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Developing research collaborations and building capacity in palliative and end-of-life care in the North West Coast of England: the PalCaRe-NWC partnership. 在英格兰西北海岸发展缓和和临终关怀方面的研究合作和能力建设：PalCaRe-NWC伙伴关系。
Public health research (Southampton, England)
Pub Date : 2025-03-19 DOI: 10.3310/AWLT2995
Lesley Dunleavy, Ruth Board, Seamus Coyle, Andrew Dickman, John Ellershaw, Amy Gadoud, Jaime Halvorsen, Nick Hulbert-Williams, Liz Lightbody, Stephen Mason, Amara Callistus Nwosu, Andrea Partridge, Sheila Payne, Nancy Preston, Brooke Swash, Vanessa Taylor, Catherine Walshe

Background: The North West Coast area of England (Lancashire, Merseyside, Cheshire and South Cumbria) has high palliative care need (third highest prevalence in England) and historically low recorded National Institute for Health and Care Research research activity (second lowest research recruitment rate in England). To stimulate research activity, a new research partnership was formed to support and encourage palliative care research, funded by the National Institute for Health and Care Research from January 2022 until June 2023.

Objectives: To develop a sustainable palliative care research partnership infrastructure across the North West Coast. To work with palliative care providers, patients and the public, and research staff to further understand local barriers and facilitators to palliative and end-of-life care research, and develop and implement solutions to these barriers. To build capacity in palliative and end-of-life care research through the mentorship of emerging research leaders and share expertise across organisations. To facilitate the development of high-quality research grant applications.

Activities: Phased activities were planned and actioned throughout the funded period to develop and embed an active palliative care research partnership across the region. These included: a survey and working groups to rapidly identify current local barriers to research and their sustainable solutions; individual and group support activities to build research capabilities and capacity; development and submission of high-quality, clinically relevant research proposals to the National Institute for Health and Care Research and other funders.

Results: Survey participants (n = 293) were mainly from clinical settings (71%), with 45% being nurses. While around three-quarters of participants were not research active, most wanted to increase their involvement. Key barriers identified from both the survey and working groups (n = 20 professional participants) included: lack of organisational research culture and capacity (including prioritisation and available time); research knowledge (including skills/expertise and funding opportunities); research infrastructure (including collaborative opportunities across multiple organisations and governance challenges); and patient and public perceptions of research (including vulnerabilities and burdens). Based on these findings, the partnership is working with national stakeholders to develop user-friendly resources to facilitate hospice-based research. Three action learning sets, that met several times (n = 15 staff), and two networking events (n = 78 participants) took place to facilitate collaboration and research capacity building. Eleven research grant applications totalling £5,435,967 were submitted as a direct result of partnership activities between January 2022 and June 2023.

