England Region Research Articles

Healthy dietary patterns and the incidence of chronic kidney disease: results from a prospective cohort study

BackgroundUnhealthy diets contribute to the onset and progression of chronic kidney disease (CKD), with poor dietary habits identified as significant lifestyle factors that elevate CKD risk.MethodsData from the UK Biobank cohort, which included over 500,000 participants aged 40–69 from diverse regions of England, Wales, and Scotland, were analyzed. Participants, who completed at least one online 24-hour dietary recall assessment, were included in the study. The baseline for analysis was the first 24-hour dietary recall in 2011, with follow-up extending until the earliest occurrence of CKD diagnosis, death, or the end of the study period.ResultsA total of 207,268 British individuals who completed at least one online 24-hour dietary recall assessment were included in this study. Four healthy dietary pattern scores were evaluated: the Healthy Plant-based Diet Index (hPDI), the Healthy Eating Index (HEI)-2015, the Mediterranean Diet (MED) Score, and the Alternative Mediterranean Diet (AMED) Score. These scores assessed the association between dietary patterns and the incidence of CKD. Relative to the lowest dietary scores, the HR for CKD was 0.79 (95% CI, 0.73–0.87) for the hPDI, 0.80 (95% CI, 0.73–0.87) for the HEI-2015, 0.86 (95% CI, 0.81–0.93) for the MED, and 0.84 (95% CI, 0.78–0.90) for the AMED (all p < 0.001).ConclusionThis study provides robust evidence linking healthy dietary patterns to a reduced risk of CKD. Further clinical trials are needed to confirm whether adherence to such diets can lower the risk of CKD.

Exploring the Experiences of LTCF Staff in Implementing Visitation Policies in England During the COVID-19 Pandemic

Background: Restrictions on family visitation to long-term care facilities (LTCFs) during the COVID-19 pandemic remain an area of contention for residents, family members and staff members. Current research has explored the experience of family members; however, fewer studies have explored the impact of visitation restrictions from the perspective of LTCF staff members. We examined the experiences of LTCF staff members in implementing visitation restrictions, including maintaining contact with families, in England over the course of the COVID-19 pandemic. Method: A sample of twenty-four LTCF staff members employed at eight LTCFs in one region of England was recruited. Qualitative, in-depth interviews were conducted with staff members to explore their experiences of implementing government policies during the COVID-19 pandemic. Thematic analysis was used to analyse data on maintaining contact and visitation with relatives. Results: Five broad themes were identified from the data. These were: (i) engaging with family members on visitation, (ii) facilitating visitation with family members, (iii) maintaining remote contact with family members, (iv) managing visitation restrictions with residents and (v) navigating equitable access for residents and family members. While some staff welcomed the introduction of national guidance on restrictions as a source to refer family members to for justification of the LTCFs’ decisions to restrict access, others reflected on the negative effect of limited social contact on resident wellbeing and difficulties in implementing the guidance. At times, LTCFs felt conflicted in their responsibility for supporting family members in visiting at the same time as communicating, enforcing and policing visitation restrictions. Guidance on facilitating remote contact required substantial time and resources required to support it. Discussion: The extent to which restricting visitation was a proportionate response to reducing the spread of COVID-19, within the wider context of negative impacts on relatives and family members, is an ongoing debate. This study identified some of the challenges experiences by LTCF staff in implementing such guidance, and calls into question the practicality of restricting visitation. Further research is needed on how social contact can be maintained between relatives and their families during pandemics, which is both equitable and achievable.

Bringing Young People, Health and Social Care Professionals, Transition Champions and Policymakers Together Through Hybrid Methods of Participation: Creating a Space for Shared Understanding of What Is Required to Improve Young People's Healthcare Transition.

