搜索结果：Public health research (Southampton, England)

Exposure to particulate matter is linked to increased mortality, respiratory and cardiovascular diseases, including lung cancer, ischaemic heart disease and asthma, among other adverse health outcomes. Emissions of particulate matter from agriculture occur directly from farming activities and from reaction of ammonia with acidic pollutants to form fine particles (PM2.5: particles with diameter of 2.5 μm or less). In the United Kingdom, ammonia has slightly increased in recent years, in contrast to other PM2.5 sources. In addition, NH3 emissions can contribute to nitrogen deposition, which, in excess of critical thresholds, may result in biodiversity loss. Our objectives were to assess the effectiveness and cost-effectiveness of inter-related interventions to: (1) assess the annual health impacts of air pollution (PM2.5) from intensive livestock agriculture and farming on the general population; (2) valuate the effectiveness and cost-effectiveness of the specific interventions at the national level; (3) assess impacts on ecosystems; and (4) examine the extent to which rural residents are concerned about agriculture and their health. We performed a health impact assessment based on PM2.5 exposures associated with three levels of agricultural intervention. We also performed an economic analysis, capturing valuation of health and productivity, and costs to the national health service, as well as an assessment of ecosystem impacts based on nitrogen deposition and biodiversity loss. A survey of rural residents' health was undertaken to investigate links between self-reported health and agriculture. The three intervention scenarios comprised 19 individual mitigation actions at a farm level, each with differing uptake levels in low, medium and high scenarios. The health impact assessment and economic analyses included all-cause mortality, and incidence of lung cancer, ischaemic heart disease, cerebrovascular disease, and childhood asthma incidence. The ecosystem analysis examined biodiversity loss, and the rural residents survey addressed respiratory, gastrointestinal, and neurological diseases. Modest changes in PM2.5 concentrations across the United Kingdom associated with the low, medium and high intervention scenarios resulted in relatively small impacts compared to national baseline levels of mortality and morbidity (i.e. -0.01% to -0.05%). Overall, United Kingdom-wide avoided costs ranged from £78.1 to £93.4M, with much lower annual avoided costs to the national health service. All habitats had a relative increase in biodiversity under all scenarios with expected benefits of £3.4-4M. There were 450-500 respondents in each of the 2 waves of the rural resident surveys. No associations were identified between any self-reported disease occurrence and farm-related variables. Our approach used several different models, requiring important assumptions and uncertainties. Respondents to the residents' survey tended to be aged over 45 and female and findings are applicable primarily to this demographic. Based on the modest modelled changes in PM2.5 concentrations associated with the intervention scenarios, we estimated small impacts with human health, as well as economic and ecosystem effects. We found no evidence of self-reported health issues in relation to farms or farming practices. Impacts from alternative farming interventions should be assessed to maximise PM2.5 reductions in the United Kingdom. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129449. Air pollution, such as particulate matter, can cause poor health. There are different sources of particulate matter, one of which is ammonia from farming. Other sources of particulate matter have decreased in the United Kingdom, but ammonia has increased recently. This study aimed to evaluate interventions to reduce the particulate matter created from farming. We included three different farming scenarios, or interventions, to limit particulate matter releases. We analysed the health impacts, costs, and possible effects on ecosystems of scenarios with less particulate matter. The health and economic assessments looked at deaths, lung cancer, heart disease, stroke, and childhood asthma. The study examined biodiversity loss from nitrogen pollution. We also asked how rural residents felt about their health and living near farms. Our results showed that the small particulate matter reductions from the interventions would have little benefit on the rates of death and disease. The cost-savings to the national health service were also small. The interventions would benefit ecosystems by increasing biodiversity. Surveys of rural residents did not show health problems were related to farming. Overall, the interventions would have small positive effects on health, the economy, and ecosystems. In general, people did not think farming caused poorer health. It would be useful to study other farming interventions to help reduce particulate matter and compare impacts on health, economy and the environment.

Net Zero policies rarely consider air quality and physical activity health cobenefits, cost-benefit analysis, exposure indoors and exposure inequalities. To calculate the air quality, health and economic costs and benefits of United Kingdom Net Zero policy, impacts on inequalities and consult the public on the acceptance of Net Zero policy. We used sophisticated emissions and air quality models, Life Table health impact analysis, United Kingdom Government cost-benefit methods and estimated exposure inequalities. We compared 2030 and 2040 United Kingdom PM10, PM2.5, nitrogen dioxide and ozone predictions using existing air quality policy, or Business as Usual, with Net Zero policy. We predicted Net Zero 2050 pollutant concentrations. Business as Usual scenarios were from United Kingdom Government projections and Net Zero scenarios were from the Climate Change Committee's sixth Carbon Budget. We used the Balanced Net Zero and Widespread Innovation Pathways for road transport, building heating and active travel. United Kingdom air pollution, including exposure inequalities, mortality, morbidity and economic costs and benefits. Air quality: Under Business as Usual, nitrogen dioxide and particulate matter reduced by 2030 due to new vehicles. The 2040 Balanced Net Zero Pathway and Widespread Innovation scenarios showed further reductions, driven by electric vehicle uptake, reduced vehicle kilometre travelled compared with Business as Usual, and low-carbon building heating. Particulate matter reductions from buildings was two and three times greater than from road transport, for Widespread Innovation and Balanced Net Zero Pathways, respectively. Balanced Net Zero Pathway+ 2050 predictions showed additional air pollution benefits. Exposure inequalities analysis: In 2019, urban central professionals experienced 14 µg m-3 higher nitrogen dioxide concentrations than rural elderly. At 1.5 µg m-3, PM2.5 concentrations varied less across geodemographic groups. Despite future improvements in nitrogen dioxide, inequalities persisted, but were less pronounced, due in part to Net Zero policies. Indoor air pollution: Removing gas cooking at home for Net Zero may result in greater nitrogen dioxide reductions than changes in outdoor air pollution. Health and active travel impacts: Compared with Business as Usual, Balanced Net Zero Pathway gave 4.9 (95% confidence interval 1.0 to 9.0) million life-years gained across the United Kingdom, to 2154, including 1.1 (95% confidence interval 0.7 to 1.6) million life-years gained from active travel. Avoided chronic obstructive pulmonary disease and childhood asthma cases were 201,000 (95% confidence interval 150,000 to 250,000) and 192,000 (95% confidence interval 64,600 to 311,000). Monetised morbidity benefits of £52.1B (95% confidence interval 36.4 to 67.8) added significantly to mortality benefits of £77.9B (95% confidence interval 42.9 to 90.8). Total yearly air pollution and active travel benefits were £153B (95% confidence interval 122 to 184), rising to £278B (95% confidence interval 228 to 334), including outcomes with weaker evidence. Costs/benefits: Building sector Balanced Net Zero Pathway air quality health benefits were £21.3B (95% confidence interval 16.4 to 26.2) by 2050 and were £98.4B (95% confidence interval 75.7 to 121.1) by 2154. Transport benefits were £9.1B (95% confidence interval 7.0 to 11.2) by 2050 and were £36.5B (95% confidence interval 28.1 to 44.9) by 2154. Balanced Net Zero Pathway building sector operating costs alone did not achieve break-even, but with greenhouse gases reductions (lower benefits) break-even was achieved by 2052. Air pollution health benefits reduced the building sector time to break-even by between 3.1 (95% confidence interval 2.5 to 4.7) and 6.3 (95% confidence interval 4.7 to 7.6) years. Public engagement: Conversations reflected an intergenerational commitment to Net Zero policies, although there was uncertainty about an individual's impact. Uncertainties in future air quality and meteorological conditions; through lack of evidence, being unable to use multipollutant models and indoor air pollution, missing indoor health and monetised benefits; some health outcomes with weaker health evidence strongly influenced the results. The COVID pandemic prevented us from exploring social acceptance as planned. This study identified health and economic cobenefits through reductions in greenhouse gases, air pollution, inequalities and increased exercise. To separately evaluate the health and monetary impacts of indoor and outdoor air pollution; to understand the overlapping effects of PM2.5 and nitrogen dioxide health impacts; to develop effective ways of communicating the health and economic benefits and to increase the social acceptability of Net Zero. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129406. We wanted to know how climate policies like Net Zero can help reduce air pollution and bring benefits for our health, the environment and the economy. We compared future air pollution predicted under current policies with that predicted under more ambitious Net Zero policies. We focused on electric vehicles in transport, using electricity to heat buildings and for cooking, and using more e-bikes. If Net Zero policies are adopted, harmful air pollution will reduce. These policies support switching to electric vehicles, driving less, cycling and walking more and using cleaner energy like electricity to heat our homes and for cooking. We found that Net Zero policies made people healthier, bringing benefits of billions of pounds. Increases in cycling, because of Net Zero, also led to large health benefits. Air pollution in your home can affect your health. Net Zero policies that promote home insulation, electric heating and the removal of home fossil fuel use altogether, including gas cooking, are highly effective in reducing harmful pollutants indoors. We highlighted that poorer communities live in areas with higher air pollution than richer ones but that the difference between those with the highest and lowest air pollution levels reduces with Net Zero policies. It is important that Net Zero policy focuses on the most in need in society and addresses affordability. Understanding the combined effect of air pollution and climate policy offers the potential to be more ambitious. Our study contributes to the evidence on Net Zero’s health and economic benefits and supports policy action.