背景英格兰西北海岸地区（兰开夏郡、默西赛德郡、柴郡和南坎布里亚郡）对姑息关怀的需求很高（发病率在英格兰排名第三），而国家健康与护理研究所的研究活动记录却一直很少（研究招募率在英格兰排名倒数第二）。为了激励研究活动，成立了一个新的研究合作伙伴关系，以支持和鼓励姑息关怀研究，由国家健康与护理研究所提供资金，从 2022 年 1 月起至 2023 年 6 月止：在整个西北海岸发展可持续的姑息关怀研究合作基础设施。与姑息关怀服务提供者、患者和公众以及研究人员合作，进一步了解当地姑息关怀和临终关怀研究的障碍和促进因素，并制定和实施解决这些障碍的方案。通过对新兴研究领导者的指导，提高姑息关怀和生命末期关怀研究的能力，并在各机构间共享专业知识。促进开发高质量的研究补助金申请：在整个受资助期间，计划并开展了分阶段的活动，以发展和巩固整个地区积极的姑息关怀研究合作伙伴关系。这些活动包括：通过调查和工作小组迅速确定当地目前的研究障碍及其可持续的解决方案；开展个人和小组支持活动，以建设研究能力；制定并向国家健康与护理研究所和其他资助方提交高质量、临床相关的研究提案：调查参与者（n = 293）主要来自临床机构（71%），其中 45% 是护士。虽然约四分之三的参与者并不积极从事研究工作，但大多数人都希望更多地参与其中。调查和工作组（n = 20 名专业参与者）发现的主要障碍包括：缺乏组织研究文化和能力（包括优先级和可用时间）；研究知识（包括技能/专业知识和资助机会）；研究基础设施（包括跨多个组织的合作机会和管理挑战）；以及患者和公众对研究的看法（包括脆弱性和负担）。基于这些发现，该合作伙伴关系正与国家利益相关者合作开发用户友好型资源，以促进以临终关怀为基础的研究。为促进合作和研究能力建设，举办了三次行动学习小组会议（n = 15 名工作人员）和两次网络活动（n = 78 名参与者）。2022 年 1 月至 2023 年 6 月期间，合作活动的直接成果是提交了 11 份研究补助金申请，总金额达 5,435,967 英镑：局限性：调查和工作组的结果以及由此产生的活动代表了英国特定地区工作人员的观点和需求，公众代表性有限：事实证明，为支持伙伴关系工作而提供的资金能够有效地推动研究活动，从而成功提交研究补助金申请并建设研究能力。但是，需要考虑的是，如果无法获得持续资助，如何保持合作关系、嵌入当地组织并进一步发展非传统利益相关者（如临终关怀机构和社会护理提供者）的工作：西北海岸临床研究网络提供了短期资助（2023年7月至2024年3月），以促进和维持西北海岸姑息关怀研究合作组织的扩展：本文介绍了由美国国家健康与护理研究所（NIHR）公共卫生研究计划资助的独立研究，奖励编号为NIHR135334。
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引用次数: 0
Building multi-professional UK partnerships and networks to improve access to palliative care for people experiencing homelessness. 建立英国多专业合作关系和网络，改善无家可归者获得姑息关怀的机会。
Public health research (Southampton, England)
Pub Date : 2025-03-12 DOI: 10.3310/JWRG6933
Briony Hudson, Jodie Crooks, Caroline Shulman, Kate Flemming
<p><strong>Background: </strong>People experiencing homelessness have high rates of multi-morbidity and age-related conditions at a young age. Despite having high support needs, they have disparately low access to palliative care services and often die at a young age. To facilitate access to support for this group towards the end of life, a multi-professional approach should be taken. Over recent years, clinical and research activities have begun to address this issue. However, until now, there has been no centralised United Kingdom-based group to facilitate collaboration and shared learning.</p><p><strong>Aim: </strong>To build multi-professional partnerships across the United Kingdom to promote shared learning and a multidisciplinary approach to supporting people experiencing homelessness who may be approaching the end of their lives.</p><p><strong>Method: </strong>This project had three workstreams: (1) development of a Palliative Care and Homelessness Extensions of Community Healthcare Outcomes network; (2) a rapid review around involving people with experience of multiple exclusion in palliative and end-of-life care research; and (3) a qualitative study to identify recommendations for involving people with lived experience of homelessness in future palliative and end-of-life care research.