Can pain be self-managed? Pain change in vulnerable participants to a health education programme.

Chronic pain exerts a significant impact on the quality of life, giving rise to both physical and psycho-social vulnerabilities. It not only leads to direct costs associated with treatments, but also results in indirect costs due to the reduced productivity of affected individuals. Chronic conditions can be improved by reducing modifiable risk factors. Various educational programs, including the Chronic Disease Self-Management Programme (CDSMP), have demonstrated the advantages of enhancing patient empowerment and health literacy. Nevertheless, their efficacy in addressing pain symptoms has received limited attention, especially concerning vulnerable populations. This research aims to assess the effectiveness of the CDSMP in alleviating pain among socio-economically vulnerable participants with chronic conditions. By accounting for a wide range of variables, and using data from the EFFICHRONIC project (EU health programme), we investigated the changes in pain levels after the intervention, among 1070 participants from five European countries. Our analyses revealed a significant reduction in pain following the intervention. This finding supports the notion that training programs can effectively ameliorate pain and alleviate its impact on the quality of life, particularly in vulnerable populations. Younger participants, as well as those with higher education levels and individuals experiencing higher levels of pain at baseline, were more likely to experience a reduction in their pain levels. These findings underscore the importance of recognising the social determinants of health. The study was registered at ClinicalTrials.gov (ISRCTN70517103).

A mixed method evaluation of a theory based intervention to reduce sedentary behaviour in contact centres- the stand up for health stepped wedge feasibility study.

INTRODUCTION: Contact centres have higher levels of sedentary behaviour than other office-based workplaces. Stand Up for Health (SUH) is a theory-based intervention developed using the 6SQuID framework to reduce sedentary behaviour in contact centre workers. The aim of this study was to test acceptability and feasibility of implementing SUH in UK contact centres. METHODS: The study was conducted in 2020-2022 (pre COVID and during lockdown) and used a stepped-wedge cluster randomised trial design including a process evaluation. The intervention included working with contact centre managers to develop and implement a customised action plan aligning with SUH's theory of change. Workplace sedentary time, measured using activPAL™ devices, was the primary outcome. Secondary outcomes included productivity, mental wellbeing, musculoskeletal health and physical activity. Empirical estimates of between-centre standard deviation and within-centre standard deviation of outcomes from pre-lockdown data were calculated to inform sample size calculations for future trials. The process evaluation adopted the RE-AIM framework to understand acceptability and feasibility of implementing the intervention. Interviews and focus groups were conducted with contact centre employees and managers, and activity preferences were collected using a questionnaire. RESULTS: A total of 11 contact centres participated: 155 employees from 6 centres in the pre-lockdown data collection, and 54 employees from 5 centres post-lockdown. Interviews and focus groups were conducted with 33 employees and managers, and 96 participants completed an intervention activity preference questionnaire. Overall, the intervention was perceived as acceptable and feasible to deliver. Most centres implemented several intervention activities aligned with SUH's theory of change and over 50% of staff participated in at least one activity (pre-lockdown period). Perceived benefits including reduced sedentary behaviour, increased physical activity, and improved staff morale and mood were reported by contact centre employees and managers. CONCLUSIONS: SUH demonstrates potential as an appealing and acceptable intervention, impacting several wellbeing outcomes. TRIAL REGISTRATION: The trial has been registered on the ISRCTNdatabase: http://www.isrctn.com/ISRCTN11580369.

Benefits, risks, barriers, and facilitators to cycling: a narrative review.

There is large potential to increase cycling participation worldwide. Participation in cycling is associated with lower risk of mortality from any cause, and incidence of cardiovascular disease and type 2 diabetes, as well as positive mental health and well-being. The largest potential for health gains likely to come from increasing participation amongst those who do not currently cycle regularly, rather than encouraging those who already cycle regularly to cycle more. Replacing car journeys with cycling can lead to reductions in air pollution emissions and lower pollutant exposure to the general population. Important gaps and uncertainties in the existing evidence base include: the extent to which the health benefits associated with cycling participation are fully causal due to the observational nature of much of the existing evidence base; the real-world economic cost-benefits of pragmatic interventions to increase cycling participation; and the most effective (combination of) approaches to increase cycling participation. To address these uncertainties, large-scale, long-term randomised controlled trials are needed to: evaluate the effectiveness, and cost-effectiveness, of (combinations of) intervention approaches to induce sustained long-term increases in cycling participation in terms of increases in numbers of people cycling regularly and number of cycling journeys undertaken, across a range of population demographic groups; establish the effects of such interventions on relevant outcomes related to health and wellbeing, economic productivity and wider societal impacts; and provide more robust quantification of potential harms of increasing cycling participation, such as collision risks.

