Work In UK Research Articles

The changing shape of the career profession in the UK

This paper summarises the main findings of a survey of career professionals in the UK working in independent/private practice and of members of the National Association of Educational Guidance for Adults (NAEGA). These two groups represent the majority of career professionals working with adults and include both those working mainly in the private sector and those working in the public, education and voluntary sectors. The survey highlights similarities and differences in the background and working practices of these two groups but also shows the diversity in terms of experience and backgrounds of career professionals working in this sector. As the provision of career support for adults becomes more significant, implications for the career profession are discussed.

Emollient application from birth to prevent eczema in high-risk children: the BEEP RCT.

Atopic eczema is a common childhood skin problem linked with asthma, food allergy and allergic rhinitis that impairs quality of life. To determine whether advising parents to apply daily emollients in the first year can prevent eczema and/or other atopic diseases in high-risk children. A United Kingdom, multicentre, pragmatic, two-arm, parallel-group randomised controlled prevention trial with follow-up to 5 years. Twelve secondary and four primary care centres. Healthy infants (at least 37 weeks' gestation) at high risk of developing eczema, screened and consented during the third trimester or post delivery. Infants were randomised (1 : 1) within 21 days of birth to apply emollient (Doublebase Gel®; Dermal Laboratories Ltd, Hitchin, UK or Diprobase Cream®) daily to the whole body (excluding scalp) for the first year, plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). Families were not blinded to allocation. Primary outcome was eczema diagnosis in the last year at age 2 years, as defined by the UK Working Party refinement of the Hanifin and Rajka diagnostic criteria, assessed by research nurses blinded to allocation. Secondary outcomes up to age 2 years included other eczema definitions, time to onset and severity of eczema, allergic rhinitis, wheezing, allergic sensitisation, food allergy, safety (skin infections and slippages) and cost-effectiveness. One thousand three hundred and ninety-four newborns were randomised between November 2014 and November 2016; 693 emollient and 701 control. Adherence in the emollient group was 88% (466/532), 82% (427/519) and 74% (375/506) at 3, 6 and 12 months. At 2 years, eczema was present in 139/598 (23%) in the emollient group and 150/612 (25%) in controls (adjusted relative risk 0.95, 95% confidence interval 0.78 to 1.16; p = 0.61 and adjusted risk difference -1.2%, 95% confidence interval -5.9% to 3.6%). Other eczema definitions supported the primary analysis. Food allergy (milk, egg, peanut) was present in 41/547 (7.5%) in the emollient group versus 29/568 (5.1%) in controls (adjusted relative risk 1.47, 95% confidence interval 0.93 to 2.33). Mean number of skin infections per child in the first year was 0.23 (standard deviation 0.68) in the emollient group versus 0.15 (standard deviation 0.46) in controls; adjusted incidence rate ratio 1.55, 95% confidence interval 1.15 to 2.09. The adjusted incremental cost per percentage decrease in risk of eczema at 2 years was £5337 (£7281 unadjusted). No difference between the groups in eczema or other atopic diseases was observed during follow-up to age 5 years via parental questionnaires. Two emollient types were used which could have had different effects. The median time for starting emollients was 11 days after birth. Some contamination occurred in the control group (< 20%). Participating families were unblinded and reported on some outcomes. We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children. Emollient use was associated with a higher risk of skin infections and a possible increase in food allergy. Emollient use is unlikely to be considered cost-effective in this context. To pool similar studies in an individual patient data meta-analysis. This trial is registered as ISRCTN21528841. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/67/12) and is published in full in Health Technology Assessment; Vol. 28, No. 29. See the NIHR Funding and Awards website for further award information.

Achieving internal legitimacy and job satisfaction in UK and US multinational corporation subsidiaries in Nigeria: Do acculturation strategies matter?

