English Health Research Articles

Between coercion, conditionality and abandonment: A descriptive analysis of English mental health spending and provision under austerity

While critical scholarship has demonstrated the harmful effects of austerity on public mental health, relatively little attention has been paid to austerity’s impacts on health services themselves. In response, this paper develops a descriptive analysis of mental health spending and provision in England during the austerity period, from 2009–10 to 2019–20. It examines spending patterns at the national and local level, highlighting a major growth in funding that has been overlooked by prior studies. Then it interrogates national trends in mental health provisioning, utilisation and treatment. The paper argues that austerity has divergent impacts on localities which are best understood as multiple localised austerities. Meanwhile, the overall mental health service landscape under austerity is characterised by three trends, all of which have the potential to harm public health. Inpatient services are utilising more coercion; community services are increasingly conditionalised; and a significant population – too ill for work but judged too healthy for treatment – has been abandoned by services. For critical scholars and practitioners of public health, these findings highlight the complexity of the political, economic and institutional dynamics which distribute spending cuts and therefore mediate austerity’s effects on health.

Biomechanics intervention promotes college students’ English vocabulary acquisition and mental health

The ability to access and use vocabulary effectively is critical to academic performance. Strong English vocabulary is important for college students because they will not only understand course material but also engage in discussion and writing activities, and interact with colleagues and teachers. However, the word order learning can be difficult, often leading to dissatisfaction and decreased desire students. The effectiveness of biomechanical intervention college students improves their mental health and develop vocabulary in English. A total of 145 college students participated in this study. Participants were randomly assigned to group A, which received a biomechanics-based exercise program, and group B, which received a traditional physical activity (PA) program. Participants completed validated questionnaires to measure mental health indicators, including anxiety, stress, and overall well-being. The questionnaires used included the Perceived Stress Scale (PSS), a well-established tool in psychological research. This research conducted tests that assessed various aspects of vocabulary knowledge, including word recognition, meaning, and usage in context. The data was analyzed using statistical methods, including descriptive statistics, t-tests, and regression analysis. ANOVA was to analyze connections between two groups. The data was analyzed using SPSS version 29 software. The results showed that it significantly improved English vocabulary acquisition and cognition health in Group A. These students also reported well, if low, mental health levels of stress and anxiety increased well-being in general. This study emphasizes biomechanics, which can be incorporated into language learning, showing increased PA. Vocabulary acquisition and positively influence mental health. The results showed that significantly improved English vocabulary acquisition and cognition health in Group A. These students also reported good, if low, mental health levels of stress and anxiety and increased well-being in general.

Understanding and Assisting the Recovery of Non-English-Speaking Trauma Survivors: Assessment of the NESTS Pathway.

Spanish-speaking trauma and burn patients have unique needs in their post-discharge care navigation. The confluence of limited English proficiency, injury recovery, mental health, socioeconomic disadvantages, and acute stressors following hospital admission converge to enhance patients' vulnerability, but their specific needs and means of meeting these needs have not been well described. This prospective, cross-sectional survey study describes the results of a multi-institutional initiative devised to help Spanish-speaking trauma and burn patients in their care navigation after hospitalization. The pathway consisted of informational resources, intake and follow up surveys, and multiple points of contact with a community health worker who aids in accessing community resources and navigating the healthcare system. From January 2022-November 2023, there were 114 patients identified as eligible for the NESTS pathway. Of these, 80 (70.2%) were reachable and consented to participate, and 68 of these patients were approached in person during their initial hospitalization. After initial screening, 60 (75.0%) of the eligible patients had a mental health, social services, or other need identified via our survey instrument. During the initial consultation with the CHW, 48 of the 60 patients with any identified need were connected to a resource (80%). Food support was the most prevalent need (N=46, 57.5%). More patients were connected to mental health resources (N=16) than reported need in this domain (N=7). The NESTS pathway identified the specific needs of Spanish-speaking trauma and burn patients in their recovery, notably food, transportation, and utilities. The pathway also addressed disparities in post-discharge care by connecting patients with community resources, with particular improvement in access to mental healthcare.