Promoting physical activity to patients: a scoping review of the perceptions of doctors in the United Kingdom.

BACKGROUND: The physician-patient encounter presents an ideal opportunity for physical activity (PA) promotion. This review aims to (i) explore the breadth and depth of existing literature investigating doctors' perceptions of PA promotion in the United Kingdom (UK) and (ii) identify factors influencing the extent to which doctors engage in PA promotion during patient interactions. METHODS: A five-stage scoping review methodology and the PRISMA-ScR guidance were followed: Stage 1-research questions specified; Stage 2-relevant studies identified by searching five electronic databases and manual screening of references; Stage 3-studies screened using Covidence™; Stage 4-study data extracted and charted; and Stage 5-findings from included studies were analysed, summarised and reported using (i) descriptive numerical analysis to provide insight into study characteristics and (ii) narrative summary of the evidence categorised by factors that influence doctors' engagement with PA promotion. RESULTS: In total, 16,961 studies were screened. Nineteen studies were included in the review with most conducted in primary care focusing on the perceptions of general practitioners. Seven influencing factors were identified: knowledge and training, personal interest and PA level, time, resources, confidence, the perceived role of the doctor and patient relevance. CONCLUSION: This review provides new evidence that historical barriers and influencing factors have a persisting impact on the ability and willingness of UK doctors to engage with PA promotion with patients. Previous efforts to address these factors would appear to have had limited success. Further intervention efforts are required to ensure more widespread and effective PA promotion to patients.

"Are We Working (Too) Comfortably?": Understanding the Nature of and Factors Associated with Sedentary Behaviour When Working in the Home Environment.

Home working has increased due to COVID-19, but little is known about how this change has impacted the health risk behaviour of elevated sedentary time. The aim of this cross-sectional exploratory study was to assess occupational sitting behaviour when working at home, and use the Capability Opportunity Motivation-Behaviour (COM-B) model to identify influences on this behaviour. University staff (n = 267; 69% female; 92% white) who were predominantly working from home completed a questionnaire to assess sitting time, sitting breaks, demographic and occupational characteristics, and a 7-item COM-B questionnaire and open-ended questions to assess influences on time spent sitting whilst working from home. Data were analysed descriptively, a repeated measures ANOVA was used to determine differences in the COM-B items, and binary logistic regression was used to examine predictors of sitting time. Staff spent on average 89.5% (SD = 17.1) of their time sitting whilst working at home, and took an average of 1.36 (1.38) sitting breaks per hour. There were significant and meaningful differences in the influence of the COM factors on ability and willingness to reduce sitting behaviour (p < .0001; ηp 2 = .38), and the open-ended responses added further context. The included variables accounted for 20.7% of variance in sitting behaviour, with age, sitting breaks, motivation-automatic, and opportunity-physical contributing significantly. Working from home leads to elevated levels of sitting, and the COM-B provides a useful model to identify key influences on ability and willingness to reduce sitting. Strategies incorporating regular breaks, habit formation/reversal, and restructuring the physical environment may be beneficial.

Development and optimisation of a multi-component workplace intervention to increase cycling for the Cycle Nation Project.

The Cycle Nation Project (CNP) aimed to develop, test the feasibility of and optimize a multi-component individual-/social-level workplace-based intervention to increase cycling among office staff at a multinational bank (HSBC UK). To do this, we first explored barriers to cycling in a nationally-representative survey of UK adults, then undertook focus groups with bank employees to understand any context-specific barriers and ways in which these might be overcome. These activities led to identification of 10 individual-level, two social-level, and five organizational-level modifiable factors, which were mapped to candidate intervention components previously identified in a scoping review of cycling initiatives. Interviews with HSBC UK managers then explored the practicality of implementing the candidate intervention components in bank offices. The resultant pilot CNP intervention included 32 core components across six intervention functions (education, persuasion, incentivisation, training, environmental restructuring, enablement). Participants received a loan bike for 12-weeks (or their own bike serviced), and a 9-week cycle training course (condensed to 6 weeks for those already confident in basic cycling skills), including interactive information sharing activities, behavior change techniques (e.g., weekly goal setting), bike maintenance training, practical off-road cycling skill games and on-road group rides. Sessions were delivered by trained bank staff members who were experienced cyclists. The CNP pilot intervention was delivered across three sites with 68 participants. It was completed in two sites (the third site was stopped due to COVID-19) and was feasible and acceptable to both women and men and across different ethnicities. In addition, the CNP intervention was successful (at least in the short term) in increasing cycling by 3 rides/week on average, and improving perceptions of safety, vitality, confidence, and motivation to cycle. Following minor modifications, the long-term effectiveness and cost-effectiveness of the CNP intervention should be tested in a full-scale randomized controlled trial.

