Exploring substance misuse in a prison in Wales: a cross-sectional analysis.

BACKGROUND: Since 2015, the risks of dying due to drug-related causes are higher in prison than in the general population, with opiates and psychoactive substances being the most common substances recorded on death certificates in prison. Many individuals use drugs before entering the prison environment, it is not clear which individuals continue to use drugs while in prison. This study is a first step towards identifying characteristics of those who use drugs in prison, while exploring substances commonly used. METHODS: This retrospective cross-sectional analysis was performed on 299 men (mean age 38 years [SD 11]) in a long-stay UK prison in South Wales who participated in a research study exploring cardiometabolic risk in prison, in which substance misuse was included as a risk variable. All men aged 25 years or older with no previous diagnosis of cardiometabolic illness were eligible to participate. Data were collected between Oct 7 and Oct 23, 2019. Participants were asked details about their substance use before and since entering the prison. Mental wellbeing was assessed using the short Warwick Edinburgh Mental Wellbeing Score and low mental wellbeing calculated as 1 SD below the population mean score. To examine associations between characteristics (age groups, mental wellbeing, exposure to prison environment) and drug use, we used binary logistic regression (adjusted for characteristics such as age group, mental wellbeing, and exposure to prison environment ). FINDINGS: Overall, 195 (65%) of 299 participants reported a history of drug use before entering prison. Since entering prison 49 (16%) participants reported using drugs including methadone, and 24 (8%) reported using drugs excluding methadone. The next leading substances used in prison were spice (11 [4%] participants) and cannabis (six [2%] participants). All those who used drugs in prison had a history of drug use. Individuals more likely to continue using drugs in prison were aged 39 years and younger (adjusted odds ratio [aOR] 4·72, 95% CI 1·88-11·89; p=0·0009), with reported low mental wellbeing (3·38, 1·54-7·41; p=0·002), and had spent collectively more than 2·5 years in the prison environment (4·77, 2·09-10·91; p=0·0002). INTERPRETATION: This study, from a limited sample, describes the characteristics of those who use drugs in prison. Harm reduction interventions targeted to these individuals could reduce the risk of prison drug-related deaths. These findings should be interpreted with some caution, as this is a single site and may not reflect the wider UK prison environment. FUNDING: Public Health Wales.

A 3-year review of deaths in people under community justice supervision in Wales: a cross-sectional analysis.

BACKGROUND: Despite little fluctuation in the numbers of people under community justice supervision in England and Wales, the number of deaths in this population has more than doubled between 2013-14 and 2020-21, from 560 to 1343 deaths. Contributing factors and causes of mortality are somewhat unknown. The aim of this study was to understand the number and the leading causes of people dying while under community justice supervision in Wales, UK, between April 1, 2018, and March 31, 2021. METHODS: Public Health Wales in collaboration with HM Prison and Probation Service in Wales were provided with identifiable data (name, date of birth, date of death, and the Probation Delivery Unit) of 306 individuals (aged ≥18 years) who had died during this time period while under community justice supervision. Following de-duplication and matching of National Health Service (NHS) numbers using the Welsh Demographic System, 266 deaths were linked to the live Office for National Statistics (ONS) Death Registry to obtain the cause of death. Deaths were grouped based on the International Classification of Diseases (ICD)-10 code assigned as their underlying cause of death. FINDINGS: In this cross-sectional study, the mortality rate overall was higher in women than in men (7·5 vs 5·6 deaths per 1000 population), despite the majority of deaths being in men, with less than 40 deaths in women. Mortality rates were nearly double in those aged 50 years and older (9·4 deaths per 1000 population) than in those aged 18-49 years (5·0 deaths per 1000 population). Drugs or alcohol were considered a primary cause of death for just under half of all deaths (n=115; 43%), with opiates being the most commonly named substance (n=63; 24%). 70 drug-related deaths involved poly-drug use. Accidental drug-related deaths were four times higher in those aged 18-49 years than in those aged 50 years and older (2·3 vs 0·6 deaths per 1000 population). Diseases of the circulatory system accounted for 13% (n=34) of all deaths and were 5 times higher in those aged 50 years and older than those aged 18-49 years (2·2 vs 0·4 deaths per 1000 population). INTERPRETATION: This study provides valuable insight into the leading causes of death among this cohort, notably deaths associated with substance misuse in younger age groups and with circulatory disease in older age groups. The increase in substance misuse-related deaths reflects recent national UK trends. Further research is required to understand which of these deaths were preventable. FUNDING: None.

