Southwest England Research Articles

Factors affecting oral health care for asylum seekers and refugees in England: a qualitative study of key stakeholders' perspectives and experiences.

Aims To investigate factors influencing oral health behaviours and access to dental services for asylum seekers and refugees (ASRs).Methods A qualitative research study using purposeful sampling was undertaken in South West England. Online semi-structured interviews with stakeholders working with or supporting ASRs were analysed through reflexive thematic analysis.Results Twelve participants providing support to ASRs in various capacities participated. Two interviewees had lived experience of forced displacement and the UK asylum process. Key themes into what hinders ASRs' oral health care were: prioritising safety and survival; variations in cultural norms and practice; lack of knowledge about dental care; financial hardship and affordability of care; a gulf of understanding of what dental care would be like and experiences of it; and structures of dental services that leave vulnerable groups behind. Opportunities for improving oral health care were: accessible oral health education; partnership working and creating supportive environments; translation; providing culturally sensitive and person-centred care; and incorporating ASRs' views into service design.Conclusions Several factors affect to what extent ASRs can and are willing to engage with oral health care. Co-developing accessible and relevant prevention programmes and ensuring equitable access to dental services for ASRs is important. Future research should explore ASRs' views and experiences of dental care and explore informed suggestions on how to optimise oral health promotion and provision of care.Supplementary InformationZusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-022-4340-5 für autorisierte Leser zusätzliche Dateien abrufbar.

TBE in United Kingdom

Until 2019, TBE was considered only to be an imported disease to the United Kingdom. In that year, evidence became available that the TBEV is likely circulating in the country and a first “probable case” of TBE originating in the UK was reported. In addition to TBEV, louping ill virus (LIV), a member of the TBEV-serocomplex, is also endemic in parts of the UK. Reports of clinical disease caused by LIV in livestock are mainly from Scotland, parts of North and South West England and Wales.

Distinct microplastic patterns in the sediment and biota of an urban stream

Urban freshwaters, their sediments and resident biota are often highly susceptible to microplastic contamination from catchment-specific sources. Water velocity and spatiotemporal dynamics within the system can impact microplastic loads, while biological features may additionally impact levels within freshwater biota. Here, we investigated the spatiotemporal variations in microplastic loads collected from sediment, macroinvertebrate and fish samples from an urban watercourse (Bourne Stream) in Dorset, southwest England. Sediment particles were mostly fragments of colours (especially orange and purple) whereas microplastics in both macroinvertebrates and fishes were blue/green and fibres. Across all sample types, the dominant particle size class was ≤100 μm. Median (M) and range (R) of microplastic loads within each sample type were sediment: M = 0.06, R = 0–0.36 particles g−1; macroinvertebrates: M = 0, R = 0–4 particles per batch; and fishes: M = 1, R = 0–6 particles per individual. Sediment loads varied spatially, with the highest load in the most upstream site, whereas biotic loads did not vary across space and time. Macroinvertebrate batch loadings varied between taxa and feeding guild, with counts significantly higher in annelids but lower in herbivores. Fish counts were higher in species with true, differentiated stomachs, but with the effects of species, feeding guild and body size being non-significant. Within sites, mean microplastic loads did not correlate between sediment, macroinvertebrate and fish samples. These results suggest that sediment freshwater microplastic loadings may vary spatially but that these trends are not reflected by, or correlated to, those in the biota where ingestion varies with biological traits. Assessments of freshwater microplastic contamination must therefore consider sampling spatiotemporally and across different biotic communities to fully understand the scale of contamination, and to subsequently undertake effective mitigation steps.