A multi-stakeholder conference was held in 2023, celebrating the achievements of the Burdett National Transition Nursing Network (BNTNN). The BNTNN had been implemented across England in 2020 to map the current state of young people's healthcare transition into adult services across England, andwork with key stakeholders to coach them through making sustainable quality improvements to young people's transition services. This work was funded by the Burdett Trust for Nursing, following the success of an exemplar Model for Quality Improvement (QI) for Transition, which had been developed at a Teaching Hospital in England. The BNTNN consisted of a National Lead Nurse, four Regional Nurse Advisors based in host organisations in the four main regions of England, and an Expert Advisor for the care of young people. A research team was appointed to evaluate the impact of the BNTNN, leading the National Transition Evaluation Study. The BNTNN Lead Nurse worked in partnership with NHS England to provide national solutions to high-level barriers to the implementation of transition pathways. Young people with long-term conditions have participated and engaged with the BNTNN since its inception, throughout the QI project and research through membership to the Transition Advisory Group. Young people, professionals, staff members and policymakers were included in our hybrid conference in March 2023. The BNTNN and research team brought these groups together to share learning from the 3-year project, celebrating and showcasing achievements in each region as a result of the expert advice and support from the network. Young people contributed their experiences of transition journeys into adult services, and policymakers reflected upon national developments. Provider organisations from each region showcased their transition transformation journeys, sharing successes and challenges encountered during the QI process. The research team provided an update, and was responsible for capturing content and discussions on the day. With 405 attendees, the conference provided peer support and guidance, and enabled connections between young people, health and social care professionals, transition champions and policymakers. The primary aim was to forge long-lasting collaborations for the benefit of improving health services and outcomes for young people. In this article we highlight how it is possible to bring key stakeholders together through hybrid methods of participation, and how this enabled a shared understanding and a combined commitment to progress young people's transition services for the future. Young people who are experts by experience have been involved throughout this 3-year project and in the ongoing evaluation. Here we highlight the importance of involving young people, professionals, staff members and policymakers when creating a space for shared understanding of what is required to improve services for young people transitioning into adult healthcare services. NCT05867745 [ClinicalTrials.gov].

Acceptability and feasibility of shared medical appointments to support self-management of anxiety and depression in primary care in England: a qualitative study of service user/patient perspectives

ObjectiveShared medical appointments (SMAs) are an innovative care delivery method that provides delivery of clinical care while also supporting self-management. Their usefulness for mental health conditions has only briefly been...

NHS-Galleri trial: Enriched enrolment approaches and sociodemographic characteristics of enrolled participants.

Certain sociodemographic groups are routinely underrepresented in clinical trials, limiting generalisability. Here, we describe the extent to which enriched enrolment approaches yielded a diverse trial population enriched for older age in a randomised controlled trial of a blood-based multi-cancer early detection test (NCT05611632). Participants aged 50-77 years were recruited from eight Cancer Alliance regions in England. Most were identified and invited from centralised health service lists; a dynamic invitation algorithm was used to target those in older and more deprived groups. Others were invited by their general practice surgery (GP-based Participant Identification Centres in selected regions); towards the end of recruitment, specifically Asian and Black individuals were invited via this route, as part of a concerted effort to encourage enrolment among these individuals. Some participants self-referred, often following engagement activities involving community organisations. Enrolment took place in 11 mobile clinics at 151 locations that were generally more socioeconomically deprived and ethnically diverse than the England average. We reduced logistical barriers to trial participation by offering language interpretation and translation and disabled access measures. After enrolment, we examined (1) sociodemographic distribution of participants versus England and Cancer Alliance populations, and (2) number needed to invite (NNI; the number of invitations sent to enrol one participant) by age, sex, index of multiple deprivation (IMD) and ethnicity, and GP surgery-level bowel screening participation. Approximately 1.5 million individuals were invited and 142,924 enrolled (98% via centralised health service lists/invitation algorithm) in 10.5 months. The enrolled population was older and more deprived than the England population aged 50-77 years (73.3% vs 56.8% aged 60-77 years; 42.3% vs 35.3% in IMD groups 1-2). Ethnic diversity was lower in the trial than the England population (1.4% vs 2.8% Black; 3.3% vs 5.3% Asian). NNI was highest in Black (32.8), Asian (28.2) and most-deprived (21.5) groups, and lowest in mixed ethnicity (8.1) and least-deprived (4.6) groups. Enrolment approaches used in the NHS-Galleri trial enabled recruitment of an older, socioeconomically diverse participant population relatively rapidly. Compared with the England and Cancer Alliance populations, the enrolled population was enriched for those in older age and more deprived groups. Better ethnicity data availability in central health service records could enable better invitation targeting to further enhance ethnically diverse recruitment. Future research should evaluate approaches used to facilitate recruitment from underrepresented groups in clinical trials.

