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4.
PLoS One ; 19(3): e0299833, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38427673

RESUMO

In our study, we introduce indicators that quantify the influence of each country in complex trade scenarios involving the exchange of raw materials, intermediate goods, and final products across multiple countries. We systematically employ an agent-based model to simulate the propagation of failures from one node to the entire network. This approach allows for the assessment of the impact of each country and the identification of patterns of interaction in the multi-step trade network. Unlike conventional analyses of trade networks, which depict straightforward single-step import/export transactions, our approach captures the intricate realities of processes like raw material procurement, production, and sales in numerous countries from a macroscopic perspective. The findings of our analysis of trade data spanning from 1990 to 2022 reveal several key insights. Firstly, sensitivity to changes in trade volume leading to global failures within interconnected networks has intensified over time. The potential of failure propagation across countries has increased over time, as has the interconnectedness of countries in the global trade landscape. Secondly, despite the increased sensitivity to changes in global trade volume, many countries have become less vulnerable to the influence of others within their multi-step trade networks. This trend aligns with deglobalization, which is evidenced by events such as Brexit and the surge in protectionist measures; these changes indicate a shift in the balance of influence within global trade networks. Thirdly, the results of our analysis of the relationship between load changes and global failures from a regional perspective reveal an intriguing phenomenon: despite limited direct trade connectivity, the interaction between the Latin American and Sub-Saharan African regions is considerable. This suggests the existence of hidden connections between intermediary countries, such that one region's actions can alter the load sensitivity of another, impacting them in unforeseen ways. Furthermore, intra-regional interactions are diminishing in East Asia, while Europe is experiencing a gradual increase in interactions. These trends reflect evolving regional influence, the dynamics of geographic proximity, and the results of economic integration efforts. Additionally, even though the observed period was not long enough to confirm a long-term trend, the previous trend direction was affirmed to persist despite a temporary decrease in trading and reduced sensitivity due to the COVID-19 pandemic. Our study highlights the complexity of global trade dynamics and the need to consider multi-step trade networks and their potential cascading effects when analyzing trade patterns and vulnerabilities.


Assuntos
Comércio , Internacionalidade , Humanos , União Europeia , Pandemias , Reino Unido
5.
PLoS One ; 19(3): e0294974, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38427674

RESUMO

INTRODUCTION: Antipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients with serious mental illness often have cardiovascular and metabolic comorbidities, and antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review. We explore perceptions of healthcare professionals and managers/directors of policy regarding reasons for increasing prevalence and management of antipsychotics in primary care. METHODS: Qualitative study using semi-structured interviews with 11 general practitioners (GPs), 8 psychiatrists, and 11 managers/directors of policy in the United Kingdom. Data was analysed using thematic analysis. RESULTS: Respondents reported competency gaps that impaired ability to manage patients prescribed antipsychotic medications, arising from inadequate postgraduate training and professional development. GPs lacked confidence to manage antipsychotic medications alone; psychiatrists lacked skills to address cardiometabolic risks and did not perceive this as their role. Communication barriers, lack of integrated care records, limited psychology provision, lowered expectation towards patients with serious mental illness by professionals, and pressure to discharge from hospital resulted in patients in primary care becoming 'trapped' on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between services exacerbate this risk, with socioeconomic deprivation and lack of access to non-pharmacological interventions driving overprescribing. Professionals voiced fears of censure if a catastrophic event occurred after stopping an antipsychotic. Facilitators to overcome these barriers were suggested. CONCLUSIONS: People prescribed antipsychotics experience a fragmented health system and suboptimal care. Several interventions could be taken to improve care for this population, but inadequate availability of non-pharmacological interventions and socioeconomic factors increasing mental distress need policy change to improve outcomes. The role of professionals' fear of medicolegal or regulatory censure inhibiting antipsychotic deprescribing was a new finding in this study.