New Control Methods Against the Cabbage Stem Flea Beetle in Oilseed Rape Crops

Cabbage stem flea beetle (CSFB) is one of the most damaging pests of oilseed rape (OSR) grown in the UK. An intensive research effort is underway in the UK and throughout OSR growing regions of continental Europe to develop new control methods for this pest. In the first article of a series of three, we review this research and consider approaches to this pest problem that may be available immediately and in the short-term. Agronomic practices (sowing date, seed rate, crop defoliation, companion crops, etc) are being investigated and several of these approaches are already being used on farm. The use of physically acting biopesticides such as fatty acids, while not yet being used may also provide an effective solution and could be available in the short-term. Each of these approaches has the potential to form part of future Integrated Pest Management (IPM) programmes but importantly none should be seen as simple replacements for conventional synthetic insecticides. Solutions that may be available in the medium and longer-term will be discussed in the next articles. The cabbage stem flea beetle (CSFB), Psylliodes chrysocephala (Coleoptera: Chrysomelidae) is one of the most important pests of winter OSR crops in central and northern European countries. The adult beetle causes 'shot holing' feeding damage on cotyledons and true leaves of young winter OSR plants in late summer-early autumn. The larvae feed inside petioles and stems of the plants, causing additional damage. The focus on making food production more environmentally friendly means reduced chemical inputs, protecting nontarget species and overall biodiversity. This led to the withdrawal of systemic synthetic neonicotinoid pesticide seed treatments in many crops (oilseed rape included) in 2013. Since the withdrawal of neonicotinoid seed treatments, there has been a reliance on pyrethroid insecticides. This has been seen with a shift in the use of insecticides in oilseed rape, with CSFB the target for 28% of insecticide applications in 2012 (before neonicotinoid seed treatments were withdrawn) to 75% in 2020. The result of this shift has been the development of resistance to this group of insecticides in CSFB population. This situation has become so severe that some UK populations of CSFB are now 100% resistant to the pyrethroid insecticide lambda-cyhalothrin. These changes have led to the area of oilseed rape grown in the UK being halved (756,000 hectares in 2012 versus 307,000 hectares in 2021), with growers citing CSFB as one of the main reasons for this decrease. At the same time, the number of insecticide spray rounds has increased from two to three between 2012 and 2020, with these applications dominated by the use of pyrethroids. The most widely used pyrethroid insecticide, lambda-cyhalothrin, has also increased as a proportion of the insecticide-treated area from 32% in 2012 to 76% in 2020. Additional surveys by Fera, completed as part of the CropMonitor information service, between 2009 and 2020 show that the number of CSFB larvae per plant increased from an average of 0.5 larvae per plant in the years before the withdrawal of neonicotinoids, to more than 2 larvae per plant the following year in 2014 in East England, and almost 5 larvae per plant in 2019 in the South West of England. Here we present solutions that are currently available or that could be made available in the short-term. We consider how each of these approaches could be used in Integrated Pest Management (IPM) programmes.

Attitudes and adherence to changes in nutrition and physical activity following surgery for prostate cancer: a qualitative study

ObjectivesInterventions designed to improve men’s diet and physical activity (PA) have been recommended as methods of cancer prevention. However, little is known about specific factors that support men’s adherence to...

Impact of School and Peer Connectedness on Adolescent Mental Health and Well-Being Outcomes during the COVID-19 Pandemic: A Longitudinal Panel Survey.

School closures and social distancing measures during the pandemic have disrupted young people’s daily routines and social relationships. We explored patterns of change in adolescent mental health and tested the relationship between pre-pandemic levels of school and peer connectedness and changes in mental health and well-being between the first lockdown and the return to school. This is a secondary analysis of a longitudinal 3-wave panel survey. The study sample included 603 students (aged 13–14) in 17 secondary schools across south-west England. Students completed a survey pre-pandemic (October 2019), during lockdown (May 2020) and shortly after returning to school (October 2020). Multilevel models, with random effects, were conducted for anxiety, depression and well-being outcomes with school and peer connectedness as predictor variables. Symptoms of anxiety decreased from pre-pandemic to during the first UK lockdown and increased on the return to school; anxious symptoms decreased the most for students reporting feeling least connected to school pre-pandemic. Students reporting low levels of school and peer connectedness pre-pandemic experienced poorer mental health and well-being at all time points. Low school connectedness pre-pandemic was associated with a greater increase in anxious and depressive symptoms between lockdown and the return to school when compared to students with medium levels of school connectedness. No associations were found with high school connectedness or with low/high peer connectedness. For adolescents with poor school connectedness, the enforced time away from school that the pandemic caused led to reduced anxiety. Going forwards, we need to consider ways in which to promote connection with school as a way of supporting mental health and well-being.

