and number of ED adult mental health-related attendances in the 24months post-PDU implementation compared to that in the 24months pre-PDU implementation. The two PDUs (one urban and one rural) with longer (average) stays and high staff-to-patient ratios observed post-PDU decreases in the pattern of weekly voluntary psychiatric admissions relative to pre-PDU trend (Rural: -0.45%/week, 95% confidence interval [CI]=-0.78%, -0.12%; Urban: -0.49%/week, 95% CI=-0.73%, -0.25%); PDU implementation in each was associated with an estimated 35-38% reduction in total voluntary admissions in the post-PDU period. The (urban) PDU with the highest throughput, lowest staff-to-patient ratio and shortest average stay observed a 20% (-20.4%, CI=-29.7%, -10.0%) level reduction in mental health-related ED attendances post-PDU, although there was little impact on long-term trend. Pooled analyses across sites indicated a significant reduction in the number of voluntary admissions following PDU implementation (-16.6%, 95% CI=-23.9%, -8.5%) but no significant (long-term) trend change (-0.20%/week, 95% CI=-0.74%, 0.34%) and no short- (-2.8%, 95% CI=-19.3%, 17.0%) or long-term (0.08%/week, 95% CI=-0.13, 0.28%) effects on mental health-related ED attendances. Findings were largely unchanged in secondary (ITS) analyses that considered the introduction of other service initiatives in the study period. The introduction of PDUs was associated with an immediate reduction of voluntary psychiatric inpatient admissions. The extent to which PDUs change long-term trends of voluntary psychiatric admissions or impact on psychiatric presentations at ED may be linked to their configuration. PDUs with a large capacity, short length of stay and low staff-to-patient ratio can positively impact ED mental health presentations, while PDUs with longer length of stay and higher staff-to-patient ratios have potential to reduce voluntary psychiatric admissions over an extended period. Taken as a whole, our analyses suggest that when establishing a PDU, consideration of the primary crisis-care need that underlies the creation of the unit is key.

Annotated checklist and community composition of introduced, cryptogenic, and native polychaetes in floating dock communities of New England, USA

Abstract This study presents the first comprehensive annotated checklist of polychaetes collected from floating dock communities across New England and adjacent New York areas, emphasizing the significance of rapid biodiversity assessment surveys in understanding marine biodiversity. With 61% of the identified species classified as cryptogenic, the research highlights the complexity of marine biogeography and the challenges of distinguishing between native and non-native species. The incorporation of DNA barcoding has significantly improved species identification and revealed the presence of cryptic species complexes. The study's findings illustrate the prevalence of tubicolous families (Spionidae, Serpulidae, Sabellidae, and Terebelllidae) that are susceptible to anthropogenic dispersal mechanisms. It also addresses the challenge posed by the high proportion of cryptogenic species, calling for enhanced taxonomic and genetic analyses to resolve their origins and ecological roles. Despite the temporal variation in polychaete composition across years, the absence of distinct community assemblages suggests a level of resilience within floating dock communities. Our study advocates for the continuation and expansion of rapid assessment surveys, coupled with the integration of genetic methodologies, to provide a clearer picture of marine biodiversity.

Persons diagnosed with COVID-19 in England in the Clinical Practice Research Datalink (CPRD): a cohort description

ObjectiveTo create case definitions for confirmed COVID-19 diagnoses, COVID-19 vaccination status and three separate definitions of high risk of severe COVID-19, as well as to assess whether the implementation of...