Physical culture, posing, and the medium of fitness magazines

ABSTRACT Physical culture describes a new socio-political interest in physical activity which emerged in the late nineteenth century and became a global phenomenon. Physical culture was concerned with the ‘commercial and ideological cultivation of the body’, as made manifest in gymnasium and keep fit cultures. This paper focuses specifically on physical culture magazines, which began to be sold with regularity in North America and Europe from the late 1890s, and contributed to the movement’s spread in this period. Publications relied on a reciprocal relationship with their readers to craft their content and remain financially viable. Reader-submitted content, be it images or letters, helped these magazines shape the practices and values of physical culturists. Critically, many of these magazines were transnational in nature, republishing articles and images from other publications and from readers across the world. This article is driven by a two-pronged argument: first, that magazine cover images helped to implicitly inform ways of presenting the male body. Second, that this was a transnational phenomenon. The article discusses the rise of physical culture in Europe before examining two popular physical culture magazines from the early twentieth century, the French magazine La Culture Physique and the English magazine Health and Strength. Using examples of cover images and reader submissions to these two publications, the article demonstrates how the growing mediums of physical culture magazines and photography provided crucial avenues for countless men around the world to re-evaluate their relationships with their bodies.

The impact of COVID-19 vaccination on patients with congenital heart disease in England: a case-control study

BackgroundStudies predating widespread COVID-19 vaccination identified patients with congenital heart disease (CHD) as a group at increased risk of severe outcomes from COVID-19. Here we evaluate the impact of vaccination...

Impacts of the COVID-19 pandemic on deprivation-level differences in cardiovascular hospitalisations: a comparison of England and Denmark using the OpenSAFELY platform and National Registry Data

ObjectivesTo examine the impact of the COVID-19 pandemic on deprivation-related inequalities in hospitalisations for cardiovascular disease (CVD) conditions in Denmark and England between March 2018 and December 2021.DesignTime-series studies in...

Trends in Pediatric Hospital Admissions Caused or Contributed by SARS-CoV-2 Infection in England

To investigate the changing characteristics of SARS-CoV-2 related pediatric hospital admissions over time. A national, observational cohort study from 1, July 2020, to August 31, 2023, using English population-linked electronic health records. We identified 45,203 children under 18 years old in whom SARS-CoV-2 either caused or contributed to hospitalization, excluding those admitted with "incidental" infection. Studied outcomes were types of hospitalization and severe hospitalizations involving either critical care or PIMS-TS. There were 45,920 SARS-CoV-2 related hospitalizations in children: 34,870 (75.9%) due to COVID-19; 1,845 (4.0%) due to pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS); 8,330 (18.1%) with SARS-CoV-2 as contributor to admission; and 875 (1.9%) acquired nosocomial SARS-CoV-2 infection. The most notable changes between the first three waves (March 2020 through November 2021) and the omicron era (December 2021 onwards) were: a fall in PIMS-TS from 1,575 of 14,020 (11.2%) to 270 of 31,905 (0.8%); a reduction in critical care use from 1,175 of 14,020 (8.4%) to 1,390 of 31,905 (4.4%); a fall in mortality rate among those hospitalized from 521 per 100,000 to 249 per 100,000; and a drop in the median age of hospitalized children from 4.7 (IQR 0.6,12.3) to 1.1 (IQR 0.3,6.4) years. Of children hospitalized, infants, 10.2% of whom had a recorded underlying health condition, comprised 4,225 of 14,020 (30.1%) admissions 2020 through 2021 and 15,555 of 31,900 (48.8%) since 2022. (p<0.001 for all comparisons). Infants are now the most affected age group by SARS-CoV2, at least partially related to having the least immunity to the virus, and are most vulnerable to respiratory illnesses.

Cross-cultural adaptation of the writer-reader relationship in non-translated and translated English health information websites on HIV and TB diagnostic testing