Critical care drowning admissions in Southwest England 2009-2020, a retrospective study.

In the United Kingdom (UK), 600 deaths per annum are attributable to drowning. Despite this there is scarce critical care data on drowning patients globally. We describe drowning cases admitted to critical care units with a focus on functional outcomes. Medical records for critical care admissions following a drowning event were retrospectively reviewed across six hospitals in Southwest England for cases presenting in the period between 2009 and 2020. Data was collected according to the Utstein international consensus guidelines on drowning. Forty-nine patients were included, 36 males and 13 females, including seven children. Median submersion duration was 2.5min 20 cases were in cardiac arrest when rescued. At discharge 22 patients had preserved functional status, 10 patients had a reduced functional status. 17 patients died in hospital. Admission to critical care following drowning is uncommon and associated with high rates of mortality and poor functional outcomes. We find that 31% of those who survived a drowning event subsequently required an increased level of assistance with their activities of daily living.

P02 Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single-centre retrospective cohort study

BackgroundDefining the gold standard for appropriate antibiotic prescribing is challenging due to the subjective nature of evaluating quality in prescribing. In 2017 the UK Government Scientific Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection (APRHAI) used the Delphi process to define appropriate antibiotic prescribing, and developed an audit tool that supports patient-level assessment of antibiotic appropriateness in NHS hospitals.ObjectivesTo quantify excess antibiotic use in a 750-bed acute hospital in the south-west of England (bottom 20th centile on PHE Fingertips for total antibiotic prescribing), and to determine where in the prescribing process the opportunity to safely reduce antibiotic use is: (A) initiation, (B) the pre-72 h review, or (C) course length optimization.MethodsThe EPMA system was used to identify patients discharged from medical specialties in August 2020 who had received at least one dose of antibiotic. Patients were grouped by discharging medical specialty, as follows: acute medicine, elder care, renal, endocrine, gastroenterology, respiratory and cardiology. Medical notes for 25% of discharges from each specialty were requested and audited against the APRHAI audit tool. A junior doctor completed the audit form for each patient with the case then discussed by two infection specialists until consensus was reached. Excess days of antibiotic therapy (DOTs) were calculated for each of the three timepoints (A–C).ResultsIn total, 184 of 647 (28%) patients discharged from medical specialties were audited: 85 female, 99 male, median age 69 years (IQR 60–82), total DOTs 1658 of which 403 (24%) were excess. Excess DOTs by timepoint: A (initiation) 112 (28%), B (pre-72 h review) 184 (46%), C (course length) 107 (27%). Ninety-four of 187 (50%) of patients recorded zero excess DOTs.ConclusionsWe did not identify any excess DOTs in half of all patients initiated on antibiotics. However, in the other half we identified a significant proportion of excess DOTs with most excess DOTs at the pre-72 h review.

Review of the clinical spectrum of typical and atypical Lyme neuroborreliosis in southwest England

BackgroundLyme disease is endemic in the UK with a high incidence in southwest England. Neurological involvement occurs in approximately 5% of infected individuals. Previous reviews in southwest England have shown a consistent phenotype in most cases, however anecdotal review suggests a small number of atypical cases, with diverse presentations, which provide a diagnostic challenge, even to experienced neurologists.MethodsWe performed a retrospective, observational study of all identified cases (positive screening ELISA confirmed by immunoblot and neurological symptoms) of neuroborreliosis from six hospitals between January 2015 and December 2017. In addition, we reviewed atypical cases seen over the last decade in the regional neurosciences centre in depth.Results72 patients were included in the observational study. 83% had characteristics of Bannwarth’s syndrome (cranial neuropathy, radiculopathy and CSF pleocytosis). Unusual cases included mononeu- ritis multiplex.Central nervous system involvement was rare. We saw cases presenting with cerebrovascular events, meningitis and encephalitis. Complete resolution of symptoms was reported in 72% of patients. 28% of patients reported residual symptoms, most commonly fatigue and memory problems.ConclusionsThis is the largest UK review of neuroborreliosis. The presentation is usually typical, but atypical presentations vary and can be challenging. The majority of patients recover fully.amyrossrussell@gmail.com