Prenatal Diagnosis of Congenital Heart Disease in Liveborn Infants in the New England Region.

Prenatal diagnosis of congenital heart disease requiring early cardiac catheterization or surgical intervention enables optimal delivery planning for appropriate postnatal cardiovascular intervention and care. This allows for improved morbidity and mortality. Prior national data reported prenatal diagnosis rates of 32% for congenital heart disease requiring intervention in infants in the first 6months of life in the New England region. With improved technology, access to care and changes to the obstetrical ultrasound guidelines for mid trimester fetal study, it is expected that diagnostic rates should improve. The New England Congenital Cardiology Association (NECCA) conducted a quality improvement study to determine the rates of prenatal detection in the current era with the hypothesis that there has been improvement in detection rates in this region. Ten of fourteen medical centers delivering pediatric cardiology care in New England contributed prenatal diagnosis data for 286 infants born at the participating centers during a one year period. The overall prenatal detection rate was 68%. Detection rates ranged from 39 to 90%. When fetal echocardiogram was performed at a pediatric cardiology center, the detection rate was 95% with only 7 moderate (7/195; 3.6%) and 3 severe (3/195; 1.5%) diagnostic discrepancies. Prenatal diagnostic rate and accuracy are high among pediatric cardiology centers in the New England region, and much improved over historical data. To improve fetal detection of congenital heart disease further, future work is needed to better determine the etiology of missed prenatal diagnoses and efforts should be focused on increasing appropriate referrals to pediatric cardiology centers for fetal evaluation.

Variation in the commissioning of specialist weight management services and bariatric surgery across England: Results of a freedom of information-based mapping exercise across the 42 integrated Care Systems of England.

Specialist weight management services including bariatric surgery are commissioned within regions of England called Integrated Care Systems (ICSs) with eligibility and treatment guidelines determined as part of the National Institute for Health and Care Excellence (NICE) guidance. Reported variation in commissioning and bariatric surgery eligibility criteria has not been previously mapped. Freedom of Information (FOI) requests provide a tool, supported by legislation, to ask questions of public authorities including ICSs such that they must respond accurately. FOIs were sent to all 42 ICSs in England asking 4 questions aiming to establish whether there is variation in the commissioning of specialist weight management services and the eligibility criteria for bariatric surgery across England. Responses were presented descriptively and mapped across England. Responses were received from 41 out of 42 ICSs, with 34 reporting that they provide commissioned medical weight management programmes and 38 funding bariatric surgery. Thirteen reported using criteria that were not compliant with NICE guidance. A large area of the country centred around the East of England does not have a bariatric unit reducing access to care. There is significant geographical variation in the availability of both bariatric and specialist medical weight management services across England, with large portions of the country without local access to a service or no service at all. Where services are available, there is significant inconsistency in eligibility for bariatric surgery despite nationally available guidance.

Estimating the burden of underdiagnosis within England: A modelling study of linked primary care data.