The ideal multilingual health information website is relatable to all readers. Natives and immigrants should have a culturally adapted website in their language hosted by their place of residence that imparts the facts and incites a call to action to improve health, and ultimately reduces disease in the diverse community. The writer’s word choices and attitude as conveyed through the text influence the reader’s decision-making process. This paper will examine the differences between the non-translated and translated English versions of multilingual health information websites on HIV and TB diagnostic testing. These samples pertain to a large interdisciplinary study whose purpose is to determine whether the multilingual health communication websites are appropriately written regarding health literacy, and whether each cultural population, in terms of language adaptation, would receive the health information as intended. The study questions whether there exist differences between the translated and non-translated texts in English, Spanish and Catalan; this paper focuses on the two English sub-corpora. A comparable corpus of seventy-three multilingual health information websites underwent a quantitative and a qualitative analysis. The methodology is based on adaptations of Clerehan et al.’s (2005) Evaluative Linguistic Framework to assess the writer-reader relationship. The findings show statistically significant differences between the two English subcorpora as regards the writers’ and translators’ approach; the non-translated English sub-corpus contained more relational and engagement markers, whereas the translated English sub-corpus had more persuasion markers. These results should serve researchers and professionals in the translation and language sciences as well as the public health field for, respectively, future studies and techniques to improve the composition of multilingual health information texts in culturally diverse countries.

Ongoing Decline in Continuity With GPs in English General Practices: A Longitudinal Study Across the COVID-19 Pandemic.

Relationship continuity of care has declined across English primary health care, with cross-sectional and longitudinal variations between general practices predicted by population and service factors. We aimed to describe cross-sectional and longitudinal variations across the COVID-19 pandemic and determine whether practice factors predicted the variations. We conducted a longitudinal, ecological study of English general practices during 2018-2022 with continuity data, excluding practices with fewer than 750 patients or National Health Service (NHS) payments exceeding £500 per patient. Variables were derived from published data. The continuity measure was the product of weighted responses to 2 General Practice Patient Survey questions. In a multilevel mixed-effects model, the fixed effects were 11 variables' interactions with time: baseline continuity, NHS region, deprivation, location, percentage White ethnicity, list size, general practitioner and nurse numbers, contract type, NHS payments per patient, and percentage of patients seen on the same day as booking. The random effects were practices. Main analyses were based on 6,010 practices (out of 7,190 active practices). During 2018-2022, mean continuity in these practices declined (from 29.3% to 19.0%) and the coefficient of variation across practices increased (from 48.1% to 63.6%). Both slopes were steepest between 2021 and 2022. Practices having more general practitioners and higher percentages of patients seen the same day had slower declines. Practices having higher baseline continuity, located in certain non-London regions, and having higher percentages of White patients had faster declines. The remaining variables were not predictors. Variables potentially associated with greater appointment availability predicted slower declines in continuity, with worsening declines and relative variability immediately after the COVID-19 lockdown, possibly reflecting surges in demand. To achieve better levels of continuity for those seeking it, practices can increase appointment availability within appointment systems that prioritize continuity.Annals Early Access article.

Английские эвфемизмы на тему здоровья и болезни

Euphemisms for disease created by means of abbreviation and rhyming slang reflect new capabilities of euphemisms. This research is relevant since such euphemisms are widely used and require a more detailed examination. The article aimed to identify some synonymous euphemistic and dysphemistic names from the arsenal of communicatively correct expressions on the topic of health and illness in English, as well as to provide a sociocultural commentary on euphemisms in the form of rhyming slang and abbreviations characterizing two deadly diseases – cancer and AIDS – and such an unpleasant ailment as haemorrhoids. The key research method used here is descriptive, implemented in the techniques of systematization, generalization and interpretation of language material. The linguistic methods include contextual analysis and semantic interpretation. The topic of health and disease is represented by examples of euphemisms and dysphemisms selected from authoritative dictionaries of euphemisms and general and rhyming slang, as well as English-language fiction. Euphemisms and dysphemisms serve as an effective way to overcome taboos; they are used to smooth out unpleasant moments and “cover up” sensitive issues for the interlocutor, provided that the exact meaning of the statement can be guessed. In particular, the author selected euphemisms for cancer, AIDS and haemorrhoids in the form of rhyming slang and abbreviation since they had been overlooked by specialists in English euphemisms, which brings an element of novelty to the study of modern English euphemisms. Euphemisms associated with rhyming slang in Englishspeaking countries constitute a promising area of research. The main points and conclusions of this paper can be used when discussing euphemisms during lectures and seminars on the theory of language, lexicology, stylistics, text interpretation, and cross-cultural communication.

Sexual Safety in English mental health in-patient beds: has nothing been learned?