Directional ballistic transport in the two-dimensional metal PdCoO2.

In an idealized infinite crystal, the material properties are constrained by the symmetries of the unit cell. The point-group symmetry is broken by the sample shape of any finite crystal, but this is commonly unobservable in macroscopic metals. To sense the shape-induced symmetry lowering in such metals, long-lived bulk states originating from an anisotropic Fermi surface are needed. Here we show how a strongly facetted Fermi surface and the long quasiparticle mean free path present in microstructures of PdCoO2 yield an in-plane resistivity anisotropy that is forbidden by symmetry on an infinite hexagonal lattice. We fabricate bar-shaped transport devices narrower than the mean free path from single crystals using focused ion beam milling, such that the ballistic charge carriers at low temperatures frequently collide with both of the side walls that define the channel. Two symmetry-forbidden transport signatures appear: the in-plane resistivity anisotropy exceeds a factor of 2, and a transverse voltage appears in zero magnetic field. Using ballistic Monte Carlo simulations and a numerical solution of the Boltzmann equation, we identify the orientation of the narrow channel as the source of symmetry breaking.

Assessment of the role of the Edinburgh dysphagia score in referral triage in a national service evaluation of the urgent suspected upper gastrointestinal cancer pathway.

BACKGROUND: The British Society of Gastroenterology has recommended the Edinburgh Dysphagia Score (EDS) to risk-stratify dysphagia referrals during the endoscopy COVID recovery phase. AIMS: External validation of the diagnostic accuracy of EDS and exploration of potential changes to improve its diagnostic performance. METHODS: A prospective multicentre study of consecutive patients referred with dysphagia on an urgent suspected upper gastrointestinal (UGI) cancer pathway between May 2020 and February 2021. The sensitivity and negative predictive value (NPV) of EDS were calculated. Variables associated with UGI cancer were identified by forward stepwise logistic regression and a modified Cancer Dysphagia Score (CDS) developed. RESULTS: 1301 patients were included from 19 endoscopy providers; 43% male; median age 62 (IQR 51-73) years. 91 (7%) UGI cancers were diagnosed, including 80 oesophageal, 10 gastric and one duodenal cancer. An EDS ≥3.5 had a sensitivity of 96.7 (95% CI 90.7-99.3)% and an NPV of 99.3 (97.8-99.8)%. Age, male sex, progressive dysphagia and unintentional weight loss >3 kg were positively associated and acid reflux and localisation to the neck were negatively associated with UGI cancer. Dysphagia duration <6 months utilised in EDS was replaced with progressive dysphagia in CDS. CDS ≥5.5 had a sensitivity of 97.8 (92.3-99.7)% and NPV of 99.5 (98.1-99.9)%. Area under receiver operating curve was 0.83 for CDS, compared to 0.81 for EDS. CONCLUSIONS: In a national cohort, the EDS has high sensitivity and NPV as a triage tool for UGI cancer. The CDS offers even higher diagnostic accuracy. The EDS or CDS should be incorporated into the urgent suspected UGI cancer pathway.

The chronic disease Self-Management Programme: A phenomenological study for empowering vulnerable patients with chronic diseases included in the EFFICHRONIC project.