The ever-increasing organizations’ quest for multinational investments despite cross-border tensions and cultural diversity in the international business environment necessitates acculturation research. This research aims to determine the nature of acculturation strategies adopted among local workers in UK and US MNCs’ subsidiaries in Nigeria and how the acculturation strategies relate to internal legitimacy and job satisfaction among the workers. Utilizing a quantitative research design, the study uses a structured questionnaire to draw data from 454 Nigerians working in UK and US multinational corporations’ subsidiaries in Nigeria. The research finds that Nigerian workers in UK and US MNCs’ subsidiaries in Nigeria predominantly adopt the integrated acculturation strategy. The study further finds that the integration strategy significantly results in internal legitimacy and job satisfaction among the local workers. Contrary to expectations, assimilation, separation, and marginalization acculturation strategies insignificantly relate to internal legitimacy and job satisfaction. We highlighted the acculturation strategy the UK and US MNC subsidiaries in Nigeria can use to achieve internal legitimacy and job satisfaction among local employees.

Treatment satisfaction in adults with atopic dermatitis: a cross-sectional, population-based study examining patient and physician perspectives in the US.

Studies examining the real-world treatment satisfaction in adults with atopic dermatitis (AD) and the physicians who treat adults with AD are scarce. We sought to characterize treatment satisfaction of adults with AD and physicians' perceived patient satisfaction with AD treatment. We performed a cross-sectional study of adults > = 18 years of age (modified AD UK Working Party Criteria, age onset < = 18 [N = 767]) with AD and a parallel-physician survey among allergists/immunologists [N = 148], dermatologists [N = 149] and primary care medicine [N = 104]. Logistic regression models were used to examine factors associated with patient treatment satisfaction (PTS) or physician-perceived patient treatment satisfaction (pPTS). Factors associated with increased PTS included female, older age, and receiving a written eczema action plan (EAP). Severe AD, itch, pain, and insomnia, greater impact on partner relationships, feeling not adequately informed about AD causes, and being separated, never married, or living with a partner was associated with less PTS. From the physician's perspective, mild AD and development of EAP was associated with increase pPTS, whereas being in practice longer was associated with less pPTS. Limitations include the potential for misclassification of AD and the inability to match AD patients to individual physicians. Recognizing which factors are associated with treatment satisfaction can help inform counseling and decision-making strategies, including the use of an eczema action plan, and support patient-physician outcomes alignment.

P23 The influence of maternal inflammatory status on the risk of atopic eczema in offspring during infancy

Abstract Introduction and aims Maternal influences on infantile atopic eczema are complex, with emerging evidence for a protective role for maternal T helper (Th)1 inflammation during pregnancy. Substantial literature on characterization of a proinflammatory dietary pattern, led us to hypothesize that analyses of maternal diet and markers of inflammation might help identify mechanisms influencing the risk of infantile atopic eczema. The aim of this study was to examine the associations between energy-adjusted dietary inflammatory index (eDII) scores indicative of a proinflammatory diet pattern, maternal serum neopterin levels (a biomarker elevated in Th1 immune activation which counteracts Th2 inflammation seen in atopic eczema), and infantile risk of atopic eczema. Methods Within the UK Southampton Women’s Survey, scores for the eDII were derived from mothers’ diets (questionnaires at preconception, early and late pregnancy). Atopic eczema was ascertained at age 6 and 12 months using the UK Working Party Diagnostic Criteria (n = 262 and 270, respectively). Late pregnancy maternal serum neopterin levels were measured in a subsample (n = 497). Directed acyclic graphs were used to determine covariates to be included in linear regression analyses. Results A higher eDII score in late pregnancy was associated with a reduced risk of atopic eczema at age 6 months [odd ratios (OR) 0.89, 95% CI confidence interval (CI) 0.81–0.98; P = 0.02], with a similar trend at age 12 months (OR 0.91, 95% CI 0.83–1.00; P = 0.06). Consistent with this, and adjusting for maternal body mass index, education, smoking during pregnancy, and recent eczema, and infant filaggrin single-nucleotide polymorphism rs7512552, breastfeeding duration and sex, higher maternal serum concentrations of neopterin were associated with lower risks of infant eczema at age 6 months (OR 0.72, 95% CI 0.51–1.01; P = 0.05) and 12 months (OR 0.71, 95% CI 0.53–0.96; P = 0.03). Conclusions These findings suggest that a proinflammatory maternal diet that promotes a Th1 predominant environment protects the developing infant from Th2 inflammation and reduces the risk of atopic eczema.