Seeking Good Work in the COVID-19 Recovery: Shifting Priorities and Employment Choices Among Workers.

OBJECTIVE: Disruption to working lives spurred by the COVID-19 pandemic may shape people's preferences for future employment. We aimed to identify the components of work prioritized by a UK sample and the employment changes they had considered since the start of the COVID-19 pandemic. METHODS: A nationally representative longitudinal household survey was conducted in Wales at two time points between 2020 and 2021. RESULTS: Those in poorer health prioritized flexibility and were more likely to consider retiring. Those with limiting preexisting conditions or low mental well-being were more likely to consider becoming self-employed. Those experiencing financial insecurity (including those with high wage precarity or those furloughed) were more likely to consider retraining, becoming self-employed, or securing permanent employment. CONCLUSIONS: Ensuring flexible, secure, and autonomous work is accessible for individuals facing greater employment-related insecurity may be key.

Challenges to self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales.

BACKGROUND: Self-isolation is challenging and adherence is dependent on a range of psychological, social and economic factors. We aimed to identify the challenges experienced by contacts of coronavirus disease 2019 (COVID-19) cases to better target support and minimize the harms of self-isolation. METHODS: The Contact Adherence Behavioural Insights Study (CABINS) was a 15-minute telephone survey conducted with confirmed contacts of COVID-19 (N = 2027), identified through the NHS Wales Test Trace Protect (TTP) database. RESULTS: Younger people (aged 18-29 years) were three times more likely to report mental health concerns (adjusted odds ratio [aOR]: 3.16, 95% confidence interval [CI]: 2.05-4.86) and two times more likely to report loneliness (aOR: 1.96, CI: 1.37-2.81) compared to people aged over 60 years. Women were 1.5 times more likely to experience mental health concerns (aOR: 1.51, 95% CI: 1.20-1.92) compared to men. People with high levels of income precarity were eight times more likely to report financial challenges (aOR: 7.73, CI: 5.10-11.74) and three times more likely to report mental health concerns than their more financially secure counterparts (aOR: 3.08, CI: 2.22-4.28). CONCLUSION: Self-isolation is particularly challenging for younger people, women and those with precarious incomes. Providing enhanced support is required to minimize the harms of self-isolation.

New types of investments needed to address barriers to scaling up wildfire risk mitigation.

Background: Wildfire mitigation is becoming increasingly urgent, but despite the availability of mitigation tools, such as prescribed fire, managed wildfire, and mechanical thinning, the USA has been unable to scale up mitigation. Limited agency capacity, inability to work across jurisdictions, lack of public support, and procedural delays have all been cited as barriers to mitigation. But in the context of limited resources and increasing urgency, how should agencies prioritize investments to address these barriers? Results: To better understand different investments for scaling up mitigation, we examined how the wildfire problem is framed, building on existing social science demonstrating that agency approaches depend in part on how problems are framed. Using national-level policy documents and in-depth interviews, we found three ways of framing the barriers to scaling up mitigation, each emphasizing certain aspects of the problem and prioritizing different solutions or investments. The first framing, the Usual Suspects, focused on inadequate resources, cumbersome procedural requirements, delays due to litigation, and lack of public support. The solutions-to increase funding, streamline NEPA, limit litigation, and educate the public-suggest that more resources and fewer restrictions will enable agencies to scale up mitigation. The second framing, Agency-Agency Partnerships, focused on the ways that organizational structure and capacity constrain the development of effective cross-boundary collaboration. Here solutions prioritized organizational changes and capacity building to enable agencies to navigate different missions and build trust in order to develop shared priorities. The third framing, Engaging the Public, focused on lack of public support for mitigation, the need for meaningful public engagement and multi-stakeholder collaboration, and investments to build support to scale up mitigation. Conclusions: This analysis reveals that investing in collaborative capacity to advance agency-agency partnerships and public engagement might not slow down mitigation, but rather enable agencies to "go slow to go fast" by building the support and mechanisms necessary to increase the pace and scale of mitigation work. Reframing the wildfire problem through a careful analysis of competing frames and the underlying assumptions that privilege particular solutions can reveal a broader suite of solutions that address the range of key barriers.

