British Population Research Articles

Learning emotional dialects: A British population study of cross-cultural communication.

The aim of the current research was to explore whether we can improve the recognition of cross-cultural freely-expressed emotional faces in British participants. We tested several methods for improving the recognition of freely-expressed emotional faces, such as different methods for presenting other-culture expressions of emotion from individuals from Chile, New Zealand and Singapore in two experimental stages. In the first experimental stage, in phase one, participants were asked to identify the emotion of cross-cultural freely-expressed faces. In the second phase, different cohorts were presented with interactive side-by-side, back-to-back and dynamic morphing of cross-cultural freely-expressed emotional faces, and control conditions. In the final phase, we repeated phase one using novel stimuli. We found that all non-control conditions led to recognition improvements. Morphing was the most effective condition for improving the recognition of cross-cultural emotional faces. In the second experimental stage, we presented morphing to different cohorts including own-to-other and other-to-own freely-expressed cross-cultural emotional faces and neutral-to-emotional and emotional-to-neutral other-culture freely-expressed emotional faces. All conditions led to recognition improvements and the presentation of freely-expressed own-to-other cultural-emotional faces provided the most effective learning. These findings suggest that training can improve the recognition of cross-cultural freely-expressed emotional expressions.

Medicaid Expansions and Access to Substance Abuse Treatment Services Among Limited English Proficiency Populations.

Although the myriad of provisions under the Affordable Care Act (ACA) have generally increased coverage and financial access to the health systems, language barriers represent a serious challenge to access to care among Limited English Proficiency (LEP) populations. The aim of this study was to examine the effect of Medicaid expansions under the ACA on the availability of language services and Medicaid acceptance in substance abuse treatment (SAT) facilities. A quasi-experimental difference-in-differences design with multiple time periods was used to compare changes in the availability of language services and Medicaid as a payment source between Medicaid expansion and nonexpansion states. Facility-level observational data in the National Survey of Substance Abuse Treatment Services 2010-2019 was included. Availability of LEP services and Medicaid acceptance in the SAT facilities. The proportion of SAT facilities that provide LEP services increased from 40% in 2013 to 53% in 2019. The proportions by state are heterogeneous, ranging from approximately 20% to 70%. The ACA Medicaid expansions are not associated with changes in the availability of LEP services in the facilities. Moreover, Medicaid acceptance in the expansion states increased gradually following the expansion; however, the estimates are not statistically significant. The ACA Medicaid expansion had no impact on the availability of LEP services and the acceptance of Medicaid as a payment source in the SAT facilities.

Predictors of cardiovascular risk in familial hypercolesterolemia.

Familial hypercholesterolemia is associated with an increased risk of cardiovascular disease. The current international guidelines of the main scientific societies consider that, all people with Familial Hypercholesterolemia have a high or very high cardiovascular risk. However, the occurrence of atherosclerotic cardiovascular disease is very heterogeneous in this population. Stratifying risk within people with familial hypercholesterolemia is essential to identify individuals who require intensive cholesterol-lowering therapies. In the last year, several studies have been published focusing on the contribution of diabetes to Familial Hypercholesterolemia, the role of stroke, as a manifestation of atherosclerotic disease, and the external validation of the SAFEHEART risk equation in the English population diagnosed with Familial Hypercholesterolemia. It is necessary the development of a tool that allows us to identify, in a simple, reproducible, and universal way, patients who may have a high risk of suffering a cardiovascular event and who are susceptible to more intensive treatments to reduce cholesterol levels.

An online RCT on behavioural expectations effects of COVID-19 certification policies in England

ObjectiveThe aim of this study was to compare the effects of different types of COVID-19 certification policy on subsequent behavioural expectations. Design4 × 2 between-subjects pre-registered randomised controlled trial. MethodIn August 2022, participants (n = 2726) in England were presented with a scenario describing a rise in COVID-19 infections and the introduction of new protective measures. The protective measures described varied with regards to the setting (healthcare vs. recreational) and the type of policy (no certification vs. vaccination vs. vaccination or free Lateral Flow test vs. vaccination or Lateral Flow test at personal cost). Participants then answered questions on their expectations to receive another dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine and to adhere to other protective behaviours following the announcement, as well as questions based on Self-Determination Theory, COVID-19 vaccine hesitancy and broader vaccine hesitancy. ResultsWe found no main effects of setting or type of certification on expectation to receive the next dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine, or to adhere to other protective measures, when controlling for baseline expectations. ConclusionsThese findings suggest that it is unlikely that the concept of certification, however it is framed, alters inclinations in the English population towards COVID-19 and seasonal flu vaccination or inclinations towards adhering to other protective behaviours within settings to which certification would apply. These findings are based on a hypothetical scenario and should be interpreted with caution.