Subjective Job Insecurity and the Rise of the Precariat: Evidence from the United Kingdom, Germany, and the United States

Abstract There is a widespread belief that work is less secure than in the past, that an increasing share of workers are part of the “precariat.” It is hard to find much evidence for this in objective measures of job security, but perhaps subjective measures show different trends. This paper shows that in the United States, the United Kingdom, and Germany, workers feel as secure as they ever have in the past 30 years. This is partly because job insecurity is very cyclical and (pre-COVID) unemployment rates very low, but there is also no clear underlying trend towards increased subjective measures of job insecurity. This conclusion seems robust to controlling for the changing mix of the labor force, and it is true for specific subsets of workers.

Number of overseas pharmacists applying to work in UK falls by two-thirds in one year

Number of overseas pharmacists applying to work in UK falls by two-thirds in one year

Effect of trade unions on the mental health of UK workers before and during the COVID-19 pandemic: a longitudinal analysis using Understanding Society data

BackgroundAlthough trade union membership rates have continuously decreased over the past 30 years, about 50% of UK employees are still represented by a union. Yet, studies on the association between collective bargaining and workers' mental health are sparse, especially in the pandemic context. This study examines differences on UK workers' mental health due to trade union presence and membership between pre-pandemic and pandemic periods. MethodsIn this longitudinal study, we analysed Understanding Society panel data in which the same participants are followed over time. The data concerned individuals aged 16 years and older and were collected biannually before COVID-19 pandemic (Waves 8–10: 2017–2020) and on a more frequent basis during pandemic (all COVID-19 surveys from 2020 [April, May, June, July, September, November] to 2021 [January, March, September] periods). The primary outcome was General Health Questionnaire-12 (GHQ-12) caseness (GHQ-12 score ≥4: probability of caseness). Two exposures were used separately: trade union presence and trade union membership, interacting with a binary variable splitting time periods between before and during the pandemic. Our analytical sample included 49 915 observations from 5988 individuals. 3341 (56%) individuals worked in unionised workplaces. We fitted mixed–effects logistic regression models adjusting for age, gender, ethnicity, UK residence, educational level, financial situation, workplace size, and survey interview date. We then replicated the analyses including a 3-way interaction with industry. All Understanding Society participants gave written informed consent. Ethics approval was not required. FindingsIn our sample, approximately 41% were male and 59% were female, and the mean age was 47·2 years (SD 11·4). Comparing pre-pandemic and pandemic periods, we found that the odds of GHQ-12 caseness for those in non-unionised workplaces increased by 45% (odds ratio 1·45, 95% CI 1·17–1·80), whereas in unionised workplaces odds increased by 28% (1·28, 1·05–1·57). When analysis was confined to unionised workplaces, the odds of GHQ-12 caseness for non-union members increased more (1·40, 1·07–1·83) compared with members (1·18, 0·91–1·53); however, with wide CIs. Overall, industry had no modification effect in both exposures. Sensitivity analysis using GHQ-36 as a continuous outcome demonstrated no real change in the patterns of the results. InterpretationThe mental health of workers in unionised workplaces appears to have worsened less than the mental health of those in non-unionised workplaces; however, there is insufficient evidence of effect differential by type of industrial sector. Designing policies that encourage and facilitate trade union presence in workplaces should be promoted, as they are likely to mitigate adverse mental health effects in times of extreme uncertainty. FundingMedical Research Council, Chief Scientist Office, Belgian National Scientific Fund.