Agriculture dominates United Kingdom ammonia emissions, from livestock manure exposed to the atmosphere via livestock housing, storage, land and grazing. Ammonia significantly contributes to the formation of PM2.5 (particles with diameter of 2.5 μm or less) concentrations in Europe which are associated with adverse human health outcomes. Ammonia emissions contribute to nitrogen deposition, whereby reactive compounds of nitrogen are deposited into the biosphere, potentially resulting in biodiversity loss. Recent research has not found sufficient evidence for effectiveness of interventions to reduce ammonia emissions and little evidence on the cost-effectiveness of interventions. The current study aimed to address this knowledge gap. The study aimed to assess effectiveness and cost-effectiveness of two agricultural interventions to mitigate ammonia emissions - improved housing for farmed animals and improved manure application. Emission measurements were made at five farms (dairy, pig, poultry). Information on uptake of mitigation measures, barriers and enablers for implementation were determined through an online survey and focus groups with farmers, supplemented by stakeholder interviews. Chemical transport and dispersion modelling estimated population exposures to air pollution at local and national levels under three scenarios (low, medium, high intervention uptake). A health impact assessment estimated health effects associated with the scenarios, and data on self-reported health issues were collected via an online survey of rural residents. Economic evaluation methods estimated cost-benefits of the scenarios and impact on ecosystems. Farmers favour mitigation measures which are cheaper, and build on existing practices, such as amending diet or extending the grazing season. However, these are less effective in decreasing ammonia emissions. Scenarios based on realistic current, and future, uptake levels of measures showed little impact on air quality, partly due to the ammonia-rich United Kingdom atmosphere minimising conversion of ammonia emissions to particulate matter. Consequently, minimal impact of mitigation measures was evident on health outcomes and costs. There was no evidence that self-reported health symptoms from rural residents were related to living near a farm, type of farm or seasonality of farm activities, consistent with results of local dispersion modelling which estimated that most emissions from animal housing dispersed within 1 km. Impacts of COVID-19 and the United Kingdom's withdrawal from the European Union on the agricultural industry affected the recruitment and availability of farms and farmers, resulting in fewer field measurements than planned. A lower response to the farmers' survey was mitigated by the quality of data provided by participants and the successful series of focus groups. The study highlights the need for enhanced communication with the farming community to encourage implementation of more effective mitigation measures, such as air scrubbers, or those relating to slurry storage, currently perceived to be too expensive and complex. Greater clarity on benefits is essential so that farmers understand not only what they need to do but also how and why. Further investigation of the health impacts of ammonia emission should focus on those exposed on the farm, or resident nearby animal houses. Further modelling development of key atmospheric processes is also indicated to minimise uncertainties associated with the regional modelling. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129449. Air pollution damages lung and heart health, contributing to premature death and hospital admissions. These health effects are associated with exposure to very small particles, including from reactions of ammonia emitted from farming, the main United Kingdom producer of ammonia, principally from animal manure in livestock housing, fertilisation of fields and animal grazing. Recently, other United Kingdom sources of particles have decreased, but ammonia levels have not. This study aimed to assess the effectiveness of improved cattle housing and manure storage and application, at reducing emissions of gases and particles. We measured ammonia emissions from five farms and used surveys, focus groups and interviews with farmers and stakeholders to understand views on ammonia reduction measures. Computer models were used to estimate the impact of emissions reduction on exposure and related health issues of people near farms and the wider United Kingdom population. We calculated savings in National Health Service costs. We also surveyed people living near farms about their health. The study found that the measures that farmers were currently prepared to consider implementing reduced ammonia emissions by up to 13%, but the overall reduction in air pollution particles was limited (around 1%). Improvements in health and cost-savings were also small, and surveys of rural residents did not show health problems were related to farming. The study also showed that emissions from farms almost entirely dispersed into the background air within 1 km. Farmers were interested in reducing their environmental impact and favoured cheaper interventions building on existing practices, which also tended to be less effective in reducing ammonia emissions. Barriers to using these interventions were costs and lack of knowledge. To reduce ammonia emissions, future policies should address the barriers and clearly communicate benefits to the environment and to farmers. It would be useful to study more effective farming interventions to reduce air pollution.