Demographic and socioeconomic predictors of religious/spiritual beliefs and behaviours in a prospective cohort study (ALSPAC) in Southwest England: Results from the parental generation

Background: We explored associations between possible demographic and socioeconomic causes of religious/spiritual beliefs and behaviours (RSBB) in the parental generation of the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: We used a prospective birth cohort study (ALSPAC) in Southwest England with 14,157 enrolled mothers and 14,154 associated partners. Three RSBB outcome measures collected during pregnancy were examined: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other) and religious attendance (frequency of attendance at a place of worship). Multiple demographic and socioeconomic exposures were assessed (23 in mothers and 22 in partners). We explored age-adjusted associations between each exposure and outcome using multinomial regression, in addition to exposure-age interactions. Results: Many demographic and socioeconomic factors were associated with RSBB outcomes, including age, ethnicity, marital status, education, income and deprivation. Overall, higher socioeconomic position was associated with increased levels of RSBB, particularly regarding religious attendance. For instance, compared to mothers with the lowest level of educational attainment, a degree-level education was associated with six-fold increase in the relative risk ratio of religious attendance at least once a week, relative to not attending at all (RRR=5.90; 95% CI=[4.44; 7.86]). The magnitude of these associations often varied by outcome, e.g., income was associated with religious attendance, but not religious affiliation. Although results were demographically and socially patterned, overall effect sizes were relatively small, with a largest pseudo-R2 value of 2.4%. Patterns of association were similar for both mothers and partners. Conclusion: These findings demonstrate that numerous demographic and socioeconomic factors are associated with RSBB in this population. While additional work is needed to assess whether any of these associations are causal, this descriptive paper can help inform future studies using this data by considering appropriate confounders and thus attempt to minimise bias that confounding may introduce.

Leaving No One Behind: Interventions and Outcomes of the COVID-19 Vaccine Maximising Uptake Programme.

The devastating impact of COVID-19 on individuals and communities has accelerated the development of vaccines and the deployment of ambitious vaccination programmes to reduce the risks of infection, infection transmission and symptom severity. However, many people delay or refuse to get vaccinated against COVID-19, for many complex reasons. Vaccination programmes that are tailored to address individual and communities’ COVID-19 concerns can improve vaccine uptake rates and help achieve the required herd-immunity threshold. The Maximising Uptake Programme has led to the vaccination of 7979 people from February–August 2021 in the South West of England, UK, who are at high risk of severe illness from COVID-19 and/or may not access the COVID-19 vaccines through mass vaccination centres and general practices. These include: people experiencing homelessness; non-English-speaking people; people from minority ethnic groups; refugees and asylum seekers; Gypsy, Roma, Travelers and boat people; and those who are less able to access vaccination centres, such as people with learning difficulties, serious mental illness, drug and alcohol dependence, people with physical and sensory impairment, and people with dementia. Outreach work coupled with a targeted communication and engagement campaign, co-designed with community leaders and influencers, have led to significant engagement and COVID-19 vaccine uptake among the target populations.

Use of linked patient data to assess the effect of Long-COVID on system-wide healthcare utilisation.

Background: Within the relatively early stages of the COVID-19 pandemic, there had been an awareness of the potential longer-term effects of infection (so called Long-COVID) but little was known of the ongoing demands such patients may place on healthcare services. Objective: To investigate whether COVID-19 illness is associated with increased post-acute healthcare utilisation. Method: Using linked data from primary care, secondary care, mental health and community services, activity volumes were compared across the 3months preceding and proceeding COVID-19 diagnoses for 7,791 individuals, with a distinction made between whether or not patients were hospitalised for treatment. Differences were assessed against those of a control group containing individuals who had not received a COVID-19 diagnosis. All data were sourced from the authors' healthcare system in South West England. Results: For hospitalised COVID-19 cases, a statistically significant increase in non-elective admissions was identified for males and females <65 years. For non-hospitalised cases, statistically significant increases were identified in GP Doctor and Nurse attendances and GP prescriptions (males and females, all ages); Emergency Department attendances (females <65years); Mental Health contacts (males and females ≥65years); and Outpatient consultations (males ≥65years). Conclusion: There is evidence of an association between positive COVID-19 diagnosis and increased post-acute activity within particular healthcare settings. Linked patient-level data provides information that can be useful to understand ongoing healthcare needs resulting from Long-COVID, and support the configuration of Long-COVID pathways of care.