Prevalence of medical emergency events in primary dental care within the UK

Introduction Dental professionals have an ethical and legal obligation to diagnose and manage medical emergencies which may occur in primary dental care.Aims and objectives To investigate the prevalence of medical emergencies in UK primary dental care and explore the medical emergency training needs of UK primary dental care professionals.Design and setting Cross-sectional survey, targeting dentists, dental hygienists and dental therapists across the UK working within primary dental care.Materials and methods An online survey was distributed via dental society mailing lists, social media groups and a dental conference. The questionnaire consisted of participants demographics and training in, prevalence of and confidence surrounding medical emergencies.Results Respondents (n = 400) were dentists (55.8%), dental hygienists/therapists (38.8%) and specialists (5.5%). Most participants received basic life support training (62%) in 2019, before COVID-19. The most common medical emergencies were syncope, non-specific collapse and hypoglycaemia, being encountered every 1.59, 1.64 and 8.26 years, respectively. The preferred method for medical emergency training was practical based, with more training in administering emergency drugs and equipment identified as a training need.Conclusion Dental professionals will encounter medical emergencies in primary dental care every 1-2 years and are therefore not uncommon.

Hand Hygiene Messaging Design in the Workplace: Views From the Workforce-Introduction.

The study aimed to (1) discover workers' attitudes toward the use of novel video screens to improve hand sanitization in the workplace and (2) discover what workers' preferences are for hand hygiene (HH) messaging style and tone and reasons for their preferences. Practicing good HH in non-medical office settings is vital to curb the spread of a range of common and infectious diseases. Despite this, workers are rarely consulting in the construction of HH messages. The qualitative views of users can provide us with the "why" rather than the "what" and can highlight areas of cynicism, concern and overall attitudes to HH. A survey was completed by 520 UK workers concerning attitudes and views toward HH messaging and the use of a video-based hand sanitizer unit. Analysis consisted of both qualitative and quantitative methods. Workers were skeptical toward the use of digital technologies within HH interventions, and there were misgivings about the role that video could play. Results demonstrated a strong preference for positive and supportive messages. Educational and trustworthy qualities were well rated. Messages that emphasized surveillance, previously successful in a clinical setting, or guilt, were not well received. Visual approaches that utilized serious illustration were valued. This study highlights how consulting workers before the design of HH initiatives is important in guiding the design process. The resultant user-centered criteria promotes the use of positive, motivational, thought-provoking, surprising, and visual approaches to HH messaging.

Does Diversity Equate Efficiency? Its Impact on Job Satisfaction, Teamwork, and Employee Productivity among UK Workers

This study set out to answer the question, "Does workplace diversity equate efficiency?" considering factors such as teamwork, job satisfaction, and productivity. Data was gathered from 197 UK workers via a questionnaire to achieve the study's aim. The first section of the questionnaire aimed to gather information on the respondents' demographics, the second part sought information about the employees' perspectives on workplace diversity, teamwork, job satisfaction, and productivity. As a result, SPSS was used to analyze the data and outcomes were displayed in frequency tables, a scatterplot, and a regression analysis. Statistical analysis revealed a significant relationship between the four independent variables, as diversity in the workplace significantly impacted employee productivity, teamwork, and job satisfaction.

Working from home and subjective wellbeing during the COVID-19 pandemic: The role of pre-COVID-19 commuting distance and mode choices

Working from home (WFH) was prevalent among previous daily commuters during the COVID-19 pandemic and is expected to continue in post-COVID-19 society. By using WFH enforced by the UK government during the pandemic as a real-world experiment, our study investigates the relationship between switching from commuting to WFH, and subjective wellbeing (SWB). Particular interest lies in determining the extent to which this relationship depends on homeworkers' commuting behaviours prior to the COVID-19 outbreak. The data we used is from a COVID-19 panel survey on UK workers who were born in 1970. Results from the between-individual analysis and fixed-effect analysis show that the transition to WFH was not indicative of life satisfaction but it was conducive to affective wellbeing in the short term. This positive effect on affective wellbeing became insignificant after specific experiences of WFH were taken into account; that is, positive homeworking experiences were a result of strong social support, healthy daily lifestyles and stable financial circumstances during the pandemic. Crucially, the impact of switching to WFH on SWB was moderated by the pre-pandemic commuting behaviour. Previous long-distance commuters (one-way commuting distance >30 miles) reported better affective wellbeing when they could work from home, while commuters who had frequently walked or cycled to work had worse SWB outcomes after switching to WFH.