</p><p><strong>Results: workstream 1: </strong>A National Palliative Care and Homelessness Extensions of Community Healthcare Outcomes (ECHO) network was successfully established in the UK, with 10 sessions running over 12 months. A total of 268 people registered to the network, with an average of 52 participants per session. Evaluation of the network illustrated positive experiences and appetite for continuation of the network. The majority of attendees surveyed (78%) agreed that the network had increased their awareness of complexities and challenges faced by people experiencing homelessness and 85% of respondents reported better connections with others who are interested in or are working in this field.</p><p><strong>Workstream 2: </strong>A rapid review was conducted to summarise existing evidence and reflections on co-producing palliative care research with inclusion health groups, including people with lived experience of homelessness. Given the scarcity of existing research within this area, the review provided a starting point from which to explore the successes and challenges of co-research in this field. The review advocates for greater guidance around the involvement of people with lived experience of homelessness in palliative and end-of-life care research.</p><p><strong>Workstream 3: </strong>Professionals with experience of involving people experiencing homelessness in their work were interviewed (<i>n</i> = 16), and focus groups were held with people with lived experience of homelessness (<i>n</i> = 11). Recommendations were co-developed to support researchers to involve people with lived experience of homelessness in their palliative and end
背景：无家可归的人在年轻时患有多种疾病和与年龄有关的疾病的比例很高。尽管他们有很高的支持需求，但他们获得姑息治疗服务的机会却很低，而且往往在年轻时死亡。为了方便这个群体在生命结束时获得支持，应该采取多专业的方法。近年来，临床和研究活动已经开始解决这个问题。然而，到目前为止，还没有一个集中的英国小组来促进合作和共享学习。目的：在联合王国各地建立多专业伙伴关系，促进共享学习和多学科方法，以支持可能即将结束生命的无家可归者。方法：本项目有三个工作流程：(1)开发社区医疗保健成果网络的姑息治疗和无家可归者扩展；(2)在姑息治疗和临终关怀研究中涉及多重排斥经历者的快速回顾；(3)一项定性研究，以确定在未来的姑息治疗和临终关怀研究中涉及无家可归者的建议。结果：工作流程1：在英国成功建立了全国社区医疗保健成果的姑息治疗和无家可归者扩展（ECHO）网络，为期12个月，共10次会议。共有268人注册了该网络，平均每次会议有52人参加。对网络的评估表明了积极的体验和对网络延续的渴望。接受调查的大多数与会者（78%）同意，该网络提高了他们对无家可归者所面临的复杂性和挑战的认识，85%的受访者表示，他们与其他对这一领域感兴趣或正在从事这一领域工作的人建立了更好的联系。工作流程2：进行了快速审查，以总结与包容健康团体（包括有无家可归生活经历的人）共同开展姑息治疗研究的现有证据和思考。鉴于该领域现有研究的稀缺性，本综述为探索该领域合作研究的成功和挑战提供了一个起点。该报告倡导对有过无家可归经历的人参与姑息治疗和临终关怀研究提供更大的指导。工作流程3：采访了在工作中涉及无家可归者的专业人员（n = 16），并与有无家可归生活经历的人（n = 11）进行了焦点小组讨论。共同制定了建议，以支持研究人员让有无家可归生活经历的人参与他们的姑息治疗和临终关怀研究——TIFFIN建议。结论：该项目强调了专业团体之间在支持患有严重疾病的无家可归者方面进行合作和共享学习的意愿。通过这项拨款制定的TIFFIN建议，促进了有过无家可归经历的人在姑息治疗和临终关怀研究中的创伤知情和有意义的参与。由于该网络的成功，第二轮会议于2023年11月至2024年11月举行，第三轮网络计划于2025年春季举行。资助：本文介绍了由国家卫生与保健研究所（NIHR）公共卫生研究计划资助的独立研究，奖励号为NIHR135250。
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引用次数: 0
Using natural experiments to evaluate population health interventions: a framework for producers and users of evidence. 利用自然实验评价人口健康干预措施：证据提供者和使用者的框架。
Public health research (Southampton, England)
Pub Date : 2025-03-01 DOI: 10.3310/JTYW6582
Peter Craig, Mhairi Campbell, Manuela Deidda, Ruth Dundas, Judith Green, Srinivasa Vittal Katikireddi, Jim Lewsey, David Ogilvie, Frank de Vocht, Martin White