A Review of the Success and Recurrence Rate of Hemorrhoids Following Rubber Band Ligation in Blackpool and the Fylde Coast Area of England

Introduction: Despite the existence of various operative and non-operative procedures to treat hemorrhoids, no standard treatment procedure for the disease exists to date. Rubber band ligation is a simple outpatient and easy to perform procedure to treat hemorrhoids, which can be done at the doctor’s office with no need for anesthesia and exceptionally minimal risk of complications. In this study, we report the efficacy of this technique among hemorrhoids patients in the in Blackpool and the Fylde Coast area of England. Materials & Methods: A retrospective case study involving ninety-eight symptomatic grade I, II and III hemorrhoids’ patients were conducted at Blackpool teaching hospital (NHS foundation trust), UK over a 3-year period. Electronic patients’ data were retrieved and analyzed for efficacy of the rubber band ligation procedure and recurrence of hemorrhoids, one year after the procedure. Results: Of the ninety-eight patients analyzed, 66 (67.3%) were males, and 32 (32.7%) were females. They had a mean (± SD) age of 53.6±15.0 years. Most of the patients, 87 (88.8%), presented with the primary symptom of rectal bleeding. Only 8 (8.2%) of the patients reported recurrence of hemorrhoids 6 months after the procedure, while 11 (11.2%) reported recurrence at 12 months after the procedure. Conclusion: In summary, it was an effective technique with only 11.2% recurrence rate 12 months after the procedure. Given its convenience and ease of performance, we believe it could be a useful technique for our setting. However, further studies, preferably prospective studies on larger number of patients and for longer duration will be required to establish its wider application. Our study reveals a significantly lower rate of recurrence in comparison to previously carried out studies and further emphasized that is safe and highly effective procedure We also noted a decreased rate of complications with only one patient requiring a readmission following the procedure, this in contrast to previous studies.

THE IMPACT OF LIVING IN MULTIGENERATIONAL NEIGHBOURHOODS ON LONELINESS IN LATER LIFE

Abstract Intergenerational solidarity has been identified as a key factor for effective social functioning. However, evidence suggests that divisions between younger and older generations within Great Britain (GB) have never been greater. Growing residential age segregation is thought to be driving intergenerational division. This, in turn, is assumed to lead to an increased risk of loneliness among older adults. However, to date, this has not been empirically tested. To examine this issue, we created a new measure of multigenerational neighbourhoods, for all lower super output areas in England and Wales. These were linked to individuals aged 50 and over living in England and Wales in 2018/2019 in the UK Household Longitudinal Survey (N = 14,196). Loneliness was measured using the UCLA-3 scale. Multilevel regression analyses were performed. Covariates included, area level deprivation, urban/rural, residential tax band, home ownership, individual age, sex, marital status and financial situation. The results show that the mix of generations within a neighbourhood has a weak (r = 0.33) and non-significant (p=.493) association with loneliness among older adults. To the best of our knowledge this is the first study to directly examine the impact of neighbourhood age diversity on loneliness in later life. Our findings suggest that the mere presence of different generations within a neighbourhood is not a sufficient condition to combat loneliness in later life

Guiding decisions on the future of dams: A GIS database characterizing ecological and social considerations of Dam decisions

In the United States and elsewhere, there are a growing number of dams which have exceeded their design life and will need to be repaired or removed in the coming decades. Most of these dams no longer serve their original purpose and removal can provide ecological benefits and eliminate future maintenance costs and hazards. However, many decision-makers have been ill-prepared by community resistance to proposals to remove dams. Given the number of dam removal initiatives that have failed or been delayed due to community resistance, both ecological and social attributes of dams need to be better mapped and conveyed in understandable ways. The goal of this study was to support future decisions regarding dams by 1) developing a set of metrics to assess the social and ecological dimensions of dams, and 2) using these metrics to develop a GIS database, for the 1000+ dams in the Narragansett Bay/Rhode Island area of southern New England. The database characterizes the ecological benefits of dam removal or modification, in terms of fish passage, and the social dimensions that may need to be considered when engaging a community in discussions about the future of a dam. Our emphasis was on small-head dams (i.e. <5 m tall) which comprise most dams in the study area. We created social value metrics that used GIS data to assess dams and their impoundments for potential benefits to waterfront properties, history, sense-of-place, and recreation. We modeled our ecological metrics and ranking system after the Nature Conservancy's Northeast Aquatic Connectivity study which considered factors relating to river connectivity and watershed quality. We evaluated our social and ecological metrics using case studies of dams in the study area that had been previously removed or modified. We assumed that both sets of dams were ecologically important, but the modified dams had higher social value that prohibited their removal. Dams that had been removed or modified were both ranked as high priority in terms of value for fish passage, particularly for diadromous fish. Dams that were modified to include fish passage had substantially larger impoundments, more waterfront properties, and more features associated with recreational or cultural value (e.g. boating opportunity, visibility, etc.). Our social metrics were consistent with expectations based on the limited case studies (7 removals, 19 modifications) available in the study area. We made the dam assessment metrics readily accessible to stakeholders through an interactive ArcGIS Online web map.