SP6.7 Variation in UK anti-reflux surgery practice - A Collaborative Multicentre National Audit (ARROW study)

Abstract Aims There is significant variation in the work-up of patients for anti-reflux surgery. This study describes the current variation in UK work up and perioperative management for anti-reflux surgery (ARS), and adherence to clinical guidelines. Methods A 12-month UK-wide multicentre prospective national audit was undertaken using a secure online platform. Data collection included demographics, symptoms, pre-operative investigations, intraoperative details, and postoperative outcomes within 90 days. Audit standards (AS) were taken from BSG, ICARUS and AUGIS guidelines. Results 630 patients from 38 centres were analysed. Patients had a median age 58 years (18-92, F:M 384:245), median ASA 2, and median BMI 29kg/m2. Oesophageal manometry was performed in 332 patients (54%, AS 100%). Twenty-four-hour pH monitoring was performed in 319 patients (53%, AS 100%). Endoscopy was performed in 520 patients (83%, AS 100%). Laparoscopic or robotic surgery was recorded in 506 and 63 patients, respectively (99%, AS 95%). Two patients underwent open surgery and four laparoscopic cases converted to open. Only 3% (22) patients were day-cases. Overall, 45 patients were re-admitted (7%, AS &amp;lt;10%); three units had a &amp;gt;10% readmission rate which corresponded with high day-case rates. Less than one percent of patients had an unplanned re-operation. Of those with recorded follow up (60%), 94% had recorded full/partial resolution of symptoms; 86% having nil further requirement for PPI. Conclusions There is wide variation in practice, especially regarding preoperative work up, adherence to existing guidelines and low day-case rates. More work is required to assess how the variation in practice affects patient outcomes.

Interview with Caroline Abrahams, Charity Director, Age UK

Caroline Abrahams is the Charity Director of Age UK, Britain’s leading charity focused on improving experiences of later life. The interview – conducted by Siân Adiseshiah, Amy Culley and Jonathon Shears – took place on Microsoft Teams on 10 June 2022. The conversation ranges across such issues pertaining to the focus of the special issue as age as a protected characteristic; ageism as a widespread experience; the importance of language and terminology; the place of narrative in the work of Age UK; the intersection of old age with gender as well as race, class and sexuality; the impact of the COVID-19 pandemic on older people; pensions and the gender pay gap; the suspension of the Triple Lock; and intergenerational relations.

Re/Definitions of teachers and teaching work in UK and US policy discourses under Covid-19 and their implications for social justice

ABSTRACT This article is concerned with the discourses of teachers and teaching work that have circulated in UK and US education policy circles during the COVID-19 pandemic. Drawing on UK and US policy texts published in Spring and Summer 2020, we discuss how the policy discourses underpinning these texts re/define and mis/recognise teaching work. On a theoretical level, the article bears on a poststructuralist tradition calling, inter alia, for a critical deconstruction of discourses and the relationships of power they sustain, while also borrowing from critical theorists’ understandings of social justice. We argue that while some aspects of teachers’ work have attracted more visibility and recognition, these processes have been partial and coexist with the strengthening of some of the hierarchies of teaching work in place prior to the pandemic.