Parental Experiences of Adolescent Cancer-Related Pain: A Qualitative Study

ObjectiveDespite advancing medical treatments, pain remains a significant outcome of adolescent cancer, as both a problematic and distressing symptom. With adolescents spending substantial periods of time at home during cancer treatment, parents perceive themselves as central to the experience and management of adolescents’ pain. The present study aimed to explore parental experiences of adolescent cancer-related pain during, and recently after, completing cancer treatment.MethodsWe interviewed 21 parents of adolescents (aged 12–18 years) with cancer, recruited through a hospital in South West England. Interviews were analyzed using reflexive inductive thematic analysis.ResultsTwo themes were generated. The first theme, “Parental perceptions of being at the heart of pain management,” focused on the role of parents in adolescents’ pain journeys, and the vast knowledge they gained. The second, “Adapting and readjusting expectations,” captured parents’ journeys in learning to adjust their lives according to adolescents’ pain and difficulties they faced throughout this process.ConclusionsFindings highlighted parents’ crucial role throughout adolescents’ pain experiences; learning how to manage adolescents’ pain, and supporting them with the detrimental impact on their lives. The findings emphasize the importance of a multidisciplinary approach to supporting families to manage pain. They also indicate a need for targeted research studies investigating parental experiences of adolescent cancer-related pain. This will help professionals understand how best to support parents and adolescents throughout the cancer journey and ultimately improve the physical and psychological outcomes of young people in the longer term.

The Skin We Live in: Pigmentation Traits and Tanning Behaviour in British Young Adults, an Observational and Genetically-Informed Study.

Skin cancer incidence has been increasing worldwide, representing a particularly high burden for populations of European ancestry. Outdoor and indoor tanning using ultraviolet (UV) radiation devices are major risk factors for skin cancer. While tanning behaviours can be modified by targeted interventions to reduce skin cancer rates, there is insufficient evidence on the motivations for tanning preferences and their relationship with pigmentation phenotypes. The present observational and genetically-informed study investigates motives for tanning and the role that pigmentation phenotypes play on outdoor and indoor tanning behaviour in British young adults. This study included 3722 participants from the Avon Longitudinal Study of Parents and Children in South West England, with data on pigmentation features, tanning ability and preferences, and SNP genotypes. Liking to tan and outdoor tanning were strongly influenced by pigmentary traits and tanning ability. However, the association of these phenotypes with UV indoor tanning was weaker. Our results provide evidence to support the implementation of skin cancer preventative interventions that consider individual biological characteristics and motives for undergoing outdoor and indoor tanning.

Teaching Key Stage 3 literature: the challenges of accountability, gender and diversity

AbstractThis article presents the results of a study, conducted in parts of Wales and southwest England, focusing on what literature is being taught to learners aged 11–14 years. By exploring this area, we gain insight into influences on teacher choices and the challenges faced by teachers. Our research, which included a survey of over 170 teachers as well as teacher interviews, provides a snapshot of young people's experiences studying literature in the early secondary years (Key Stage 3). The results show that while some schools provide variety and diversity in their choice of texts and authors, the majority provide a limited diet of literature with texts mainly from male writers, with male protagonists. Girls are rarely the main focus. Nor do the majority of children study literature written by or about those from black and minority ethnic backgrounds, highlighting a lack of diversity. Literature teaching at Key Stage 3 is increasingly influenced by the demands of GCSE and exam accountability. We hope the study can act as a catalyst for discussion about what ought to be the purpose and focus of literature study in England, Wales and beyond.

Web-based support services to help prevent suicide in young people and students: A mixed-methods, user-informed review of characteristics and effective elements.