INTRODUCTION: The Chronic Disease Self-Management Programme (CDSMP) has resulted in improved health outcomes for patients. However, research has focused mainly on those with chronic conditions and has not extensively explored prevention programmes targeting individuals with specific vulnerability profiles. AIM: This study aimed to understand the effects of the CDSMP on the lived experience of vulnerable patients included in the EFFICHRONIC project in France, based on their needs and expectations before and after participation. METHODS: We conducted a qualitative phenomenological semio-pragmatic study based on 37 in-depth interviews with 20 patients (20 before/17 after CDSMP). RESULTS: By transforming existential dimensions (identity, relationship with others and bodily experience), chronic illness generates new needs in the vulnerable person. By resonating with the expectations and needs of participants, the CDSMP induces motivation and a sense of belonging to a community of peers. It has enabled the participants to become actors of their own health until empowerment. Although some limitations are reported, the programme has awakened a desire in the participants to take better care of their health and to develop personal skills with, for some, a desire to become involved in health education. CONCLUSION: Our phenomenological approach highlighted the resonance between the programme (its design and implementation) and the lived experience of patients, as an effective element of empowerment. This necessitates training the facilitators to elicit the lived experience of patients. Furthermore, as a patient-centred approach is required, the facilitators need to learn how to adapt the design of the programme to the singularity of the patient. PATIENT OR PUBLIC CONTRIBUTION: Patients provided the data that were collected through in-depth interviews, and their experiences before and after the programme were analysed.

The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC): International consensus statement and user guide.

Effective physical activity messaging plays an important role in the pathway towards changing physical activity behaviour at a population level. The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC) are outputs from a recent modified Delphi study. This sought consensus from an international expert panel on how to aid the creation and evaluation of physical activity messages. In this paper, we (1) present an overview of the various concepts within the PAMF and PAMC, (2) discuss in detail how the PAMF and PAMC can be used to create physical activity messages, plan evaluation of messages, and aid understanding and categorisation of existing messages, and (3) highlight areas for future development and research. If adopted, we propose that the PAMF and PAMC could improve physical activity messaging practice by encouraging evidence-based and target population-focused messages with clearly stated aims and consideration of potential working pathways. They could also enhance the physical activity messaging research base by harmonising key messaging terminologies, improving quality of reporting, and aiding collation and synthesis of the evidence.

Evaluating the citywide Edinburgh 20mph speed limit intervention effects on traffic speed and volume: A pre-post observational evaluation.

OBJECTIVES: Traffic speed is important to public health as it is a major contributory factor to collision risk and casualty severity. 20mph (32km/h) speed limit interventions are an increasingly common approach to address this transport and health challenge, but a more developed evidence base is needed to understand their effects. This study describes the changes in traffic speed and traffic volume in the City of Edinburgh, pre- and 12 months post-implementation of phased city-wide 20mph speed limits from 2016-2018. METHODS: The City of Edinburgh Council collected speed and volume data across one full week (24 hours a day) pre- and post-20mph speed limits for 66 streets. The pre- and post-speed limit intervention data were compared using measures of central tendency, dispersion, and basic t-tests. The changes were assessed at different aggregations and evaluated for statistical significance (alpha = 0.05). A mixed effects model was used to model speed reduction, in the presence of key variables such as baseline traffic speed and time of day. RESULTS: City-wide, a statistically significant reduction in mean speed of 1.34mph (95% CI 0.95 to 1.72) was observed at 12 months post-implementation, representing a 5.7% reduction. Reductions in speed were observed throughout the day and across the week, and larger reductions in speed were observed on roads with higher initial speeds. Mean 7-day volume of traffic was found to be lower by 86 vehicles (95% CI: -112 to 286) representing a reduction of 2.4% across the city of Edinburgh (p = 0.39) but with the direction of effect uncertain. CONCLUSIONS: The implementation of the city-wide 20mph speed limit intervention was associated with meaningful reductions in traffic speeds but not volume. The reduction observed in road traffic speed may act as a mechanism to lessen the frequency and severity of collisions and casualties, increase road safety, and improve liveability.

Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project.