All mental health Trusts in England were surveyed, using freedom of Information Requests, as part of an enquiry into sexual safety incidents. A response rate of 72 % was obtained. Results revealed that sexual safety incidents and mixed-sex ward breaches are both increasing. Very few Trusts are adhering to the national guidance on sexual safety standards. Only one audit of safety standards was provided with full data. The Minister of Health has ordered an enquiry by the Health Services Safety Investigation Board with findings to be reported in 12 months’ time. We argue more urgent action is needed now.

Navigating the pandemic: an exploration of health behavioral dynamics among Asian Americans during COVID-19

The COVID-19 pandemic brought Asian Americans sharply into focus, revealing both the strengths and vulnerabilities within this community. Despite a myriad of studies on their experiences and health disparities during the outbreak, gaps persist in our understanding of their health literacy, beliefs, and healthcare behaviors. Leveraging the snowball sampling method, our study engaged 20 diverse Asian Americans, delving into facets ranging from English proficiency and health literacy to cultural health beliefs and preventive behaviors. Notably, participants exhibited high English proficiency and health literacy. Their health choices, shaped by their Asian heritage, showcased a proactive approach to combating COVID-19. Most did not defer or sidestep healthcare, underlining their commitment to well-being. These insights underscore the resilience and adaptability of the Asian American community. By decoding their health behaviors and beliefs, our study aims to refine public health strategies, ensuring they resonate not just with Asian Americans but potentially with other ethnic cohorts amidst global health crises.

The impact of the English national health inequalities strategy on inequalities in mortality at age 65: a time-trend analysis.

During the 1997-2010 Labour government, several policies were implemented to narrow health inequalities as part of a national health inequalities strategy. Many of these policies are likely to have had a disproportionately large impact on people aged 65 and over. We aimed to understand the association between the health inequalities strategy period and inequalities in mortality at age 65-69. We use population at risk and mortality data covering 1991-2019 to calculate mortality rate at age 65-69 at the Local Authority level. We use the 2019 Index of Multiple Deprivation to examine geographical inequalities. We employ segmented linear regression models with marginal spline terms for the strategy period and interact these with an indicator of deprivation to understand how inequalities changed before, during and after the strategy. The reporting of this study adheres to STROBE guidelines. Mortality rates in each deprivation quintile improved continuously throughout the period of study. Prior to the programme (1991-9) there was no significant change in absolute inequalities. However, during the strategy (2000-10) there was a significant decrease in absolute inequalities of -9.66 (-17.48 to -1.84). The period following the strategy (2011-19) was associated with a significant increase in absolute inequalities of 12.84 (6.60 to 19.08). Our results were robust to a range of sensitivity tests. The English health inequalities strategy was associated with a significant reduction in absolute inequality in mortality age 65-69. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach.

Linguistic variation, Philippine English and mental health issues

AbstractThis article is a study of how Filipinos talk about their depression and recovery in Philippine English, as compared to how users from other Englishes talk about their experiences with the same illness. As such, this is an attempt at examining what contextual factors give rise to variations in Englishes. World Englishes research has posited that different geographical and cultural contexts engender ‘new’ Englishes; hence, different Englishes are named via country or culture and are considered to be distinct from each other. This article is concerned with the issue of how contexts of use, such as depression, can lead to systemic changes in the English that different individuals use. This study extends research on how particular discursive features may characterize one variety of English as compared to another by examing how ideational and interpersonal meanings relate to construe a ‘world’ of depression in Philippine English and Inner Circle Englishes.

Digital Health Education for the Future: The SaNuRN (Santé Numérique Rouen-Nice) Consortium's Journey.