The online world may provide an alternative means to engage young people and students with suicidal feelings, who are typically reluctant to seek help. We aimed to map, characterise and obtain user evaluation of current online suicide support for this group in order to assess the usefulness of current provision and how it may be improved. We conducted a mixed-methods study, comprised of an internet search, content analysis of site features and qualitative interviews with site users: 9 young people and 4 general practitioners. Data collection took place in 2019 and 2020 in the UK. Young people participants were recruited through the well-being networks of a large University in South-West England and via a national young person's mental health app. General practitioners were recruited locally through professional networks. We identified a wide range of easily accessible online support, including examples of interactive services, such as live chat and text messaging, but a lack of support that is both suicide-specific and young adult-specific, and an absence of online suicide or mental health crisis support services tailored specifically for students. Qualitative data showed that clarity, brevity and immediacy are the most important facets of engaging crisis help for young people, and that young people may prefer to use text-based rather than verbal forms of communication when seeking help. Few services provided access to active peer support, outside of lived-experience stories, which were evaluated as both valuable and potentially harmful. There is a need to further develop tailored suicide specific online crisis support for young people and students, which is able to 'speak to' their age-specific needs and preferences. While lived experience may provide a valuable means of supporting young audiences, caution is required since this may have unintended negative consequences and further research is needed to understand the safe framing of such material.

Modelling the effect of COVID-19 mass vaccination on acute hospital admissions.

Managing high levels of acute COVID-19 bed occupancy can affect the quality of care provided to both affected patients and those requiring other hospital services. Mass vaccination has offered a route to reduce societal restrictions while protecting hospitals from being overwhelmed. Yet, early in the mass vaccination effort, the possible impact on future bed pressures remained subject to considerable uncertainty. The aim of this study was to model the effect of vaccination on projections of acute and intensive care bed demand within a 1 million resident healthcare system located in South West England. An age-structured epidemiological model of the susceptible-exposed-infectious-recovered type was fitted to local data up to the time of the study, in early March 2021. Model parameters and vaccination scenarios were calibrated through a system-wide multidisciplinary working group, comprising public health intelligence specialists, healthcare planners, epidemiologists and academics. Scenarios assumed incremental relaxations to societal restrictions according to the envisaged UK Government timeline, with all restrictions to be removed by 21 June 2021. Achieving 95% vaccine uptake in adults by 31 July 2021 would not avert the third wave in autumn 2021 but would produce a median peak bed requirement ∼6% (IQR: 1-24%) of that experienced during the second wave (January 2021). A 2-month delay in vaccine rollout would lead to significantly higher peak bed occupancy, at 66% (11-146%) of that of the second wave. If only 75% uptake was achieved (the amount typically associated with vaccination campaigns), then the second wave peak for acute and intensive care beds would be exceeded by 4% and 19%, respectively, an amount which would seriously pressure hospital capacity. Modelling influenced decision-making among senior managers in setting COVID-19 bed capacity levels, as well as highlighting the importance of public health in promoting high vaccine uptake among the population. Forecast accuracy has since been supported by actual data collected following the analysis, with observed peak bed occupancy falling comfortably within the inter-quartile range of modelled projections.

P179 A feasibility randomised controlled trial of a fibromyalgia self-management programme in a community setting with a nested qualitative study