The Association Between Street Network Accessibility and Cognitive Impairment

AbstractBackgroundAccess to different amenities has been hypothesised to reduce the risk of cognitive impairment in older adults. Literature in urban planning shows that a well‐connected street network enables access to amenities, however, the role of street network accessibility has not been studied extensively in relation to cognitive function. The aim of this study is to investigate the cross‐sectional relationship between street network accessibility and cognitive impairment in older people in England, UK.MethodThe baseline data from the Cognitive Function and Ageing Study (CFAS) II (2008‐2011), a cohort study of people aged 65+ across three areas in England, was used (N = 7485) excluding 144 housebound participants. Cognitive impairment was defined by the Mini Mental State Exam (MMSE) score: mild‐severe (MMSE&lt;26) and moderate‐severe (MMSE&lt;21). Using Geographical Information System (GIS) data, proximity to a main road was represented by betweenness centrality (shortest routes corresponding to high potential of through movement) of the street network, using normalised angular choice (NACH ‐ range of 0‐1.5, with 0.9+ meaning a main road). Mean NACH was calculated within 300m walk of participants’ postcode centroid and categorised into tertiles (low = NACH&lt;0.8, medium = NACH 0.8‐0.9, high = NACH&gt;0.9). Logistic regression was used to investigate the relationship between proximity to a main road, the risk of mild‐severe and moderate‐severe cognitive impairment adjusting for age, sex, education, and area deprivation.ResultThe prevalence was 24% for mild‐severe cognitive impairment and 7.3% for moderate‐severe cognitive impairment. Compared to those living at low proximity from a main road, those who lived at medium (OR 0.817 95% CI [0.716, 0.932]) and high proximity (OR 0.756 95% CI [0.662, 0.863]) had lower risk of mild‐severe cognitive impairment. The adjusted associations remained similar (OR 0.771 95% CI [0.671, 0.886] for medium proximity, OR 0.755 95% CI [0.656, 0.869] for high proximity). Proximity to a main road was not associated with moderate‐severe cognitive impairment.ConclusionThe results suggest evidence for the role of proximity to a main road in reducing the risk of mild‐severe cognitive impairment in non‐housebound individuals, but not moderate‐severe cognitive impairment. More research is needed on other aspects of street network accessibility.

Computationally efficient localised spatial smoothing of disease rates using anisotropic basis functions and penalised regression fitting

The spatial variation in population-level disease rates can be estimated from aggregated disease data relating to N areal units using Bayesian hierarchical models. Spatial autocorrelation in these data is captured by random effects that are assigned a Conditional autoregressive (CAR) prior, which assumes that neighbouring areal units exhibit similar disease rates. This approach ignores boundaries in the disease rate surface, which are locations where neighbouring units exhibit a step-change in their rates. CAR type models have been extended to account for this localised spatial smoothness, but they are computationally prohibitive for big data sets. Therefore this paper proposes a novel computationally efficient approach for localised spatial smoothing, which is motivated by a new study of mental ill health across N=32,754 Lower Super Output Areas in England. The approach is based on a computationally efficient ridge regression framework, where the spatial trend in disease rates is modelled by a set of anisotropic spatial basis functions that can exhibit either smooth or step change transitions in values between neighbouring areal units. The efficacy of this approach is evidenced by simulation, before using it to identify the highest rate areas and the magnitude of the health inequalities in four measures of mental ill health, namely antidepressant usage, benefit claims, depression diagnoses and hospitalisations.

