Testing a policy intervention in the lab: differences between students and non-students in switching bank accounts.

The reliance on student samples has long been a subject of debate in experimental approaches to studying behaviour. We contribute to this discussion by looking at differences in financial behaviour between a student and a non-student sample in three sets of lab experiments conducted in Spain, Germany and Poland (n=857). Participants from both samples switched more often and made better financial decisions after they received a message encouraging them to switch financial service providers. While the size of the effect on switching frequency was comparable between the two samples, the effect on switching quality was significantly stronger on non-students. Further analysis suggests this is due to a better performance of students before the prompt leaving less room for improvement by the reminder. Results suggest that experimental evidence derived from students should be generalized with caution.

Oculomotor Behaviour in Individuals with Long COVID-19.

OBJECTIVE: To determine, the impact of long COVID-19 on oculomotor behaviour. DESIGN: A case-control study. SETTING: Spanish Association of Persistent COVID. PARTICIPANT: Participants were 75 cases (64 women, 11 men, mean age 46.4 years ±8.9) and 42 controls (22 women, 20 men, mean age 53.5 years ±13.13). INTERVENTION: An eye-tracking test based on visual search paradigm and the Adult Developmental Eye Movement Test were used to evaluate the participants. MAIN MEASURES: The primary outcomes in the Adult Developmental Eye Movement Test were horizontal reading time, vertical reading time, and their ratio. And for the eye-tracking test the time to find the target, the duration, and the number of eye fixations. RESULTS: In cases and controls, eye movement test results were horizontal(Hadj) reading time 74.2 ± 22.7 s vs 52.0 ± 6.1 s (p < .0001); vertical(Vadj) reading time 67.6 ± 17.8 s vs 50.4 ± 6.9 s (p < .0001); Hadj/Vadj ratio 0.9 ± 0.1 vs 1.0 ± 0 (p = .0032), respectively; and eye-tracking test results were fixation number 11.3 ± 3.07 vs 3.51 ± 2.57 (p < .0001); fixation duration 2.01 ± 0.79 s vs 1.5 ± 0.4 s (p = .0013), and time to find target 24.5 ± 8.0 vs 18 ± 9.4 (p = .0034), respectively. CONCLUSIONS: Data showed a lower performance in oculomotor behaviour in people with long COVID-19, compared to healthy individuals. It cannot be affirmed an ocular musculature dysfunction; the differentiated behaviour could be associated to cognitive alterations affected in these people. Both tests used could be an useful tool for the clinical assessment of these participants. Further studies are needed to explore the utility of these procedures.

Exploring the multiple dimensions of perceived food access in the local food environment in Flanders: perceptions of adults in socioeconomically disadvantaged situations.

Persons in socioeconomically disadvantaged situations are more susceptible and disproportionally exposed to unhealthy food environments, which results in limited access to healthy foods and poorer dietary outcomes. This qualitative paper examines the various dimensions of perceived food access to healthy and unhealthy foods (i.e., availability, affordability, accessibility, accommodation, desirability, convenience and acceptability) within the local food environment among persons in socioeconomically disadvantaged situations. A total of 23 participants in socioeconomically disadvantaged situations expressed their perceptions of food access within their local food environment and its role in their eating behaviour through participant-driven photo-elicitation in a focus group context (n=7) and researcher-driven photo-elicitation interviews (n=16). Reflexive thematic analysis has been used to analyse our data through an access framework. Four overarching themes were constructed. The first two themes concern barriers to perceived food access in respectively the home and community food environment - including the importance of kitchen infrastructure, household composition and transport options. The third theme encompasses the interaction of perceived food access with the sociocultural environment, highlighting its dual role as facilitator (e.g., through food sharing practices) and barrier (e.g., through social stigma and shame). The fourth theme concerns awareness and the ability to navigate within the information food environment, which has also been proposed as a novel dimension of food access. This study emphasizes the complexity of food access and the need for a multifaceted approach that integrates perceptions to ensure equitable access to healthy foods.

Gut microbiota and eating behaviour in circadian syndrome.