Genomics Reveals Complex Population History and Unexpected Diversity of Eurasian Otters (Lutra lutra) in Britain Relative to Genetic Methods.

Conservation genetic analyses of many endangered species have been based on genotyping of microsatellite loci and sequencing of short fragments of mtDNA. The increase in power and resolution afforded by whole genome approaches may challenge conclusions made on limited numbers of loci and maternally inherited haploid markers. Here, we provide a matched comparison of whole genome sequencing versus microsatellite and control region (CR) genotyping for Eurasian otters (Lutra lutra). Previous work identified four genetically differentiated "stronghold" populations of otter in Britain, derived from regional populations that survived the population crash of the 1950s-1980s. Using whole genome resequencing data from 45 samples from across the British stronghold populations, we confirmed some aspects of population structure derived from previous marker-driven studies. Importantly, we showed that genomic signals of the population crash bottlenecks matched evidence from otter population surveys. Unexpectedly, two strongly divergent mitochondrial lineages were identified that were undetectable using CR fragments, and otters in the east of England were genetically distinct and surprisingly variable. We hypothesize that this previously unsuspected variability may derive from past releases of Eurasian otters from other, non-British source populations in England around the time of the population bottleneck. Our work highlights that even reasonably well-studied species may harbor genetic surprises, if studied using modern high-throughput sequencing methods.

Genomic epidemiology of syphilis in England: a population-based study

Syphilis is a sexually transmitted bacterial infection caused by Treponema pallidum subspecies pallidum. Since 2012, syphilis rates have risen dramatically in many high-income countries, including England. Although this increase in syphilis prevalence is known to be associated with high-risk sexual activity in gay, bisexual, and other men who have sex with men (GBMSM), cases are rising in heterosexual men and women. The transmission dynamics within and between sexual networks of GBMSM and heterosexual people are not well understood. We aimed to investigate if whole genome sequencing could be used to supplement or enhance epidemiological insights around syphilis transmission. We linked national patient demographic, geospatial, and behavioural metadata to whole T pallidum genome sequences previously generated from patient samples collected from across England between Jan 1, 2012, and Oct 31, 2018, and performed detailed phylogenomic analyses. Of 497 English samples submitted for sequencing, we recovered 240 genomes (198 from the UK Health Security Agency reference laboratory and 42 from other laboratories). Three duplicate samples (same patient and collection date) were included in the main phylogenies, but removed from further analyses of English populations, leaving 237 genomes. 220 (92·8%) of 237 samples were from men, nine (3·8%) were from women, and eight (3·4%) were of unknown gender. Samples were mostly from London (n=118 [49·8%]), followed by southeast England (n=29 [12·2%]), northeast England (n=24 [10·1%]), and southwest England (n=15 [6·3%]). 180 (76·0%) of 237 genomes came from GBMSM, compared with 25 (10·5%) from those identifying as men who have sex with women, 15 (6·3%) from men with unrecorded sexual orientation, nine (3·8%) from those identifying as women who have sex with men, and eight (3·4%) from people of unknown gender and sexual orientation. Phylogenomic analysis and clustering revealed two dominant T pallidum sublineages in England. Sublineage 1 was found throughout England and across all patient groups, whereas sublineage 14 occurred predominantly in GBMSM older than 34 years and was absent from samples sequenced from the north of England. These different spatiotemporal trends, linked to demography or behaviour in the dominant sublineages, suggest they represent different sexual networks. By focusing on different regions of England we were able to distinguish a local heterosexual transmission cluster from a background of transmission in GBMSM. These findings show that, despite extremely close genetic relationships between T pallidum genomes globally, genomics can still be used to identify putative transmission clusters for epidemiological follow-up. This could be of value for deconvoluting putative outbreaks and for informing public health interventions. Wellcome funding to the Sanger Institute, UK Research and Innovation, National Institute for Health and Care Research, European and Developing Countries Clinical Trials Partnership, and UK Health Security Agency.