Background: There has been a substantial increase in the conduct of natural experimental evaluations in the last 10 years. This has been driven by advances in methodology, greater availability of large routinely collected datasets, and a rise in demand for evidence about the impacts of upstream population health interventions. It is important that researchers, practitioners, commissioners, and users of intervention research are aware of the recent developments. This new framework updates and extends existing Medical Research Council guidance for using natural experiments to evaluate population health interventions.

Methods: The framework was developed with input from three international workshops and an online consultation with researchers, journal editors, funding representatives, and individuals with experience of using and commissioning natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project had a funder-assigned oversight group and an advisory group of independent experts.

Results: The framework defines key concepts and provides an overview of recent advances in designing and planning evaluations of natural experiments, including the relevance of a systems perspective, mixed methods and stakeholder involvement throughout the process. It provides an overview of the strengths, weaknesses, applicability and limitations of the range of methods now available, identifies issues of infrastructure and data governance, and provides good practice considerations.

Limitations: The framework does not provide detailed information for the substantial volume of themes and material covered, rather an overview of key issues to help the conduct and use of natural experimental evaluations.

Conclusion: This updated and extended framework provides an integrated guide to the use of natural experimental methods to evaluate population health interventions. The framework provides a range of tools to support its use and detailed, evidence-informed recommendations for researchers, funders, publishers, and users of evidence.

Study registration: This methodological project was not registered.

Funding: This project was jointly funded by the Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR), with project reference MC_PC_21009. The work is published in full in Public Health Research; Vol. 13, No. 3.