Eating behaviour and circadian rhythms are closely related. The type, timing, and quantity of food consumed, and host circadian rhythms, directly influence the intestinal microbiota, which in turn impacts host circadian rhythms and regulates food intake beyond homeostatic eating. This Opinion discusses the impact of food intake and circadian disruptions induced by an obesogenic environment on gut-brain axis signalling. We also explore potential mechanisms underlying the effects of altered gut microbiota on food intake behaviour and circadian rhythmicity. Understanding the crosstalk between gut microbiota, circadian rhythms, and unhealthy eating behaviour is crucial to addressing the obesity epidemic, which remains one of the biggest societal challenges of our time.

How strong is the evidence supporting the WHO guidelines on physical activity, sedentary behaviour and sleep in early childhood?

BACKGROUND: The WHO issued recommendations about the ideal amount of physical activity, sedentary behaviour and sleep in infants, toddlers and preschool children. To facilitate their interpretation and translation into public health policies, we analysed the quantity and quality of the evidence that supported the development of each WHO recommendation. METHODS: All data for each exposure-outcome pair analysed in the studies informing WHO guidelines were extracted, and predefined criteria, based upon GRADE methodology, were used to classify each outcome and study result. RESULTS: Among the 237 studies that could be included, 37 were experimental and 200 were observational, yielding 920 analyses of exposure-outcome associations. Sixty-two analyses used a relevant outcome, with or without significant results. Five of the 10 WHO recommendations were based upon zero analyses with significant results on relevant health outcomes. The remaining recommendations were mostly based upon analyses evaluating obesity-related outcomes. Eight of the 10 GLs thresholds were not supported by any significant analysis on clinically relevant outcomes. CONCLUSION: While these findings should not be interpreted as an attempt to disprove the benefits of healthy lifestyle habits in early childhood, neither to minimize the work of the experts in this complex research field, very limited evidence currently supports the adoption of recommended thresholds as behavioural surveillance and public health interventions targets. Therefore, until further data are available, public health interventions should be developed balancing whether to focus on the achievement of specific targets that are still not supported by high-quality evidence or on the general promotion of healthy behaviours.

Enhancing making every contact count (MECC) training and delivery for the third and social economy (TSE) sector: a strategic behavioural analysis.

OBJECTIVE: To enhance Making Every Contact Count (MECC, an opportunistic approach to health promotion), training in the Third and Social Economy (TSE, all groups and organisations primarily working towards social justice, outside of the government or household) by examining the degree to which the behavioural content of MECC training tackled significant factors influencing MECC delivery. METHODS AND MEASURES: A strategic behavioural analysis design. Semi-structured interviews with service providers (n = 15) and users (n = 5) were coded for barriers and facilitators of MECC delivery using the Theoretical Domains Framework (TDF). Existing MECC training was coded for behaviour change techniques (BCTs) and intervention functions (IFs). The degree to which BCTs and IFs addressed the key TDF domains of influences on MECC delivery in the TSE were examined using prespecified tools. RESULTS: Seven key TDF domains of influences in MECC delivery were identified. Overall, only 9/31 linked BCTs were utilised within MECC training, with percentage utilisation of relevant BCTs for each domain ranging from 0% to 66.7%. Training adequately addressed 2/7 key domains. CONCLUSION: The TSE and healthcare share many common key TDF domains, although there are differences in how each are relevant. Limitations and recommendations for MECC training are discussed.

Investigating the physicochemical properties, sensory profile and consumer acceptability of beetroot dark chocolate.