Coming to terms with the past: perception of residents about lifestyle migrants’ returning

ABSTRACT The legal regulations regarding the right of possession of foreign-national real persons are important factors affecting the rate of foreign migrations. The British have been among the citizens of the top 10 countries with the highest rates of real estate possession in Turkey until 2021, and they mostly preferred Didim. The British population constituted one-fourth of the region's total population in the mid-2000s. However, a flow of return migration began in 2012, and the number of returning British lifestyle migrants dramatically increased in the following years. This study aims to develop an understanding of the reasons for the return migration of British lifestyle migrants from the viewpoint of the local people by adopting a qualitative research method. For this purpose, data were collected in 2018, 2019, 2021 and 2022 through observations and interviews in Didim, hosting the highest number of British lifestyle migrant population in Turkey. At the end of the analyses, four main reasons, abuse of goodwill, economic obstacles, legal loopholes regarding the problems and other vexing issues, were found for the return migration of British lifestyle migrants.

Links between Sleep Apnoea and Insomnia in a British Cohort.

Poor sleep is a major public health problem with implications for a wide range of critical health outcomes. Insomnia and sleep apnoea are the two most common causes of poor sleep, and recent studies have shown that these disorders frequently co-occur. Comorbid insomnia and sleep apnoea can substantially impair quality of life and increase the overall risk of mortality. However, the causal and physiological links between sleep apnoea and insomnia are unclear. It is also unknown whether having a higher risk for one condition can increase the risk of developing the other. Here, we investigated links between sleep apnoea and insomnia in a British population using a combination of self-reported questionnaires and causal inference. We found that 54.3% of the cohort had moderate insomnia, 9.4% had moderate sleep apnoea, and that 6.2% scored high for both conditions. Importantly, having a higher risk of sleep apnoea was associated with a higher risk of insomnia and vice versa. To determine the causal directionality between sleep apnoea and insomnia, we used Mendelian randomisation and found evidence that sleep apnoea could cause insomnia, but not the reverse. To elucidate how both sleep apnoea and insomnia were linked to each other, we looked at the behavioural markers of poor sleep. We found that feeling fatigued after sleeping and having noticeable sleep problems were linked to a higher burden of both sleep apnoea and insomnia. In conclusion, our results show that sleep apnoea increases the risk of developing insomnia, and both conditions can result in fatigue. We highlight the importance of considering and treating the symptoms of both conditions.

Eating disorders and physical multimorbidity in the English general population

PurposePeople with eating disorders may be at increased risk for physical health problems, but there are no data on the relationship between eating disorders and physical multimorbidity (i.e., ≥ 2 physical conditions) and its potential mediators. Thus, we investigated this association in a representative sample of adults from the UK, and quantified the extent to which this can be explained by various psychological and physical conditions, and lifestyle factors.MethodsCross-sectional data of the 2007 Adult Psychiatric Morbidity Survey were analyzed. Questions from the five-item SCOFF screening instrument were used to identify possible eating disorder. Respondents were asked about 20 physical health conditions. Multivariable logistic regression and mediation analysis were conducted.ResultsData on 7403 individuals aged ≥ 16 years were analyzed [mean (SD) age 46.3 (18.6) years; 48.6% males]. After adjustment, possible eating disorder was associated with 2.11 (95%CI = 1.67–2.67) times higher odds for physical multimorbidity. Anxiety disorder explained the largest proportion this association (mediated percentage 26.3%), followed by insomnia (21.8%), perceived stress (13.4%), depression (13.1%), obesity (13.0%), and alcohol dependence (4.3%).ConclusionFuture longitudinal studies are warranted to understand potential causality and the underlying mechanisms in the association between eating disorder and multimorbidity, and whether addressing the identified potential mediators in people with eating disorders can reduce multimorbidity.

Repeat expansions in NOP56 are a cause of spinocerebellar ataxia Type 36 in the British population.