Research in real supermarkets can be challenging due to competing health and business agendas. This study used a 2-dimensional (2D) simulated supermarket to investigate whether visual attention to, and intended purchase of, products in prominent store locations (checkout, end-of-aisle, store entrance) differed for healthy, unhealthy or non-food items. The study also explored if these findings were modified by participants' level of educational attainment. Women from Wessex, UK, took part in one of two trials. Phase 1: 201 women completed an online questionnaire in which all participants viewed simulated supermarket journeys depicting healthy, unhealthy and non-food product routes, starting at the store entrance and ending at the checkout, in a random order. Participants clicked on items (i) that they were interested in and then (ii) that they wished to purchase. Phase 2: 71 women participated in an eye-tracking study in which all participants again viewed all journey types, followed by a series of side-by-side preferential looking scenes to allow comparison of attention between the three product types, presented in a random order. Twelve participants took part in semi-structured interviews to better understand their views on what influences product attention; data were analysed using thematic analysis. Phase 1: Participants demonstrated higher attention to food items compared to non-food items but their intention to purchase was higher for healthy foods than both unhealthy and non-food items. Phase 2: there was no difference in attention across product types during the journey task. In the preferential looking task, participants spent more time viewing healthy products than unhealthy or non-food products. Participants also exhibited higher intention to purchase healthy products than unhealthy or non-food items. Interview participants used shopping lists and avoided certain aisles to prevent unhealthy purchases. They wanted to see healthy foods or essential non-food options at prominent store locations. Women intend to make more healthy purchases than unhealthy purchases when they shop but supermarket strategies to promote less healthy foods in prominent locations in stores may undermine this intent. These findings support the use of prominent positioning of healthier items in stores as a useful strategy to increase healthy sales and support current and planned food policies. This was a quasi-experimental study of participants' attention in an online questionnaire (phase 1) and an eye-tracking study (phase 2) and trial registration was not required. Participants did not receive an intervention.

High levels of smoking among people who experience imprisonment contribute to their high mortality and morbidity rates and to inequalities. Scotland's prisons became smokefree in 2018. However, questions remain about how to prevent high relapse to smoking post release. Summarise evidence on supporting people to reduce tobacco-related harms post release. Understand experiences, opportunities and challenges for reducing tobacco-related harms for people leaving smokefree prisons and for families. Feasibility test a household-targeted intervention to support people released from smokefree prisons to reduce tobacco-related harms. Update cost-effectiveness of smokefree prison policy. Partnership-working with key stakeholders. Scoping reviews; qualitative; health economic modelling. Prisons in Scotland; staff, people in prison, family members. Our scoping reviews show that evidence on interventions to support people leaving smokefree prisons to remain tobacco-free is weak. There is no evidence on smoking rates among people released from smokefree prisons allowing vaping. Significant barriers remain for people from underserved communities to create smokefree homes. Our modelling highlights that offering effective smoking cessation support to people leaving smokefree prisons would be cost saving at both the personal and societal levels. The challenges people face on release from prison and variability in throughcare support often render smoking relapse prevention a low priority for them, their families and service providers. However, in terms of long-term prevention of ill health and premature death, the high rates of relapse to smoking (~50-80%) continue to fuel inequalities. Supporting people leaving smokefree prisons to remain abstinent will help governments to achieve ambitions to create smokefree societies. Progress may be achieved by greater integration of support for tobacco-harm reduction with services addressing interconnected needs, such as harmful use of other substances and underlying mental ill health. The extensive impact of coronavirus disease discovered in 2019 in prisons into 2023, alongside challenges due to overcrowding and staffing pressures, limited the opportunities for partnership working and the number of interviews we could conduct. This meant that we were unable to test the feasibility of delivering a household-based intervention to reduce tobacco-related harms in this population. Progress in developing suitable interventions to prevent very high relapse-to-smoking rates following release from smokefree prisons is required. Helping people released from smokefree prisons to remain abstinent from tobacco post release could deliver considerable benefits. However, in the face of substantial challenges, preventing relapse to smoking has become entrenched as a low priority - for many service providers, people leaving smokefree prisons and their families. Greater success in reducing tobacco-related harms among this often-overlooked population may be achieved through more holistic models of service delivery. Aspirations for countries to become tobacco-free may require a rethink of what is needed to support underserved populations in whom smoking remains entrenched. Further research is required to better understand what approaches are feasible and effective for maintaining smoking abstinence following release from prison, including development and evaluation of integrated/holistic approaches which tackle smoking/vaping behaviours in the context of use of other substances and needs. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131613. Smoking and breathing other people’s smoke (‘second-hand smoke’ exposure) damages health. In 2018, a new law was introduced to stop people in prison from smoking tobacco in Scottish prisons (‘smoke-free prisons’). Afterwards, second-hand smoke levels in prisons were much lower than before, but we know that most people go back to smoking after leaving prison. We also know that smoking inside homes is more common in the communities to which people often return to after leaving prison. We wanted to find out what opportunities and challenges are there to helping reduce smoking and second-hand smoke exposures for people leaving smoke-free prisons and families. We looked at other recent studies to find out what works best to (1) support people to not smoke after leaving prison and (2) support people to not smoke indoors at home. We interviewed people in prison, staff and families. We also studied what things might make the wider benefits of smoke-free prisons cost saving for everyone. We found that not enough is known about how to help people not to smoke after leaving a smoke-free prison or how to help people to overcome their difficulties with taking smoking outside. We learned from people in prison, staff and families about the many reasons why people often go back to smoking after leaving prison. One important reason is that stopping smoking is often a low priority for people who are struggling with basic needs, like finding suitable housing. Our study suggests that giving people who leave prison support that works to help stop smoking indoors at home or to stop smoking completely would be good for them and for society. A limit to our study was that, due to COVID-19 impacts, we were unable to develop a programme to reduce smoking and second-hand smoke exposure in people leaving prison.