BACKGROUND: The incorporation of functional food ingredients in chocolate that seek to eliminate, if not completely, most of the added sugar content, as well as the use of alternative chocolate production techniques, have gained popularity in recent years. This study aimed to incorporate red beetroot powder into dark chocolate and investigate the effect of red beetroot powder concentration and processing time in a melanger on the physicochemical properties, sensory profile and consumer acceptability of beetroot dark chocolate. RESULTS: The addition of red beetroot powder increased the moisture content, particle size distribution and hardness of the chocolates, while the opposite was true for processing time with no effect on the colour. Except for taste, which had an average score of 3.2 ± 1.8 on the 7-point hedonic scale, consumers scored all the other sensory attributes of the chocolates above 4.0. Among the chocolates with red beetroot powder, samples with a 15% red beetroot powder addition had a high average overall acceptability score of >5, while the 30% sample scored <4. CONCLUSION: Red beetroot powder can be used to replace sugar in dark chocolate without affecting its physicochemical properties, sensory profile or consumer acceptability. However, the target market should be considered when determining the level of red beetroot powder incorporation in terms of chocolate taste. This research has the potential to improve the overall health-promoting properties of dark chocolate by eliminating added sugar (partially or completely). It would also help to diversify beetroot utilization, allow small-scale processors to venture into chocolate production and expand the small-scale chocolate value chain. © 2024 Society of Chemical Industry.

A Healthy Conversation Skills intervention to support changes to physical activity and dietary behaviours in community-dwelling older adults during the COVID-19 pandemic.

AIMS: Physical activity (PA) and nutrition are important determinants of health in late adulthood. However, low levels of PA and poor nutrition are common in older adults and have become more prevalent during the COVID-19 pandemic. We hypothesised that Healthy Conversation Skills could be used to support health behaviour changes beneficial for health in older adults and thus conducted a study nested within the UK Hertfordshire Cohort Study. METHODS: Between November 2019 and March 2020, 176 participants were visited at home. A trained researcher administered a questionnaire and undertook anthropometric and physical performance tests. A total of 89 participants were randomised to the control group and received a healthy living leaflet; 87 participants in the intervention group were interviewed using Healthy Conversation Skills at the initial visit with follow-up telephone calls at 1, 3, 6 and 9 months. Follow-up at 1 year by postal questionnaire assessed change in PA and diet. In total, 155 participants (79 control and 76 intervention) completed the baseline and 1-year follow-up. RESULTS: At baseline, median (lower quartile, upper quartile) age (years) was 83.1 (81.5, 85.5) and median PA time (min/day) from walking, cycling and sports was 30.0 (15.0, 60.0). In total, 95% of participants completed the intervention; the total response rate for postal questionnaires was 94%. There were no statistically significant differences in outcomes between the trial arms. In women, there was a tendency for greater increases in diet quality in the intervention group compared to the control group (p = 0.075), while among men, there was a tendency for reduced decline in self-reported physical function in the intervention group compared to the control group (p = 0.081). CONCLUSION: We have shown that it is viable to utilise Healthy Conversation Skills via telephone to promote healthier lifestyles in older adults. Larger appropriately powered studies to determine the efficacy of such an intervention are now warranted.

Resistance exercise breaks during prolonged sitting augment the blood flow response to a subsequent oral glucose load in sedentary adults.

Sitting-induced impairments in postprandial blood flow are an important link between sedentary behaviour and cardiometabolic disease risk. The objective of this work was to examine the effects of resistance exercise breaks (REB) performed every 30 min during an otherwise sedentary 3-h period on the vasodilatory response to a subsequent oral glucose load in sedentary adults. Twenty-four sedentary adults (27 ± 7 years, 16 females) completed two conditions. Fasting blood glucose, insulin, popliteal artery blood flow (PABF) and gastrocnemius perfusion were measured immediately before standardized breakfast consumption. After breakfast, the 3-h REB or uninterrupted (SIT) intervention period commenced. Participants sat at a workstation, and popliteal artery shear rate (PASR) was measured 60 and 120 min into this period. In the REB condition, participants performed a 3-min REB (3 × [20 s squats, 20 s high knees, 20 s calf raises]) every 30 min. Following the intervention period, baseline measurements were repeated. Participants then consumed a 75 g glucose beverage, and PABF and perfusion were measured every 30-60 min for the following 120 min. Relative to SIT, REB increased PASR at 60 min (+31.4 ± 9.2/s, P = 0.037) and 120 min (+37.4 ± 10.2/s, P = 0.019) into the intervention period. Insulin and glucose increased (P < 0.001) in response to glucose consumption, with no differences between conditions (P ≥ 0.299). In response to the glucose load, perfusion (1.57 vs. 1.11 mL/100 mL/min, P = 0.023) and PABF (+45.3 ± 11.8 mL/min, P = 0.001) were greater after REB versus SIT. Performing 3-min REB every 30 min during an otherwise sedentary 3-h period augmented leg blood flow responses to an oral glucose load. HIGHLIGHTS: What is the central question of this study? Can 3-min resistance exercise breaks (REB) performed during an otherwise sedentary 3-h period augment the vasodilatory response to a subsequent oral glucose load in sedentary adults? What is the main finding and its importance? Performing 3-min REB, which included squats, high knees, and calf raises, every 30 min augmented lower limb blood flow responses to a subsequent oral glucose load compared to 3 h of uninterrupted sitting in sedentary adults. Sitting-induced impairment in postprandial vasodilatory function has been identified as a link between sedentary behaviour and cardiometabolic disease. Thus, the current study presents a potentially effective strategy to offset this risk.