Accuracy of Local Authority Population Forecasts Produced by a New Minimal Data Model: A Case Study of England

The preparation of forecasts for small and local area populations involves many challenges. Standard cohort-component models are problematic because of small numbers, which make estimation of rates unreliable. Because of this, the Synthetic Migration Population Projection (SYMPOPP) model was designed to forecast local populations without need for detailed area-specific information. This model had been used successfully for small area forecasts in Australia. The objective of the paper is to assess its performance when applied to local areas in England. The model uses a bi-regional structure based on a movement population account. Sub-models of total population change are employed to control future change. Fertility, mortality and migration rates are borrowed from national statistics, constrained to small area indicators. The model uses an Excel workbook with VBA routines and is relatively easy and quick to use. Model inputs were calibrated for 2006–2011 and used to forecast for 2011–2021. Results were tested against the census-based 2021 mid-year populations. A new error statistic, Age Structure Error, was used to evaluate Basic and Refined model versions against official projections. The two versions of SYMPOPP posted lower errors. The simple models had fewer areas with errors of 10% or more (12.3–12.6%) compared with the official projections (14.5% of areas). Investigation revealed that these errors occurred in local authorities with high military, student, prison, or ethnic minority populations, influenced by factors not captured in a projection model for the general population.

A community-based approach to identifying and prioritising young people’s mental health needs in their local communities

BackgroundIdentifying locally relevant and agreed-upon priorities for improving young people’s mental health, aligned with social and environmental factors, is essential for benefiting target communities. This paper describes a participatory approach to engage young people and professionals in identifying such priorities, whilst considering the social determinants related to them.MethodsWe utilised a community-based participatory approach to support young people and professionals in identifying, reviewing, refining, and prioritising, locally relevant opportunity areas that are crucial for understanding and addressing social determinants of young people’s mental health. We adopted a flexible five-stage process, which enabled greater reflection and adaptation in response to young people’s and professionals’ feedback and reflections.ResultsOver seven months, we engaged with young people and professionals in Northern Devon, (a rural area in southwest England), involving over 290 individuals to identify locally relevant priorities for supporting young people’s mental health. Three priorities were identified for subsequent exploration using co-design approaches: (1) identity and belonging; (2) mental health awareness and literacy; and (3) diverse opportunities (for education, employment and leisure). The engagements suggested that designing initiatives and strategies in these areas could contribute to improvements in young people’s mental health.ConclusionYoung people in Northern Devon prioritised three themes for the next phase of the Kailo Programme—mental health literacy, access to diverse careers and employment opportunities, and identity and belonging within their communities. Rural communities face unique barriers associated with these issues, related to less diverse populations, lack of access to reliable and affordable transport and local industries, and seasonal working. The perceived neglect by authorities towards rural young people has resulted in a lack of activities and opportunities catering to their specific needs, compared to urban areas. Although the government has recognised the need to address these disparities, community members suggest that there is still more work to be done.

Effectiveness of primary care psychological therapy services for treating depression and anxiety in autistic adults in England: a retrospective, matched, observational cohort study of national health-care records