Antecedentes: La mitigación de incendios es una tarea urgente, aunque a pesar de la disponibilidad de herramientas de mitigación, tales como quemas prescriptas, manejo del fuego, y raleos mecánicos, EEUU no ha sido aún capaz de aumentar proporcionalmente la mitigación de sus incendios. Las limitaciones en las capacidades de las agencias, la inhabilidad de trabajar entre jurisdicciones, la falta de apoyo de la sociedad, y demoras en los procedimientos, han sido citados como barreras para la mitigación. Ahora bien, en el contexto de recursos limitados e incrementos en las urgencias, ¿cómo deberían las agencias priorizar las inversiones para enfrentar esas barreras? Resultados: Para entender mejor las distintas inversiones para aumentar proporcionalmente las tareas de mitigación, examinamos cómo el problema de los incendios es enmarcado y construido en la ciencia social existente, demostrando que los enfoques de las agencias dependen, en parte, en cómo esos problemas son abordados. Usando documentos de políticas públicas y entrevistas profundas e intuitivas, encontramos tres vías de enmarcar las barreras para aumentar proporcionalmente la mitigación, cada una enfocando ciertos aspectos del problema y priorizando diferentes soluciones o inversiones. El primer enfoque, las "Sospechas Habituales", estuvo orientado hacia la inadecuación de los recursos, procedimientos incómodos, demoras debidas a litigios, y la falta de respaldo público. Las soluciones -incrementar los recursos, simplificar los procedimientos de la ley ambiental, limitar los litigios, y educar al público- sugieren que más recursos y menos restricciones permitirán a las agencias aumentar proporcionalmente la mitigación. El segundo enfoque "Asociación Agencia-Agencia", se orientó en la forma en que la estructura organizacional y su capacidad condicionan el desarrollo de una colaboración efectiva entre agencias. La solución aquí prioriza los cambios organizacionales y la capacidad de construcción para permitir a las agencias acometer diferentes misiones y crear confianza para poder desarrollar prioridades compartidas. El tercer enfoque "Comprometer al Público" se enfoca en la falta de apoyo del público para la mitigación, y la necesidad de atraer al público y la colaboración de diferentes ciudadanos interesados, en realizar aportes necesarios para construir aportes para el desarrollo de prioridades de mitigación. Conclusiones: Este análisis revela que la inversión en capacidad colaborativa para avanzar en la asociación agencia-agencia y el compromiso público puede no reducir la mitigación, más sin embargo permitir a las agencias "ir despacio para ir más rápido" para construir el soporte y mecanismos necesarios para incrementar la velocidad y la escala del trabajo de mitigación. Reencuadrar el problema de los incendios forestales a través de un cuidadoso análisis de encajes competitivos y suposiciones subyacentes que privilegie soluciones particulares, puede revelar un más amplio conjunto de soluciones que atienda el rango de barreras claves.

Evaluating the impact of a prison smoking ban on the cardiovascular health of men in a UK prison.

PURPOSE: Smoking rates are known to be higher amongst those committed to prison than the general population. Those in prison suffer from high rates of comorbidities that are likely to increase their risk of cardiovascular disease (CVD), making it more difficult to manage. In 2016, a tobacco ban began to be implemented across prisons in England and Wales, UK. This study aims to measure the effect of the tobacco ban on predicted cardiovascular risk for those quitting smoking on admission to prison. DESIGN/METHODOLOGY/APPROACH: Using data from a prevalence study of CVD in prisons, the authors have assessed the effect of the tobacco ban on cardiovascular risk, using predicted age to CVD event, ten-year CVD risk and heart age, for those who previously smoked and gave up on admission to prison. FINDINGS: The results demonstrate measurable health gains across all age groups with the greatest gains found in those aged 50 years and older and who had been heavy smokers. Quitting smoking on admission to prison led to a reduced heart age of between two and seven years for all participants. ORIGINALITY/VALUE: The data supports tobacco bans in prisons as a public health measure to reduce risk of CVD. Interventions are needed to encourage maintenance of smoking cessation on release from prison for the full health benefits to be realised.