People leaving prison face significant barriers to reintegration, often resulting in homelessness, which exacerbates health issues and increases recidivism. Critical time interventions aim to support vulnerable individuals during significant life transitions by providing time-limited, emotional and practical support. While effective in other contexts, the impact of housing-led critical time interventions for people leaving prison in the United Kingdom remains unclear. The PHaCT study was a pilot randomised controlled trial of a housing-led critical time intervention for people leaving prison at risk of homelessness. This study aimed to determine whether a full-scale randomised controlled trial of the critical time intervention model in prison leavers at risk of homelessness was feasible. The pilot was a parallel two-arm, individual-level randomised controlled trial of a pre-existing critical time intervention intervention with an integrated process evaluation and embedded exploratory health economic evaluation. Recruitment occurred in fours male prisons across England and Wales with participants followed up in the communities. Prisons were randomised by site to either receive the critical time intervention or receive usual support, and participants were recruited within 12 weeks of their release. The locations were predetermined by where the intervention was already being delivered by the intervention provider (critical time intervention teams). Critical time intervention included pre-engagement, transition to community, try-out and transfer of care phases, each lasting 3 months. Data collection methods included baseline surveys, follow-up assessments at 3, 6 and 9 months, qualitative interviews, and session observations. Routine data linkage was explored separately to assess feasibility. Progression criteria included recruitment, retention, process evaluation and fidelity. Thirty-four male participants (mean age 38 years) were recruited, with 19 assigned to the intervention and 15 to control. The study achieved a high recruitment rate of 92%, but retention was a significant challenge, with only 18% of participants retained at 9 months follow-up. The process evaluation found critical time intervention was acceptable to staff and participants, but ethical concerns around randomisation and informed consent were raised. Fidelity to the critical time intervention model was generally high, though contextual instability in housing and criminal justice systems posed challenges. Data collection methods for health economics and data linkage were feasible and acceptable. The approval to access prisons was lengthy and support provided by Clinical Research Networks was delayed. Contextual instability within the housing and criminal justice systems, including a lack of social housing, high recall rates, the removal of the requirement to have a probation officer and the emergency early release of people in prison, further complicated the trial. Ethical concerns around randomisation and informed consent affected trial acceptability. The trial methodology faced significant challenges. Low retention rates, ethical concerns by intervention delivery staff around randomisation and contextual instability suggest that a full-scale randomised controlled trial is not feasible. The findings highlight the need for systemic changes within the research support provided to prison-based studies, housing and criminal justice systems to support research in prisons and interventions for people leaving prison. Decision-makers should prioritise policies that increase the availability of affordable housing and provide post-release support. Future research should explore alternative study designs and more intensive recruitment and retention strategies. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR134281. People leaving prison often struggle when returning to the community, leading to homelessness, worse health and higher chances of committing more crimes. Critical time intervention is a structured support model delivered by trained caseworkers to help during this transition. Critical time intervention includes four phases, pre-engagement, transition to community, try-out and transfer of care, each lasting 3 months. Caseworkers support individuals to secure housing, access services and build life skills. From October 2023 to August 2024, 34 men leaving three prisons in England and Wales were recruited for a pilot study. Participants were randomly assigned to either receive critical time intervention or usual support. The study aimed to test whether a full-scale research project could be done to evaluate critical time intervention. We assessed recruitment (did people take part), retention (could we stay in touch), fidelity (was critical time intervention delivered as planned) and acceptability (were the study and intervention acceptable to participants and staff). Data were collected through surveys at baseline and at 3, 6 and 9 months, interviews and session observations. Most people agreed to take part, but it was difficult to maintain contact over time. Critical time intervention was well received by staff and participants, but the research process faced challenges. These included high rates of return to prison, limited housing options, reduced probation contact and emergency early releases. Critical time intervention was valued by those who delivered and received it, but conducting a larger study to evaluate its effects would be difficult. Maintaining contact with participants was challenging, and wider issues in housing and criminal justice systems suggest a full-scale trial may not be feasible. Future work should focus on improving support for prison leavers and adapting research methods to better suit this population.

Co-design is increasingly used in health and social care research, but its application with older adults in community settings may raise methodological challenges. Age-adapted co-design methods are needed to support meaningful participation. This study developed and examined an age-adapted co-design methodology in a community setting involving older adults with Type 2 diabetes mellitus (T2DM). A qualitative approach was adopted, which included exploratory interviews, design probes, clarification interviews, a co-design workshop and evaluation interviews. A total of 24 participants were involved across the study, including older adults with T2DM, community workers, healthcare professionals and extended reality (XR) designers. The methodology was examined in terms of acceptability, appropriateness and feasibility. The methodology was generally found to be acceptable, appropriate and feasible. Participants described the interviews, design probes and workshop activities as manageable and low-burden, particularly when tasks drew on everyday life. Visual materials such as stickers, icons, images and videos, together with simple prompts and reduced writing demands, supported understanding of the research activities, expression and positive emotional engagement. The study also identified challenges related to unfamiliar co-design concepts, the interpretation of some visual tools, workshop duration and practical implementation constraints such as staffing, space, funding, health conditions and time availability. Participant feedback and researcher reflection informed iterative refinements to the materials, workshop preparation, communication strategies and activity format during the study. This study demonstrates the value of an age-adapted, multi-stage co-design methodology for engaging older adults in community health research. The findings highlight the importance of grounding co-design in lived experience, using age-friendly materials and refining methods iteratively. Older adults with T2DM, community workers, healthcare professionals and XR designers contributed to this study. Their experiences and feedback informed the refinement of the research materials, co-design activities and methodological process.

The growing prevalence of multiple long-term conditions (MLTC) - two or more long-term health conditions - has been recognised as one of the most significant health challenges facing contemporary societies. People living with MLTC experience poorer outcomes than people with one long-term condition and may be disadvantaged by health care systems configured for single conditions. Recognition of the significance of these inequities has led to increased investments in MLTC research, and a body of qualitative literature on lived experience is developing. However, conducting qualitative MLTC research presents challenges to researchers. Encompassing an extensive range of condition combinations, the MLTC population is incredibly diverse, and constructing a sampling strategy for the small numbers of participants typical in qualitative inquiry requires careful thought. Additionally, MLTC is a construct not embedded in public consciousness, which may affect participant self-identification and research engagement. Furthermore, the risk of issues commonly experienced in qualitative health research, such as participant distress and low recruitment rates, can be exacerbated due to the ill-health experienced by some people living with MLTC. In this article, we share reflections from a cross-institution Qualitative Methods Community of Practice in MLTC Research, describing the challenges experienced and practical steps taken to address difficulties and mitigate risks. We aim to provide tips and guidance to qualitative health researchers new to MLTC inquiry to support planning and delivery of their research in this rapidly growing field.

