Effect In England Research Articles

The impact of the English calorie labelling policy on the energy content of food offered and purchased in worksite cafeterias: a natural experiment

BackgroundOn 6 April 2022, legislation came into effect in England requiring calorie labels to be applied to food items on menus of larger food businesses. This study aimed to assess the impact of calorie labelling on (a) food purchased and (b) energy content of menu options in worksite cafeterias.MethodsProduct-level sales data and energy content of available items was obtained from 142 worksite cafeterias from January 2022-October 2022. Interrupted-time-series (ITS) analysis with level and slope change evaluated daily energy (kcal) purchased per item, and ITS with level change assessed mean energy per option available on menus before and after calorie labelling. Each analysis was conducted 6 weeks and 6 months from implementation. A post-hoc ITS examined weekly energy purchased per item over a longer period (March 2021-October 2022; 135 sites).ResultsThere was no evidence calorie labelling changed the energy content of foods purchased (6-week: + 0.60 cal/product, 95%CI:-2.54, + 3.75; 6-month: + 1.59 cal/product, 95%CI:-0.96, + 4.16). Post-hoc analyses suggested calorie labels were associated with a reduction in mean energy of items purchased over time (-0.65 kcal/week, 95%CI:-0.81,-0.49), but a significant increase (+ 3 kcal, 95%CI: + 0.43, + 5.60) at the point of implementation. There was a reduction in the mean energy content of menu options at each seasonal menu change (April 2022:-1.79 kcal, 95%CI:-3.42,-0.15; July 2022:-4.18 kcal, 95% CI:-7.65,-0.73).ConclusionThis large observational study in worksite cafeterias found no evidence to indicate the introduction of calorie labelling led to any immediate reduction in energy purchased by customers. There was some evidence of increasing impact over time, possibly associated with changes in menu offerings, but this effect was small and cannot be directly attributed to calorie labelling.

Individuals with restrictive eating disorders' experience of the introduction of calories on menus in England: An interpretative phenomenological analysis study.

In April 2022 the Calorie Labelling (Out of Home) Regulations came into effect in England where cafés, restaurants, and takeaways with over 250 employees were required to provide calorie labelling on menus. Concerns have been raised regarding the potential negative impact this could have on individuals with eating disorders (EDs), yet this has not been explored using qualitative methodology. Eleven participants with a current or previously diagnosed restrictive ED were interviewed in September 2022. Interpretative Phenomenological Analysis (IPA) was used to explore their experience of the introduction of calories on menus. Using IPA we established six themes and seven subordinate themes. These included the introduction of calories on menus as an 'attack' on individuals with EDs; the prominent visual display of calories as an attentional pull; normalising of calories counting; the impact on behaviour; and associated strategies for managing. This contributes to research surrounding the implications for public health policies on individuals with EDs, especially their ability to reinforce and amplify disordered thoughts and behaviours, and the need for greater consideration of how to minimise impact and potential harm of large public health campaigns.

The impact of COVID-19 certification mandates on the number of cases of and hospitalizations with COVID-19 in the UK: A difference-in-differences analysis.

Mandatory COVID-19 certification, showing proof of vaccination, negative test, or recent infection to access to public venues, was introduced at different times in the four countries of the UK. We aim to study its effects on the incidence of cases and hospital admissions. We performed Negative binomial segmented regression and ARIMA analyses for four countries (England, Northern Ireland, Scotland and Wales), and fitted Difference-in-Differences models to compare the latter three to England, as a negative control group, since it was the last country where COVID-19 certification was introduced. The main outcome was the weekly averaged incidence of COVID-19 cases and hospital admissions. COVID-19 certification led to a decrease in the incidence of cases and hospital admissions in Northern Ireland, as well as in Wales during the second half of November. The same was seen for hospital admissions in Wales and Scotland during October. In Wales the incidence rate of cases in October already had a decreasing tendency, as well as in England, hence a particular impact of COVID-19 certification was less obvious. Method assumptions for the Difference-in-Differences analysis did not hold for Scotland. Additional NBSR and ARIMA models suggest similar results, while also accounting for correlation in the latter. The assessment of the effect in England itself leads one to believe that this intervention might not be strong enough for the Omicron variant, which was prevalent at the time of introduction of COVID-19 certification in the country. Mandatory COVID-19 certification reduced COVID-19 transmission and hospitalizations when Delta predominated in the UK, but lost efficacy when Omicron became the most common variant.

