English Regions Research Articles

The impact of COVID-19 and associated public health restrictions on trends in police-recorded violence in an English police force area

BackgroundThe COVID-19 pandemic, and associated public health measures, had a marked impact on a number of health and wellbeing outcomes, including alcohol use and violence. Current literature presents a mixed view of the impact of the pandemic on violence trends. The current study utilises police offence data from a region of northern England to examine the impact of lockdowns, and subsequent relaxation of restrictions, on trends in violent offences.MethodsTime series analyses using seasonal auto-regressive integrated moving average (SARIMA) modelling was used to investigate the impacts of the COVID-19 public health measures on weekly offence trends from April 1 2018 to March 20 2021. Additionally, pre-pandemic data were used to forecast expected trends had the pandemic not occurred. These expected trends were then compared to actual data to determine if the average levels of violence were outside the forecasted expectations. Overall violence and six subtypes (violence with and without injury, sexual offences including rape, domestic violence, and alcohol-related violent offences) were examined.ResultsOverall, the observed trend in police recorded violent offences demonstrated fluctuating patterns in line with commencement and easing of public health restrictions. That is, offence numbers declined during lockdowns and increased after relaxation of restrictions. However, the majority of observed values fell within the expected range. This broad pattern was also found for subtypes of violent offences.ConclusionsWhile violent crime trends demonstrated fluctuations with lockdowns, and subsequent easing of restrictions, these changes were not demonstrably larger than expected trends within this English region, suggesting that a sustained amplification in violence was not observed within this data. However, it is important to acknowledge the high levels of violence reported in this region across the study period, which should be used as a key driver for investing in long-term approaches to violence prevention. Given the extent of unreported violence generally, and that victims/survivors may come into contact with other support services (without reporting to the police), it is vital that policy and practice decisions take a holistic approach, considering a broad range of data sources.

Why are there higher rates of children looked after in Wales?

PurposeThe purpose of this paper is to consider some possible reasons for the relatively high rate in Wales of children looked after by local authorities.Design/methodology/approachSelected potential explanations for Wales having higher rates were tested against aggregate data from published 2021 Government statistics. Wales was compared with England and English regions for area deprivation, local authority spending, placements at home and kinship foster care. Descriptive statistics were produced, and linear regression was used where appropriate.FindingsWales has higher overall children looked-after rates and a bigger recent increase in these than any English region. Deprivation in Wales was higher than in most English regions. However, a smaller percentage of Welsh variation in local authority looked-after rates was explained by deprivation than was the case for England. Spending on preventative services has increased in recent years in Wales whilst decreasing in England, and there was not a clear relationship between spending on preventative services and the looked-after rate. Wales had a higher rate of care orders placed at home and more children per head of population in kinship foster care than any English region. Some of the explanations that have been suggested for Wales’s particularly high looked-after rates seem to be supported by the evidence from aggregate data and others do not. Practice variation is likely to also be an important part of the picture.Originality/valueThis is an original comparison of Wales, England and English regions using aggregate data. More fine-grained analysis is needed using individual-level data, multivariate analysis and qualitative methods.

FRI-165 - A modelling study of the impact of scaling up of HCV case finding and treatment for people who inject drugs in English region of Bristol and Severn

FRI-165 - A modelling study of the impact of scaling up of HCV case finding and treatment for people who inject drugs in English region of Bristol and Severn

The VP in language contact: on creation event lexicalization in Canadian French

Abstract The effects of language contact on semantic and syntactic properties of verbs can be considered as not yet extensively studied. This contribution is concerned with French as a typical verb-framed language that cannot freely combine manner verbs with result-denoting arguments within the VP. Drawing on creation events, the study explores if restrictions can loosen, and lexicalization preferences change when French is in contact to a satellite-framed language like English. Judgment data from bilingual speakers of Canadian French (CaFr) are compared to data from speakers of Hexagonal French (HFr). The analysis addresses how selective copying from English is relevant for the acceptability of different VPs and considers how the factors of individual and social language dominance might influence the judgments within the CaFr group. The results show that French manner verbs and direct objects can be coerced into creation readings in both test groups as long as only the selectional restrictions of a particular verb have to be adapted. When, however, a general constraint of French has to be overridden to arrive at a creation reading, acceptability is higher in the CaFr group, who can resort to combinatorial copying from English. Furthermore, VPs in which manner is not lexicalized in the verb are somewhat more accepted in the HFr group than in the CaFr group. Within the CaFr group, certain cases of satellite framing are judged somewhat better by speakers from an English dominant region, while VPs without a manner verb reach slightly higher scores among speakers from Quebec. It is thus shown how structural and speaker-related factors can affect the acceptability of event descriptions in language contact.