Spinocerebellar ataxias form a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by progressive cerebellar ataxia. Their prevalence varies among populations and ethnicities. Spinocerebellar ataxia 36 is caused by a GGCCTG repeat expansion in the first intron of the NOP56 gene and is characterized by late-onset ataxia, sensorineural hearing loss and upper and lower motor neuron signs, including tongue fasciculations. Spinocerebellar ataxia 36 has been described mainly in East Asian and Western European patients and was thought to be absent in the British population. Leveraging novel bioinformatic tools to detect repeat expansions from whole-genome sequencing, we analyse the NOP56 repeat in 1257 British patients with hereditary ataxia and in 7506 unrelated controls. We identify pathogenic repeat expansions in five families (seven patients), representing the first cohort of White British descent patients with spinocerebellar ataxia 36. Employing in silico approaches using whole-genome sequencing data, we found an 87 kb shared haplotype in among the affected individuals from five families around the NOP56 repeat region, although this block was also shared between several controls, suggesting that the repeat arises on a permissive haplotype. Clinically, the patients presented with slowly progressive cerebellar ataxia with a low rate of hearing loss and variable rates of motor neuron impairment. Our findings show that the NOP56 expansion causes ataxia in the British population and that spinocerebellar ataxia 36 can be suspected in patients with a late-onset, slowly progressive ataxia, even without the findings of hearing loss and tongue fasciculation.

The prevalence and clustering of alcohol consumption, gambling, smoking, and excess weight in an English adult population

BackgroundThe aim of this study was to examine the prevalence and clustering of four health risks (increasing−/higher-risk drinking, current smoking, overweight/obesity, and at-risk gambling), and to examine variation across sociodemographic groups in the English adult population. MethodsWe analysed data from the 2012, 2015, 2016, and 2018 Health Survey for England (n = 20,698). Prevalence odds ratios (POR) were calculated to examine the clustering of risks. We undertook a multinomial multilevel regression model to examine sociodemographic variation in the clustering of health risks. ResultsOverall, 23.8% of the adult English population had two or more co-occurring health risks. The most prevalent was increasing−/higher-risk drinking and overweight/obesity (17.2%). Alcohol consumption and smoking were strongly clustered, particularly higher-risk drinking and smoking (POR = 2.68; 95% CI = 2.31, 3.11; prevalence = 1.7%). Higher-risk drinking and at-risk gambling were also clustered (POR = 2.66; 95% CI = 1.76, 4.01), albeit with a very low prevalence (0.2%). Prevalence of multiple risks was higher among men for all risk combinations except smoking and obesity. The odds of multiple risks were highest for men and women aged 35–64 years. Unemployed men and women with lower educational qualifications had a higher odds of multiple risks. The relationship between deprivation and multiple risks depended on the definition of multiple risks, with the clearest socioeconomic gradients seen for the highest risk health behaviours. ConclusionAn understanding of the prevalence, clustering, and risk factors for multiple health risks can help inform effective prevention and treatment approaches and may support the design and use of multiple behaviour change interventions.

Needs Analysis Of Scientific Article Writing Training For English Teachers: A Mixed Method

Writing and publishing scientific papers is something that is not only important for researchers, but also for teachers who teach in junior high to high school related to the need to increase teacher professionalism. Therefore, this study aims to analyze the need for training in the ability to write scientific articles in English teachers. This research employs mixed methods whereby quantitative data analysis will be supported by qualitative analysis. Purposive random sampling was used in the selection of research respondents which involved 30 teachers as a sample of a total of 150 English teacher population. This analysis was carried out based on the factors that can affect the difficulty of the process of writing scientific papers including the writing environment; obstacles caused by the topic of writing; the author’s motivation; and the processes, knowledge, and skills involved in writing. The results of this study are expected to be able to become a reference in developing writing training, especially for English teachers and can be an evaluation for teachers about the actions that must be taken to develop the ability to write scientific pap

Association of a Mediterranean Lifestyle With All-Cause and Cause-Specific Mortality: A Prospective Study from the UK Biobank

ObjectiveTo examine the association between the Mediterranean lifestyle and all-cause, cancer, and cardiovascular disease (CVD) mortality in a British population. Patients and MethodsWe studied 110,799 individuals 40 to 75 years of age from the UK Biobank cohort, free of CVD or cancer between 2009 and 2012 who were followed-up to 2021. The Mediterranean lifestyle was assessed at baseline through the Mediterranean Lifestyle (MEDLIFE) index, derived from the lifestyle questionnaire and diet assessments and comprising three blocks: (1) “Mediterranean food consumption,” (2) “Mediterranean dietary habits,” and (3) “physical activity, rest, social habits, and conviviality.” Death information was retrieved from death register records. Cox regression models were used to analyze the study associations. ResultsDuring a median 9.4-year follow-up, 4247 total deaths, 2401 cancer deaths, and 731 CVD deaths were identified. Compared with the first quartile of the MEDLIFE index, increasing quartiles had HRs of 0.89 (95% CI, 0.81 to 0.97), 0.81 (95% CI, 0.74 to 0.89), and 0.71 (95% CI, 0.65 to 0.78) (P-trend<.001 for all-cause mortality). For cancer mortality, the quartiles had HRs of 0.90 (95% CI, 0.80 to 1.01), 0.83 (95% CI, 0.74 to 0.93), and 0.72 (95% CI, 0.64 to 0.82) (P-trend<.001). All MEDLIFE index blocks were independently associated with lower risk of all-cause and cancer death, and block 3 was associated with lower CVD mortality. ConclusionHigher adherence to the Mediterranean lifestyle was associated with lower all-cause and cancer mortality in British middle-aged and older adults in a dose-response manner. Adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations may be possible and part of a healthy lifestyle.