INTRODUCTION: The Chronic Disease Self-Management Program (CDSMP) improves self-efficacy and health outcomes in people with chronic diseases. In the context of the EFFICHRONIC project, we evaluated the efficacy of CDSMP in relieving frailty, as assessed by the self-administered version of Multidimensional Prognostic Index (SELFY-MPI), identifying also potential predictors of better response over 6-month follow-up. METHODS: The SELFY-MPI explores mobility, basal and instrumental activities of daily living (Barthel mobility, ADL, IADL), cognition (Test Your Memory-TYM Test), nutrition (Mini Nutritional Assessment-Short Form-MNA-SF), comorbidities, medications, and socio-economic conditions (social-familiar evaluation scale-SFES). Participants were stratified in three groups according to the 6-month change of SELFY-MPI: those who improved after CDSMP (Δ SELFY-MPI < 0), those who remained unchanged (Δ SELFY-MPI = 0), and those who worsened (Δ SELFY-MPI > 0). Multivariable logistic regression was modeled to identify predictors of SELFY-MPI improvement. RESULTS: Among 270 participants (mean age = 61.45 years, range = 26-93 years; females = 78.1%) a benefit from CDSMP intervention, in terms of decrease in the SELFY-MPI score, was observed in 32.6% of subjects. SELFY-MPI improvement was found in participants with higher number of comorbidities (1-2 chronic diseases: adjusted odd ratio (aOR)=2.38, 95% confidence interval (CI) =1.01, 5.58; ⩾ 3 chronic diseases: aOR = 3.34, 95% CI = 1.25, 8.90 vs no chronic disease), poorer cognitive performance (TYM ⩽ 42: aOR = 2.41, 95% CI = 1.12, 5.19 vs TYM > 42) or higher risk of malnutrition (MNA-SF ⩽ 11: aOR = 6.11, 95% CI = 3.15, 11.83 vs MNA-SF > 11). CONCLUSION: These findings suggest that the CDSMP intervention contributes to decreasing the self-perceived severity of frailty (SELFY-MPI score) in more vulnerable participants with several chronic diseases and lower cognitive performance and nutritional status.

Use of natural experimental studies to evaluate 20mph speed limits in two major UK cities.

INTRODUCTION: Reductions in traffic speed can potentially offer multiple health and public health benefits. In 2016, implementation of 20mph (30kph) speed limit interventions began in Edinburgh (city-wide) and Belfast (city centre). The aims of this paper are to describe 1) the broad theoretical approach and design of two natural experimental studies to evaluate the 20mph speed limits in Edinburgh and Belfast and 2) how these studies allowed us to test and explore theoretical mechanisms of 20mph speed limit interventions. METHODS: The evaluation consisted of several work packages, each with different research foci, including the political decision-making processes that led to the schemes, their implementation processes, outcomes (including traffic speed, perceptions of safety, and casualties) and cost effectiveness. We used a combination of routinely and locally collected quantitative data and primary quantitative and qualitative data. RESULTS: The evaluation identified many contextual factors influencing the likelihood of 20mph speed limits reaching the political agenda. There were substantial differences between the two sites in several aspects related to implementation. Reductions in speed resulted in significant reductions in collisions and casualties, particularly in Edinburgh, which had higher average speed at baseline. The monetary value of collisions and casualties prevented are likely to exceed the costs of the intervention and thus the overall balance of costs and benefits is likely to be favourable. CONCLUSIONS: Innovative study designs, including natural experiments, are important for assessing the impact of 'real world' public health interventions. Using multiple methods, this project enabled a deeper understanding of not only the effects of the intervention but the factors that explain how and why the intervention and the effects did or did not occur. Importantly it has shown that 20mph speed limits can lead to reductions in speed, collisions and casualties, and are therefore an effective public health intervention.

Stand Up for Health: Programme theory for an intervention to reduce sedentary behaviour in contact centres.

BACKGROUND: Contact centre staff spend up to 95 % of their day seated, which can lead to a range of negative health outcomes. The aim of this study was to develop a programme theory for a complex intervention to reduce sedentary behaviour in contact centres. METHODS: The 6SQuID model was used. A literature review, and focus groups at one contact centre were used to: understand the problem (step 1); identify modifiable factors (step 2); and develop a theory of change (step 3). A workshop shaped a theory of action (step 4), and the programme theory was refined after testing activities over 6 months (step 5). The intervention is currently undergoing further evaluation and feasibility testing in a larger scale stepped wedge randomised controlled study in 11 contact centres (Step 6). RESULTS: Step 1: Limited opportunity to sit less, and move more at work was identified as the main problem. Step 2: Modifiable factors were identified at four levels of the centre. Step 3: A theory of change was developed around cultural norms and individual behaviour change. Step 4: Actions were developed to 'activate' the theory of change. Step 5: Activities were implemented, and adapted over 6 months and the programme theory was refined. CONCLUSION: The programme theory behind this intervention is robust, evidence based, adaptive and transferable.

A modified Delphi study to enhance and gain international consensus on the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC).