SaNuRN is a five-year project by the University of Rouen Normandy (URN) and the Côte d’Azur University (CAU) consortium to optimize digital health education for medical and paramedical students, professionals, and administrators. The project includes a skills framework, training modules, and teaching resources. In 2027, SaNuRN is expected to train a significant portion of the 400,000 health and paramedical professions students at the French national level. Our purpose is to give a synopsis of the SaNuRN initiative, emphasizing its novel educational methods and how they will enhance the delivery of digital health education. Our goals include showcasing SaNuRN as a comprehensive program consisting of a proficiency framework, instructional modules, and educational materials and explaining how SaNuRN is implemented in the participating academic institutions. SaNuRN is a project aimed at educating and training health-related and paramedics students in digital health. The project results from a cooperative effort between URN and CAU, covering four French departments. The project is based on the French National Referential on Digital Health (FNRDH), which defines the skills and competencies to be acquired and validated by every student in the health, paramedical, and social professions curricula. The SaNuRN team is currently adapting the existing URN and CAU syllabi to FNRDH and developing short-duration video capsules of 20 to 30 minutes to teach all the relevant material. The project aims to ensure that the largest student population earns the necessary skills, and it has developed a two-tier system involving facilitators who will enable the efficient expansion of the project’s educational outreach and support the students in learning the needed material efficiently. With a focus on real-world scenarios and innovative teaching activities integrating telemedicine devices and virtual professionals, SaNuRN is committed to enabling continuous learning for healthcare professionals in clinical practice. The SaNuRN team introduced new ways of evaluating healthcare professionals by shifting from a knowledge-based to a competencies-based evaluation, aligning with the Miller teaching pyramid and using the Objective Structured Clinical Examination and Script Concordance Test in digital health education. Drawing on the expertise of URN, CAU, and their public health and digital research laboratories and partners, the SaNuRN project represents a platform for continuous innovation, including telemedicine training and living labs with virtual and interactive professional activities. The SaNuRN project provides a comprehensive, personalized 30-hour training package for health and paramedical students, addressing all 70 FNRDH competencies. The program is enhanced using AI and NLP to create virtual patients and professionals for digital healthcare simulation. SaNuRN teaching materials are open-access. The project collaborates with academic institutions worldwide to develop educational material in digital health in English and multilingual formats. SaNuRN offers a practical and persuasive training approach to meet the current digital health education requirements.

Mechanisms of mental illness anti-stigma messaging matter: Leveraging mental health communication inequities among Latinx populations to understand what works and what we can do better

BackgroundSince 1950, public communication about the neurobiological-psychosocial basis of mental illness from the diathesis-stress model has promoted reception to treatment yet violent/dangerous stereotypes have increased during this period. Moreover, public mental health communication efforts have predominantly diffused in English-language media, excluding Spanish/Latinx media and its consumers from these efforts. To inform future mental health communication strategies, this study leverages high versus low diffusion of public mental health communication across English and Spanish/Latinx media to examine public mental health communication effects on stigma and treatment beliefs via neurobiological-psychosocial beliefs. MethodsA quota sample of 2058 U.S.-based Latinx residents ages 13–86 with diverse language/cultural media preferences was recruited to self-complete a survey about mental health information acquisition in 2021. Assessments ascertained frequency of Spanish/Latinx and English media use and mental health content scanning and seeking (α = 0.86–0.94); and items from the General Social Survey about mental illness neurobiological-psychosocial causal beliefs (α = 0.72)—genetics, brain chemistry, environment, stress; treatment beliefs—mental illness improves with treatment or on its own; and stigma beliefs—violent/dangerous and bad character stereotypes and unwillingness to socialize with a person with mental illness. Structural equation models estimated total, direct, and indirect effects of Spanish/Latinx and English media exposures on treatment and stigma beliefs via neurobiological-psychosocial beliefs, net individual/family factors. ResultsSpanish/Latinx media reduced, while English media increased, neurobiological-psychosocial beliefs (p < 0.01). Neurobiological-psychosocial beliefs, in turn, increased treatment and stigma beliefs (p < 0.01), simultaneously. Indirect pathways were also significant (p < 0.05). Proportion mediated on treatment beliefs was one-third for Spanish/Latinx and two-thirds for English media. Proportion mediated on stigma beliefs for all media exposures averaged ≥1. ConclusionsWhile consumers of Spanish/Latinx media report lower neurobiological-psychosocial knowledge that impedes treatment beliefs, consumers of English media report greater neurobiological-psychosocial and treatment knowledge and, consequently, more stigma. Innovation in public mental health communication is needed to counter stigma and health inequity.