Undiagnosed chronic disease has serious health consequences, and variation in rates of underdiagnosis between populations can contribute to health inequalities. We aimed to estimate the level of undiagnosed disease of 11 common conditions and its variation across sociodemographic characteristics and regions in England. We used linked primary care, hospital and mortality data on approximately 1.3 million patients registered at a GP practice for more than one year from 01/04/2008-31/03/2020 from Clinical Practice Research Datalink. We created a dynamic state model with six states based on the diagnosis and mortality of 11 conditions: coronary heart disease (CHD), stroke, hypertension, chronic obstructive pulmonary disease, type 2 diabetes, dementia, breast cancer, prostate cancer, lung cancer, colorectal cancer, and depression/anxiety. Undiagnosed disease was conceptualised as those who died with a condition but were not previously diagnosed. This was combined with observed data on the incidence of diagnosis, the case fatality rate in the diagnosed, and an assumption about how that rate varies with diagnosis to estimate the number of undiagnosed disease cases over the total number of disease cases (underdiagnosis) in each population group. We estimated underdiagnosis by year, sex, 10-year age group, relative deprivation, and administrative region. We then applied small-area estimation techniques to derive underdiagnosis estimates for health planning areas (CCGs). Levels of underdiagnosis varied between 16% for stroke and 69% for prostate cancer in 2018. For all diseases, the level of underdiagnosis declined over time. Underdiagnosis was not consistently concentrated in areas with high deprivation. For depression/anxiety and stroke, underdiagnosis was estimated to be higher in less deprived CCGs, whilst for CHD and T2DM, it was estimated to be higher in more deprived CCGs, with no apparent relationships for other conditions. We found no uniform spatial patterns of underdiagnosis across all diseases, and the relationship between age, deprivation and the probability of being undiagnosed varied greatly between diseases. Our findings suggest that underdiagnosis is not consistently concentrated in areas with high deprivation, nor is there a uniform spatial underdiagnosis pattern across diseases. This novel method for estimating the burden of underdiagnosis within England depends on the quality of routinely collected data, but it suggests that more research is needed to understand the key drivers of underdiagnosis.

Minority stress and protective factors for body image concerns and disordered eating among a cohort of transgender and nonbinary youth: A preliminary longitudinal study

Background Transgender and/or nonbinary (TNB) youth experience elevated risk of body image concerns and disordered eating compared to their cisgender counterparts, yet drivers of this risk remain poorly understood. This exploratory community-engaged study examined longitudinal associations between gender minority stressors and protective factors and disordered eating and body image concerns among TNB youth. Methods 30 TNB youth (age 13–17 years) from the U.S. New England region completed five waves of online surveys (December 2015–February 2019). Gender minority stressors included non-affirmation of gender identity and internalized cissexism. Protective factors included gender identity-related pride, community connectedness, and social support. Outcomes included disordered eating behaviors, body image concerns, body image-related avoidance, depersonalization, and trans-specific body image concerns. Results Gender-related pride was associated with fewer trans-specific body image concerns and vomiting for weight control in TNB youth. Over the study period, 20–40% reported dieting, 4–10% reported vomiting for weight control, and 8–23% reported binge eating. Greater gender minority stressors at the previous wave were associated with greater body image-related avoidance, depersonalization, and trans-specific body image concerns at the current wave. Conclusions Elevated risk of disordered eating and body image concerns in TNB youth highlight the need for screening, prevention, and systems-level efforts to address anti-TNB discrimination.

Enhancing Surgical Curriculum: Trainees' Perspectives on Laparoscopic Simulation and Assessment.

Introduction Laparoscopic simulation has been used in many curricula. The United Kingdom (UK) surgical curriculum lacks summative assessment for laparoscopic skills. This study explores surgical trainees' perceptions of using simulated laparoscopic assessmentas a summative tool in the UK. Methodology This was a semi-structured interview study conducted in person for 10 higher surgical trainees recruited voluntarily in the northern region of England. A thematic analysis was used to analyse the data. Results The findings generally showed positive perceptions among the trainees for simulated laparoscopic assessment. The trainees highlighted that the current assessments are formative and often subjective. Trainees suggested introducing summative assessment might fit with current changes in the national curriculum. The interviews also showed that simulated laparoscopic assessment would positively affect the trainees, curriculum, and patients. In addition, trainees expressed that the introduction of such a change should be staged and tailored to the training grade. However, the majority did not support making it part of CCT requirements. The trainees emphasised that implementing such a change can face challenges such as cost, tension between training and service provision, and culture change. The practicality of introducing simulated laparoscopic assessment was discussed in terms of skills to be assessed, fidelity, and progression signposting. Conclusion The study highlighted the trainees' perceptions about simulated laparoscopic assessment, which was generally positive, and raised issues regarding challengesin its implementation. Further discussion in surgical societies is required and in-depth research is needed before implementating simulated laparoscopic assessment for trainee certification.