Poor diet is a leading risk factor of non-communicable diseases. Product placement strategies in retail outlets can influence customers' food preferences. The United Kingdom government introduced legislation in October 2022 restricting chain retailers from using location promotions on unhealthy food and drinks. High-quality scientific evidence is needed to inform the inclusion of healthier product placement approaches into these regulations. In the context of Brexit, COVID-19 and the cost-of-living crisis, this study assessed whether positioning an expanded fresh fruit and vegetable section near store entrances in discount supermarkets, which do not routinely market produce this way, improved store sales, household purchasing and diet. This natural experiment had a prospective matched controlled cluster design, involving 36 stores (18 intervention and 18 control) across England. The intervention was implemented continuously for 6 months. Control stores were matched on store sales, customer profiles and neighbourhood deprivation. Participants were women, aged 18-60 years, with loyalty cards and were assigned to their primary store (n = 280 intervention and n = 300 control). Weekly store sales and household data from loyalty cards were provided by the collaborating supermarket chain. Dietary quality, household food waste and demographic characteristics were collected through questionnaires. A process evaluation and economic evaluation were completed. Store-level sales of fruit and vegetables were greater in intervention stores than predicted at intervention implementation and 3 and 6 months' follow-up, equivalent to ≈ 2525, ≈ 1940 and ≈ 1450 extra portions per store per week, respectively. Effect sizes were somewhat stronger in stores where the produce section moved forwards more than 14 m. The proportion of households purchasing fruit and vegetables were somewhat protected among intervention compared to control participants after 3 and 6 months. Changes in dietary quality were small but generally in the expected direction for health benefit. Changes in frequency of household fruit and vegetable waste were negligible at 3 months' follow-up but increased at 6 months. The intervention was implemented according to the study protocol, with marked differences in the positioning of fresh fruit and vegetables between intervention and control stores post-intervention implementation. Fresh fruit and vegetable availability increased post intervention in intervention compared with control stores. Interviews with store staff demonstrated that changes in staff attitudes had a positive reinforcing effect on intervention implementation. Assessment of the policy context showed that stakeholders across the food system largely support the United Kingdom government's unhealthy placement ban; some felt it does not go far enough. This study shows that positioning produce sections near supermarket entrances can improve the nutrition profile of store sales and may improve household purchasing and diet. The United Kingdom Food (Promotion and Placement) Regulations could be refined to require a produce section near supermarket entrances to increase its health impact. Future research should continue to build the evidence for which healthy eating interventions are effective in retail outlets. Further evaluations of real-world supermarket intervention studies using robust scientific study designs are required, alongside process and economic evaluations, to provide evidence for policy intervention to improve retail food environments in the United Kingdom and internationally. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 17/44/46. Supermarkets are a major source of food for families. Discount supermarkets have less-healthy environments than other supermarkets and are used more by families living on lower incomes. We worked with a United Kingdom discount supermarket chain to assess if moving a bigger fresh fruit and vegetable section near store entrances improves what people buy. A total of 580 women aged 18–60 years who regularly shopped at one of 36 stores (18 with changes and 18 with no changes) across England took part. Women did a survey over the phone four times (once before the change in layout and 1, 3 and 6 months after). The survey asked about the foods they and their young children (aged 2–6 years) usually ate, where they shopped for food and how much they spent each week, as well as their age, number of children and highest educational qualification. Information about the food each woman bought from loyalty card data and the total sales of fruit and vegetables for each store in the study was given by the supermarket. We found that the sales of fruit and vegetables were higher in stores where they had been moved to the front when compared to stores where they remained at the back of the store, though the size of the impact decreased over time. We found that during the time of Brexit, COVID-19 and the cost-of-living crisis, all families bought fewer fruit and vegetables over time. Families who shopped mostly at study stores with fruit and vegetables near the front entrance had a smaller decline in fruit and vegetable purchases than families who shopped at stores with fruit and vegetables towards the back. Our study provides new information that governments could use to make all supermarkets place fruit and vegetables near the front of their stores so people buy and eat more fresh produce.

Despite UK targets to reduce stillbirth, there has been comparatively less research focused on stillbirth than on other pregnancy complications. This study aimed to ensure that future research addresses the most important contemporary questions regarding stillbirth by updating the 2015 UK Stillbirth Priority Setting Partnership (PSP), in accordance with the James Lind Alliance (JLA), in collaboration with over 30 professional and stakeholder organizations. The Stillbirth PSP was accepted by the JLA for a refreshed list of priorities in June 2024, and a steering group was formed. A survey was then developed in English to identify potential research questions regarding stillbirth and perinatal death in the UK. The initial survey was open from 3 February 2025 to 7 April 2025, during which professionals and people affected by stillbirth were invited to submit research questions relating to either the causes, impact, prevention or management of stillbirth or pregnancy loss after 20 weeks' gestation. The questionnaire was publicized via social media and by stakeholder organizations. Participants' responses were analyzed, duplicate or out-of-scope questions were removed, and indicative questions were formulated from those submitted. Literature searches were carried out in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychInfo to identify which of the submitted questions had been answered in previously published work. The remaining unanswered research questions were carried forward into a second prioritization survey, which was hosted online from 15 September 2025 to 16 October 2025. The research questions at the highest priority level were determined by consensus at a face-to-face workshop in November 2025, involving participants with lived experience and healthcare professionals. The initial survey received 1261 responses from 525 participants. A further 24 research questions were identified from 10 clinical practice guidelines. Of these 1285 questions, 120 were out of scope. After removing duplicates and combining responses, there were 89 indicative questions. Literature searches determined that 10 questions had been answered previously. The remaining 79 questions were carried forward into the second prioritization survey and were ranked by 441 participants. The top 26 questions were taken to the face-to-face workshop, which prioritized 12 research questions by consensus. The prioritized topics for future research included prediction, prevention, understanding of the causes and management of stillbirth. This updated Stillbirth PSP indicates that researchers should prioritize studies addressing the identified research priorities, because these reflect the most important research questions for those affected by stillbirth and frontline professionals. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Incomplete and inconsistent reporting amongst research studies in people with Multiple Long-Term Conditions (MLTC) hinders the comprehensive evaluation, synthesis, and interpretation of study findings for application by clinicians, researchers, patients and policymakers. This limitation leads to heterogeneous findings, duplication of work and restricts the practical application of research outcomes in clinical settings, public health strategies, and policymaking. Given the high prevalence and complexity of MLTC, there is a pressing need for standardised guidelines to promote clarity, consistency, and comprehensiveness in study reporting. Such guidelines can enhance transparency and reproducibility, thereby increasing the impact of research on healthcare decisions and policy development. We followed a four-stage process of guidelines development: a review of MLTC reporting practices; a workshop with diverse stakeholders to identify and refine items for inclusion; a prioritisation consensus exercise to agree on key items; and pilot-testing to refine interpretation and usability of the guidelines. This work has produced the first set of reporting guidelines addressing the need for standardised reporting in MLTC research. Application of these guidelines has the potential to improve research clarity and reproducibility, enabling better comparisons across studies and shared learning. Improved reporting standards will also facilitate the translation of research findings into effective healthcare strategies and policies, contributing to better health outcomes for MLTC patients. These initial guidelines offer a structured approach to improving the reporting quality of MLTC research. Future evaluations will assess its impact on research transparency and real-world application.