Abstract 810: Assessing human papillomavirus (HPV) awareness and intentions to participate in HPV vaccination and clinical trials (CT) among Latinos/as in Los Angeles (LA) County: A multicomponent intervention

Abstract Background: The incidence of HPV-related cancers continues to disproportionately affect women and men of Latino origin. In LA, a total of 20,868 individuals have been diagnosed with HPV-related cancers from 2009 to 2019. HPV infection knowledge and interpersonal barriers contribute to HPV vaccine delay and refusal. Similarly, Latinos/as continue to also have low participation in clinical trials research. To address the low knowledge, attitudes, and intentions towards HPV vaccination and participation in clinical trials (CT), we have adopted the NCI National Outreach Network framework and have used community health educators to deliver bilingual-culturally appropriate workshops on HPV and CT. Methods: Individuals, 18 and over and parents with eligible age children (in respect to the HPV initiative) were recruited through community outreach and local community partnerships to participate in the bilingual (English and Spanish) health education workshops. A baseline assessment was administered before each educational workshop and a follow-up assessment was administered after to evaluate change in HPV and CT knowledge, intentions to vaccinate, and likelihood to participate in CT. Descriptive statistics were calculated to assess distribution of demographic variables of interest and a paired T-test was used to explore matched pre-post differences in knowledge scores and intentions. Results: 290 (HPV) 272 (CT) individuals participated in the workshops. The mean age of participants was 41.13yrs with a (SD=11.63). More than half of participants were women 453 (81.7%), men 94 (16.9%) and other 7 (1.26%). Comparing HPV knowledge scores of matched pre-and post-surveys, showed that for baseline (n=182) (M=72.9%, SD=13.3) was statistically different from post-scores (n=182) (M=81%, SD=9.85) where p&amp;lt;0.05. Intentions were measured using a Likert scale, baseline (M=4.1), agree to get HPV vaccine, post (M=4.5) strongly agree to get HPV vaccine. In respect to CT baseline knowledge (n=174) (M=75.3%, SD=0.15), following a Likert scale response of (M=3.4), unsure to join a clinic trial. In assessing post-CT scores (N=174) (M=78%, SD:0.14), mean scores were significant where p&amp;lt;0.05 and an increase to (M=3.7) agree to join a clinical trial. After workshops attendance, not only was knowledge increased, but intentions to vaccinate against HPV and to participate in a clinical trial was strengthen. Conclusions: Strengthening community-based education and providing the necessary tools, can help reframe misconceptions about HPV and HPV vaccination and promote willingness to vaccinate and participate in clinical trials. Citation Format: Alejandra Ramos, Carolina Aristizabal, Lourdes A. Baezconde-Garbanati. Assessing human papillomavirus (HPV) awareness and intentions to participate in HPV vaccination and clinical trials (CT) among Latinos/as in Los Angeles (LA) County: A multicomponent intervention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 810.

Implementing the English health inequalities agenda: addressing challenges to person-level, cross-sectoral data linkage, access and routine use for local authority public health.

Local authorities are central to the implementation of English Integrated Care Systems' health inequalities agendas, embedding public health into population health management planning. They work with partners to deliver a range of 'health determinant' services and facilities for people in a defined geographic area. This work is substantially premised on the use of cross-sectoral data that is linked at the individual level, readily available, longitudinal and contemporaneous. However, multiple challenges exist to such data availability. This paper elaborates upon these challenges to local authority public health systems and their potential solutions.

Risk of fractures in half a million survivors of 20 cancers: a population-based matched cohort study using linked English electronic health records