Context-driven communication during deep-sea foraging in a social toothed whale.

Social deep-diving odontocetes face the challenge of balancing near-surface proximity to oxygen and group members with foraging in the deep sea. Individuals rely on conspecifics for critical life functions, such as predator defence, but disperse during foraging to feed individually. To understand the role of social acoustic mediation during foraging in deep-diving toothed whales, we investigated the context of social burst-pulse call production in Risso's dolphin (Grampus griseus) using biologgers. Dolphins produced context-specific burst pulses predominantly during daytime foraging, preceding or following foraging dives and in the early descent of daytime deep dives. Individuals applied differential short and long burst-pulse calls intended for either near-surface receivers (horizontal transmission) or deep-foraging receivers (vertical transmission). Our results show that deep-diving toothed whales are reliant on acoustic communication during certain foraging contexts, to relay information including foraging conditions or an individual's location. Moreover, they accentuate the importance of maintaining acoustic contact with conspecifics, specifically when dispersed during deeper foraging. It also signifies that our oceanic top predators may be specifically vulnerable to the current strong increase in anthropogenic noise. Potential masking of the signals from group members communicating at a distance could undermine their social cohesion, and hence their capacity to maintain vital life functions.

Recovery from social isolation requires dopamine in males, but not the autism-related gene nlg3 in either sex.

Social isolation causes profound changes in social behaviour in a variety of species. However, the genetic and molecular mechanisms modulating behavioural responses to social isolation and social recovery remain to be elucidated. Here, we quantified the behavioural response of vinegar flies to social isolation using two distinct protocols (social space preference and sociability, the spontaneous tendencies to form groups). We found that social isolation increased social space and reduced sociability. These effects of social isolation were reversible and could be reduced after 3 days of group housing. Flies with a loss of function of neuroligin3 (orthologue of autism-related neuroligin genes) with known increased social space in a socially enriched environment were still able to recover from social isolation. We also show that dopamine (DA) is needed for a response to social isolation and recovery in males but not in females. Furthermore, only in males, DA levels are reduced after isolation and are not recovered after group housing. Finally, in socially enriched flies mutant for neuroligin3, DA levels are reduced in males, but not in females. We propose a model to explain how DA and neuroligin3 are involved in the behavioural response to social isolation and its recovery in a dynamic and sex-specific manner.

Dynamics of direct hydrocarbon PEM fuel cells.

Hydrocarbon fuels contain approximately 50 times more energy per unit mass than commercial batteries, thus converting even 10% of the energy contained in hydrocarbon fuels to electrical energy could present a more mass-efficient electrical energy source than batteries. Considering the storability of hydrocarbon fuels compared to hydrogen, the viability of direct hydrocarbon polymer electrolyte membrane fuel cells was examined. With extremely pure (> 99.99%) propane, the cell Open-Circuit Voltage (OCV) was only 0.05 V and produced negligible power. However, with addition of trace quantities of unsaturated hydrocarbons, the cell had an OCV of 0.85 V and produced power, even after the unsaturated hydrocarbon addition was discontinued. At sufficiently high current densities, power output gradually decreased then the cell rapidly "extinguished" but by periodically shutting off the current for short time intervals the average power density could be increased significantly. Chemical analysis revealed that no significant amounts of hydrocarbon intermediates or CO were present in the effluent and that conversion of the hydrocarbon fuel to CO2 and H2O was nearly complete. An analytical model incorporating the relative rates of conversion of active anode catalyst sites to inactive sites and vice versa was developed to interpret this behavior. The model predictions were consistent with the experimental observations; possible physical mechanisms are discussed.