17th Century Protestant Thoughts and the Sermons of the English East India Company

The aim of this article is to show the religious thoughts of the Reformation and its effects in England and how prayer guides and prayers were written for the English East India Company during the 17th century. The religious changes of the Early Modern Era can be found even in the relation of trading companies to religion. Religiousness was very important in that time, not only in the motherland but also on the seas and in foreign lands. Next to theological theories, 17th century sermons, prayers and prayer guides were also consulted in the writing process of this article. Religion and trade did not exclude each other, the contemporaries thought that these mutually helped each other and the merchants were the link that connected the two even more.

Harmonising patient-access programmes: the Dutch DRUG Access Protocol platform.

Over the past decades, many new targeted anticancer drugs have been introduced, and many more are expected to follow. Many of these drugs are only being tested in non-randomised studies, as they target small and newly defined patient populations. This approach is concerning, given that non-randomised studies are susceptible to bias and confounding and there is no consensus on critical appraisal tools or review methodologies. 1 Quigley JM Thompson JC Halfpenny NJ Scott DA Critical appraisal of nonrandomized studies—a review of recommended and commonly used tools. J Eval Clin Pract. 2019; 25: 44-52 Google Scholar Health-care authorities and payers, therefore, often raise concerns about the clinical effectiveness and cost-effectiveness of these therapies, which leads to lengthy dossier evaluation and price negotiations. The DRUG Access Protocol: access inequality and European harmonisationWe commend the initiators of the DRUG Access Protocol (DAP) for their efforts to combine earlier access to medicine with structured data collection.1 Although this is a novel programme in the Netherlands, similar programmes covering compassionate use, evidence generation, and reimbursement are already in effect in England (Early Access to Medicines Scheme) and France (L'Accès Précoce).2,3 The benefits of the DAP in providing conditional reimbursement of registered drugs and thereby creating access are evident. Full-Text PDF The DRUG Access Protocol: access inequality and European harmonisation – Authors' replyWe would like to respond to the comments of Tobias Polak and colleagues on the establishment of the DRUG Access Protocol (DAP) in the Netherlands.1 First, we fully agree that there is a clear, unmet need to systematically collect data and prevent delayed and unequal access to effective drugs; these were the most important reasons for initiating DAP. Therefore, the concerns of Polak and colleagues surprised us. First, DAP is indeed a national solution, simply because each country has its own system for evaluating drugs and reimbursement. Full-Text PDF

1128 Fracture Neck of Femur Patients in The Age of Covid-19

Abstract Aim The current climate of the COVID19 pandemic has forced various changes in the function of Trauma & Orthopaedic department and the management of fracture neck of femur (NOF) patients.We aim to assess the effect of reduced theatre capacity and delayed time to operative management due to the COVID19 outbreak on the 30-day mortality rate of fracture neck of femur (NOF) patients admitted to our trust. Method Retrospective data collection for all patients admitted to a single centre with NOF fractures since lockdown came into effect in England on March 23rd up to July 31st 2020 and the same time frame in 2019. Results During that period 129 patients were admitted with NOF fracture and of those 110 (85%) had outdoor injury and 19 (15%) were care home residents. The mean Length of Stay (LOS) was 8 days. In 2019, 121 patients were admitted, of whom 87 (72%) had outdoor injury and 34 (28%) were care home residents and the mean LOS was 22 days. In 2019 84% of patients went into theatre before 36 hours post-injury while only 70% in 2020. In 2020 8 patients treated conservatively while only 1 patient received conservative management in 2019.In total, during the COVID19 period there were 14 (11%) inpatient deaths, while only 2 (2%) inpatients deaths in 2019. The 30-day mortality rate was similar in both periods. Conclusions Due to COVID19 we noted a significant decrease in length of stay and increase in the conservative management of NOF fractures and inpatient deaths compared to 2019.