背景：在过去十年中，自然实验评估的开展有了实质性的增加。这是由于方法的进步、常规收集的大型数据集的可用性增加以及对上游人口健康干预措施影响证据的需求增加所推动的。重要的是，研究人员、从业人员、委员和干预研究的使用者都要意识到最近的发展。这一新框架更新并扩展了医学研究理事会关于利用自然实验评估人口健康干预措施的现有指导。方法：该框架是根据三个国际研讨会的投入和与研究人员、期刊编辑、资助代表以及具有使用和委托自然实验评估经验的个人的在线咨询而制定的。项目组由具有自然实验评估专业知识的研究人员组成。该项目有一个资金分配的监督小组和一个由独立专家组成的咨询小组。结果：该框架定义了关键概念，并概述了自然实验设计和规划评估的最新进展，包括系统视角的相关性、混合方法和整个过程中的利益相关者参与。它概述了目前可用的各种方法的优点、缺点、适用性和局限性，确定了基础设施和数据治理的问题，并提供了良好的实践注意事项。局限性：该框架没有提供所涵盖的大量主题和材料的详细信息，而是概述了有助于进行和使用自然实验评价的关键问题。结论：这一更新和扩展的框架为使用自然实验方法评估人口健康干预措施提供了综合指南。该框架为支持其使用提供了一系列工具，并为研究人员、资助者、出版商和证据使用者提供了详细的循证建议。研究注册：本方法学项目未注册。资助：本项目由医学研究委员会（MRC）和国家卫生与保健研究所（NIHR）共同资助，项目编号MC_PC_21009。这项研究全文发表在《公共卫生研究》杂志上；第13卷第3期
{"title":"Using natural experiments to evaluate population health interventions: a framework for producers and users of evidence.","authors":"Peter Craig, Mhairi Campbell, Manuela Deidda, Ruth Dundas, Judith Green, Srinivasa Vittal Katikireddi, Jim Lewsey, David Ogilvie, Frank de Vocht, Martin White","doi":"10.3310/JTYW6582","DOIUrl":"10.3310/JTYW6582","url":null,"abstract":"<p><strong>Background: </strong>There has been a substantial increase in the conduct of natural experimental evaluations in the last 10 years. This has been driven by advances in methodology, greater availability of large routinely collected datasets, and a rise in demand for evidence about the impacts of upstream population health interventions. It is important that researchers, practitioners, commissioners, and users of intervention research are aware of the recent developments. This new framework updates and extends existing Medical Research Council guidance for using natural experiments to evaluate population health interventions.</p><p><strong>Methods: </strong>The framework was developed with input from three international workshops and an online consultation with researchers, journal editors, funding representatives, and individuals with experience of using and commissioning natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project had a funder-assigned oversight group and an advisory group of independent experts.</p><p><strong>Results: </strong>The framework defines key concepts and provides an overview of recent advances in designing and planning evaluations of natural experiments, including the relevance of a systems perspective, mixed methods and stakeholder involvement throughout the process. It provides an overview of the strengths, weaknesses, applicability and limitations of the range of methods now available, identifies issues of infrastructure and data governance, and provides good practice considerations.</p><p><strong>Limitations: </strong>The framework does not provide detailed information for the substantial volume of themes and material covered, rather an overview of key issues to help the conduct and use of natural experimental evaluations.</p><p><strong>Conclusion: </strong>This updated and extended framework provides an integrated guide to the use of natural experimental methods to evaluate population health interventions. The framework provides a range of tools to support its use and detailed, evidence-informed recommendations for researchers, funders, publishers, and users of evidence.</p><p><strong>Study registration: </strong>This methodological project was not registered.</p><p><strong>Funding: </strong>This project was jointly funded by the Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR), with project reference MC_PC_21009. The work is published in full in <i>Public Health Research</i>; Vol. 13, No. 3.</p>","PeriodicalId":74615,"journal":{"name":"Public health research (Southampton, England)","volume":"13 3","pages":"1-59"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT. 社区环境中孤独感和社会隔离的社会网络干预：PALS集群-随机对照试验。
Public health research (Southampton, England)
Pub Date : 2025-03-01 DOI: 10.3310/WTJH4379
Rebecca Band, Karina Kinsella, Jaimie Ellis, Elizabeth James, Sandy Ciccognani, Katie Breheny, Rebecca Kandiyali, Sean Ewings, Anne Rogers