Exploring the Health Impacts and Inequalities of the New Way of Working: Findings From a Cross-Sectional Study.

OBJECTIVE: The aim of the study is to provide insights into the working Welsh adult population's perceptions of the health impacts of working from home (WFH), their ability to WFH, and their WFH preferences. METHODS: Data were collected from 615 working adults in Wales between November 2020 and January 2021 in a household survey. RESULTS: More than 45% of those able to WFH reported worsened mental well-being and loneliness. Working from home worsened the diets, physical activity, smoking, and alcohol use of those in poorer health. Approximately 50% were able to WFH, although individuals living in more deprived areas, in atypical employment or with precarious income, were less able to WFH. Nearly 60% wanted to WFH to some capacity. CONCLUSIONS: The new way of working introduces new challenges to preserving workforce mental well-being, regulating health behaviors, and tackling inequalities. Hybrid models and targeted health support could make WFH healthier and more equitable.

Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales.

BACKGROUND: The public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic. METHODS: Data were collected from a cross-sectional, nationally representative household survey of the working age population (18-64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher's exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes. RESULTS: Of our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on 'furlough' was more likely in younger (18-29 years) and older (60-64 years) workers, those in lower skilled jobs and from households with less financial security. CONCLUSION: A number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

Shifting priorities and employment choices among workers in Wales during the COVID-19 pandemic: a longitudinal analysis.

BACKGROUND: Employment is a determinant of health. The COVID-19 pandemic disrupted working lives, forcing individuals to adapt to new ways of working. These shifts might shape people's priorities and their consideration of changes for future work. We examined how these outcomes differed depending on self-reported health status. METHODS: In this longitudinal analysis, we used data from the COVID-19 Employment and Health in Wales Study; a nationally-representative household survey of workers aged 18-64 years. Timepoint 1 (T1) data were collected between May 27, 2020, and June 22, 2020, and timepoint 2 (T2) data between Nov 30, 2020, and Jan 29, 2021. Participants who responded at both timepoints were eligible. Respondents selected five employment priorities at both timepoints, and the employment changes they considered during the COVID-19 pandemic at T2 only. We used multivariable logistic regressions (including sociodemographics, current employment factors, and self-reported health) and examined associations with health firstly for employment priorities, and secondly for the consideration of employment changes. Health measures were self-reported general health, limiting pre-existing health conditions (both using National Survey for Wales validated questions), and mental wellbeing (using the shortened Warwick Edinburgh Mental Well-being Scale). FINDINGS: We analysed data from 592 respondents (382 [65%] women). 766 (56%) of 1358 T1 respondents were excluded as no T2 responses were provided. Those who self-reported poor general health were consistently more likely to prioritise flexible working arrangements than those rating fair or above (T1 adjusted odds ratio [aOR] 2·06 [95% CI 1·10-3·88], p=0·033; T2 aOR 1·87 [95% CI 1·05-3·33], p=0·034). Those with low (as opposed to average) mental wellbeing were more likely to consider securing a permanent contract (aOR 5·49 [95% CI 1·32-22·81], p=0·023, and those with limiting pre-existing conditions were four times more likely to consider becoming self-employed (aOR 4·00 [95% CI 1·35-11·84], p=0·011) than those without. INTERPRETATION: Promoting the adoption of flexible working policies and supporting those in poor health to obtain flexible employment could benefit people in Wales. Those with low mental wellbeing might seek the security of permanent employment, and those with limiting pre-existing conditions might value the autonomy of self-employment. FUNDING: None.