INDUSTRIALITATION EFFECTS IN GEORGE ORWELL’S THE ROAD TO WIGAN PIER (1937)

To see industrialization effects in England, this research focused on a literary work of an essay. The book can describe and express what happened in the reality. This research focuses on the book to know Industrialization effects on George Orwell The Road to Wigan Pier. The Road to Wigan Pier written in 1937 tells the experience, notes, and ideas from George Orwell when he walked down the slums area in England. In order to reveal the ideology within the book, this research uses qualitative research to interpret the data. The data were collected through purposive sampling, namely focusing on the data that concerns the industrialization encountered in the elements of the book. As a result, George Orwell divided his work into two parts. The first part content about George Orwell notes when he walked down the slums area in England. He describes slums condition, the lodging that he occupies, the state of miners condition, poverty, and unemployment. In the second part content about George Orwell idea and his critic of industrialization effects and the failure of socialism and his perspective on socialism, his opinion about socialism that the real socialist is people who actively want to see tyranny is destroyed and not only imagine that matters only to want. Keywords: Industrialization; Industrialization effects; socialism

978 Acute Appendicitis in The Age of COVID-19 – How Changing Standards Affect Patient Outcomes

IntroductionThe COVID-19 -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. We aim to assess how these changes affected patient outcomes in comparison to routine practice during the same time frame in 2019.The primary study outcomes are operative intervention, length of stay and hospital re-admission within 30 days.MethodRetrospective data collection for all patients admitted to Ipswich Hospital with suspicion of AA since lockdown came into effect in England on March 23 up to May 10th, 2020 and the same time frame in 2019.Results23 patients were admitted during the lockdown period. 39%(N = 9) were treated conservatively.14 (61%) operatively, of which 71% (N = 10) had open appendicectomy while 29% (N = 4) underwent laparoscopic appendicectomies. The mean Length of Stay(LOS) was 3.83 days. In 2019,21 patients were admitted. 33%(N = 7) were treated conservatively. All appendicectomies were laparoscopic. Mean LOS was 2 days.Re-admission rates were similar in both groups.ConclusionsDue to Covid19 a majority of patients requiring surgery underwent open appendicectomies. We noted a significant increase in both length of stay and progression from non-operative to operative intervention rates compared to 2019. The general case load was similar.

Evaluating the effects of the Licensing Act 2003 on the characteristics of drinking occasions in England and Wales: a theory of change‐guided evaluation of a natural experiment

The Licensing Act 2003 deregulated trading hours in England and Wales. Previous evaluations have focused upon consumption and harm outcomes, finding mixed results. Several evaluations speculated on the reasons for their results, noting the role of changes in the characteristics of drinking occasions. This study aimed to test proposed mechanisms of effect for the Licensing Act 2003 by evaluating changes in characteristics of drinking occasions. Design, Setting and Participants Interrupted monthly time-series analysis of effects in England and Wales versus a Scottish control series, using 2001-08 data collected via 7-day drinking occasions diaries by the market research company Kantar (n=89 192 adults aged 18+). Outcomes were start- and end-time of each reported occasion; variation in finish time; prevalence of pre-loading, post-loading and late-night drinking; and alcohol consumption (in units). After the introduction of the Act, occasions shifted later at night in England and Wales [finish time +11.4minutes; 95% confidence interval (CI)=3.6-19.2]. More occasions involved pre-loading in England and Wales relative to Scotland (0.02% increase; 95% CI=0.01-0.03). There was no evidence of changes in variation in finish time, post-loading, late-night drinking or alcohol consumption. The Licensing Act 2003 in England and Wales appears to have had only limited effects on the characteristics of drinking occasions. This may help to explain its lack of substantial impacts on alcohol harms.

Prosecuting controlling or coercive behaviour in England and Wales: Media reports of a novel offence

The offence of controlling or coercive behaviour came into effect in England and Wales in December 2015, and related offences have since been enacted in Scotland and Ireland. To date, there has been almost no empirical evaluation of the operationalisation of the new English and Welsh offence. This article fills that gap by analysing media reports relating to 107 individuals convicted of controlling or coercive behaviour, providing a profile of offenders and victims (gender and age), the types of abusive behaviours offenders engaged in and how the cases progressed through the criminal justice system (manner of conviction, sentencing outcomes). Media reporting of these cases is also discussed. The results suggest that the offence is (appropriately) operationalised in a highly gendered manner, that it has captured a diverse range of behaviours that would not previously have been considered criminal, and that media reports of this form of domestic violence have not demonstrated the negativity towards victims identified in previous studies. Further research of primary data is required to confirm these findings.