Mind the gap-national pesticide monitoring data needs for invertebrate effects assessments in English rivers.

Pesticides are an integral part of agriculture in arable and pastoral farming and in animal and pet care, but they have been shown to have detrimental impacts on biodiversity, including of freshwater systems. The United Kingdom (UK) has the 7th highest pesticide usage per area of arable land across 30 European and African countries assessed between the years 2000 and 2012 and thus an associated higher likelihood for impacts on riverine biodiversity. In our analysis of the UK's 24-year national chemical monitoring program (WIMS database; years 2000 to 2023), we show that of the nine pesticides that pose the greatest likely threat to UK freshwater invertebrates based on concentrations measured in British rivers exceeding the lowest effect concentrations (ECs) in laboratory-based toxicity tests, seven pesticides have exceeded the ECs across England between the years 2000 and 2023. The Anglian and Midland regions of England that have the highest regional arable pesticide use recorded the greatest number of pesticides exceeding the ECs for aquatic invertebrates. However, this finding may also be influenced by the more limited sampling/monitoring bias across England, and greater sampling of southern and northwest rivers is needed to better establish the potential impact of pesticides on riverine invertebrate communities in those regions.

From trusted intruder to real collaborator: Mapping the ecosystem of stakeholders and community assets in a coastal region in England, with a focus on end-of-life care and bereavement support

While policy efforts to promote health through integration across sectors are not new, the 2022 UK Health and Care Act formalised Integrated Care Systems (ICSs) as legal entities with statutory powers in England. This includes a legal responsibility to commission adequate palliative and end-of-life care services, including bereavement support, for the communities they serve. Cross-sector partnerships that leverage community assets are recommended to tackle inequities towards the end of life and in bereavement. However, the nature of effective, equitable partnership remains unclear, and asset-based approaches have been criticised for neglecting issues of power and potentially transferring the responsibility for solving social and health injustices to communities. Aware of these debates, we critically explore the conditions that enable inclusive collaborative relationships and integration across sectors, as well as the barriers that prevent this, within the ecosystem of one coastal region in England. We conducted a system mapping study, drawing on theories of death systems, social capital, and service ecosystems, understood via Service-Dominant Logic (S-D L).Our three-phase participatory, qualitative study involved three community network meetings (attended by 35–55 stakeholders across sectors), a participatory digital mapping workshop (n = 19), and semi-structured interviews analysed using inductive thematic analysis (n = 15 stakeholders across sectors). Digital mapping showed weak or unstable bridging capital between sectors. Interviews highlighted that attending to the relational foundations of integration is essential but often omitted: opportunities and time to understand each other and co-create a shared vision, understanding differences and deepening connections, and, fundamentally, addressing power differentials. Failed attempts at generating bridging capital were linked to extractive relationships, widespread staff shortages and inadequate funding and resources, particularly in the VCSE. Understanding the nature of collaboration and social capital in a locality can support public health approaches which go beyond naïve calls for cross-sector collaboration to engender meaningful change.

‘Teach and Treat’ independent prescribing pilot to launch in all regions of England

‘Teach and Treat’ independent prescribing pilot to launch in all regions of England

What are the challenges that social prescribers face when supporting people within dementia and how can these be addressed? A qualitative study.