Mental health of the nursing and midwifery workforce in Wales during the COVID-19 pandemic: a cross-sectional analysis.

BACKGROUND: The mental health of the nursing and midwifery workforce in the UK became a public health concern before the COVID-19 pandemic. Poor mental health is a known factor for those considering leaving the profession, and workforce retention of younger members is crucial for the future of the sector. The aim of this study was to provide up-to-date estimates of mental wellbeing in this workforce in Wales during the COVID-19 pandemic. METHODS: We did a cross-sectional analysis of demographics, work-related information, and health data from respondents to a national online survey of registered and student nurses and midwives and health-care support workers in Wales. The survey was open between June 23 and Aug 9, 2021, and 2910 people responded (approximately 7% of the workforce). Mental wellbeing was calculated using the Short Warwick Edinburgh Mental Wellbeing Score (SWEMWBS). We measured probable clinical depression (SWEMWBS <18) and possible mild depression (SWEMWBS 18-20). We used χ2 analysis and multinomial logistic regression (adjusted for sex and staff grouping) to examine associations between age groups and mental wellbeing. FINDINGS: We analysed data from 2781 (95·6%) of 2910 respondents (129 respondents did not answer all seven SWEMWBS questions). Overall, 1622 (58·3%) of 2781 respondents had SWEMWBSs indicative of either probable clinical depression (863 [31·0%] of 2781) or possible mild depression (759 [27·3%] of 2781). Probable clinical depression was highest among those aged 18-29 years (180 [33·8%] of 532), 30-39 years (250 [35·6%] of 703), and 40-49 years (233 [33·5%] of 696). Respondents in these age groups were twice as likely to report SWEMWBSs indicative of probable clinical depression than respondents aged 60 years and older (18-29 years adjusted odds ratio [aOR] 2·38 [95% CI 1·43-3·97], p=0·0009; 30-39 years aOR 2·86 [1·77-4·64], p<0·0001; 40-49 years aOR 2·49 [1·54-4·02], p=0·0002). INTERPRETATION: This study highlights the substantial burden of poor mental wellbeing among the nursing and midwifery workforce in Wales, especially in those aged 49 years and younger. These figures, higher than previous estimates, could reflect the mental health effect of responding to the pandemic and could have long-term implications on workforce retention. FUNDING: None.

Factors influencing initiation of health behaviour conversations with patients: Cross-sectional study of nurses, midwives, and healthcare support workers in Wales.

AIM: To identify factors influencing healthcare professionals' engagement in health behaviour conversations with patients. DESIGN: Cross-sectional survey. METHODS: Between April and June 2019, an online survey of 1338 nurses, midwives and healthcare support workers was conducted. The survey assessed whether staff felt comfortable initiating health behaviour conversations with patients about five behaviours (reducing alcohol intake; stop smoking; being more active; reducing their weight; and improving their diet) and barriers to conversation initiation. Health professionals' own health-related behaviours, self-rated health and mental wellbeing, and socio-demographic characteristics were recorded. Logistic regression models were built to assess factors associated with feeling comfortable initiating health behaviour conversations for each topic. RESULT: Less than 50% of respondents reported feeling comfortable initiating health behaviour conversations with patients. Female staff, young professionals (18 to 29 years), those in lower staff grades and those with poorer health and low mental wellbeing were less likely to report feeling comfortable having health behaviour conversations across all topics. Those who did not adhere to physical activity and dietary guidelines were less likely to initiate a conversation about being more active and having a healthy diet, respectively. Not having time to discuss the topic, suitable space to hold a conversation, and feeling worried about offending/upsetting patients were the main barriers reported. CONCLUSION: Around 6 in 10 members of the nursing, midwifery and healthcare support workforce in Wales potentially do not feel comfortable to initiate a health behaviour conversation with patients about health and wellbeing. Feeling less comfortable to initiate a conversation was associated with staff demographics and organizational factors. IMPACT: We identified those less likely to initiate health behaviour conversations as well as personal and organizational barriers to initiation. This will help to target and tailor interventions to ensure staff are equipped and enabled to hold health behaviour conversations with patients.