INTRODUCTION: Physical activity messaging is an important step in the pathway towards improving population physical activity levels, but best practice is not yet understood. A gap in the literature exists for a physical activity messaging framework to help guide creation and evaluation of messages. This study aimed to further develop and improve, and gain international expert consensus on, a standardised Physical Activity Messaging Framework and Checklist. METHODS: A modified Delphi study consisting of three online survey rounds was conducted. Each survey gathered feedback from an international expert panel using quantitative and qualitative methods. The framework and checklist were amended between each round based on survey results until consensus (defined a priori as 80% agreement) was reached. RESULTS: The final expert panel (n = 40, 55% female) came from nine countries and comprised academics (55%), healthcare and other professionals (22.5%) and government officials or policymakers (22.5%). Consensus was reached in survey 3 with 85 and 87.5% agreement on the framework and checklist, respectively. CONCLUSION: This study presents an expert- and evidence-informed framework and checklist for physical activity messaging. If used consistently, the Physical Activity Messaging Framework and Checklist may improve practice by encouraging evidence-based and target audience-focused messages, as well as enhance the research base on physical activity messaging by harmonising key terminologies and improving quality of reporting. Key next steps include further refining the Physical Activity Messaging Framework and Checklist based on their use in real-world settings.

A qualitative exploration of the mechanisms, pathways and public health outcomes of a city centre 20mph speed limit intervention: The case of Belfast, United Kingdom.

Twenty miles per hour (mph) speed limits can impact the health of the public (e.g., road safety, active travel). However, a better understanding of how individuals experience 20mph limits is required, to ensure interventions are cognisant of perceptions and potential un/intended outcomes. Focus groups (n = 9, 60 participants) to explore the Belfast 20mph intervention highlighted divergent perspectives and experiences including: 12 mechanisms (e.g., limited awareness), 15 pathways (e.g., reduced driving speed→improved liveability) and 10 public health outcomes (e.g., increased cyclist safety). Future interventions should consider un/intended outcomes and implement strategies to enhance effectiveness and mitigate harms (e.g., through training, enforcement).

Design, rationale and analysis plan for the Stand Up for Health trial in contact centres: a stepped wedge feasibility study.

BACKGROUND: Contact centres are one of the most sedentary workplaces, with employees spending a very high proportion of their working day sitting down. About a quarter of contact centre staff regularly experience musculoskeletal health problems due to high levels of sedentary behaviour, including lower back pain. There have been no previous randomised studies specifically aiming to reduce sedentary behaviour in contact centre staff. To address this gap, the Stand Up for Health (SUH) study aims to test the feasibility and acceptability of a complex theory-based intervention to reduce sedentary behaviour in contact centres. METHODS: The Stand Up for Health study has a stepped wedge cluster randomised trial design, which is a pragmatic design whereby clusters (contact centres) are randomised to time points at which they will begin to receive the intervention. All contact centre staff have the opportunity to experience the intervention. To minimise the resource burden in this feasibility study, data collection is not continuous, but undertaken on a selective number of occasions, so the stepped wedge design is "incomplete". Eleven contact centres in England and Scotland have been recruited, and the sample size is approximately 27 per centre (270 in total). The statistical analysis will predominantly focus on assessing feasibility, including the calculation of recruitment rates and rates of attrition. Exploratory analysis will be performed to compare objectively measured sedentary time in the workplace (measured using an activPAL™ device) between intervention and control conditions using a linear mixed effects regression model. DISCUSSION: To our knowledge, this is the first stepped wedge feasibility study conducted in call centres. The rationale and justification of our novel staircase stepped wedge design has been presented, and we hope that by presenting our study design and statistical analysis plan, it will contribute to the literature on stepped wedge trials, and in particular feasibility stepped wedge trials. The findings of the study will also help inform whether this is a suitable design for other settings where data collection is challenging. TRIAL REGISTRATION: The trial has been registered on the ISRCTN database: http://www.isrctn.com/ISRCTN11580369.

Get the message? A scoping review of physical activity messaging.