Centring the voices of schools in widening participation discourse: how building closer partnerships with educators can benefit WP providers’ practice

Many organisations in the UK work with schools to try to increase the numbers of young people from underrepresented groups progressing to higher education. However, public debate about the efficacy of these programmes rarely centres the views of schools themselves, often giving the sense that schools are passive recipients of these activities rather than key stakeholders. This study begins to rectify this omission by conducting a series of interviews gathering in-depth information from school representatives about their views on, and interactions with, external widening participation providers. Participants had a range of ideas as to how interventions could be improved and made more impactful, and also pinpointed areas of difficulty, including target pupil selection and quality of some providers’ delivery. Schools expressed a sense of overload in dealing with numerous approaches from external providers and wished for more access to ‘filter’ mechanisms to provide quality assurance; however, some also wished to work more closely with known organisations. It was also notable that none of the schools were working with providers to evaluate the impact of activities. Our findings demonstrate that listening to the voice of the school has the potential to make outreach activities more impactful.

PA30 The modifying effect of maternal body mass index on the influence of maternal vitamin D supplementation on offspring risk of atopic eczema

Abstract We recently published evidence from a randomized controlled trial of the protective effect of antenatal cholecalciferol supplementation on the risk of infantile atopic eczema in infants that were breastfed for &amp;gt; 1 month. Reports that cholecalciferol supplementation has a smaller effect on circulating 25-hydroxyvitamin D levels in individuals with a higher body mass index (BMI) led us to examine whether maternal BMI modifies the effect of vitamin D supplementation on offspring atopic eczema in the first 4 years of life. In the Maternal Vitamin D Osteoporosis Study, which was a double-blind, randomized, placebo-controlled trial, mothers were supplemented (from 14 weeks’ gestation until delivery) with cholecalciferol 1000 IU daily or matched placebo. Maternal characteristics, including BMI, were recorded from pre-pregnancy, and offspring atopic eczema was ascertained based on the UK Working Party Criteria for the Definition of Atopic Dermatitis at the age of 12 (n = 636), 24 (n = 611) and 48 (n = 450) months. Mothers and offspring characteristics did not differ between the intervention and placebo groups except for longer breastfeeding duration in the intervention group. Maternal pre-pregnancy BMI was found to modify the effect of intervention on offspring eczema, so associations between maternal cholecalciferol supplementation and offspring eczema were stratified by categories of BMI (&amp;lt; 25, 25–30 and &amp;gt; 30 kg m−2), with findings expressed as odds ratios (ORs). Models were adjusted for breastfeeding duration, and infant sex as sensitivity analysis showed that the intervention had an impact on male infants that were breastfed. As reported previously, the offspring of mothers who received 1000 IU cholecalciferol had lower ORs of atopic eczema at 12 months of age [OR 0.57, 95% confidence interval (CI) 0.33–0.98]; the intervention did not affect the risk of atopic eczema in offspring at 24 and 48 months. Stratified analysis demonstrated reduced odds of atopic eczema at 12 months of age in the intervention group in infants whose mothers had a BMI &amp;lt; 25 kg m−2 (OR 0.28, 95% CI 0.09–0.92) and 25–30 kg m−2 (OR 0.20, 95% CI 0.04–1.06) but not for those with a maternal BMI &amp;gt; 30 kg m−2. The risk of atopic eczema at 24 and 48 months of age in offspring in the intervention group was not modified by maternal baseline BMI, and interaction terms between intervention and BMI were not statistically significant (P &amp;gt; 0.2). These RCT findings support evidence of an attenuated effect of cholecalciferol supplementation in mothers with a higher BMI and point toward potential preventative strategies for offspring eczema where maternal cholecalciferol supplementation can be considered and doses adjusted for BMI.

Assessment of the American Academy of Dermatology diagnostic criteria for pediatric atopic dermatitis and modification into a checkbox form: A cross-sectional study.