Self-harm in university students: A comparative analysis of data from the Multicentre Study of Self-harm in England

BackgroundIncreases in poor mental health and suicide have been identified among university students in the UK. However, little is known about self-harm in this group. AimsTo describe and identify care needs of university aged-students who self-harm via comparisons with an age-equivalent non-student group who self-harm. MethodsObservational cohort data from The Multicentre Study of Self-harm in England were used to investigate students aged 18 to 24 years who presented to emergency departments for self-harm, 2003 to 2016. Data were collected via clinician reports and medical records from five hospitals in three English regions. Characteristics, rates, repetition, and mortality outcomes were investigated. ResultsThe student sample included 3491 individuals (983, 28.2 % men; 2507, 71.8 % women; 1 unknown) compared to 7807 (3342, 42.8 % men; 4465, 57.2 % women) non-students. Self-harm increased over time in students (IRR 1.08, 95%CI 1.06–1.10, p < 0.01) but not in non-students (IRR 1.01, 95%CI 1.00–1.02, p = 0.15). There were differences in monthly distribution of self-harm with more presentations by students in October, November, and February. Characteristics were broadly similar, but students reported more problems with studying and mental health. Repetition (HR 0.78, 95%CI 0.71–0.86, p < 0.01) and mortality (HR 0.51, 95%CI 0.33–0.80, p < 0.01) were lower in students than non-students. ConclusionsSelf-harm in students may be directly related the student experience, such as academic pressure, relocation, and the transition to independent living. Wellbeing initiatives targeting these factors, alongside mental health awareness training for academic and non-academic staff may help to support students at risk.

Levelling up or widening the gap? An analysis of community renewal fund allocation in English regions using an economic resilience index

ABSTRACT This paper assesses the relationship between economic resilience in English regions and the allocation of the UK government’s Community Renewal Fund (CRF). The CRF is part of the government’s ‘Levelling Up’ agenda to address place-based inequalities. Economic resilience is measured using a composite index comprising productivity, skills, unemployment, population density and household income. Data were obtained for the five indicators at local authority (LA) level in England. Regional resilience scores were produced by calculating the weighted mean score of the constituent LAs. Regional resilience values were used to generate an ‘expected share’ funding allocation, which was compared with the actual allocation using differences and correlation. Regional resilience scores ranged from 28.5 (North East) to 66.6 (London). A total of £125.56 million was allocated in the first round of the CRF. All regions in the North received less than their expected share allocation of the CRF, with the least resilient region in England (North East) receiving £13.4 million less. The South West received £9.9 million more than their expected share. All regions in the North of England received less than their expected share allocation of the CRF. There was no significant correlation between resilience values and CRF allocations (r = −0.16, p = 0.68). The current method for CRF allocation may therefore widen existing inequalities rather than ‘level up’.

Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing.

Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D ≥4), we found statistically significant increases in the probability of depression between 2018/2019 and November/December 2020 for those with no impairment (0.110 (0.099 to 0.120) to 0.206 (0.191 to 0.222)) and mild impairment (0.139 (0.120 to 0.159) to 0.234 (0.204 to 0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in November/December 2020. Wealth and education appeared to be stronger drivers for depression and anxiety, respectively, than cognitive impairment. For example, those with no impairment in the richest two-thirds scored 1.76 (1.69 to 1.82) for depression in June/July, compared to 2.01 (1.91 to 2.12) for those with no impairment in the poorest third and 2.03 (1.87 to 2.19) for those with impairment in the poorest third. Results may be limited by the small number of people with dementia and are generalizable only to people living in the community, not to those in institutional care settings. Our findings suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand from older adults, especially those not living with cognitive impairment. Further, with little significant change among those with dementia, their existing need for support will remain; policymakers and care practitioners should ensure this group continues to have equitable access to mental health support.

Scoping of advanced clinical practitioner role implementation using national job advertisements: Document analysis.