Do forage production and ingestive behavior of locally adapted sheep differ from an irrigated silvopastoral system to an irrigated monoculture in the semi-arid region?

This study aimed to evaluate forage production and ingestive behavior of Morada Nova sheep in an intensive system with capim-tamani grass in both monoculture and silvopastoral irrigated systems in the Semi-arid region. Eighteen adult sheep, approximately 3 years old, with an average body weight of 26.8 ± 4.3 kg, were allocated to treatments with capim-tamani grass cultivated in monoculture and in silvopastoral systems with Caatinga trees. The experiment followed a completely randomized complete block design with two plots and three replications. Forage production, consumption, and behavioral activities were the assessed variables. The animals remained in the pasture daily between 6 am and 6 pm. No effects of the monoculture and silvopastoral systems were observed on the structural and productive characteristics of the capim-tamani grass pasture. There were also no observed effects on body condition score, consumption, and disappearance rate of dry matter (DM) and other nutrients in both systems. However, there was an interaction between the time animals spent under shade in monoculture and silvopastoral systems. In general, the animals spent more time under shade where there were trees, except during the period between 2 pm and 4 pm, when the times were similar. On average, the animals spent approximately 15.6% (equivalent to 1.87 h) of their total time in the artificial shade available in the monoculture system, whereas in the silvopastoral system, they remained under natural shade for approximately 40% (five and a half hours) of their time spent in the pasture during the day. The grazing frequency in both systems was approximately 70% (8.4 h) in relation to the total time spent in the pasture. The capim-tamani grass pasture managed intensively with sheep in the silvopastoral system showed similar forage production and consumption compared to the monoculture system. There was a positive influence of trees on the duration of solar radiation exposure to the animals throughout the day. The results support the need to provide shade for sheep, as well as to promote these sustainable systems in semi-arid regions.

A "Self-Milieux" perspective on help-seeking: examining the impact of a person's sociocultural background on help-seeking in people with untreated depressive symptoms.

BACKGROUND: Mental illness is a global concern and the leading cause of years lived with disability. Research on help-seeking behaviour has focused on individual factors, but there is still much unexplained variance. Suggesting complex interactions between determinants of human behaviour a new framework called Self-Milieux is proposed to represent a person's sociocultural background. The article introduces a statistical approach to determine Self-Milieux and exemplarily examines its predictive validity for health-related research. METHODS: Self-Milieux are determined through a two-stage clustering method based on the determinants socioeconomic status and self-construal profile. Descriptive analyses are used to compare Self-Milieux characteristics. Hierarchical binary logistic regression models test the association between Self-Milieux and help-seeking behaviour, while controlling for socioeconomic status as an established predictor. RESULTS: The sample size was N = 1535 (Mage = 43.17 and 64.89% female participants). Average depression severity was M = 12.22, indicating mild to moderate symptoms. Six Self-Milieux were determined and named. Participants from privileged (aOR = 0.38) and self-sufficient (aOR = 0.37) milieux were less likely to seek help from a general practitioner than those from the entitled milieu. Participants from privileged (aOR = 0.30), collaborators (aOR = 0.50), disadvantaged (aOR = 0.33), and self-sufficient (aOR = 0.21) milieux were less likely to seek help from family members than those from the entitled and family-bound milieux. DISCUSSION: The study's strengths and limitations, as well as the cluster methodology, are discussed. The comparative results for the six Self-Milieux are interpreted based on current research. For example, participants from some milieux follow a help-seeking process proposed in previous research, while participants from other milieux seem to show a different process, one that ends in informal help-seeking.

Homing of translocated native Indian pythons in Moyar River Valley, South India.