Weekend admissions and mortality for major acute disorders across England and Wales: record linkage cohort studies

BackgroundTo establish which major disorders are susceptible to increased mortality following acute admissions on weekends, compared with week days, and how this may be explained.MethodsCohorts based on national administrative inpatient and mortality data for 14,168,443 hospitalised patients in England and 913,068 in Wales who were admitted for 66 disorders that were associated with at least 200 deaths within 30 days of acute admission. The main outcome measure was the weekend mortality effect (defined as the conventional mortality odds ratio for admissions on weekends compared with week days).ResultsThere were large, statistically significant weekend mortality effects (> 20%) in England for 22 of the 66 conditions and in both countries for 14. These 14 were 4 of 13 cancers (oesophageal, colorectal, lung and lymphomas); 4 of 13 circulatory disorders (angina, abdominal aortic aneurysm, peripheral vascular disease and arterial embolism & thrombosis); one of 8 respiratory disorders (pleural effusion); 2 of 12 gastrointestinal disorders (alcoholic and other liver disease); 2 of 3 ageing-related disorders (Alzheimer’s disease and dementia); none of 7 trauma conditions; and one of 10 other disorders (acute renal failure). Across the disorders, 64% of the variation in weekend mortality effects in England and Wales was explained by reductions in admission rates at weekends and the medical disease category.ConclusionsThe effect of weekend admission on 30 day mortality is seen mainly for cancers, some circulatory disorders, liver disease and a few other conditions which are mainly ageing- or cancer-related. Most of the increased mortality is associated with reduced admission rates at weekends and the medical disease category.

‘Burn it down!’: Materialising intersectional solidarities in the architecture of the South African Embassy during the London Poll Tax Riot, March 1990

This paper offers a new way of conceptualising how intersectional solidarities are actualised. It recounts and theorises an outbreak of radical internationalism, when working class struggles in Britain and South Africa were unexpectedly linked. It examines how intersectional solidarity was materialised through a process of coming together against the architectural fabric of the South African Embassy and considers the interwoven temporalities that enabled this action to occur. On 31 March 1990, nearly a quarter of a million people demonstrated in London against the Poll Tax that was due to take effect in England and Wales the following day. On the day, the Metropolitan Police lost control of an already enraged crowd and provoked a large scale riot that engulfed the West End of London for several hours. In the midst of the riot, during a short retreat by the police, protesters took the opportunity to attack the South African Embassy in Trafalgar Square – many windows were broken and an attempt was made to set the building alight. Drawing on interviews with former anti-apartheid protesters who were present on that day (and who had concluded a four-year long Non-Stop Picket of the embassy a month earlier), this paper explores and analyses their memories of that unexpected moment when their previously symbolic call to ‘burn it down’ was (almost) materialised. In doing so, it contributes new ways of conceptualising the spatiality and temporality of intersectional solidarity.

Rethinking preventing homelessness amongst prison leavers

The Wales (Housing) Act 2015 introduced a preventative approach to addressing homelessness that impacted on prison leavers in Wales. Since the same changes will take effect in England from October 2018, this paper provides early insight into how new preventative duties have been implemented in Wales. Drawing on interviews with 114 stakeholders and 75 prison leavers, we report that the promise associated with a preventative agenda is presently not fully realised. We contend that resettlement activity might be improved if it was better incentivised and facilitated inside the prison wall. However, we also suggest the time has come for more radical options to be pursued to address homelessness amongst prison leavers. We argue against short prison sentences, which are so often causative of homelessness, and for providers of probation services to be better incentivised and resourced to take a more active role in meeting accommodation needs.

The Role of Teacher Regulatory Talk in Students' Self-Regulation Development Across Cultures.

This study is the first to explore the contribution of different types of teacher regulatory talk-directive, guiding, and autonomy supportive talk-in children's development of self-regulation across cultures. Teacher-to-student talk was analyzed under naturalistic conditions in eight Year 4 classrooms, all situated in different primary schools in England (student N=25) and Chile (N=24). Self-regulation was studied by observing students' effective metacognitive monitoring (awareness of errors) and effective metacognitive control (effective control of problems) in a series of 11-13 cube assembly tasks. Mann-Whitney U tests showed that English participants demonstrated higher levels of effective metacognitive monitoring and control, and participating teachers a similar level of teacher regulatory talk across cultures. The function that regulatory talk had in predicting students' self-regulation, however, tended to vary according to culture. OLS multiple regressions revealed that while guiding talk had the same positive effect across cultures, directive talk had a negative effect in England but null effect in Chile, and autonomy supportive talk had a positive effect in Chile but negative in England. These results indicate that it would be valuable to explore further the culturally adaptive functionality of teacher talk for students' self-regulation development.