The aim of this study is to profile the contemporary advanced clinical practitioner (ACP) role through standardized document sets. Documentary analysis of job descriptions (JDs), person specification and advertisements. England based jobs advertised on NHS jobs website from 22 January to 21 April 2021. A toatal of 143 trainee and qualified ACP roles were identified. A wide range of sectors and specialities were represented from across all English regions. The most common roles were urgent care, emergency medicine and primary care. Most qualified roles were agenda for change band 8A, although this did vary across specialities. Many roles were restricted to a small number of professions, notably nursing, physiotherapy and paramedic. Inconsistent role titles were noted. A lack of understanding of regulation across different professions was noted. The ACP role has become an accepted across healthcare providers in England. Implementation remains varied across specialities and organizations. Eligibility criteria may relate to professional bias. ACP roles are expanding but this may be at the detriment to advanced nursing posts. Inconsistency in role eligibility suggests some professional bias exists. This was scoping of ACP roles across England using job advertisements. ACP roles are common across sectors and specialities but eligibility varies. The research will have impact on those looking to recruit to ACP roles as well as those refining JDs. No EQUATOR guideline exists for document analysis. No Patient or Public Contribution. The research relates to organizational human resource information only.

Exploring the Impacts of Rurality on Service Access and Harm Among Image and Performance Enhancing Drug (IPED) Users in a Remote English Region

Image and performance enhancing drugs (IPEDs) have been highlighted in recent years as posing a potential risk to public health, with much research dedicated to exploring the use of these drugs and associated harms. While recent work has considered harm reduction for IPED users, the geographic and cultural impacts of rurality on IPED use and harms, particularly in relation to harm reduction service access, remains comparatively under-explored. Features of rurality relating to levels of economic distress, the inheritance and decline of manual labor, and rural conceptions of masculinity are important in shaping drug harms. Consequently, the “rural risk environment” for IPED users is in need of exploration. This research examines the experiences of IPED users in a remote two-county region of rural England, drawn from a multi-year ethnography and 18 qualitative interviews with IPED users, to explore the impacts of rurality and the “rural risk environment” on service access and harm (reduction) within this population. Findings highlight a number of ways in which rurality impacted on IPED users’ access to harm reduction services such as needle and syringe programs (NSP), as well as engagement with healthcare practitioners (HCP). Issues included the distances required to access services and lack of public transport between towns; the impacts of stigma in a small town context where there is little anonymity; Distrust of HCP relating to cultural mindsets and regionally derived fears regarding impacts on employment prospects, particularly military; and the impacts of rural masculinities and perceptions of the self-sufficient “real man” on help-seeking when experiencing harm. The research highlights the need to incorporate cultural geographic understandings into harm reduction policy for IPED users, and the significance of rurality on experiences of harm.

Conflict and Migration Decision: Empirical Evidence from the North West and South West Regions of Cameroon

Numerous pathways exist to explain people’s inherent motive to migrate from one place to another and multiple factors may be at play simultaneously. The objective of this work was to explore the role of income, psychological and family ties in the non-migration decision in the English speaking regions of Cameroon. Based on data collected primarily from 510 individuals regarding migration decisions and it’s determinant based on a Snowball approach. It was found that individuals with low income had higher tendency of migrating. It was also found that people refused to migrate despite the risk because of family ties. On the other hand, psychological factors have no significant effect on migration decision. Policy recommendations are also discussed.

Effectiveness of subnational implementation of minimum unit price for alcohol: policy appraisal modelling for local authorities in England.