Diagnostic criteria for atopic dermatitis (AD) are limited in their performance and/or usability. The American Academy of Dermatology (AAD) consensus criteria include hierarchical categories of disease features to improve these metrics but have not been validated. Our objective was to create and validate a checkbox form of the AAD consensus criteria in the pediatric population. We performed a cross-sectional study of 100 pediatric patients with AD (n = 58) and diseases in the differential diagnosis of AD (n = 42). Having three or more "Essential," ≥2 "Important," ≥1 "Associated" features of the AAD criteria was optimal for the diagnosis of AD in children. This combination was 91.4% (95% CI, 84.2%-98.6%) sensitive and 95.2% (88.8%-100%) specific. The UK working party criteria and the Hanifin-Rajka criteria had sensitivities of 96.6% (95% CI 91.9%-100%) and 98.3% (95% CI 94.9%-100%) and specificities of 83.3% (95% CI 72.1%-94.6%) and 71.4% (95% CI 57.8%-85.1%), respectively. The AAD criteria had significantly greater specificity than the Hanifin-Rajka criteria (p = .002). This study represents an important step in validating the AAD consensus criteria and formulating a useable checkbox form for diagnosing AD in the pediatric population.

Constraints and affordances for UK doctors-in-training to exercise agency: A dialogical analysis.

The goal of medical education is to develop clinicians who have sufficient agency (capacity to act) to practise effectively in clinical workplaces and to learn from work throughout their careers. Little research has focused on experiences of organisational structures and the role of these in constraining or affording agency. The aim of this study was to identify priorities for organisational change, by identifying and analysing key moments of agency described by doctors-in-training. This was a secondary qualitative analysis of data from a large national mixed methods research programme, which examined the work and wellbeing of UK doctors-in-training. Using a dialogical approach, we identified 56 key moments of agency within the transcripts of 22 semi-structured interviews with doctors based across the UK in their first year after graduation. By analysing action within the key moments from a sociocultural theoretical perspective, we identified tangible changes that healthcare organisations can make to afford agency. When talking about team working, participants gave specific descriptions of agency (or lack thereof) and used adversarial metaphors, but when talking about the wider healthcare system, their dialogue was disengaged and they appeared resigned to having no agency to shape the agenda. Organisational changes that could afford greater agency to doctors-in-training were improving induction, smoothing peaks and troughs of responsibility and providing a means of timely feedback on patient care. Our findings identified some organisational changes needed for doctors-in-training to practise effectively and learn from work. The findings also highlight a need to improve workplace-based team dynamics and empower trainees to influence policy. By targeting change, healthcare organisations can better support doctors-in-training, which will ultimately benefit patients.

Drivers determining TB disease screening yield in four European screening programmes: a comparative analysis.

The WHO End-TB Strategy emphasises screening for early diagnosis of tuberculosis (TB) in high-risk groups, including migrants. We analysed key drivers of TB yield differences in four large migrant TB screening programmes to inform TB control planning and feasibility of a European approach. We pooled individual TB screening episode data from Italy, the Netherlands, Sweden, and the UK and analysed predictors and interactions for TB case yield using multivariable logistic regression models. Between 2005-2018 in 2,302,260 screening episodes among 2,107,016 migrants to four countries; the programmes identified 1,658 TB cases (yield 72.0 per 100,000; 95% confidence interval, CI68.6-75.6). In logistic regression analysis, we found associations between TB screening yield and age (>55 years odds ratio, OR2.91, CI2.24-3.78), being an asylum seeker (OR3.19, CI1.03-9.83) or on a settlement visa (OR1.78, CI1.57-2.01), close TB contact (OR12.25, 11.73-12.79), and higher TB incidence in the country of origin (CoO). We demonstrated interactions between migrant typology and age, as well as CoO. For asylum seekers, the elevated TB risk remained similar above CoO incidence thresholds of 100 per 100,000. Key determinants of TB yield included close contact, increasing age, incidence in CoO and specific migrant groups including asylum seekers and refugees. For most migrants such as UK students and workers, TB yield significantly increased with levels of incidence in CoO. The high, CoO-independent TB risk in asylum seekers above a 100 per 100,000 threshold could reflect higher transmission and reactivation risk of migration routes; with implications for selecting populations for TB screening.