Online chilling effects in England and Wales

Open and free internet-based platforms are seen as an enabler of global free expression, releasing writers from commercial and space constraints. However, many are working without the assistance of an in-house lawyer, or other legal resources. This may lead to undue suppression of public interest material, with important implications for freedom of expression and the democratic function of media. Two online surveys among digital and online journalists in England and Wales in 2013 indicated that the majority of encounters with defamation and privacy law take place outside the courts, with few formally recorded legal actions. This was particularly evident in a sample of ‘hyperlocal’ and local community publishers. In light of the results, this paper calls for a reappraisal of overly simplistic judicial and media applications of the ‘chilling effect’ doctrine, in order to expose its subjectivities and complexities. Additionally, attention needs to be paid to global and cross-jurisdictional media-legal environments, in order to help develop better internet policy and legal frameworks for protecting legitimate expression.

HDM-4 adaptation for strategic analysis of UK local roads

The UK Department for Transport is concerned to know that long-term investments in maintenance of local roads are contributing optimally to the UK economy, and that road maintenance funds are distributed equitably and provide value for money for the taxpayer. This quest can be accomplished by using decision support tools capable of predicting the long-term performance and costs of maintenance of the UK local road network. This paper describes the development of the World Bank's highway development and management model HDM-4 for use by the Department for Transport at the strategic level. This involved adaptation and calibration of HDM-4 to accurately model pavement performance and road user effects in England, linking HDM-4 with the existing database system used by the Department for Transport in order to facilitate strategic level analysis and investigation of road investment choices, and conducting a trial strategy analysis of the English local road network to quantify long-term maintenance needs and assess the effects of different maintenance funding levels on the condition of the network and costs to road users. The strategic analysis derived optimal capital and recurrent maintenance needs to clear existing maintenance backlogs and thereafter keep the road network in good condition on a sustainable basis.

How local housing can unlock lasting health and care

PurposeThis paper seeks to suggest that social housing can and should be the local hub for cost‐effective, human‐scale health and wellbeing. It aims to explore the way that community‐based housing providers can help health and social care services to deliver long‐term wellbeing.Design/methodology/approachThe argument is illustrated with examples of constructive practice drawn from membership of the PlaceShapers Group of housing associations, across different parts of England.FindingsLocalism and promotion of public health lie at the roots of social housing, dating back more than 150 years. Because of their physical stake and presence in communities, social landlords are able to offer combined homes and support in a way and on a scale that few private operators can match. So social housing providers are in a prime position to add value and recast the relationship between health, wellbeing, social care and housing. But social housing organisations and their leaders will need to be highly inventive, enterprising and determined to reap the full rewards for service users and neighbourhoods.Practical implicationsChanges to the health, wellbeing and social care landscape, coming into effect in England and Wales from April 2013, present a unique opportunity to bridge the “parallel worlds” of housing and health. Local housing providers now have the chance to bond their long‐term presence, commitment and investment in communities to the new outcomes required for health and social care.Originality/valueThe lead author is chair of a grouping of community‐based housing associations working throughout England and is especially well placed to identify examples of innovative practice, such as those described in the paper.

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Doing it for the money?

From September the new School Teachers' Appraisal Regulations will come into effect in England. With Ofsted's interest in performance management, has the time for a new system of rewarding teachers arrived?

Sentencing drug offenders under the 2003 Criminal Justice Act: Challenges for the probation service

For the most part the 2003 Criminal Justice Act, which came into effect in England and Wales in April 2005, was accepted by the probation service with relatively little opposition. Given the enormity of its impact acquiescence to this degree of change ought to come as something of a surprise. The 2003 Act changed fundamentally the nature of community supervision, it brought to an end the traditional range of non-custodial penalties and replaced them with a single community order to which sentencers could add any of 12 possible requirements. This article considers the impact of the 2003 legislation on one particular offender group – drug misusers. Drug misusing offenders have the potential to pose serious difficulties for probation officers; the habitual nature of drug addiction and a tendency towards an irregular lifestyle make drug misusers particularly susceptible to breach. Under the new legislation courts have significantly fewer options available to them when responding to incidents of offender non-compliance. This article argues that many of the provisions of the 2003 Act together with developments elsewhere in the UK are likely to have impacted disproportionately on those groups whose lifestyles are chaotic and whose routines are incompatible with the terms and conditions of modern day probation practice. It concludes that greater flexibility towards non-compliance, supported by regular and consistent judicial review, would encourage improved rates of compliance and retention in treatment and improved outcomes for offenders.