Changes in the number and outcome of takeaway food outlet planning applications in response to adoption of management zones around schools in England: A time series analysis.

Physical exposure to takeaway food outlets ("takeaways") is associated with poor diet and excess weight, which are leading causes of excess morbidity and mortality. At the end of 2017, 35 local authorities (LAs) in England had adopted takeaway management zones (or "exclusion zones"), which is an urban planning intervention designed to reduce physical exposure to takeaways around schools. In this nationwide, natural experimental study, we used interrupted time series analyses to estimate the impact of this intervention on changes in the total number of takeaway planning applications received by LAs and the percentage rejected, at both first decision and after any appeal, within management zones, per quarter of calendar year. Changes in these proximal process measures would precede downstream retail and health impacts. We observed an overall decrease in the number of applications received by intervention LAs at 12 months post-intervention (6.3 fewer, 95% CI -0.1, -12.5), and an increase in the percentage of applications that were rejected at first (additional 18.8%, 95% CI 3.7, 33.9) and final (additional 19.6%, 95% CI 4.7, 34.6) decision, the latter taking into account any appeal outcomes. This effect size for the number of planning applications was maintained at 24 months, although it was not statistically significant. We also identified three distinct sub-types of management zone regulations (full, town centre exempt, and time management zones). The changes observed in rejections were most prominent for full management zones (where the regulations are applied irrespective of overlap with town centres), where the percentage of applications rejected was increased by an additional 46.1% at 24 months. Our findings suggest that takeaway management zone policies may have the potential to curb the proliferation of new takeaways near schools and subsequently impact on population health.

Changes in the number of new takeaway food outlets associated with adoption of management zones around schools: A natural experimental evaluation in England.

By the end of 2017, 35 local authorities (LAs) across England had adopted takeaway management zones (or "exclusion zones") around schools as a means to curb proliferation of new takeaways. In this nationwide, natural experimental study, we evaluated the impact of management zones on takeaway retail, including unintended displacement of takeaways to areas immediately beyond management zones, and impacts on chain fast-food outlets. We used uncontrolled interrupted time series analyses to estimate changes from up to six years pre- and post-adoption of takeaway management zones around schools. We evaluated three outcomes: mean number of new takeaways within management zones (and by three identified sub-types: full management, town centre exempt and time management zones); mean number on the periphery of management zones (i.e. within an additional 100 m of the edge of zones); and presence of new chain fast-food outlets within management zones. For 26 LAs, we observed an overall decrease in the number of new takeaways opening within management zones. Six years post-intervention, we observed 0.83 (95% CI -0.30, -1.03) fewer new outlets opening per LA than would have been expected in absence of the intervention, equivalent to an 81.0% (95% CI -29.1, -100) reduction in the number of new outlets. Cumulatively, 12 (54%) fewer new takeaways opened than would have been expected over the six-year post-intervention period. When stratified by policy type, effects were most prominent for full management zones and town centre exempt zones. Estimates of intervention effects on numbers of new takeaways on the periphery of management zones, and on the presence of new chain fast-food outlets within management zones, did not meet statistical significance. Our findings suggest that management zone policies were able to demonstrably curb the proliferation of new takeaways. Modelling studies are required to measure the possible population health impacts associated with this change.

Employer-focused interventions targeting disability employment: A systematic review.

There are a wide range of interventions that are designed to influence employer behaviour with respect to the employment of people with disabilities. This study presents the results of a systematic review looking at employer-focused interventions to improve disability employment, focusing on interventions or policies taking placing in high-income countries as per the OECD. This systematic review focuses on a broad range of potential employment-related outcomes, including the employment rate, time to return to work and length of sickness absence. The results of 71 papers that evaluate the effectiveness of a range of interventions were synthesised into a narrative review. Interventions are grouped into six broad categories: anti-discrimination legislation, quota systems, part-time sick leave, graded return to work and wage subsidy schemes. Anti-discrimination legislation is not effective at improving the employment prospects of people with disabilities. There is mixed evidence with respect to quota systems and wage subsidy schemes. However, the availability of part time sick leave or graded return to work are both consistently associated with improved work participation for people with disabilities.