<p><strong>Background: </strong>Loneliness and social isolation are associated with adverse mental and physical health outcomes in adults. However, there is a lack of existing research on effective interventions and the contexts in which these could be implemented.</p><p><strong>Primary objective: </strong>To assess the clinical and cost-effectiveness of a social network intervention compared to usual care among at-risk populations.</p><p><strong>Design: </strong>A pragmatic, community-based, cluster randomised controlled trial with embedded health economic evaluation, process evaluation and qualitative study. Outcome assessments were conducted at baseline and at 3 and 6 months.</p><p><strong>Setting: </strong>The study was conducted in collaboration with 44 community-based organisations in two regions in England.</p><p><strong>Participants: </strong>Adults aged ≥ 18 years at risk of loneliness and social isolation.</p><p><strong>Intervention: </strong>A facilitated social network tool ('project about loneliness and social networks'; PALS) designed to link people to opportunities for social involvement. First, participants map and reflect on personal social networks. Second, identification of local resources based on individual preferences, available support, and health and wellness needs.</p><p><strong>Main outcome measures: </strong>The primary outcome was mental wellness at 6-month follow-up, measured by the Short Form questionnaire-12 items mental health component score (MCS). Secondary outcomes included the Short Form questionnaire-12 items Physical Health subscale, loneliness, social isolation, well-being and collective efficacy. Economic measures assessed the cost-effectiveness of the intervention in terms of costs, quality-adjusted life-years and net monetary benefits.</p><p><strong>Results: </strong>We recruited 469 adults into the study, with 120 withdrawals (25.6%). The main trial results indicate little to no treatment effect of the intervention on either the primary or secondary outcomes compared to usual care. The within-trial economic evaluation found that PALS was inexpensive to deliver but there was no significant difference in quality-adjusted life-years, measures of well-being capability or costs, and the intervention did not lead to demonstrable cost-effectiveness in terms of net monetary benefits. The process evaluation found PALS to be acceptable to all types of community organisations, but low resource availability and capacity to sustain PALS was found across all community organisational contexts. Qualitative interviews (<i>n</i> = 20) highlighted that participants wanted to engage with meaningful social activities but barriers to doing so were psychological (i.e. confidence and competence) and practical (i.e. transport or cost).</p><p><strong>Limitations: </strong>The timing of COVID-19 and associated restrictions (approximately splitting trial follow-up into thirds of pre-COVID, during the first lockdown, and following t
背景：孤独和社会隔离与成年人不良的心理和身体健康结果相关。然而，目前缺乏关于有效干预措施和实施这些措施的背景的研究。主要目的：评估在高危人群中，与常规护理相比，社会网络干预的临床和成本效益。设计：一项实用的、基于社区的、集群随机对照试验，包含健康经济评估、过程评估和定性研究。在基线、3个月和6个月时进行结果评估。环境：这项研究是与英国两个地区的44个社区组织合作进行的。参与者：有孤独和社会隔离风险的年龄≥18岁的成年人。干预：一个便利的社会网络工具(“关于孤独和社会网络的项目”；PALS)旨在将人们与社会参与的机会联系起来。首先，参与者绘制和反思个人社交网络。第二，根据个人偏好、现有支持以及健康和保健需求确定当地资源。主要结局指标：主要结局指标为6个月随访时的心理健康状况，采用简短问卷-12项心理健康成分评分（MCS）进行测量。次要结果包括简短问卷-12项身体健康量表、孤独感、社会隔离、幸福感和集体效能。经济措施评估了干预措施的成本效益，包括成本、质量调整寿命年和净货币收益。结果：我们招募了469名成年人加入研究，其中120人退出（25.6%）。主要试验结果表明，与常规护理相比，干预对主要或次要结局几乎没有治疗效果。试验内经济评估发现，PALS的成本不高，但在质量调整生命年、福祉能力或成本方面没有显著差异，而且就净货币效益而言，干预措施没有产生可证明的成本效益。过程评估发现，所有类型的社区组织都可以接受PALS，但在所有社区组织环境中都发现资源可用性和维持PALS的能力较低。定性访谈（n = 20）强调，参与者希望参与有意义的社会活动，但这样做的障碍是心理上的（即信心和能力）和实际的（即交通或成本）。限制：COVID-19的时间和相关限制（大约将试验随访分为COVID-19前的三分之一，在第一次封锁期间，以及在试验重新开放之后）意味着其对试验的影响难以评估。虽然处理缺失数据的方法并没有改变试验的结论，但缺失数据的水平很高（6个月时大多数结果为20-30%）。结论：我们的研究结果并没有提供强有力的证据来证明PALS社会网络干预对解决孤独和社会隔离的复杂性的有效性。尽管参与者和有潜力提供这种干预的社区组织可以接受这种干预，但可持续性需要组织之间的网络方法来减轻每个组织中发现的挑战。未来的工作：未来对孤独的干预可能会受益于采用多步骤的方法，提供量身定制的心理、关系和社会成分。试验注册：该试验注册为当前对照试验ISRCTN19193075。资助：该奖项由美国国家卫生与保健研究所（NIHR）公共卫生研究项目（NIHR奖号：16/08/41）资助，全文发表在《公共卫生研究》杂志上；第13卷第1期有关进一步的奖励信息，请参阅美国国立卫生研究院资助和奖励网站。
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引用次数: 0
Establishing a research partnership for delivering palliative and end-of-life care for older people in rural and remote areas: a formative mixed-methods study. 建立研究伙伴关系，为农村和偏远地区的老年人提供姑息治疗和临终关怀：一项形成性混合方法研究。
Public health research (Southampton, England)
Pub Date : 2025-02-26 DOI: 10.3310/RWSG7439
Caroline Mogan, Nathan Davies, Karen Harrison Dening, Abigail Woodward, Caroline Watkins, Nigel Hartley, Mari Lloyd-Williams