Estimating the burden of type 2 diabetes in the UK prison environment for the next decade.

Although limited, global evidence suggests that the cardiometabolic health of those in prison is poorer than their community peers. Type 2 diabetes (T2DM) is a public health challenge and community rates are continuing to rise. Given that cardiometabolic risk factors are prevalent amongst younger individuals within the prison population, it is reasonable to assume that the prison environment will also experience an increase in new cases of T2DM. Therefore, the aim of this study was, to predict in a current prison population, how many potential new cases of T2DM could develop in the next 10 years. This study used health data collected from a prison sample (n = 299) aged 25-84 years in HMP Parc, UK, and the Diabetes UK Risk Score was used to predict T2DM risk. In terms of projecting new cases, it was estimated that in the next decade 6.4 individuals per 100 would develop T2DM, and this value increased to 16.4 individuals per 100 in those aged 50 years and older. The development of new cases across all age groups is a concern, and it appears that the prison community are a 'target population' for prevention opportunities.

Abundance of undiagnosed cardiometabolic risk within the population of a long-stay prison in the UK.

BACKGROUND: The health of people in prisons is a public health issue. It is well known that those in prison experience poorer health outcomes than those in the general community. One such example is the burden of non-communicable diseases, more specifically cardiovascular disease (CVD), stroke and type 2 diabetes (T2DM). However, there is limited evidence research on the extent of cardiometabolic risk factors in the prison environment in Wales, the wider UK or globally. METHODS: Risk assessments were performed on a representative sample of 299 men at HMP Parc, Bridgend. The risk assessments were 30 min in duration and men aged 25-84 years old and free from pre-existing CVD and T2DM were eligible. During the risk assessment, a number of demographic, anthropometric and clinical markers were obtained. The 10-year risk of CVD and T2DM was predicted using the QRISK2 algorithm and Diabetes UK Risk Score, respectively. RESULTS: The majority of the men was found to be either overweight (43.5%) or obese (37.5%) and/or demonstrated evidence of central obesity (40.1%). Cardiometabolic risk factors including systolic hypertension (25.1%), high cholesterol (29.8%), low HDL cholesterol (56.2%) and elevated total cholesterol: HDL ratios (23.1%) were observed in a considerable number of men. Ultimately, 15.4% were calculated at increased risk of CVD, and 31.8% predicted at moderate or high risk of T2DM. CONCLUSIONS: Overall, a substantial prevalence of previously undiagnosed cardiometabolic risk factors was observed and men in prison are at elevated risk of cardiometabolic disease at a younger age than current screening guidelines.

Investigating the prevalence of latent Tuberculosis infection in a UK remand prison.

BACKGROUND: Tuberculosis (TB) remains a major global public health issue and in low-incidence countries guidance identifies the need to screen for and treat latent tuberculosis infection (LTBI) with the prison environment recommended as a setting to perform LTBI screening. This study describes the findings of a LTBI screening programme which took place on entry to a remand prison in the UK. METHODS: Testing for LTBI was undertaken alongside screening for blood borne viruses in 567 men. During the screening process, information was collected on demographic variables and also specific risk factors based on World Health Organization recommendations. LTBI analysis was performed using Interferon-Gamma Release Assay (IGRA) technique. RESULTS: In total, 40 men returned an IGRA positive result (7.1%). However, irrespective of IGRA/LTBI status there was a substantial burden of risk factors present including previous prison stay, history of substance misuse and no BCG vaccination. Non-White ethnicity, a history of substance misuse and age over 34 years were the most significant factors in identifying individuals who would require treatment for LTBI (Positive IGRA result). CONCLUSIONS: The study further demonstrates that the prevalence of LTBI remains increased within the prison environment and is a setting that still requires effective LTBI management.

University students' behaviours towards accessing sexual health information and treatment.