Evidence suggests that social prescribing might have a positive impact on identity, control, creativity and quality of life in people with dementia. While evidence on the benefits of social prescribing is accumulating, there is a sparsity of research on the experiences of social prescribers. This study aims to identify the challenges that social prescribers face when supporting people with dementia and their families and strategies to address these. A qualitative study involving 24 social prescribers from all regions in England. Semi-structured interviews investigated challenges and strategies that social prescribers experience in their own practice. Data were analysed through thematic analysis. Results on "Challenges" and the respective "Strategies" are presented in a chronological order that reflects the different stages of contact with and support for the client with dementia, from referral to discharge. This study identified unique barriers that social prescribers face when working with people with dementia, particularly around communication, motivation, engagement and overdependency. It identified person and system-level strategies that can be used to address these challenges. These include expanding opportunities for dementia training, offering in-person support, including social prescribing in annual dementia reviews, and increasing integration of services within Integrated Care Systems and collaborations between health care service providers and with the third sector. Improving delivery and effectiveness of services is crucial to ensure that social prescribing fulfils its ethos of personalised care approach for all, including people with dementia, as envisioned in the NHS long term plan.

Changing suicide trends: A shift in regional disparities across the UK

BackgroundIn 2023, suicide rates in England & Wales reached their highest levels since 1999. Despite changes in legal definitions and registration methods impacting trends, this increase reflects growing individual suffering. International comparisons suggest that while the UK saw a 12 % rise in suicide rates between 1999 and 2020, many other European countries experienced significant declines. MethodsWe used publicly available data from the Office for National Statistics on suicide rates from 1981 to 2023, by sex and geographical region in England & Wales. We conducted descriptive and statistical analyses with the Joinpoint regression programme to identify significant discontinuities in trends in suicide rates. ResultsIn 1981, London had the highest suicide rates, but by 2023, it reported the lowest for both sexes, with declines of 51 % for men and 69 % for women. In contrast, the North East and North West now have much higher rates, particularly in men. Several regions have seen little improvement. ConclusionsThere are substantial regional differences in suicide trends in England. These are consistent with known social and economic changes and point to a need for whole of government responses.

Reconstructing the first COVID-19 pandemic wave with minimal data in England.

Accurate measurement of exposure to SARS-CoV-2 in the population is crucial for understanding the dynamics of disease transmission and evaluating the impacts of interventions. However, it was particularly challenging to achieve this in the early phase of a pandemic because of the sparsity of epidemiological data. We previously developed an early pandemic diagnostic tool that linked minimum datasets: seroprevalence, mortality and infection testing data to estimate the true exposure in different regions of England and found levels of SARS-CoV-2 population exposure to be considerably higher than suggested by seroprevalence surveys. Here, we re-examine and evaluate the model in the context of reconstructing the first COVID-19 epidemic wave in England from three perspectives: validation against the Office for National Statistics (ONS) Coronavirus Infection Survey, relationship among model performance and data abundance and time-varying case detection ratios. We find that our model can recover the first, unobserved, epidemic wave of COVID-19 in England from March 2020 to June 2020 if two or three serological measurements are given as additional model inputs, while the second wave during winter of 2020 is validated by estimates from the ONS Coronavirus Infection Survey. Moreover, the model estimates that by the end of October in 2020 the UK government's official COVID-9 online dashboard reported COVID-19 cases only accounted for 9.1 % of cumulative exposure, dramatically varying across the two epidemic waves in England in 2020, 4.3 % vs 43.7 %.

Understanding emotional and health indicators underlying the burnout risk of healthcare workers.