<p><strong>Background: </strong>Many older people live in rural and remote areas. As the ageing population grows, conditions such as cancer, dementia and stroke will become more prevalent, causing a huge demand for palliative and end-of-life care. However, evidence regarding models of care and interventions in rural and remote areas is limited.</p><p><strong>Aim: </strong>A new United Kingdom rural palliative care partnership was funded for 12 months. It aimed to understand the models of palliative and end-of-life care for older people with cancer, dementia and stroke in rural/remote areas across all four nations of the United Kingdom. It also aimed to identify the core priorities for research into rurality and palliative care for older people.</p><p><strong>Methods: </strong>The project consisted of three integrated components, including: (1) a scoping review of relevant literature on rural palliative care for older people with cancer, dementia and stroke; (2) stakeholder engagement workshops using a modified Nominal Groups Technique and (3) qualitative interviews with family carers who supported rural-/remote-dwelling older adults towards the end of life.</p><p><strong>Results: </strong>Our scoping review was undertaken in 2022. The search identified 1128 unique citations, of which five papers were included. There were no United Kingdom studies on models of palliative and end-of-life care delivered to older people with cancer, dementia or stroke within rural/remote locations. However, international models of care were identified. Models included technological interventions to reach those in remote locations, the role of palliative care nurses and the use of volunteers. Articles highlighted the importance of not replacing face-to-face care with technology for ease of reaching more people and emphasised the importance of effective interdisciplinary working in rural and remote palliative care. Additionally, three online workshops to develop research capacity, identify models of care, understand issues of rurality and determine research priorities were attended by 15-20 stakeholders. Qualitative interviews were also undertaken with 20 family carers who had supported rural-/remote-dwelling older adults at their end of life. Data identified that rural/remote communities face challenges in accessing palliative and end-of-life care due to issues such as transport to and distance from services, poor broadband coverage and problems with workforce recruitment and retention. Synthesising the data from these methods helped to identify some interventions and models of care for palliative and end-of-life care for older people in rural and remote areas. It also helped us to jointly shape and develop research priorities, which included workforce planning and service composition, facilitating preferred place of death and the role of technology. However, there are gaps in our understanding about how to improve the family carer support as well as digital literacy
背景：许多老年人生活在农村和偏远地区。随着老龄化人口的增长，癌症、痴呆和中风等疾病将变得更加普遍，从而导致对姑息治疗和临终关怀的巨大需求。然而，关于农村和偏远地区的护理和干预模式的证据有限。目的：资助一个新的英国农村姑息治疗伙伴关系，为期12个月。它旨在了解英国所有四个国家的农村/偏远地区患有癌症、痴呆和中风的老年人的姑息治疗和临终关怀模式。它还旨在确定农村和老年人姑息治疗研究的核心优先事项。方法：该项目由三个组成部分组成，包括：(1)对农村癌症、痴呆和中风老年人姑息治疗的相关文献进行范围综述；(2)使用改进的名义团体技术的利益相关者参与研讨会；(3)对支持农村/偏远地区老年人临终的家庭照顾者进行定性访谈。结果：我们的范围审查于2022年进行。搜索发现了1128个独特的引用，其中包括5篇论文。英国没有对农村/偏远地区为患有癌症、痴呆或中风的老年人提供的姑息治疗和临终关怀模式进行研究。但是，确定了国际护理模式。这些模式包括向偏远地区提供技术干预、缓和护理护士的作用和志愿者的使用。文章强调了不以技术取代面对面护理的重要性，以方便接触到更多的人，并强调了在农村和远程姑息治疗中有效的跨学科工作的重要性。此外，15-20名利益攸关方参加了三个在线研讨会，以发展研究能力、确定护理模式、了解农村问题和确定研究重点。还对20名家庭照顾者进行了定性访谈，这些家庭照顾者曾在生命的最后时刻支持住在农村/偏远地区的老年人。数据表明，农村/偏远社区在获得姑息治疗和临终关怀方面面临挑战，原因包括服务地点之间的交通和距离、宽带覆盖范围差以及劳动力招聘和保留问题。综合这些方法的数据有助于确定农村和偏远地区老年人姑息治疗和临终关怀的一些干预措施和护理模式。它还帮助我们共同确定和制定研究优先事项，其中包括劳动力规划和服务组成、促进首选死亡地点和技术的作用。然而，我们对如何改善家庭照顾者支持以及老年人的数字素养以帮助他们从技术干预中受益的理解存在差距。结论：总体而言，在农村和偏远地区，特别是在英国，缺乏针对患有癌症、痴呆和中风的老年人的姑息治疗和临终关怀模式和干预措施的研究。考虑到生活在这些地区的独特挑战，迫切需要在农村和偏远地区共同设计基于社区的姑息治疗和临终关怀模式。资助：本文介绍了由国家卫生与保健研究所（NIHR）公共卫生研究计划资助的独立研究，奖励号为NIHR135350。
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引用次数: 0
Innovation and diversity in public health team engagement in local alcohol premises licensing: qualitative interview findings from the ExILEnS study. 公共卫生团队参与地方酒精场所许可的创新和多样性：来自ExILEnS研究的定性访谈结果。
Public health research (Southampton, England)
Pub Date : 2025-01-01 DOI: 10.3310/RNVD1542
Richard Purves, Andrea Mohan, Rachel O'Donnell, Matt Egan, Nason Maani, Niamh Fitzgerald