English and Irish population comparison using STR markers: Insights into genetic disparities and historical influences

Short tandem repeat (STR) markers are commonly used in forensic investigations and kinship testing due to their cost-effectiveness and high discriminatory power. In the United Kingdom, STR allele frequency databases are available for different population groups, including the White group, which includes individuals of both English and Irish ethnicity. However, considering differences in historical migrations and influences between England and Ireland, distinct genetic differences might exist between these populations. This study aimed to generate allele frequency data for English and Irish populations using the VeriFiler Express PCR Amplification Kit, which contains loci utilised in national databases. Buccal swabs were collected from 577 English and 500 Irish volunteers with self-proclaimed English and Irish ethnicity respectively. DNA profiling and statistical analyses were performed to assess allele frequencies and forensic parameters, and to perform population comparisons. The results showed minimal genetic differentiation (Fst = 0.0013) between the English and Irish populations. Comparison with other European populations revealed close genetic relationships between the English population and Scandinavian countries, while the Irish population displayed closer genetic links to Western European countries. These findings support historical influences such as Viking migrations and highlight the need for further research using additional markers to explore the genetic makeup and history of the English and Irish populations. Although a single allele frequency database may be suitable due to the observed genetic similarity, the establishment of separate databases should be considered to ensure maximum population representation.

Healthcare in England was affected by the COVID-19 pandemic across the pancreatic cancer pathway: A cohort study using OpenSAFELY-TPP.

Healthcare across all sectors, in the UK and globally, was negatively affected by the COVID-19 pandemic. We analysed healthcare services delivered to people with pancreatic cancer from January 2015 to March 2023 to investigate the effect of the COVID-19 pandemic. With the approval of NHS England, and drawing from a nationally representative OpenSAFELY-TPP dataset of 24 million patients (over 40% of the English population), we undertook a cohort study of people diagnosed with pancreatic cancer. We queried electronic healthcare records for information on the provision of healthcare services across the pancreatic cancer pathway. To estimate the effect of the COVID-19 pandemic, we predicted the rates of healthcare services if the pandemic had not happened. We used generalised linear models and the pre-pandemic data from January 2015 to February 2020 to predict rates in March 2020 to March 2023. The 95% confidence intervals of the predicted values were used to estimate the significance of the difference between the predicted and observed rates. The rate of pancreatic cancer and diabetes diagnoses in the cohort was not affected by the pandemic. There were 26,840 people diagnosed with pancreatic cancer from January 2015 to March 2023. The mean age at diagnosis was 72 (±11 SD), 48% of people were female, 95% were of White ethnicity, and 40% were diagnosed with diabetes. We found a reduction in surgical resections by 25-28% during the pandemic. In addition, 20%, 10%, and 4% fewer people received body mass index, glycated haemoglobin, and liver function tests, respectively, before they were diagnosed with pancreatic cancer. There was no impact of the pandemic on the number of people making contact with primary care, but the number of contacts increased on average by 1-2 per person amongst those who made contact. Reporting of jaundice decreased by 28%, but recovered within 12 months into the pandemic. Emergency department visits, hospital admissions, and deaths were not affected. The pandemic affected healthcare in England across the pancreatic cancer pathway. Positive lessons could be learnt from the services that were resilient and those that recovered quickly. The reductions in healthcare experienced by people with cancer have the potential to lead to worse outcomes. Current efforts should focus on addressing the unmet needs of people with cancer. This work was jointly funded by the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1); NIHR (NIHR135559, COV-LT2-0073), and Health Data Research UK (HDRUK2021.000, 2021.0157). This work was funded by Medical Research Council (MRC) grant reference MR/W021390/1 as part of the postdoctoral fellowship awarded to AL and undertaken at the Bennett Institute, University of Oxford. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency (UKHSA), or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Trait analysis in a population of the Greater Butterfly-orchid observed through a 16-year period.