Human reproduction is tightly regulated by circadian and metabolic signals. However, the extent to which alterations in these systems affect fertility, especially in females with overweight or obesity who are at increased risk of infertility, remains poorly understood. This study, nested within the Healthy Early Life Moments in Singapore (HELMS) integrated lifestyle intervention program, aims to: (i) examine the associations between changes in circadian behavior and metabolic health indicators over a 3-month period and subsequent reproductive outcomes during a year of conception attempts, (ii) identify risk factors associated with these changes, and (iii) elucidate the biological mechanisms underpinning these relationships in females attempting to conceive. This prospective observational cohort study will enroll 283 females with a BMI of 25-40 kg/m² participating in the HELMS program at KK Women's and Children's Hospital, Singapore. Participants will be followed for one year as they attempt to conceive. At baseline and at the 3-month mark, circadian behavior will be assessed using validated questionnaires, tracking diaries, and digital wearables. Metabolic health will be evaluated through anthropometry, body fat composition, a metabolic syndrome score, and an insulin resistance index. Blood samples will be collected to analyze metabolic biomarkers and gene expression levels. We will use modified Poisson regression models to examine associations with the clinical pregnancy rate (primary outcome) and discrete-time proportional hazards models to estimate associations with fecundability (secondary outcome) within one year of conception attempts. This study is pivotal for identifying potential novel modifiable risk factors to address low fertility rates. Insights from this research will generate hypotheses for interventions designed to enhance preconception care. By screening and managing circadian behaviors and metabolic profiles among females with overweight and obesity, these strategies may benefit those experiencing unexplained infertility. Ultimately, this approach could foster a shift towards a more holistic and patient-centered model of reproductive healthcare. Human reproduction is shaped by the body’s internal clock and metabolism, but it is not yet clear how changes in these systems affect fertility, particularly in women with overweight or obesity, who are at higher risk of infertility. This study, part of the Healthy Early Life Moments in Singapore (HELMS) program, aims to better understand these links. A total of 283 women with a body mass index between 25 and 40 kg/m2 will be recruited at KK Women’s and Children’s Hospital, Singapore, and followed for one year while trying to conceive. At baseline and 3-month follow-up, participants’ daily routines, including the timing of eating and sleep, will be recorded using questionnaires, diaries, and wearable devices. Their metabolic health will be assessed through body fat, waist size, blood sugar control, and blood tests for biomarkers and gene activity. Researchers will analyze how changes in these patterns relate to the chances of becoming pregnant and the time it takes to conceive. This work is important because it may reveal lifestyle and health factors that can be modified to improve fertility. The findings will help shape new approaches to support women before pregnancy. By addressing daily routines such as meal timing and sleep, alongside metabolic health, this study may offer practical strategies for women struggling to conceive without a clear medical cause identified through standard reproductive investigations. In the long run, this approach could lead to more personalized and supportive fertility care that looks beyond medical treatment to the whole person.

A renewed focus on disease prevention has placed genomics firmly in the spotlight. Policymakers and health services across Europe are considering ways to facilitate disease prevention and early disease detection through population-level initiatives such as newborn genomic screening and polygenic risk scores. This commentary explores, through the lens of duty-based ethics, the ethical considerations in the design of genomic screening programmes. As genomic medicine becomes embedded in public health strategies, a robust ethical framework is essential to ensure that its promises are realised equitably and responsibly.

Return to work is achieved by <&#x2005;50% stroke survivors. Evidence on support for return to work is lacking. To determine whether Early Stroke Specialist Vocational Rehabilitation is more clinically effective and cost-effective at supporting return to work 12 months after stroke than usual care. Pragmatic, observer-blind, multicentre superiority randomised controlled trial with embedded health economic evaluation. Participants were individually randomised, 5&#x2005;:&#x2005;4, to receive occupational therapy-led Early Stroke Specialist Vocational Rehabilitation&#x2005;+&#x2005;usual care. Questionnaire follow-up at 3, 6 and 12 months post randomisation. Mixed-methods process evaluation explored intervention experience, fidelity, compliance and implementation. Twenty-one NHS stroke services in England and Wales. Patients with new stroke within 12 weeks, aged &#x2265;&#x2005;18, in paid/unpaid work at stroke onset. People not intending to return to work excluded. Occupational therapists assessed stroke impact on participants and their job; co-ordinated NHS/employer/other stakeholders' support; negotiated job accommodations, monitored return to work and explored alternatives if return to work were unfeasible. Usual care involved NHS rehabilitation provided by community teams and medical follow-up. Primary outcome: self-reported return to work for &#x2265;&#x2005;2 hours/week 12 months post randomisation. Secondary outcomes: mood, functional ability, participation, productivity, work self-efficacy, health-related quality of life, confidence, mortality, carer strain, cost-consequences, COVID-19 impact. Between 1 June 2018 and 7 March 2022, 583 participants [mean age 54 years (standard deviation 11.1), 69.0% male, mean 29.9 days (standard deviation 20.0) post stroke, 452 (82.8%) ischaemic stroke] were randomised to Early Stroke Specialist Vocational Rehabilitation (n&#x2005;=&#x2005;324) or usual care (n&#x2005;=&#x2005;259). Primary and secondary outcome data were available for 454 (77.9%) and 316 (54.2%) participants, respectively. Intention-to-treat analysis showed no statistically significant difference in return to work between groups at 12 months [165/257 (64.2%) Early Stroke Specialist Vocational Rehabilitation vs. 117/197 (59.4%) usual-care, adjusted odds ratio 1.12 (95% confidence interval 0.8 to 1.87), p&#x2005;=&#x2005;0.3582]. Similar proportions of adverse events occurred in both groups [40/241 (16.6%) attended accident and emergency, 24/244 (9.1%) hospital admissions, 6/266 (2.3%) work accidents at 12 months]. Exploratory subgroup analyses indicated Early Stroke Specialist Vocational Rehabilitation potentially benefits older people (60+), and those with two or more post-stroke impairments. Health economic outcomes were consistent with primary clinical outcomes. Analysis using multiple imputation, adjusting for age, sex, utility or cost at baseline and site found Early Stroke Specialist Vocational Rehabilitation had higher costs [incremental cost &#xa3;1337 (95% confidence interval -1113 to 3787) and slightly more favourable incremental quality-adjusted life-years of 0.019 (95% confidence interval -0.012 to 0.051)]. Early Stroke Specialist Vocational Rehabilitation was valued by participants and service managers. In contrast, usual-care participants reported limited or no vocational rehabilitation and poor communication. Intervention compliance was achieved for 244 (75.3%) participants. Mentor support for occupational therapies appeared to increase fidelity. Most participants had mild-moderate stroke, unlike our feasibility evaluation which informed the sample size (powered to detect an absolute 13% difference in return to work). More people return to work than anticipated. There was significant loss to follow-up for primary, secondary and health economic outcomes. Employers proved difficult to recruit and engage. REturn To work After stroKE was unable to demonstrate an effect or cost effect of Early Stroke Specialist Vocational Rehabilitation on return to work 12 months post randomisation. The COVID-19 pandemic influenced employer behaviour, and remote working diluted Early Stroke Specialist Vocational Rehabilitation mechanisms in a predominantly mild-moderate sample, many of whom were able to self-navigate return to work. Research is needed to confirm Early Stroke Specialist Vocational Rehabilitation benefits in people marginalised by age or post-stroke impairment, and determine what interventions benefit younger stroke survivors. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/130/11. Many people cannot REturn To work After stroKE and there is little National Health Service support for this. We developed early, stroke specialist vocational rehabilitation to support people to return to and remain in work. This was available for up to 1 year. We recruited working people aged 18 or over, within 12 weeks of new stroke and allocated at random, whether they received the new rehabilitation in addition to usual National Health Service care or usual National Health Service care only. Twelve months later we compared the potential benefits of the new rehabilitation to its costs in terms of how many in each group had returned to work. The trial recruited 583 stroke patients from 21 hospitals. Most people recruited had mild&#x2013;moderate stroke. Although 5% more people returned to work with the new rehabilitation, this difference was not statistically significant and might have happened by chance rather than because of the new rehabilitation. Overall, the new rehabilitation was found unlikely to offer the National Health Service value for money in the short term. Additional exploratory analysis suggested older people and those with more stroke disability might be more likely to benefit from the new rehabilitation. However, more research is needed to confirm these findings. The new rehabilitation was delivered as intended and valued by stroke survivors and National Health Service managers. Stroke survivors who received usual National Health Service care only, received little rehabilitation, which was poorly co-ordinated with limited or no vocational rehabilitation. The COVID-19 pandemic came at a critical point. It made flexible, home-based working the norm, particularly for managerial roles, reducing the effect of the new rehabilitation. People who sustain stroke with few lasting disabilities may be able to return to work without specialist support. However, further research is needed to confirm this and determine whether this applies to people of all ethnicities and job types.