Assuntos
Antipsicóticos , Clínicos Gerais , Humanos , Antipsicóticos/uso terapêutico , Pessoal Administrativo , Reino Unido/epidemiologia , Atenção Primária à Saúde , Atenção à Saúde
7.
BMC Public Health ; 24(1): 793, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481190

RESUMO

BACKGROUND: This study examined perceptions of coercion, pressures and procedural injustice and how such perceptions influenced psychological well-being in those who experienced a UK COVID-19 lockdown, with a view to preparing for the possibility of future lockdowns. METHODS: 40 individuals categorised as perceiving the lockdown(s) as either highly or lowly coercive took part in one of six asynchronous virtual focus groups (AVFGs). RESULTS: Using thematic analysis, the following key themes were identified in participants' discussions: (1) Choice, control and freedom; (2) threats; (3) fairness; (4) circumstantial factors; and (5) psychological factors. CONCLUSIONS: As the first qualitative study to investigate the psychological construct of perceived coercion in relation to COVID-19 lockdowns, its findings suggest that the extent to which individuals perceived pandemic-related lockdowns as coercive may have been linked to their acceptance of restrictions. Preparing for future pandemics should include consideration of perceptions of coercion and efforts to combat this, particularly in relation to differences in equity, in addition to clarity of public health messaging and public engagement.


Assuntos
COVID-19 , Coerção , Humanos , Pandemias/prevenção & controle , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Justiça Social , Reino Unido/epidemiologia
8.
BMJ Open ; 14(3): e078545, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38479737

RESUMO

INTRODUCTION: A trauma-informed approach (TIA) means working with awareness that people's histories of trauma may shape the way they engage with services, organisations or institutions. Young people with adverse childhood experiences may be at risk of retraumatisation by organisational practices in schools and universities and by employers and health agencies when they seek support. There are limited evidence-based resources to help people working in the public sector to work with adolescents in trauma-informed ways and the needs of adolescents have not been central in resource development. This study contributes to public sector capacity to work in trauma-informed ways with adolescents by codesigning and evaluating the implementation of a youth-informed organisational resource. METHODS AND ANALYSIS: This is an Accelerated Experience-based Co-design (AEBCD) Study followed by pre-post evaluation. Public sector organisations or services, and adolescents connected with them, will collaboratively reflect on lived experience data assembled through creative arts practice, alongside data from epidemiological national data sets. These will present knowledge about the impact of adverse childhood experiences on adolescents' mental health (stage 1). Collaboratively, priorities (touch points) for organisational responses will be identified (stage 2), and a low-burden resource will be codesigned (stage 3) and offered for implementation (stage 4) and evaluation (stage 5) in diverse settings. The study will provide insights into what adolescents and public sector organisations in the UK want from a TIA resource, the experience of services/organisations in implementing this and recommendations for resource development and implementation. ETHICS AND DISSEMINATION: The UK National Health Service Health Research Authority approved this study (23/WM/0105). Learning will be shared across study participants in a workshop at the end of the study. Knowledge products will include a website detailing the created resource and a youth-created film documenting the study process, the elements of the codesigned resource and experiences of implementation. Dissemination will target academic, healthcare, education, social care, third sector and local government settings via knowledge exchange events, social media, accessible briefings, conference presentations and publications.


Assuntos
Setor Público , Medicina Estatal , Humanos , Adolescente , Atenção à Saúde , Saúde Mental , Reino Unido
9.
BMJ ; 384: q504, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38479756
10.
BMJ ; 384: e076962, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38479774