"But what do you really think?" Nurses' contrasting explicit and implicit attitudes towards people with disabilities using the implicit association test.

AIMS: To investigate how nurses' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non-healthcare providers. METHOD: We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non-healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021. DATA SOURCES: We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/. REPORTING: STROBE checklist. RESULTS: There is a distinct contrast between nurses' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD-among all groups-has not improved over the 15 year period of our sample. CONCLUSIONS: We present a contrast between nurses' explicit and implicit attitude towards PWD compared to non-healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently. IMPLICATIONS: We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding. PATIENT OR PUBLIC CONTRIBUTION: There is no patient or public contribution.

Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis.

A variety of factors are associated with greater COVID-19 morbidity or mortality, due to how these factors influence exposure to (in the case of morbidity) or severity of (in the case of mortality) COVID-19 infections. We use multiscale geographically weighted regression to study spatial variation in the factors associated with COVID-19 morbidity and mortality rates at the local authority level across England (UK). We investigate the period between March 2020 and March 2021, prior to the rollout of the COVID-19 vaccination program. We consider a variety of factors including demographic (e.g. age, gender, and ethnicity), health (e.g. rates of smoking, obesity, and diabetes), social (e.g. Index of Multiple Deprivation), and economic (e.g. the Gini coefficient and economic complexity index) factors that have previously been found to impact COVID-19 morbidity and mortality. The Index of Multiple Deprivation has a significant impact on COVID-19 cases and deaths in all local authorities, although the effect is the strongest in the south of England. Higher proportions of ethnic minorities are associated with higher levels of COVID-19 mortality, with the strongest effect being found in the west of England. There is again a similar pattern in terms of cases, but strongest in the north of the country. Other factors including age and gender are also found to have significant effects on COVID-19 morbidity and mortality, with differential spatial effects across the country. The results provide insights into how national and local policymakers can take account of localized factors to address spatial health inequalities and address future infectious disease pandemics.

Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care.

Background: The primary objective of this study is to investigate the implicit and explicit attitudes of healthcare professionals - in particular nurses - towards transgender people. This is especially important in light of recent calls for improved trans-affirming care provision by healthcare professionals to generate quality healthcare access and outcomes for transgender people. Methods: We use publicly available data from the transgender version of the Implicit Association Test from 2020 to 2022. We focus on differences between three subsets of participant: (1) non-healthcare professionals (N = 177,810), (2) non-nursing healthcare professionals (N = 22,443) and (3) nursing healthcare professionals (N = 11,996). We present the results of parametric statistical tests (t-tests) and an ordinary least squares regression, to analyse the robustness of our results when controlling for a host of sociodemographic characteristics. Results: We find that non-healthcare professionals have significantly lower implicit bias towards transgender people compared to healthcare professionals. Further, within healthcare professionals, we find nurses have significantly higher implicit bias towards transgender people compared to non-nurses. We show how implicit bias and explicit attitudes are highly correlated. Further, we provide evidence that healthcare professionals - but in particular nurses - conflate sex and gender identity. Conclusion: Whilst nurses continue to have higher levels of implicit and explicit bias towards transgender people there remains a need to globally establish additional enhanced trans-affirming care training provision for nursing and medical students.

The importance of disability representation to address implicit bias in the workplace.

Introduction: People are disabled by barriers in society, not by their impairment. Barriers can be physical or be caused by people's implicit and explicit attitudes towards people with disabilities. Methods: We utilise the Implicit Association Test to investigate implicit attitudes towards people with disabilities among Human Resource professionals and people involved in making hiring decisions. Results: We find no significant differences between people who work for large companies or Small- to Medium-sized Enterprises. Similarly, working in Human Resources (or making recruitment decisions) has no effect on implicit bias. We supply the first evidence linking a person's own health status (measured using EQ-5D-5L) to their implicit bias. We find that a worse health status is associated with lower implicit bias towards people with disabilities. In addition, we find women have lower implicit bias than men. Discussion: The discussion reflects on the need for greater disability representation within the workplace - especially in making hiring decisions.