Evidence exists on the potential impact of national level minimum unit price (MUP) policies for alcohol. This study investigated the potential effectiveness of implementing MUP at regional and local levels compared with national implementation. Evidence synthesis and computer modelling using the Sheffield Alcohol Policy Model (Local Authority version 4.0; SAPMLA). Results are produced for 23 Upper Tier Local Authorities (UTLAs) in North West England, 12 UTLAs in North East England, 15 UTLAs in Yorkshire and Humber, the nine English Government Office regions and England as a whole. Health Survey for England (HSE) data 2011-13 (n = 24 685). Alcohol consumption, consumer spending, retailers' revenues, hospitalizations, National Health Service costs, crimes and alcohol-attributable deaths and health inequalities. Implementing a local £0.50 MUP for alcohol in northern English regions is estimated to result in larger percentage reductions in harms than the national average. The reductions for England, North West, North East and Yorkshire and Humber regions, respectively, in annual alcohol-attributable deaths are 1024 (-10.4%), 205 (-11.4%), 121 (-17.4%) and 159 (-16.9%); for hospitalizations are 29 943 (-4.6%), 5956 (-5.5%), 3255 (-7.9%) and 4610 (-6.9%); and for crimes are 54 229 (-2.4%), 8528 (-2.5%), 4380 (-3.5%) and 8220 (-3.2%). Results vary among local authorities; for example, annual alcohol-attributable deaths estimated to change by between -8.0 and -24.8% throughout the 50 UTLAs examined. A minimum unit price local policy for alcohol is likely to be more effective in those regions, such as the three northern regions of England, which have higher levels of alcohol consumption and higher rates of alcohol harm than for the national average. In such regions, the minimum unit price policy would achieve larger reductions in alcohol consumption, alcohol-attributable mortality, hospitalization rates, NHS costs, crime rates and health inequalities.

British Enlightenment Theatre: Dramatizing Difference

British Enlightenment Theatre: Dramatizing Difference

Is the self-reporting of mental health problems sensitive to public stigma towards mental illness? A comparison of time trends across English regions (2009–19)

PurposeThe prevalence of mental health problems has rapidly increased over time. The extent to which this captures changes in self-reporting due to decreasing stigma is unclear. We explore this by comparing time trends in mental health and stigma-related indicators across English regions.MethodsWe produced annual estimates of self-reported mental disorders (SRMDs) across waves of the Health Survey for England (2009–18, n = 78,226) and three stigma-related indicators (knowledge, attitudes, and intended behaviour) across waves of the Attitudes Towards Mental Illness survey (2009–19, n = 17,287). Differences in trends were tested across nine Government Office Regions using linear models, adjusting for age, sex, ethnicity, marital status, and social class.ResultsIn 2009, SRMDs did not vary by region (p = 0.916), whereas stigma-related indicators did (p < 0.001), with London having the highest level of stigma and the North East having lowest level of stigma. Between 2009 and 2018, the prevalence of SRMDs increased from 4.3 to 9.1%. SRMDs increased and stigma-related indicators improved at different rates across regions over time (SRMDs p = 0.024; stigma-related indicators p < 0.001). London reported the lowest increase in SRMDs (+ 0.3 percentage point per year) yet among the largest improvements in attitudes and intended behaviour across regions.ConclusionsImprovements in attitudes towards mental illness did not mirror changes in self-reported mental health problems across English regions over the past decade. The findings do not support the argument that changes in public stigma, at least when defined at this regional scale, have been driving the increase in self-reported mental health indicators in recent years.

Persistent inequalities in consultation incidence and prevalence of low back pain and osteoarthritis in England between 2004 and 2019.

We wanted to determine whether socioeconomic inequalities in primary care consultation rates for two major, disabling musculoskeletal conditions in England narrowed or widened between 2004 and 2019. We analysed data from Clinical Practice Research Datalink Aurum, a national general practice electronic health records database, linked to national deprivation ranking of each patient's registered residential postcode. For each year, we estimated the age- and sex-standardized consultation incidence and prevalence for low back pain and OA for the most deprived 10% of neighbourhoods through to the least deprived 10%. We then calculated the slope index of inequality and relative index of inequality overall and by sex, age group and geographical region. Inequalities in low back pain incidence and prevalence over socioeconomic status widened between 2004 and 2013 and stabilized between 2014 and 2019. Inequalities in OA incidence remained stable over socioeconomic status within the study period, whereas inequalities in OA prevalence widened markedly over socioeconomic status between 2004 and 2019. The widest gap in low back pain incidence and prevalence over socioeconomic status was observed in populations resident in northern English regions and London and in those of working age, peaking at 45-54 years. We found persistent, and generally increasing, socioeconomic inequalities in the rate of adults presenting to primary care in England with low back pain and OA between 2004 and 2019.