RESUMO

OBJECTIVE: To examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years. DESIGN: Retrospective secondary data analysis. DATA SOURCES: Cancer registration data, cancer mortality and national population data from the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland. SETTING: 23 cancer sites were included in the analysis in the UK. PARTICIPANTS: Men and women aged 35-69 years diagnosed with or who died from cancer between 1993 to 2018. MAIN OUTCOME MEASURES: Change in cancer incidence and mortality age standardised rates over time. RESULTS: The number of cancer cases in this age range rose by 57% for men (from 55 014 cases registered in 1993 to 86 297 in 2018) and by 48% for women (60 187 to 88 970) with age standardised rates showing average annual increases of 0.8% in both sexes. The increase in incidence was predominantly driven by increases in prostate (male) and breast (female) cancers. Without these two sites, all cancer trends in age standardised incidence rates were relatively stable. Trends for a small number of less common cancers showed concerning increases in incidence rates, for example, in melanoma skin, liver, oral, and kidney cancers. The number of cancer deaths decreased over the 25 year period, by 20% in men (from 32 878 to 26 322) and 17% in women (28 516 to 23 719); age standardised mortality rates reduced for all cancers combined by 37% in men (-2.0% per year) and 33% in women (-1.6% per year). The largest decreases in mortality were noted for stomach, mesothelioma, and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women. Most incidence and mortality changes were statistically significant even when the size of change was relatively small. CONCLUSIONS: Cancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes.


Assuntos
Neoplasias Renais , Neoplasias , Neoplasias do Colo do Útero , Adulto , Feminino , Masculino , Humanos , Incidência , Estudos Retrospectivos , Sistema de Registros , Reino Unido/epidemiologia , Mortalidade
11.
Zootaxa ; 5415(4): 570-576, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38480181

RESUMO

The ant genus Strumigenys is a hyper diverse pantropical group of specialised predatory leaf litter dwelling ants. Species richness peaks within tropics, with few species extending into the West Palaearctic realm. A significant proportion of Strumigenys species known from the West Palaearctic are non-native, spread via human commerce, and predominately establishing populations within artificially heated greenhouses. In Britain, two Strumigenys species were previously known, S. rogeri Emery, 1890 and S. perplexa (Smith, 1876). Here we add a third species, S. emmae (Emery, 1890) based upon specimens from the humid tropical biomes at the Eden Project, Cornwall (UK). A single record outlined here is noted as the earliest known record of S. emmae from Europe thus far, pre-dating previous records by four years. We provide high resolution images, measurements, and discussion on the ecology of the species. In addition, an updated key to the Strumigenys of the Europe is supplied.


Assuntos
Formigas , Ecossistema , Humanos , Animais , Reino Unido
13.
BMJ Open ; 14(3): e079027, 2024 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-38471681

RESUMO

INTRODUCTION: Obesity increases the risk of morbidity and mortality. A major driver has been the increased availability of ultra-processed food (UPF), now the main UK dietary energy source. The UK Eatwell Guide (EWG) provides public guidance for a healthy balanced diet but offers no UPF guidance. Whether a healthy diet can largely consist of UPFs is unclear. No study has assessed whether the health impact of adhering to dietary guidelines depends on food processing. Furthermore, our study will assess the impact of a 6-month behavioural support programme aimed at reducing UPF intake in people with overweight/obesity and high UPF intakes. METHODS AND ANALYSIS: UPDATE is a 2×2 cross-over randomised controlled trial with a 6-month behavioural intervention. Fifty-five adults aged ≥18, with overweight/obesity (≥25 to <40 kg/m2), and ≥50% of habitual energy intake from UPFs will receive an 8-week UPF diet and an 8-week minimally processed food (MPF) diet delivered to their home, both following EWG recommendations, in a random order, with a 4-week washout period. All food/drink will be provided. Participants will then receive 6 months of behavioural support to reduce UPF intake. The primary outcome is the difference in weight change between UPF and MPF diets from baseline to week 8. Secondary outcomes include changes in diet, waist circumference, body composition, heart rate, blood pressure, cardiometabolic risk factors, appetite regulation, sleep quality, physical activity levels, physical function/strength, well-being and aspects of behaviour change/eating behaviour at 8 weeks between UPF/MPF diets, and at 6-month follow-up. Quantitative assessment of changes in brain MRI functional resting-state connectivity between UPF/MPF diets, and qualitative analysis of the behavioural intervention for feasibility and acceptability will be undertaken. ETHICS AND DISSEMINATION: Sheffield Research Ethics Committee approved the trial (22/YH/0281). Peer-reviewed journals, conferences, PhD thesis and lay media will report results. TRIAL REGISTRATION NUMBER: NCT05627570.