Burnout of healthcare workers is of increasing concern as workload pressures mount. Burnout is usually conceptualised as resulting from external pressures rather than internal resilience and although is not a diagnosable condition, it is related to help seeking for its psychological sequelae. To understand how staff support services can intervene with staff heading for burnout, it is important to understand what other intrapsychic factors are related to it. A diary tool was used by staff in a region of England to self-monitor their wellbeing over time. The tool explores many areas of mental health and wellbeing and enabled regression analysis to predict which of the various factors provided the strongest indicators of burnout. Using a multiple linear regression model, burnout was found to be most associated with depression, receptiveness, mental wellbeing, and connectedness (p<0.05). It was also shown that 71% of the variance present in the response variable, i.e. burnout, explained by independent variables. Both the Spearman Rank Correlation and the Variance Inflation Factor methods found no evidence for multicollinearity in our regression models. We showed how burnout can be explained using a handful of factors including emotional and mental health indicators. The findings suggest a simple set of indicators can predict burnout and could be used for screening. The data suggests attention to four factors around social safeness, grounding and care in the self, hope and meaning, and having sufficient energy could form the basis of wellbeing programs.

Developing and Comparing Four Families of Bayesian Network Autocorrelation Models for Binary Outcomes: Estimating Peer Effects Involving Adoption of Medical Technologies

ABSTRACTDespite the extensive use of network autocorrelation models in social network analysis, network autocorrelation models for binary dependent variables have received surprisingly scant attention. In this paper, we develop four network autocorrelation models for a binary random variable defined by whether the peer effect (also termed social influence or contagion) acts on latent continuous outcomes leading to an indirect effect under a normal or a logistic distribution or on the probability of the observed outcome itself under a probit or a logit link function defining a direct effect to account for interdependence between outcomes. For all models, we use a Bayesian approach for model estimation under a uniform prior on a transformed peer effect parameter () designed to enhance model computation and compare results to those under the uniform prior for . We use simulation to assess the performance of Bayesian point and interval estimators for each of the four models when the model that generated the data is used for estimation (precision assessment) and when each of the other three models instead generated the data (robustness assessment). We construct a United States New England region patient‐sharing hospital network and apply the four network autocorrelation models to study the adoption of robotic surgery, a new medical technology, among hospitals using a cohort of United States Medicare beneficiaries in 2016 and 2017. Finally, we develop a deviance information criterion for each of the four models to compare their fit to the observed data and use posterior predictive p‐values to assess the models' ability to recover specified features of the data. The results find that although the indirect peer effect of the propensity of peer hospital adoption on that of the focal hospital is positive under both latent response autocorrelation models, the direct peer effect of the peer hospital's probability of adopting robotic surgery on the probability of the focal hospital adopting robotic surgery decreases under both mean autocorrelation data models. However, neither of these associations is statistically significant.

Examining the effectiveness and economic benefits of home fire safety visits

Home safety visits form an important part of fire prevention strategies adopted by fire and rescue services. However, to date, limited research focus has been directed toward examining whether this prevention activity is effective in achieving the aim of reducing accidental dwelling fires (ADFs) or the social and economic value of this. Accordingly, focusing on one region of England (Merseyside), the following study adopts outcome evaluation and cost-benefit analysis approaches to examine (i) the impact of home safety visits on ADFs, injuries, and fire containment and (ii) the cost-effectiveness of home safety visits. Data was sourced from Merseyside Fire and Rescue Service, the UK Home Office, and a systematic search of existing economic models. Findings of the outcome evaluation highlight that ADFs are significantly less likely to occur in properties that receive a home safety visit. Increasing the number of home safety visits conducted is also associated with a significant reduction in ADFs. Results of cost-benefit analysis highlight that every £1 invested in home safety visits results in a saving of £2.75 from reductions in ADFs, injuries, and fatalities. Overall, findings indicate that home safety visits are both an effective and cost-effective form of fire prevention. Findings pose important implications for informing fire sector discussions regarding the resourcing of prevention and the development of frameworks to demonstrate efficiency and effectiveness.

Implementation and impact of NHS-funded tobacco dependence services in England: a mixed-method evaluation protocol

IntroductionTobacco smoking remains a leading cause of ill-health, premature mortality and a driver of health inequalities. To support smokers in England, a comprehensive approach to treating tobacco dependence is being...