A quantitative cross-sectional study assessing the surgical trainee perception of the operating room educational environment

BackgroundLimited hours and service provision are diminishing training opportunities, whilst increasing standards of surgical proficiency is being sought. It is imperative to maximise the value of each educational event. An objective measure of higher surgical trainee perception of the operating room environment in England has not been performed before and this can steer future change in optimising educational events in theatre. The Operating Room Educational Environment Measure (OREEM) evaluates each component of the learning environment to enable optimisation of these educational events. However, the OREEM has not yet been assessed for reliability in higher surgical trainees in England.The aim of the current study was to explore areas of strength and weakness in the educational environment in the operating room as perceived by surgical trainees’ in one English region. The secondary aim was to assess the reliability of the OREEM.MethodsUsing a quantitative approach, data was collected over one month from surgical trainees in England using the OREEM.ResultsFifty-four surgical trainees completed the questionnaire. The OREEM had good internal consistency (α = 0.906, variables = 40). The mean OREEM score was 79.16%. Areas for improvement included better learning opportunities (average subscale score = 72.9%) and conducting pre- and post-operative teaching (average score = 70.4%). Trainees were most satisfied with the level of supervision and workload (average subscale score = 82.87%). The learning environment favoured senior trainees (p = 0.017). There was a strong correlation between OREEM and the global satisfaction score (p < 0.001).ConclusionsThe OREEM was shown to be a reliable measure of the educational environment. It can be used to identify areas of improvement and as an audit tool. The current perception of the education environment is satisfactory, however, areas of improvement include reducing service provision, empowering trainees to plan lists, improving teamwork and using tools to optimise the educational value of each operation. There is a favourable attitude regarding the use of improvement tools, especially for dissatisfied trainees.

Conflict and Livelihood Changes in the South West Region of Cameroon: A Social Capital Perspective

The relevance of acceptable livelihoods for the socioeconomic wellbeing and human survival cannot be overemphasized especially within a socio-political context. This study attempts to understand the livelihood changes that have taken place between 2015 and 2020 for displaced and resident households within the communities in Manyu from a social capital perspective. Despite being replete with conflicts in the past, the recent uptick of socio-political crisis in Cameroon’s two English speaking regions have led to several deaths, displacement of persons and livelihoods are affected. For a long duration of the crisis (6 years), very little attempt has been made to understand how the crisis is changing the livelihood dynamics of different actors in the affected areas of Manyu Division. As an exploratory study, we employ purposive sampling and simple random sampling to respectively select the two divisions and study communities. Quantitative data was collected using a survey questionnaire and interview guide while for qualitative data, an observation guide, participant observation and key informant interviews were considered. The study reveals that the existing social order of communities is replaced by a new form of chaotic dictatorial and coercive structure without respect for human dignity but self-interest. Also, a common meal can pacify tensions during conflicts by building trust, solidarity and netness for conciliation and social harmony. Greater strides be made between contending faction to resolve the conflict so displaced persons and households could return to normal life.

Future tense—Reorienting higher education toward an unknown future

In view of the recent pandemic and growing wicked problems associated with an uncertain, complex and unknown future, this paper explores academics' conceptualizations of the future. Inspired by Kuhn, we chose the academic conference as a public sphere where members of small networks of trusted peers and other such micro-communities gather, creating and recreating the past, present, and future through conversation and collaboration as the site of this paper. We thematically analyzed 83 calls from 39 conferences covering four English speaking regions: North America, Europe, Africa, and Australia/International and five different conference foci, including Teaching and Learning, SOTL, academic staff/faculty development, educational technology and Future Conferences, from 2019 to 2022. Applying thematic analysis, two main themes emerged in relation to the future: responsiveness and temporality. Responsiveness is reflective of the currently dominant neo-liberal paradigm, which seeks to foster incremental adaptations to changing conditions whereas temporality is indicative of more fundamental shifts in thinking. The findings reflect not just what the future may hold, but potentially deeper changes in the relationship between universities and their past, present, and future.

INCOME ATTAINMENT OF IMMIGRANT WOMEN IN CANADA: DOES REGION OF BIRTH MATTER?

Using data from the 2001 Census of Canada, this study compares earnings of 30-year-old immigrant women and their Canadian born counterparts. The central question is whether region of birth has any impact on the earnings of immigrant women in Canada. Multiple regression analysis results indicate that region of birth has significant impact on the earnings of immigrant women in Canada. More specifically, immigrant women who were born in Asia, Africa and other non English speaking regions were clearly disadvantaged in terms of income attainment compared to Canadian born women. Overall, this study provides a strong evidence of “origin effect” for immigrant women in their country of destination.