Autistic adults report a higher prevalence of anxiety and depression than adults without identified autism but have poorer access to appropriate mental health care. Evidence-based psychological therapies are recommended in treatment guidelines for autistic adults, but no study has investigated their effectiveness in large samples representative of the autistic population accessing routine care. This study aimed to examine therapy outcomes for autistic adults in a primary care service. In this retrospective, matched, observational cohort study of national health-care records, we used the MODIFY dataset that used linked electronic health-care records, including national data, for individuals who accessed psychological therapy in primary care in Improving Access to Psychological Therapies (IAPT) services in 211 clinical commissioning group areas in England, UK. All adults aged 18 years or older who had completed a course of IAPT in 2012-19 were eligible, and were propensity score matched (1:1) with a comparison group without identified autism. Exact matching was used, when possible, for a range of sociodemographic factors. Primary outcomes were routine metrics that have been nationally defined and used to evaluate IAPT treatments: reliable improvement, reliable recovery, and reliable deterioration. Secondary outcomes were calculated pre-post treatment changes in scores for Patient Health Questionnaire-9, Generalised Anxiety Disorder Assessment-7, and Work and Social Adjustment Scale measures. Subgroup analyses investigated differential effects across a range of sociodemographic factors. Of 2 515 402 adults who completed at least two sessions of IAPT in 2012-19, 8761 had an autism diagnosis (5054 [57·7%] male and 3707 [42·3%] female) and 1 918 504 did not (631 606 [32·9%] male and 1 286 898 [67·0%] female). After propensity score matching, 8593 autistic individuals were matched with an individual in the comparison group. During IAPT treatment, symptoms of depression and generalised anxiety disorder decreased for most autistic adults, but symptoms were less likely to improve in the autism group than in the comparison group (4820 [56·1%] of 8593 autistic adults had reliable improvement vs 5304 [61·7%] of 8593 adults in the matched group; adjusted odds ratio [ORadj] 0·75, 95% CI 0·70-0·80; p<0·0001) and symptoms were more likely to deteriorate (792 [9·2%] vs 619 [7·2%]; ORadj 1·34, 1·18-1·48; p<0·0001). In the comparison group, improved outcomes were associated with employment and belonging to a higher socioeconomic deprivation category, but this was not the case for autistic adults. Evidence-based psychological therapy for depression or anxiety might be effective for autistic adults but less so than for adults without identified autism. Treatment moderators appear different for autistic individuals, so more research is needed to allow for better targeted and personalised care. Alzheimer's Society.

Association between distance to nearest automated external defibrillator and socioeconomic deprivation in Great Britain

Abstract Background Disparities in socioeconomic status manifest in death from out of hospital cardiac arrest (OHCA). Inequalities in access to automated external defibrillators (AED) due to socioeconomically determined location of AEDs may be associated with OHCA survival. Purpose To investigate distances between nearest AED location and postcode by socioeconomic deprivation for the population of Great Britain (GB). Methods AED location data for 2022 were drawn from the British Heart Foundation The Circuit registry. All 1,677,466 unit postcodes in Great Britain were linked to the Index of Deprivation for the corresponding Lower Layer Super Output Area using the 2019 Ministry of Housing Communities and Local Government tool. The median distance by road from the centre of each postcode to the nearest AED was calculated using geographic information systems. The proportion available 24/7 was also reported. Multilevel linear mixed regression models fit by country and adjusted for urban/rural status and clustering to calculate predicted marginal mean distances to the nearest active AED, and nearest AED accessible 24/7 by deprivation decile. Results 78,425 unique AED locations were included in the analysis (Table 1). The median distance to nearest AED was 762.1m (IQR 410.8 - 1221.0) in GB; 742.7m (407.2 - 1340.7) in Scotland, 738.8m (422.6 - 1223.5) in England, and 511.5m (282.9 - 937.3) in Wales. For 24/7 access AEDs, median distances were greater: 964.0m (524.7 - 1667.5), 994.1m (538.5 – 1832.3), 990.8m (544.9 - 1683.3), and 569.7m (316.8 - 1033.4), respectively. Overall, there was little evidence of a trend in nearest AED distance by deprivation (fig 1). In Scotland the nearest AED was, on average, 108m further away in the most compared with the least deprived areas. In England, the nearest AED was closer to postcodes in the least deprived areas of England (predicted mean 20m) and Wales (predicted mean 95m). In England, AEDs with 24/7 access were further from postcodes with increasing deprivation (predicted mean 99m further than least deprived areas). In Scotland, nearest 24/7 access AEDs were 317m further away in the most deprived areas, and 62m closer in Wales, but with no evidence of a linear trend. At a typical walking speed (1.31m/sec), on average in GB it would take 17 minutes to retrieve an AED and 21 minutes out of hours. In England and Scotland out of hours, those in the most deprived areas would be delayed access to an AED by 2.5 and 8 minutes respectively compared the least deprived. Conclusions Overall, the median distance to nearest AED across postcodes in GB is at odds with the likelihood of successful resuscitation. Graded social inequalities were not observed in AED access across GB. However, substantive differences were observed in 24/7 AED access between most and least deprived areas of England and Scotland. Greater and more equitable access to AEDs has the potential to save lives and improve outcomes for people with OHCA.