A large English population of the temperate tuberous Greater Butterfly-orchid, Platanthera chlorantha, was monitored through a 16-year period. Each June the number of flowering plants was counted and 60 flowering plants were measured in situ for four morphological traits, selected for both ease of measurement and their contrasting contributions to the life history of the species. Trait data were tested annually in pairwise combinations for individual plants, before mean values throughout the study period were regressed and cross-correlated against each other and against local data for four meteorological parameters. Labellar spur length proved to be more constrained than either flower number or stem height, and rarely yielded statistically significant correlations with other traits, whereas the three remaining traits reliably showed modest but significant correlations. Mean values and coefficients of variation differed only modestly among years and showed few of any meaningful trends. Spring rainfall and insolation had no detectable effect on traits of plants flowering that June; instead, they impacted on trait expression during the following year, presumably as a result of differential resourcing of replacement tubers formed during the previous year. High spring rainfall in year t-1 increased leaf area and stem height in year t, whereas the widely fluctuating number of flowering plants was highest in years immediately following those characterised by relatively dry and/or sunny springs. The "decision" to flower is taken during the previous summer, though it may be modified through winter/spring abortion of above-ground organs. The proportion of the population electing to flower is the only measured parameter that impacts significantly on annual reproductive output, emphasising the under-rated difficulty of evolving through directional selection. Any attempt to predict the behaviour of plant species in response to climate change must integrate information on demography with that on life history, habitat preference and intimate symbioses.

Types of Nursing Care Delivery to Improve Student's Resilience in Online Learning: A Systematic Scoping Review

The Covid-19 pandemic has led to a shift from traditional classroom instruction to online learning. Students who learn online, experience mental health issues because of these developments. To solve this issue, people must be resilient enough to modify their learning styles. The study aims to identify the nursing care delivery modalities that can improve students’ resilience during the online learning phase. Scoping review was employed in this study with the help of articles from the databases of CINAHL, PubMed, and ProQuest. The words ”resilience” and ”student OR undergraduate student” and ”pandemic covid-19 OR covid-19” were used in the English language. Full text, randomized control trial or quasi-experiment research designs, the use of the English language, student populations and samples, and publication dates within the last 10 years were the requirements for inclusion in this study (2013-2022). We found 10 articles discussing about nursing interventions to increase resilience in students who learning online. There are training interventions mindfulness interventions, and internet-based interventions. The three interventions can increase student resilience in online learning so that student achievement increases and can adapt to changes in learning methods. There are three types of nursing interventions to increase resilience during the Covid- 19 pandemic for students, namely training, mindfulness, and Internet-based intervention.&#x0D; Keywords: online learning, resilience, students

Developing and Validating a Self-Care Self-Efficacy Scale for Oral Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Protocol for a Mixed Methods Study.

Oral anticoagulation therapy (OAC) is the cornerstone treatment for preventing venous thromboembolism and stroke in patients with nonvalvular atrial fibrillation (NVAF). Despite its significance, challenges in adherence and persistence to OAC regimens have been reported, leading to severe health complications. Central to addressing these challenges is the concept of self-efficacy (SE) in medication management. Currently, there is a noticeable gap in available tools specifically designed to measure SE in OAC self-care management, while such tools are crucial for enhancing patient adherence and overall treatment outcomes. This study aims to develop and validate a novel scale aimed to measure self-care self-efficacy (SCSE) in patients with NVAF under OAC, which is the patients' Self-Care Self-Efficacy Index in Oral Anticoagulation Therapy Management (SCSE-OAC), for English- and Italian-speaking populations. We also seek to assess patients' SE in managing their OAC treatment effectively and to explore the relationship between SE levels and sociodemographic and clinical variables. Using a multiphase, mixed methods observational study design, we first conceptualize the SCSE-OAC through literature reviews, patient focus groups, and expert consensus. The scale's content validity will be evaluated through patient and expert reviews, while its construct validity is assessed using exploratory and confirmatory factor analyses, ensuring cross-cultural applicability. Criterion validity will be examined through correlations with clinical outcomes. Reliability will be tested via internal consistency and test-retest reliability measures. The study will involve adult outpatients with NVAF on OAC treatment for a minimum of 3 months, using both e-surveys and paper forms for data collection. It is anticipated that the SCSE-OAC will emerge as a reliable and valid tool for measuring SE in OAC self-care management. It will enable identifying patients at risk of poor adherence due to low SE, facilitating targeted educational interventions. The scale's validation in both English and Italian-speaking populations will underscore its applicability in diverse clinical settings, contributing significantly to personalized patient-centered care in anticoagulation management. The development and validation of the SCSE-OAC represent a significant advancement in the field of anticoagulation therapy. Validating the index in English- and Italian-speaking populations will enable personalized patient-centered educational interventions, ultimately improving OAC treatment outcomes. The SCSE-OAC's focus on SCSE introduces a novel approach to identifying and addressing individual patient needs, promoting adherence, and ultimately improving health outcomes. Future endeavors will seek to extend the validation of the SCSE-OAC across diverse cultural and linguistic landscapes, broadening its applicability in global clinical and research settings. This scale-up effort is crucial for establishing a universal standard for measuring SCSE in OAC management, empowering clinicians and researchers worldwide to tailor effective and culturally sensitive interventions. ClinicalTrials.gov NCT05820854; https://tinyurl.com/2mmypey7. PRR1-10.2196/51489.