In the Eastern Mediterranean Region (EMR), 78.1 million people experience hearing loss of any degree, with 22.1 million having disabling hearing loss, projected to reach 51.7 million by 2050. Unless global action is taken, the worldwide burden could reach over 700 million people with disabling hearing loss by 2050. This systematic review presents the first comprehensive health systems analysis of ear and hearing care (EHC) in the region. Following PRISMA guidelines, we analysed 146 articles through the WHO health systems framework to identify systemic barriers to effective EHC integration. Our findings reveal significant health systems challenges: fragmented governance with limited cross-sectoral coordination; inadequate financing with heavy reliance on out-of-pocket payments; critical workforce shortages across the region; and inequitable service distribution between urban and rural areas. While progress has been made with initiatives such as neonatal screening programs and primary care integration, these achievements remain limited in scope. Socioeconomic factors create additional barriers, affecting both hearing loss development and healthcare access. Alternative service delivery models, including telemedicine and task-sharing, show potential but lack systematic implementation. The economic burden of unaddressed hearing loss in the EMR ($30 billion annually) contrasts with potential returns of up to $7 per dollar invested. We propose five key actions: integrating EHC into universal health coverage, establishing comprehensive services across care levels, implementing awareness campaigns, developing monitoring systems, and promoting implementation research. This analysis provides evidence-based recommendations for health system reforms to address hearing loss while optimising resource allocation in diverse EMR contexts.

Globally, it is estimated that, as of June 2025, 8.42 million people were seeking asylum due to persecution and political instability. Those seeking protection in other countries can present with undiagnosed complex health needs, including type 2 diabetes mellitus. Yet diabetes related foot health and footwear remain poorly understood in this population. This scoping review mapped evidence on diabetes, foot health and footwear among adults seeking asylum in high-income countries, with attention to postmigration factors and diabetes-related stigma. Arksey and O'Malley's scoping review framework guided the review. Levac et al. informed refinements. Reporting followed PRISMA Scoping Review standards. Searches of CINAHL, MEDLINE, PubMed and Web of Science covered January 2005 to November 2025, supplemented by grey literature. Records were screened to predefined criteria, data were charted using a structured extraction form and findings were synthesised thematically using the socioecological model and intersectionality. Eight papers were included from the United Kingdom, Australia, France and Belgium. Diabetes was noted, but asylum conditions were seldom linked to diabetes management, and stigma was rarely discussed. Foot health and footwear were largely absent. No study applied an explicit intersectional framework, despite overlapping influences of immigration status, poverty, gender and housing. Existing evidence remains limited, offering little insight into how postmigration conditions shape diabetes-related foot health among people seeking asylum. Further research is needed that is structurally informed and community-engaged. It should centre lived experience and treat stigma as relevant to diabetes care, while bringing foot health into view. People with lived experience of seeking asylum contributed to this scoping review through a Community Advisory Group established as part of the wider study. Some members also had experience of living.