Globally, it is widely recognised that young people (those under the age of 25 years) are at a higher risk of developing sexually transmitted infections (STIs). The majority of university students studying in the UK fall within this age bracket, and to help prevent such high incidence of STIs in this age group, it is essential that advice and treatment, if required, are obtained from reliable sources. This study sought to explore sources of sexual heath advice and treatment for students at Welsh universities (n = 3007). The main sources of advice were identified as the internet (49.1%) and GP/family doctors (38.9%), whilst local sexual health clinics (24.9%) and GP/family doctor services (20.2%) were the main sources for treatment in students. Males were more likely than females to report never needing advice (AOR 2.74; CI = 2.24-3.35) or requiring treatment (AOR 1.37; CI = 1.17-1.60). The apparent lack of engagement with these services by male students is a cause for concern, although one possible solution could be to further develop online methods to increase uptake of testing. Furthermore, the popularity of the internet for advice provides a timely reminder that regulation of online sexual health information is critical.

Exploring health and wellbeing in prison: a peer research approach.

PURPOSE: Those in prison have expert knowledge of issues affecting their health and wellbeing. The purpose of this paper is to report on work undertaken with male prisoners. This paper presents learning and findings from the process of engaging imprisoned men as peer researchers. DESIGN/METHODOLOGY/APPROACH: The peer researcher approach offers an emic perspective to understand the experience of being in prison. The authors established the peer research role as an educational initiative at a long-stay prison in Wales, UK to determine the feasibility of engaging imprisoned men as peer researchers. Focus groups, interviews and questionnaires were used by the peer researchers to identify the health and wellbeing concerns of men in prison. FINDINGS: The project positively demonstrated the feasibility of engaging imprisoned men as peer researchers. Four recurring themes affecting health and wellbeing for men in a prison vulnerable persons unit were identified: communication, safety, respect and emotional needs. Themes were inextricably linked demonstrating the complex relationships between prison and health. ORIGINALITY/VALUE: This was the first prison peer-research project to take place in Wales, UK. It demonstrates the value men in prison can play in developing the evidence base around health and wellbeing in prison, contributing to changes within the prison to improve health and wellbeing for all.

A shared data approach more accurately represents the rates and patterns of violence with injury assaults.

BACKGROUND: To investigate whether sharing and linking routinely collected violence data across health and criminal justice systems can provide a more comprehensive understanding of violence, establish patterns of under-reporting and better inform the development, implementation and evaluation of violence prevention initiatives. METHODS: Police violence with injury (VWI) crimed data and emergency department (ED) assault attendee data for South Wales were collected between 1 April 2014 and 31 March 2016 to examine the rates and patterns of VWI. Person identifiable data (PID) were cross-referenced to establish if certain victims or events were less likely to be reported to criminal justice services. RESULTS: A total of 18 316 police crimed VWI victims and 10 260 individual ED attendances with an assault-related injury were considered. The majority of ED assault attendances (59.0%) were unknown to police. The key demographic identified as under-reporting to police were young males aged 18-34 years, while a significant amount of non-reported assaults involved a stranger. The combined monthly age-standardised rates were recalculated and on average were 74.7 (95% CI 72.1 to 77.2) and 66.1 (95% CI 64.0 to 68.2) per 100 000 population for males and females, respectively. Consideration of the additional ED cases resulted in a 35.3% and 18.1% increase on the original police totals for male and female VWI victims. CONCLUSIONS: This study identified that violence is currently undermeasured, demonstrated the importance of continued sharing of routinely collected ED data and highlighted the benefits of using PID from a number of services in a linked way to provide a more comprehensive picture of violence.

A non-exercise method to determine cardiorespiratory fitness identifies females predicted to be at 'high risk' of type 2 diabetes.