Impact of messaging informed by behavioural science on uptake of targeted lung health checks: a service evaluation

BackgroundLung cancer is the most common cause of cancer death in the UK, and incidence is strongly associated with increasing age. Screening can improve survival by detecting cancer earlier. Targeted Lung Health Check (TLHC) programme is a lung cancer screening pilot offered to smokers or ex-smokers aged 55–74 years in certain areas of England. However, uptake remains as low as 20% in London. We did a service evaluation to assess the effect of adding messaging informed by behaviour science to invitation letters on TLHC uptake. MethodsThe intervention involved adding to the standard invitation letter a box with a two-sentence behavioural message targeted at mitigating fatalistic beliefs and low risk perception, as well as promoting clinician endorsement and the value of early detection. Allocation to receive either standard or intervention letters was done at West London GP practice level, with approximate pairing between practices. From Sept 22, 2022, to Nov 28, 2022, 9464 invitations were sent to eligible individuals (4842 standard and 4622 intervention) covering 20 GP practices. The primary outcome (uptake) was a booked appointment date within 4 months of the invitation letter being sent. TIDieR checklist was used for methodology and reporting guidelines. We used χ2 analysis to test for significant differences in uptake, and mixed-effects logistic regression to control for demographic covariates. FindingsDemographic characteristics were similar in the control and intervention groups, with mean ages of 63·3 and 63·0 years, average index of multiple deprivation (IMD) deciles of 6·33 and 5·53, and percentage of female participants 42·1% (n=2038) and 43·7% (n=2022), respectively. Uptake of TLHC was significantly higher in the intervention group (25·8%, n=1192) than in the control group (20·4%, n=987; χ2(1)=38·762, p<0·0001). A logistic regression model estimated likelihood of uptake was 37·5% (95% CI 12·1–63·2) higher in the intervention group (p=0·004). Patients aged 60–64, 65–69 and 70–75 years were 23·5% (10·7–36·3, p=0·0003), 28·3% (14·5–42·0, p<0·0001), and 32·6% (18·3–47·0, p<0·0001) more likely to attend than those aged 55–59 years. The likelihood of attendance decreased on the basis of deprivation (IMD decile; b=0·060, 95% CI 0·035–0·087, p<0·0001), female gender (b=0·156, 0·057–0·254, p=0·002), and for ex-smokers compared with smokers (b=0·580, 0·467–0·693, p<0·0001). InterpretationThis simple, no-cost addition of behavioural messaging to invitation letters can significantly improve screening uptake and is recommended for wider rollout. These findings are consistent with other studies. However, a limitation is that the allocation to study arm was at GP practice level and the study was not randomised. FundingRM Partners, the West London Cancer Alliance.

Maternal predictors of timeliness &amp; uptake of Measles, Mumps &amp; Rubella vaccine: A birth cohort study