Assuntos
Obesidade , Sobrepeso , Adulto , Humanos , Dieta , Ingestão de Energia , Reino Unido , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Nutrients ; 16(5)2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38474731

RESUMO

Examination of how terms such as culinary nutrition, culinary nutrition science, culinary medicine, culinary nutrition professional, culinary nutrition intervention, culinary nutrition activity, and culinary nutrition competency are used in practice, and the creation of consensus definitions will promote the consistent use of these terms across work areas and disciplines. Thirty leading practitioners, academics, and researchers in the fields of food and nutrition across Australia, the United States, Canada, United Kingdom, Europe, and Asia were approached by investigators via email to submit definitions of key terms using a Qualtrics survey link. Further participants were reached through snowball recruitment. Initial emails were sent in October and November 2021 with subsequent reminders between November 2021 and March 2022. Two researchers undertook content analysis of the text answers for each of the terms and generated definitions for discussion and consensus. Thirty-seven participants commenced the survey and twenty-three submitted one or more definitions. Agreed definitions fell into two categories: practice concepts and practitioners. Further discussion amongst investigators led to the creation of a visual map to demonstrate the interrelationship of terms. Culinary nutrition science underpins, and interprofessional collaboration characterizes practice in this area, however, further work is needed to define competencies and model best practice.


Assuntos
Currículo , Alimentos , Humanos , Estados Unidos , Reino Unido , Europa (Continente) , Austrália
15.
BMJ ; 384: q553, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38443088
16.
Br Dent J ; 236(5): 369, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38459297
17.
BMJ Paediatr Open ; 8(1)2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38453418

RESUMO

OBJECTIVE: Severe myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) in children and young people (CYP) is a little-understood condition which significantly impacts education, development and quality of life. We used data from a population-wide surveillance study to explore the screening investigation, referral and management of suspected cases of paediatric severe ME/CFS. METHODS: A British Paediatric Surveillance Unit (BPSU) study reported cases of CYP with suspected severe ME/CFS between February 2018 and February 2019. Paediatricians reporting cases to BPSU and allied healthcare professionals in two large specialist paediatric ME/CFS centres were invited to complete questionnaires for CYP meeting the surveillance case definition. The study focused primarily on CYP with confirmed severe ME/CFS and the extent to which their care met NICE (The National Institute for Health and Care Excellence) recommendations but also considered separately those with probable or possible severe ME/CFS. RESULTS: This study includes a total of 92 CYP with suspected severe ME/CFS; 33 meeting criteria for severe ME/CFS and an additional 59 classified as probable or possible severe ME/CFS. For 16 possible cases, incomplete investigation to exclude alternative diagnoses prevented confirmation of a severe ME/CFS diagnosis. Only 21 of 33 (64%) confirmed severe ME/CFS cases had been referred to specialist services. The management provided varied considerably between patients and four received nothing at all. Of the management provided, the most frequent approaches were medication (67%), activity management (61%) and physiotherapy (61%). Domiciliary assessments and support, and social services referrals were received by 12% and 6% of confirmed severe cases. Similar proportions of management approaches were seen in probable/possible severe ME/CFS. CONCLUSION: Full investigation is frequently incomplete in CYP with suspected severe ME/CFS and recommendations for referral and management are poorly implemented, in particular the needs of CYP who are unable to leave their home might be poorly met.