Abstract Background/Aims Fibromyalgia (FM) is a complex long-term condition affecting over 5% of the UK population. FM symptoms include widespread pain, fatigue, sleep problems, stiffness, cognitive dysfunction and psychological distress. The condition is associated with high levels of disability, frequent use of healthcare resources and loss of workdays. Current guidelines for the treatment of FM recommend non-pharmacological interventions, including cognitive behaviour therapy, aerobic exercise, warm water therapy, relaxation, and patient education. A typical patient goal is to develop the knowledge and skills needed to self-manage their condition independently. Our Fibromyalgia Self-Management Programme (FSMP) comprises six 2.5-hour sessions over six consecutive weeks and includes education about fibromyalgia, sleep hygiene, goal setting, pacing, and dietary advice. To date, the FSMP has been co-delivered by a multidisciplinary team within a secondary care service. However, delivery in the community may help improve the accessibility of the programme to people with FM. Therefore, this feasibility study aimed to determine the practicality and acceptability of conducting a future definitive randomised controlled trial (RCT) of the FSMP in a community setting. Methods An exploratory, parallel-arm, one-to-one, RCT design was used. Participants were recruited from general practices across South West England, and the FSMP was co-delivered by physiotherapists and occupational therapists across two community sites. To determine the outcome measures for a future definitive trial, several outcomes were tested. All clinical outcome measures were patient-reported and collected at baseline, six weeks and six months. Semi-structured interviews were conducted with patient participants, occupational therapists and physiotherapists to explore the acceptability and feasibility of delivering the FSMP in a community setting. Results Between April and August 2019, 20 General Practices across two sites in SW England invited 1414 patients with an FM diagnosis to participate in the study. A total of 74 participants were randomised to the FSMP intervention (n = 38) or control arm (n = 36). Attrition from the trial was 42% (31/74) at six months. A large proportion of those randomised to the intervention arm (34%, 13/38) failed to attend any sessions, with six of the 13 formally withdrawing before the intervention commenced. The proportion of missing values was small for each of the outcome measures. For the nested qualitative study, 13 patient participants and four therapists were interviewed. Three overarching themes emerged: (1) barriers and facilitators to attending the FSMP; (2) FSMP content, delivery and supporting documentation; and (3) trial processes. Conclusion It is feasible to recruit people with FM from primary care to participate in an RCT testing the clinical and cost-effectiveness of the FSMP delivered in a community setting. However, improvement in attrition and engagement with the intervention is needed. Disclosure J. Pearson: None. J. Coggins: None. S. Derham: None. J. Russell: None. N. Walsh: None. E. Lenguerrand: Other; Erik Lenguerrand and his institution are receiving funding from Ceramtec to conduct an orthopaedic research project that has no relationship to the study presented here. S. Palmer: None. F. Cramp: None.

Evidence of Former Sea Levels from a Passive Seismic Survey at a Sandy Beach; Perranporth, SW England, UK

Since the end of the last glaciation, the United Kingdom’s land surface has been altered by isostatic rebound, rising in the north and sinking in the south. Numerous studies have been published documenting the impact of isostatic rebound on relative sea levels. However, due to the difficulties in acquiring evidence to prove former sea levels, locally, these data can be sparse or absent. In this work, we explored the suitability of the passive seismic survey (PSS) method to estimate the contemporaneous beach thickness in coastal environments where there is a high impedance contrast between the beach deposits and the underlying wave-cut platform. We conducted a three-day survey at Perran Beach, Cornwall, collected 149 measurements using PSS, and interpreted the observations supported by auxiliary topographical, geological, and independent geophysical observation in the study area. The study site is a contemporaneous beach mostly composed of sand underlain by a wave-cut platform composed of igneous and sedimentary rock, therefore high impedance contrast with the sandy beach is anticipated. The elevation of the bedrock relative to the topographical elevation suggests that the bedrock elevation is −15 m ± 5 m below the present day mean sea level, which is coherent with the observation of relative sea level rise along the region of the south-west. The present study contributes to our current limited understanding of land and sea level movements by providing further subsurface information to the coastal geological archive of south-west England, a region currently in need of more data to reconstruct land- and sea-level movements.

Telerehabilitation for physical disabilities and movement impairment: A service evaluation in South West England.

Guided discussions were carried out with 44 practitioners, 7 patients and 2 carers from five health and social care organisations in South West England, and analysed thematically. Practitioners and patients had positive experiences of telerehabilitation and were optimistic about its future use. Recognized benefits for people with physical disabilities included greater flexibility, reduced travel and fatigue, having appointments in a familiar environmentand ease of involving family members. Challenges encountered were: technological (usability issues, access to technologyand digital skills); difficulties seeing or hearing patients; the lack of 'hands-on' care; and safety concerns. Facilitators were supported by colleagues or digital champions, and family members or carers who could assist patients during their appointments. Key themes in best practice were: person-centred and tailored care; clear and open communication and observationand preparation and planning. Practitioners shared tips for remote physical assessments; for example, making use of patient-reported outcomes, and asking patients to wear bright and contrasting coloured clothing to make it easier to see movement. Telerehabilitation holds promise in health and social care, but it is necessary to share good practice to ensure it is safe, effective and accessible. We collated information and recommendations that informed the content of the Telerehab Toolkit (https://www.plymouth.ac.uk/research/telerehab), a practical resource for practitioners, patients and carers, with a focus on remote assessment and management of physical disabilities and movement impairment.