Abstract Background In the United Kingdom (UK) measles, mumps &amp; rubella (MMR) vaccine uptake is below national recommendations. We aimed to identify maternal predictors for missed or late vaccination, including the association with pregnancy pertussis vaccination, added to the UK schedule in 2012. Methods We used electronic primary care records from the Clinical Practice Research Datalink to create a UK birth cohort following babies born between 01.01.2000 to 12.12.2020 and linked to their mother's record from birth. We estimated the proportion who received their 1st MMR vaccine by 2 years and 1st &amp; 2nd MMR vaccines by 5 years and examined associated maternal predictors using survival analysis and Cox proportional hazard models. We examined a sub-cohort of babies born from 01.01.2013 to estimate the impact of pregnancy pertussis vaccination on children's subsequent MMR uptake. Results Overall, 92.6% (736,495/795,497) children had 1st MMR by 5 years with 89.4% (710,797) by 2 years. Among children still in the cohort when eligible for 2nd MMR, 85.9% had two MMRs by 5 years (478,480/557,050). Lower 1st &amp; 2nd MMR uptake was associated with living in more deprived areas of England, being Black or Black British ethnicity or having mothers aged &amp;lt;20 years (1st MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) &amp; HR:0.89 (CI:0.88-0.90) respectively). Children of mothers vaccinated in pregnancy were more likely to have 1st &amp; 2nd MMRs after adjusting for ethnicity, deprivation and maternal age (1st &amp; 2nd MMRs by 5 years adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53). Conclusions There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics. Mothers vaccinated against pertussis in pregnancy are more likely to have a child vaccinated with MMR. Health professionals should promote pregnancy and childhood vaccinations during pregnancy and consider how families can be supported to access childhood vaccines. Key messages • There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics with MMR uptake lower among children living in more deprived areas. • Maternal vaccination and subsequent childhood vaccination uptake are related; pregnancy offers an opportunity to promote childhood vaccines and ensure families can access childhood vaccine services.

Understanding the geographical distribution of innovation in England: density, accessibility and spillover effects

ABSTRACT We examine the role of population density and accessibility in shaping innovation intensity in the 32,000 lower super output areas (LSOAs) in England. Our analysis focuses on firms’ registered intellectual property – patents, trademarks and registered designs – and using spatial autoregression models suggests four key results. We find a positive relationship between population density and innovation intensity, a consistent negative relationship between longer journey times to the nearest town centre and innovation intensity, and a strong interaction effect between population density and accessibility. Finally, we find strong evidence of local innovation spillovers reflecting either competition or demonstration effects.

What works in advocating for food advertising policy change across an english region – a realist evaluation

BackgroundWith increasing recognition of the role of commercial determinants of health, local areas in England have sought to restrict the advertising of products high in fat, salt and sugar (HFSS) on council-owned spaces, as part of wider strategies to reduce obesity. While there is some evidence of the impact of such policy change on behaviour, little is known about what works in the process of implementing this policy change.MethodsGuided by a realist evaluation framework that explores the interaction between context, mechanism and outcomes, this study aims to investigate the factors that influence the restriction of outdoor advertising of HFSS products in one region in England. It refines a programme theory co-produced with stakeholders from 14 local authorities within a region and uses multiple data sources from each area with an in-depth examination of four case study sites. Data sources include longitudinal realist interviews, focus groups and surveys with policy advocates and policy stakeholders. Data were analysed retroductively to understand the causal link between context, mechanism and outcomes.ResultsOutcomes were driven by five dominant mechanisms: a strategic and staggered approach to stakeholder engagement, gathering intelligence, identifying policy champions, building relationships, reframing the issue; and two secondary mechanisms of amplifying the issue and increasing public will. These led to varied outcomes with no changes in formal policy position within the evaluation period but draft policy guidance in place and changes in political will demonstrated. Dominant context factors influencing change included having a named and resourced policy advocate in place supported by an external Community of Improvement and having existing aligned local objectives. Organisational complexity and change, financial concerns, lack of local examples, ideological positions and the pandemic were also influencing contextual factors.ConclusionEffecting policy change in this area requires the commitment of an extended period and the valuing of short-term policy outcomes, such as increasing political will. The importance of a resourced and well-supported policy advocate to lead this work is fundamental and the commercially sensitive nature of this policy change means that a complex interplay of mechanisms is required which may be dominated by a strategically staggered approach to stakeholder engagement.