Assuntos
Síndrome de Fadiga Crônica , Humanos , Criança , Adolescente , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Síndrome de Fadiga Crônica/terapia , Qualidade de Vida , Serviço Social , Pessoal de Saúde , Reino Unido/epidemiologia
18.
BMC Musculoskelet Disord ; 25(1): 207, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454371

RESUMO

BACKGROUND: Interplay between physical and mental health (MH) is widely recognised amongst patients with Musculoskeletal and co-existing MH conditions. Evidence suggests that psychological interventions improve outcomes and satisfaction in patients with physical conditions, however current healthcare models continue to separate physical and mental health care, as health services are fragmented. If the delivery of MH support could be facilitated by Allied Health Professionals (AHPs), such as physiotherapists and occupational therapists (OTs), this could be an effective, low-cost way to achieve routine integration. This study aimed to explore the experiences of UK physiotherapists and OTs working with patients with MSK and co-existing MH conditions and to understand views on improving MSK services. METHODS: This was an exploratory-descriptive qualitative study using semi-structured interviews. Participants were recruited via social media and professional organisations using convenience sampling. Participants included registered UK physiotherapists or OTs within MSK settings who managed patients with MH conditions. Inductive thematic analysis was used, where single and double-level coding, single counting and inclusion of divergent cases were conducted to enhance methodological rigour. RESULTS: Three overarching themes were identified. Overarching theme one referred to openness to provide MH support, with scope of practice and lack of confidence as themes. Overarching theme two described challenges, incorporating mental health stigma, the clinical environment, and limited experience. The overarching theme referring to training, identified the need for further training and strategies to implement as themes. CONCLUSION: Many challenges to achieving optimal integration of physical and mental health care exist within MSK services. These challenges go beyond the need for additional training and knowledge acquisition and include departmental readiness such as funding, diary management, and supervision by senior colleagues/or psychologists. These need consideration in parallel to match the evolving needs of the MSK population.


Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Pessoal Técnico de Saúde , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Pesquisa Qualitativa , Reino Unido/epidemiologia
19.
BMC Public Health ; 24(1): 813, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38491419

RESUMO

BACKGROUND: Intersecting socioeconomic and demographic reasons for physical activity (PA) inequalities are not well understood for young people at risk of experiencing marginalisation and living with disadvantage. This study explored young people's experiences of PA in their local area, and the associated impacts on opportunities for good physical and emotional health and wellbeing. METHODS: Seven local youth groups were purposefully sampled from disadvantaged areas across urban, rural and coastal areas of England, including two that were specifically for LGBTQ + young people. Each group engaged in three interlinked focus groups which explored young people's perceptions and lived experience of PA inequalities. Data were analysed using an inductive, reflexive thematic approach to allow for flexibility in coding. RESULTS: Fifty five young people aged 12-21 years of different sexualities, gender and ethnicity took part. Analysis yielded four themes: PA experiences across spaces; resigned to a lack of inclusivity and 'belonging'; safety first; complexities in access and accessibility. Young people felt more comfortable to be active in spaces that were simpler to navigate, particularly outdoor locations largely based in nature. In contrast, local gyms and sports clubs, and the school environment in general, were spoken about often in negative terms and as spaces where they experienced insecurity, unsafety or discomfort. It was common for these young people to feel excluded from PA, often linked to their gender and sexuality. Lived experiences or fears of being bullied and harassed in many activity spaces was a powerful message, but in contrast, young people perceived their local youth club as a safe space. Intersecting barriers related to deprivation, gender and sexuality, accessibility, disability, Covid-19, affordability, ethnicity, and proximity of social networks. A need emerged for safe spaces in which young people can come together, within the local community and choose to be active. CONCLUSIONS: The overarching concept of 'physical activity insecurity' emerged as a significant concern for the young people in this study. We posit that PA insecurity in this context can be described as a limited or restricted ability to be active, reinforced by worries and lived experiences of feeling uncomfortable, insecure, or unsafe.


Assuntos
Exercício Físico , Identidade de Gênero , Adolescente , Humanos , Pesquisa Qualitativa , Exercício Físico/psicologia , Comportamento Sexual/psicologia , Reino Unido
20.
Vet Rec ; 194(6): 207, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38488571
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