The Burden of Respiratory Disease from Formaldehyde, Damp and Mould in English Housing

Quantifying the burden of disease from exposure to poor indoor air pollution can support policy development. In England, there is current regulatory and public attention on the health implications of residential exposure to formaldehyde, damp and mould. However, there is scarce information on these health impacts at the population scale. As such, we assessed the burden of key respiratory diseases from residential formaldehyde, damp and/or mould for the English population aged 0–14 and 15–49. We obtained data on the percentage of dwellings affected by damp and/or mould from the English Housing Survey and estimated the distribution of residential formaldehyde concentrations (annual average (μg/m3)) by pooling data from monitoring studies conducted in England. Exposures were combined with epidemiological relationships and national health data to estimate Population Attributable Fractions (PAFs), disease incidence, and Disability Adjusted Life Years (DALYs) lost associated with residential formaldehyde or damp and/or mould exposure in England. We made estimates for the year 2019 but also looked back several years in time. Exposure to formaldehyde was associated with approximately 4000 new cases of childhood asthma (~800 DALYs lost) in 2019, though the estimates were sensitive to the placement of the lower exposure threshold. Exposure to damp and/or mould was associated with approximately 5000 new cases of asthma (~2200 DALYs) and approximately 8500 lower respiratory infections (~600 DALYs) among children and adults in 2019, though the PAFs were unequally distributed across dwellings based on income and ethnicity. Alternative data sources suggest that the percentage of dwellings affected by damp and/or mould may even be higher, resulting in a possible 3–8-fold greater number of cases and DALYs. Our assessment emphasizes a potential respiratory health burden in England associated with residential formaldehyde as well as damp and/or mould, further highlighting the public health importance of good indoor air quality and good quality housing.

Cultural factors influencing the eating behaviours of type 2 diabetes in the British South-Asian population: a scoping review of the literature

Background The prevalence of type 2 diabetes mellitus (T2DM) in Britain is rising, with south-Asians being particularly vulnerable. This is attributed to cultural differences affecting south-Asians’ health behaviours in the risk and management of T2DM. Understanding cultural influences on eating practices is therefore vital in improving health behaviours in the South-Asian community and combatting the increasing burden of T2DM. Methods A scoping literature review was conducted for primary studies conducted in Britain, qualitatively examining South-Asians’ attitudes, beliefs and behaviours regarding their eating practices in the risk and management of T2DM. searches were conducted between January 2000 and December 2022 on PubMed, Applied Social Sciences Index &amp; Abstracts, Scopus, and International Bibliography of the Social Sciences. An inductive grounded theory approach was applied for data synthesis and analysis. Results 19 primary studies were identified. Stigma, lack of awareness, gender and food norms and culturally inappropriate healthcare advice prevented healthy eating behaviours. Family involvement and tailoring advice to south-Asian lifestyles enabled healthy eating. Varying attitudes existed between participants of differing age, generation, and education levels. Conclusions A multi-interventional approach is needed to improve awareness, mitigate stigma, and make healthy eating more accessible to south-Asians. Health professionals require improved understanding of the cultural context. Further research is recommended to explore social factors affecting South-Asians’ health behaviours and ensure interventions are contextually suitable.