1331P Regional variation in early diagnosis, multimorbidity and death in English males and females of different ethnicity with incident lung cancer from 2014-2019

Regional variation in treatment and outcomes of lung cancer (LC) exists in England suggesting a need for more effective and personalised disease management. However, population level data on patterns of multimorbidity (MM) at diagnosis (Dx), early Dx and mortality in LC across English regions by gender and ethnicity is scarce. From the National Cancer Registration Dataset 235208 people aged ≥ 15 years (53% male) with incident LC (2014-2019) across 21 Cancer Alliances (CA) were analysed by gender and in White, Black and South Asian (SA) ethnicities. Regional variation in the proportion with early Dx (Stage 1/2), MM (Charlson Index ≥ 1) and 1-year crude mortality rate / 100 person years (PY) was estimated. Average Percent Change (APC, %)) was estimated to assess temporal changes. The proportion of Early Dx was low but increased over time with regional variation in males (24 to 28%; APC mean (min, max): 2.8 (0.4, 7.5)%), females (28 to 34%; APC mean (min, max): 4.0 (1.2, 8.6)%), White (26 to 31%; APC mean (min, max): 3.6 (1.5, 7.3)%), Black (23 to 31%; APC mean (min, max): 6.3 (1.1, 10.1)%), and SA ethnicities (25 to 31%; APC mean (min, max): 4.6 (-0.3, 12.1)%). MM at Dx increased across all regions in males (19 to 25%; APC mean (min, max): 4.9 (0.7, 8.7)%) and females (15 to 21%; APC mean (min, max): 6.5 (0.2, 10.2)%), with SA having the highest increase in MM burden (22 to 30%; APC mean (min, max): 5.9 (3.3, 20.7)%) among all ethnicities. Crude mortality rates declined in male (124 to 104/100 PY; APC mean (min, max): -3.5 (-1.1, -7.1)%) and female (100 to 81/100 PY; APC mean (min, max): -4.6 (-1.5, -10.6)%), male having significantly higher rate (p<0.05). Correlation of early Dx with death rate reduction was not observed, with 25% regions with >28% early diagnosis but >100/100 PY death rate. High regional variations in early Dx, MM and death rate were observed across all incident lung cancer population stratum, over the analysed time period. While the early Dx and mortality reduction in lung cancer is marginal and heterogeneous across English regions, there is an urgent need to further optimise early Dx and care management pathways in multi-ethnic society with increasing multimorbidity.

Breeding bird population trends during 2013–2019 inside and outside of European badger control areas in England

AbstractSince 2013, the Department for Environment, Food and Rural Affairs (Defra) has licenced culling of European badger (Meles meles) populations in several English regions. In the first 7 years, more than 100 000 badgers have been removed. It is critical to evaluate the ecological impact of severely depressing the population of a widespread predator from large areas of the country, such as effects on breeding bird populations. Citizen science survey data on the abundance of breeding birds supports the estimation of population trends, i.e. whether species are exhibiting population growth or declines, and the effects of potential environmental influences, such as badger removal, on these trends. Here, these survey data are used together with data on the presence and amount of culling in an area to explore whether removing badgers has an effect on breeding bird populations both inside and outside culling zones from 2013–2019. This is not equivalent to a controlled trial, but collects critical, landscape‐scale evidence in real‐world conditions. In analyses evaluating the effect of culling presence, 18 of 55 bird species showed significant or near‐significant growth rate changes. Of these, four species had higher growth rates and 14 exhibited lower growth rates in cull areas, compared to areas outside of the culling zones. When using culling intensity data to assess the impact on growth rates, 10 of 55 species showed significant or near‐significant results, with only one species exhibiting a higher population growth rate in the presence of more intensive culling. Predicted sensitivity to badger effects based on species' ecologies did not predict whether the measured relationships were significant, or their directions, suggesting that other factors underlie the patterns seen. Hence, there was little evidence to indicate consistent, community‐level effects of badger removal on bird populations. A landscape‐scale, quasi‐experimental approach is strongly recommended to provide stronger inference about the complex potential ecological effects of culling predators such as the badger.