Homing is often a critical aspect of an animal's behavioural and spatial ecology. Translocation is considered to be a wildlife management strategy that could reduce human-wildlife confrontation, but this strategy may not be effective if animals attempt to home to their original capture location. Translocation of animals from sites where possible human-wildlife interaction occurs is a widespread but controversial intervention to resolve conflicts. In India, snakes are often the subject of such translocations, but there is a paucity of information on the behaviour of translocated snakes compared to resident snakes. The Indian python (Python molurus), one of the largest carnivores in the Indian subcontinent, is classified as Near Threatened by the IUCN. We conducted a two-year radio-tracking study (December 2018 to December 2020) on the movements of 14 adult Indian pythons in the Moyar River Valley, within the Sathyamangalam and Mudumalai Tiger Reserves. Eleven of the 14 pythons were translocated 0.28-55.7 kms from their capture locations, while 3 pythons were not translocated: 6 were translocated short distances (<5 km from capture; range 0.28-4.67 kms), 2 were translocated to medium distances (9-11 kms from capture location), and 3 were translocated to long distances (21-55.7 kms from capture location). Four of the six snakes translocated short distances all returned to within 500 m of their original capture locations, and all 6 returned over 60 % of the translocated distance to the initial capture location. Of the two snakes translocated medium distances, both returned to within 1.1 km of the capture location (∼90 % of the distance home). None of the three snakes that were translocated long distances successfully returned to their capture locations. Translocated pythons exhibited greater net movement distances than resident snakes within the first 2 months of release. Based on these results, long-distance translocation may be an effective strategy to minimize human-python conflict, while short or medium distance translocation is unlikely to be successful. However, more research is needed about the long-term survival of translocated snakes as well as soft-release methodologies that could prevent aberrant movement behaviour directly following release.

Laboratory-based measures of executive function and daily living skills in young children with Down syndrome: informing future interventions.

BACKGROUND: Adaptive behaviour refers to the practical skills necessary for independence and is considered a high-priority intervention target for children with neurogenetic conditions associated with intellectual disability, like Down syndrome (DS). Daily living skills (DLS) are a critical aspect of adaptive behaviour, but they have received little intervention attention, possibly because they involve a wide variety of skills across many settings. The present study aimed to advance DLS intervention science by examining the concurrent and longitudinal association between DLS performances and a cognitive skillset hypothesised to support DLS skill acquisition, executive function (EF). METHODS: Participants were 71 children with DS between the ages of 2.5 and 8.7 years (M = 5.23 years; standard deviation = 1.65) who completed a battery of adapted EF tasks and a primary caregiver who completed the Vineland Adaptive Behavior Scales 3rd Edition Parent/Caregiver Comprehensive Report Form. A subset of caregivers also provided 6- and 12-month follow-up adaptive behaviour information. RESULTS: Results demonstrated a positive association between EF task performance and DLS standard scores and v-scores both concurrently and longitudinally. CONCLUSIONS: The findings have implications for potential future intervention approaches that aim to strengthen DLS performances by advancing EF skills in this population.

The League: A person-centred approach to the development of social robotics for paediatric anxiety.

BACKGROUND: Social robots are promising tools to improve the quality of life of children and youth living with anxiety and should be developed based on the priorities of end users. However, pathways to include young people in patient-oriented research, particularly in the overlap between technology and mental health, have been historically limited. OBJECTIVE: In this work, we describe engagement with experts with lived experiences of paediatric anxiety in a social robotics research programme. We report the experiences of patient advisors in a co-creation process and identify considerations for other research groups looking to involve end users in technology development in the field of youth mental health. DESIGN: We engaged individuals with a lived experience of paediatric anxiety (current, recent past, or from a parent perspective) using three different models over the course of three years. Two initial patient partners were involved during project development, eight were engaged as part of an advisory panel ('the League') during study development and data analysis and four contributed as ongoing collaborators in an advisory role. League members completed a preparticipation expectation survey and a postparticipation experience survey. FINDINGS: Eight individuals from a range of anxiety-related diagnostic groups participated in the League as patient partners. Members were teenagers (n = 3), young adults aged 22-26 years who had connected with a youth mental health service as children within the past eight years (n = 3) or parents of children presently living with anxiety (n = 2). Preferred methods of communication, expectations and reasons for participating were collected. The League provided specific and actionable feedback on the design of workshops on the topic of social robotics, which was implemented. They reported that their experiences were positive and fairly compensated, but communication and sustained engagement over time were challenges. Issues of ethics and language related to patient-centred brain health technology research are discussed. CONCLUSIONS: There is an ethical imperative to meaningfully incorporate the voices of youth and young adults with psychiatric conditions in the development of devices intended to support their mental health and quality of life. PATIENT OR PUBLIC CONTRIBUTION: Six young people and two parents with lived experiences of paediatric anxiety participated in all stages of developing a research programme on social robotics to support paediatric mental health in a community context. They also provided input during the preparation of this manuscript.