This study examined the relationship between cardiorespiratory fitness determined by a non-exercise testing method for estimating fitness and predicted risk of developing type 2 diabetes mellitus using five risk assessments/questionnaires (Leicester Diabetes Risk Score, QDiabetes, Cambridge Risk Score, Finnish Diabetes Risk Score and American Diabetes Association Diabetes Risk Test). Retrospective analysis was performed on 330 female individuals with no prior diagnosis of cardiovascular disease or type 2 diabetes mellitus who participated in the Prosiect Sir Gâr workplace initiative in Carmarthenshire, South Wales. Non-exercise testing method for estimating fitness (expressed as metabolic equivalents) was calculated using a validated algorithm, and females were grouped accordingly into fitness quintiles <6.8 metabolic equivalents (Quintile 1), 6.8-7.6 metabolic equivalents (Quintile 2), 7.6-8.6 metabolic equivalents (Quintile 3), 8.6-9.5 metabolic equivalents (Quintile 4), >9.5 metabolic equivalents (Quintile 5). Body mass index, waist circumference, and HbA1c all decreased between increasing non-exercise testing method for estimating fitness quintiles (p < 0.05), as did risk prediction scores in each of the five assessments/questionnaires (p < 0.05). The proportion of females in Quintile 1 predicted at 'high risk' was between 20.9% and 81.4%, depending on diabetes risk assessment used, compared to none of the females in Quintile 5. A calculated non-exercise testing method for estimating fitness <6.8 metabolic equivalents could help to identify females at 'high risk' of developing type 2 diabetes mellitus as predicted using five risk assessments/questionnaires.

Examining the relationship between HbA1c and diabetes risk models in a European population indicates a lower threshold to identify 'high risk' is required.

This study examined whether changes in HbA1c values are reflected in the risk scores and categories of four validated risk-assessment tools (QDiabetes, Leicester Risk Assessment, Finnish Diabetes Risk Score and Cambridge Risk Score). Retrospective analysis was performed on 651 individuals with no prior diagnosis of cardiovascular disease or diabetes who participated in a UK workplace-based risk-assessment initiative. There were significant positive correlations (p < 0.01) revealed between HbA1c values and predicted risk scores: QDiabetes (r = 0.362), Leicester Risk Assessment (r = 0.315), Finnish Diabetes Risk Score (r = 0.202) and Cambridge Risk Score (r = 0.335). HbA1c values increased within risk prediction categories, and at 'high-risk' categories, median HbA1c values were at least 39 mmol mol(-1) (5.7%) irrespective of gender or risk-assessment model. Overall, an association is present between increases in HbA1c scores and predicted risk of type 2 diabetes. Furthermore, the 'high-risk' median HbA1c values in each of the risk assessments are more akin to the lower American recommendations rather than those suggested by the UK expert group.

Improved end-stage high-intensity performance but similar glycemic responses after waxy barley starch ingestion compared to dextrose in type 1 diabetes.

BACKGROUND: Pre-exercise carbohydrate (CHO) ingestion is an effective strategy for reducing the occurrence of hypoglycemia during or after exercise in individuals with type 1 diabetes (T1DM). The metabolic effects of ingestion of different CHOs for glycemic or performance gains have been under-researched. This study compared metabolic responses and fuel use during sub-maximal and high-intensity performance running following pre-exercise ingestion of waxy barley starch (WBS) or dextrose (DEX) in T1DM. METHODS: Seven participants attended the laboratory on two separate occasions following preliminary testing. On each visit participants consumed either 0.6 g/kg body mass of DEX or WBS 2 hours before a 26-minute discontinuous incremental treadmill protocol (4-minute running: 1.5-min rest) finishing at 80±4% V̇O2peak followed by a 10-min performance run on a non-motorized treadmill. Capillary blood samples were taken at rest, during and following exercise and analyzed for glucose (BG) and acid-base variables. Data (mean ± SEM) were analyzed using repeated measures ANOVA (P<0.05). RESULTS: BG reached similar peak values one hour after CHO ingestion and immediate pre-sub-maximal exercise BG were comparable. Resting CHO oxidation was elevated and lipid oxidation lower under WBS (P<0.05). There were no metabolic or cardio-respiratory differences during the sub-maximal exercise (P>0.05). In the final quartile of the performance run, a greater distance was completed under WBS (WBS 323±21 vs. DEX 301±20 m, P=0.02). CONCLUSIONS: Consumption of WBS demonstrated similar hyperglycemic responses to dextrose ingestion but a greater rate of CHO use at rest. Interestingly, T1DM individuals displayed an improved performance at the latter stages of a high-intensity run test.