A history of multiple myeloma, prostate cancer, and breast cancer has been associated with adverse bone health, but associations across a broader range of cancers are unclear. We aimed to compare the risk of any bone fracture and major osteoporotic fractures in survivors of a wide range of cancers versus cancer-free individuals. In this population-based matched cohort study, we used electronic health records from the UK Clinical Practice Research Datalink linked to hospital data. We included adults (aged ≥18 years) eligible for linkage, and we restricted the study start to Jan 2, 1998, onwards and applied administrative censoring on Jan 31, 2020. The cancer survivor group included survivors of the 20 most common cancers. Each individual with cancer was matched (age, sex, and general practice) to up to five controls (1:5) who were cancer-free. The primary outcomes were any bone fracture and any major osteoporotic fracture (pelvic, hip, wrist, spine, or proximal humeral fractures) occurring more than 1 year after index date (ie, the diagnosis date of the matched individual with cancer). We used Cox regression models, adjusted for shared risk factors, to estimate associations between cancer survivorship and bone fractures. 578 160 adults with cancer diagnosed in 1998-2020 were matched to 3 226 404 cancer-free individuals. Crude incidence rates of fractures in cancer survivors ranged between 8·39 cases (95% CI 7·45-9·46) per 1000 person-years for thyroid cancer and 21·62 cases (20·18-23·18) per 1000 person-years for multiple myeloma. Compared with cancer-free individuals, the risk of any bone fracture was increased in 15 of 20 cancers, and of major osteoporotic fractures in 17 of 20 cancers. Effect sizes varied: adjusted hazard ratios (HRs) were largest for multiple myeloma (1·94, 95% CI 1·77-2·13) and prostate cancer (1·43, 1·39-1·47); HRs in the range 1·20-1·50 were seen for stomach, liver, pancreas, lung, breast, kidney, and CNS cancers; smaller associations (HR <1·20) were observed for malignant melanoma, non-Hodgkin lymphoma, leukaemia, and oesophageal, colorectal, and cervical cancers. Increased risks of major osteoporotic fracture were noted most substantially in multiple myeloma (2·25, 1·96-2·58) and CNS (2·12, 1·56-2·87), liver (1·62, 1·01-2·61), prostate (1·60, 1·53-1·67), and lung cancers (1·60, 1·44-1·77). Effect sizes tended to reduce over time since diagnosis but remained elevated for more than 5 years in several cancers, such as multiple myeloma and stomach, lung, breast, prostate, and CNS cancers. Survivors of most types of cancer were at increased risk of bone fracture for several years after cancer, with variation by cancer type. These findings can help to inform mitigation and prevention strategies. Wellcome Trust.

Factors influencing public health engagement in alcohol licensing in England and Scotland including legal and structural differences: comparative interview analysis.

Greater availability of alcohol is associated with higher consumption and harms. The legal systems, by which premises are licensed to sell alcohol in England and Scotland, differ in several ways. The 'Exploring the impact of alcohol licensing in England and Scotland' study measured public health team activity regarding alcohol licensing from 2012 to 2019 and identified seven differences between England and Scotland in the timing and type of activities undertaken. To qualitatively describe the seven previously identified differences between Scotland and England in public health approaches to alcohol licensing, and to examine, from the perspective of public health professionals, what factors may explain these differences. Ninety-four interviews were conducted with 52 professionals from 14 English and 6 Scottish public health teams selected for diversity who had been actively engaging with alcohol licensing. Interviews focused primarily on the nature of their engagement (n = 66) and their rationale for the approaches taken (n = 28). Interview data were analysed thematically using NVivo. Findings were constructed by discussion across the research team, to describe and explain the differences in practice found. Diverse legal, practical and other factors appeared to explain the seven differences. (1) Earlier engagement in licensing by Scottish public health teams in 2012-3 may have arisen from differences in the timing of legislative changes giving public health a statutory role and support from Alcohol Focus Scotland. (2) Public Health England provided significant support from 2014 in England, contributing to an increase in activity from that point. (3) Renewals of statements of licensing policy were required more frequently in Scotland and at the same time for all Licensing Boards, probably explaining greater focus on policy in Scotland. (4) Organisational structures in Scotland, with public health stakeholders spread across several organisations, likely explained greater involvement of senior leaders there. (5) Without a public health objective for licensing, English public health teams felt less confident about making objections to licence applications without other stakeholders such as the police, and instead commonly negotiated conditions on licences with applicants. In contrast, Scottish public health teams felt any direct contact with applicants was inappropriate due to conflicts of interest. (6) With the public health objective in Scotland, public health teams there were more active in making independent objections to licence applications. Further in Scotland, licensing committee meetings are held to consider all new applications regardless of whether objections have been submitted; unlike in England where there was a greater incentive to resolve objections, because then a meeting was not required. (7) Finally, Scottish public health teams involved the public more in licensing process, partly because of statutory licensing forums there. The alcohol premises licensing systems in England and Scotland differ in important ways including and beyond the lack of a public health objective for licensing in England. These and other differences, including support of national and local bodies, have shaped opportunities for, and the nature of, public health engagement. Further research could examine the relative success of the approaches taken by public health teams and how temporary increases in availability are handled in the two licensing systems. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Reseacrh programme as award number 15/129/11.