'We need more support and doctors that understand the process of tapering ': A content analysis of free-text responses to a questionnaire on discontinuing long-term benzodiazepine receptor agonist use.

BACKGROUND: Many individuals worldwide continue to take benzodiazepine receptor agonists (BZRAs) long term (≥3 months). The aim of this study was to conduct a content analysis of the views and experiences of discontinuing long-term BZRA use as documented in the free-text responses of respondents to an online questionnaire examining mediators of behaviour change relating to the discontinuation of long-term BZRA use. DESIGN: The questionnaire was disseminated via online BZRA support groups to community-based adults with either current or previous experience of long-term BZRA use. The four free-text questions focused on (1) barriers and (2) facilitators to discontinuing BZRA use; (3) additional supports required to discontinue BZRA use; and (4) additional comments regarding BZRA use. Response data were analysed using summative content analysis. RESULTS: The most commonly reported barrier to BZRA discontinuation related to the consequences of stopping the medication, including withdrawal symptoms and the possibility of return of the original symptoms. The most common facilitator that respondents reported would help them in discontinuing BZRA use was support, primarily from medical professionals. Many respondents reported having been harmed or negatively affected in some way because of BZRA use. Several respondents expressed regret over ever taking BZRAs and/or reported that, with the benefit of hindsight, they should never have taken BZRAs in the first instance. CONCLUSION: The findings highlight the range of barriers faced by those attempting BZRA discontinuation and the importance of additional supports. Holistic and person-centred approaches are needed to support discontinuation of long-term BZRA use that considers an individual's personal circumstances and wider social context. PATIENT OR PUBLIC CONTRIBUTION: 'Experts by experience' with previous experience of long-term BZRA use were involved in developing the questionnaire and writing the manuscript as collaborators. Individuals with lived experience of taking BZRAs completed the questionnaire.

Patient experiences and desires for recovery after ankle fracture surgery.

OBJECTIVE: This study investigates patients' experiences of commencing weight-bearing after ankle fracture surgery and their recovery priorities to inform a new rehabilitation intervention. METHODS: Embedded within the Weight bearing in Ankle Fractures (WAX) trial, this qualitative study conducted semi-structured interviews with patients following ankle fracture surgery. The Behaviour Change Wheel (BCW) framework guided the interview questions to ensure comprehensive domain coverage. A purposive, maximum variation sampling strategy was used for participant selection. Data analysis employed a combined deductive and inductive approach. RESULTS: A total of 29 patients were interviewed, revealing five key themes: understanding the recovery journey, navigating the healthcare system, understanding personal physical capabilities, building confidence for weight-bearing, and resuming daily activities. Themes emphasised the variability in healthcare access, the impact of non-weight-bearing on independence, and the role of self-efficacy in recovery. CONCLUSIONS: The study highlighted the diversity in patient experiences and recovery challenges post-ankle fracture surgery. Patients' recovery was influenced by access to consistent healthcare advice, self-efficacy, and the physical and psychological impact of non-weight-bearing. The findings suggest a need for tailored, patient-centred rehabilitation interventions that consider individual recovery trajectories and promote self-management. These insights provide a foundational understanding for developing interventions that more effectively address patient priorities and barriers to recovery.