BACKGROUND: Understanding how to create and deliver effective physical activity (PA) messages for and to various population subgroups may play a role in increasing population PA levels. This scoping review aimed to provide an overview of what is known about PA messaging and highlight key research gaps. METHODS: We followed a 5-stage protocol proposed by Arksey & O'Malley and the Preferred Reporting Items For Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews checklist. Stage 1: research questions were identified. Stage 2: we identified relevant studies by searching electronic databases, contacting existing networks and hand searching reference lists. Stage 3: studies were screened in Covidence™ software. Stage 4: study data were extracted and charted. Stage 5: findings from included studies were collated, summarised and reported in two ways: (1) a descriptive numerical analysis providing insight into extent, nature and distribution of the included studies, and (2) a narrative summary summarizing the evidence reviewed organised by messaging concepts and by population subgroup. RESULTS: A total of 9525 references were imported into Covidence™ for screening. Of these, 123 studies were included in final analysis. We found that PA messaging evidence is complex and multidimensional in nature, with numerous concepts to consider when creating or evaluating messages. The extent to which these different PA messaging concepts have been researched is variable. Where research has accumulated and evidence is consistent, it supports the following: (1) PA messages should be framed positively and highlight short-term outcomes specifically relating to social and mental health, (2) message content should be tailored or targeted to intended recipient(s), and (3) when developing messages, formative research, psychological theory and/or social marketing principles should be used. CONCLUSION: While it is unlikely to address global inactivity on its own, PA messaging may play a valuable role improving population PA levels. However, it is a complex and multidimensional concept and greater understanding is still needed. We present a synthesis of the existing evidence, highlighting key areas where evidence has accumulated and where gaps lie, as well as recommendations for PA messaging to different population subgroups.

Beyond cycle lanes and large-scale infrastructure: a scoping review of initiatives that groups and organisations can implement to promote cycling for the Cycle Nation Project.

BACKGROUND/OBJECTIVES: Cycling has well-established positive relationships with health. Evidence suggests that large-scale infrastructure and built-environment initiatives to promote cycling are likely to be necessary but not sufficient to maximise cycling participation. Smaller-scale initiatives that can be implemented by organisations (eg, employers) and groups (eg, community groups) are therefore also important, but the full range of feasible activities to promote cycling is not known. We aimed to scope the literature and map organisational, social and individual level activities to increase cycling. METHODS: Design: Scoping review following an established five-stage process.Eligibility criteria: Studies or publicly available reports describing cycling promotion initiatives deemed feasible for organisations or groups to implement.Sources of evidence and selection: (i) online databases (Ovid (Medline), Ovid (Embase), SportDISCUS (Ebscohost), ProQuest, Web of Science), (ii) existing systematic reviews, (iii) expert stakeholder consultation. RESULTS: We extracted data from 129 studies and reports, from 20 different countries, identifying 145 cycling promotion initiatives. From these initiatives we identified 484 actions within 93 action types within 33 action categories under the nine intervention functions described by Michie et al. Environmental restructuring (micro-level), enablement, education and persuasion were the functions with the most action types, while coercion, modelling and restriction had the fewest action types. CONCLUSION: This is the first comprehensive map to summarise the broad range of action types feasible for implementation within organisation/group-based cycling promotion initiatives. The map will be a critical tool for communities, employers, practitioners and researchers in designing interventions to increase cycling.

A multicentre development and validation study of a novel lower gastrointestinal bleeding score-The Birmingham Score.

PURPOSE: Lower gastrointestinal bleeding (LGIB) is common and risk stratification scores can guide clinical decision-making. There is no robust risk stratification tool specific for LGIB, with existing tools not routinely adopted. We aimed to develop and validate a risk stratification tool for LGIB. METHODS: Retrospective review of LGIB admissions to three centres between 2010 and 2018 formed the derivation cohort. Using regressional analysis within a machine learning technique, risk factors for adverse outcomes were identified, forming a simple risk stratification score-The Birmingham Score. Retrospective review of an additional centre, not included in the derivation cohort, was performed to validate the score. RESULTS: Data from 469 patients were included in the derivation cohort and 180 in the validation cohort. Admission haemoglobin OR 1.07(95% CI 1.06-1.08) and male gender OR 2.29(95% CI 1.40-3.77) predicted adverse outcomes in the derivation cohort AUC 0.86(95% CI 0.82-0.90) which outperformed the Blatchford 0.81(95% CI 0.77-0.85), Rockall 0.60(95% CI 0.55-0.65) and AIM65 0.55(0.50-0.60) scores and in the validation cohort AUC 0.80(95% CI 0.73-0.87) which outperformed the Blatchford 0.77(95% CI 0.70-0.85), Rockall 0.67(95% CI 0.59-0.75) and AIM 65 scores 0.61(95% CI 0.53-0.69). The Birmingham Score also performs well at predicting adverse outcomes from diverticular bleeding AUC 0.87 (95% CI 0.75-0.98). A score of 7 predicts a 94% probability of adverse outcome. CONCLUSION: The Birmingham Score represents a simple risk stratification score that can be used promptly on patients admitted with LGIB.