Men with obesity infrequently engage with weight management services. To determine: (1) percentage weight loss at 12 and 24 months for text messages with or without financial incentives compared to control; (2) secondary outcomes; (3) cost-effectiveness; (4) moderators of effectiveness and (5) participant and stakeholder perspectives. Assessor-blinded randomised controlled trial. United Kingdom National Health Service perspective cost-effectiveness over 24 months and modelled lifetime horizon. Mixed-methods process evaluation. Five hundred and eighty-five men with body mass index &#x2265;&#x2005;30&#x2005;kg/m2 enrolled (July 2021-May 2022) in Belfast, Bristol and Glasgow; final follow-up June 2024. Random allocation to 12 months of behavioural text messages plus financial incentives (N&#x2005;=&#x2005;196), same texts alone (N&#x2005;=&#x2005;194) or 12-month waiting list control group offered 3 months of texts between 12 and 15 months (N&#x2005;=&#x2005;195). A &#xa3;400 financial incentive was lost if weight loss targets were not met. Weight change as a percentage of baseline weight at 12 and 24 months comparing control with (1) texts with financial incentives and (2) texts alone. Of 585 men (mean age 51 years; mean weight: 119&#x2005;kg), 227 (39%) lived in lower socioeconomic areas, 146 (25%) reported a mental health condition and 253 (40%) had multiple long-term conditions. Follow-up was completed by 426 (73%) at 12 months and 377 (64%) at 24 months. At 12 months, mean percentage weight changes (standard deviation) were -4.8% (6.1) (-5.7&#x2005;kg), -2.7% (6.3) (-3.0&#x2005;kg), and&#x2005;-&#x2005;1.3% (5.5) (-1.5&#x2005;kg) for the incentives, text-only, and control groups, respectively. Compared to control, weight loss was significantly greater with incentives [-3.2% (97.5% confidence interval -4.6 to -1.9; p&#x2005;<&#x2005;0.001)] but not texts alone (-1.4%; confidence interval -2.9 to 0.0; p&#x2005;=&#x2005;0.053). At 24 months, changes were -3.9% (-4.6&#x2005;kg), -2.6% (-3.1&#x2005;kg), and -2.2% (-2.6&#x2005;kg), no significant between-group differences. Intervention costs were &#xa3;243 for texts with incentives, &#xa3;110 for texts alone. There were no significant differences between 24-month costs and quality-adjusted life-years. Long-term modelling found texts with incentives versus control were: quality-adjusted life-year difference (95% confidence interval): 0.02 (0.007 to 0.029); cost difference: &#xa3;176 (&#xa3;43; &#xa3;311); incremental cost-effectiveness ratio: &#xa3;9748 (&#xa3;7705 to &#xa3;11,791). For texts alone versus control: quality-adjusted life-year difference: 0.03 (0.015 to 0.037); cost difference: &#xa3;16.5 (-&#xa3;117; &#xa3;152); incremental cost-effectiveness ratio: &#xa3;628 (-&#xa3;5914 to &#xa3;5384). There were no moderator effects for socioeconomic, health or well-being status for either comparison versus control. The texts with incentives group had a higher engagement in weight goal setting, food changes, self-weighing, confidence, satisfaction and quality of life compared to the control. Generalisability to women, diverse ethnic groups and people with low literacy is uncertain. Not generalisable to people with no mobile phone access. Retention was lowest in the text messages alone group. Texts with financial incentives have a modest but important effect to 12 months with clinically relevant weight loss maintenance to 24 months, are cost-effective and equally effective regardless of socioeconomic or health characteristics. Implementation, adapt for women, other cultures and longer-term follow-up. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR129703. The Game of Stones study aimed to help men lose weight and keep it off for at least 2 years. Five hundred and eighty-five men living with obesity across the United Kingdom were split into three groups by chance: supportive text messages for 1 year and opportunity to get money for weight loss the same text messages alone for 1 year neither for 1 year, then text messages for 3 months. The first two groups received the same daily text messages about changing weight-related behaviours. Group 1 was told at the start that &#xa3;400 had been put aside for them and that money would be lost if weight targets were missed. The targets were 5% weight loss at 3 months, 10% at 6 months and maintaining that 10% loss at 12 months. Money was then paid to the men after being weighed at 12 months. Every man was asked questions about their health, well-being and experiences of being in the study. After 1 year, the men in group 1 lost the most weight (5%, 5.7&#x2005;kg). The men in group 2 lost some weight (3%, 3.0&#x2005;kg) but not as much as the first group. The men in group 3 lost the smallest amount of weight (1%, 1.5&#x2005;kg). On average, men in group 1 received &#xa3;128 for meeting weight loss targets. One year after the 12-month measures, men in groups 1 and 2 had gained back some weight. Men in group 3 lost a bit more weight between year 1 and 2. Weight loss was similar whether or not men had long-term health conditions, disability, mental health issues or lived in the most deprived areas. This study showed that Game of Stones was a popular, low-cost and modestly effective way of helping men to lose weight.

Falls, especially recurrent, cause significant morbidity. Research on falls generally focuses on older adults but patterns of falling may start earlier in life. This study aimed to quantify the prevalence of falls and recurrent falls among late middle-aged community-dwelling adults and identify the socio-demographic, lifestyle and health-related factors associated with recurrent falls. The Health and Employment After Fifty (HEAF) study is a longitudinal cohort of men and women aged 50-64 years recruited in 2013-14 from across England. At baseline and each of five approximately annual follow-ups, participants reported falls in the preceding year. Participants were categorised as recurrent fallers if they experienced more than one fall on at least two occasions, non-fallers if they never reported a fall, or intermediate fallers otherwise. Multinomial logistic regression explored associations between fall category and potential risk factors, presented as relative risk ratios with 95%CI. Among 8134 participants, 7051 were eligible for this analysis. The prevalence of any falls ranged from 14-18% across follow-ups. Overall, 437 (6%) were recurrent fallers, 2738 (39%) intermediate and 3876 (55%) non-fallers. Independent predictors of recurrent falls included female gender, unpartnered, unemployed or retired and lack of home ownership. Health-related factors included obesity, fair/poor self-rated health, depression, poor sleep, slow walking speed and memory problems. The final model correctly classified 60% of participants. Recurrent falls in mid-life were relatively common. Both socio-economic and health-related characteristics, alongside female gender, were identified as predictors, suggesting potential targets for early identification and risk mitigation in this age group.

Fresh water aquifers adjoining the geothermal resources are often vulnerable to trace metal contamination and associated risks to human health. Realistic assessment of health hazard as well as source apportionment play a vital role in designing suitable remedial actions, which can be better achieved through application of probabilistic methods using Monte Carlo Simulations (MCS) and multivariate based Absolute Principal Component Score-Multiple Linear Regression (APCS-MLR) methods. In this study, a comprehensive analysis of groundwater quality was performed using multiple pollution indices (HPI, HEI, Cd, IWPI), MCS and APCS-MLR methods. Chemical results indicate that TDS, F- and NO3- showed exceedances in 19%, 38% and 23% of the samples respectively while trace metals (Fe, Mn, Pb, and As) showed higher exceedances compared to WHO limits. Pollution indices suggest that 73% of the samples fall under low contamination and the rest (27%) in high risk category. MCS infers both non-carcinogenic and carcinogenic health risks to different age groups mainly due to arsenic and lead. Sensitivity analysis indicates body weight, ingestion rate as most influential followed by arsenic concentration. High geochemical mobility is noticed for Zn and Co while Al and Ni are largely immobile. Both relative mobility index and APCS-MLR model output point to rock weathering and geothermal sources as the key contributors accounting for 19.8% of the trace metal load in this region. This integrative approach underscores the need for regular monitoring and implementation of policies for safeguarding public health in this region.