Background: Evidence suggests that controls on the physical and temporal availability of alcohol can reduce alcohol-related harms. Public health teams in England and Scotland have in recent years been given a statutory role in licensing systems through which premises are granted permits to sell alcohol. The Exploring the Impact of alcohol premises Licensing in England and Scotland study examined public health team efforts to engage in alcohol licensing from 2012 to 2019.

Objective: We aimed to describe the range of public health team practice in engaging with alcohol licensing across England and Scotland, with a particular focus on unusual or innovative practices.

Methods: Two sets of interviews were conducted with 20 public health teams in England and Scotland who were actively engaged in alcohol premises licensing. Firstly, representatives of each public health team with experience of licensing activity took part in structured face-to-face or telephone interviews (n = 41) and provided documentation to identify how and when their team engaged with alcohol premises licensing. Secondly, members of public health teams took part in in-depth one-to-one interviews (n = 28) which focused on individual roles and responsibilities. Relevant public health team activity was analysed quantitatively within 19 activities in 6 categories using the 'Public Health engagement In Alcohol Licensing' measure, as well as qualitatively using NVivo (QSR International, Melbourne, Australia). Innovative practices were identified using the highest Public Health engagement In Alcohol Licensing scores for specific activity types across single or multiple 6-month periods.

Findings: Within each of the six activity categories, a range of practices were observed. More unusual practices included having a dedicated post to work full-time on alcohol licensing; developing a standardised reviewer tool allowing the team to respond to applications and provide the most relevant evidence in a consistent and systematic way; committing to additional scrutiny of occasional licences or temporary event notices; maintaining a detailed database recording applications made, whether the public health team decided to object and the outcome of the licensing board's decision; engaging with applicants prior to them submitting an application; visiting proposed/current licensed premises to gather bespoke data; leading the writing of local licensing policy; and working closely with licensing standards officers.

Conclusions: Across six categories of public health team activity relating to the local alcohol premises licensing system, public health team practices varied, and some public health teams stood out as engaging in more innovative or intensive activities. The identified examples will be of value in informing public health team practice in what remains a relatively new area

背景：有证据表明，控制酒精在身体和时间上的可得性可以减少酒精相关危害。近年来，英格兰和苏格兰的公共卫生团队被赋予了在许可制度中的法定角色，通过该制度，场所获得了销售酒精的许可。“探索英格兰和苏格兰酒精场所许可的影响”研究调查了2012年至2019年公共卫生团队从事酒精许可的努力。目的：我们旨在描述整个英格兰和苏格兰从事酒精许可的公共卫生团队实践的范围，特别关注不寻常或创新的实践。方法：对英格兰和苏格兰20个积极从事酒类经营场所许可的公共卫生团队进行两组访谈。首先，具有许可活动经验的每个公共卫生小组的代表参加了有组织的面对面或电话访谈（n = 41），并提供了文件，以确定其小组如何以及何时从事酒类场所许可活动。第二，公共卫生小组成员参加了深入的一对一访谈（n = 28），重点是个人作用和责任。使用“公共卫生参与酒精许可”措施，对6类19项活动中的相关公共卫生小组活动进行了定量分析，并使用NVivo （QSR国际，澳大利亚墨尔本）进行了定性分析。在单个或多个6个月期间的特定活动类型中，使用最高的公共卫生参与酒精许可得分来确定创新做法。发现：在六个活动类别中，观察到一系列的实践。更不寻常的做法包括设立一个专门的职位，全职负责酒类许可；开发一个标准化的审查工具，使团队能够以一致和系统的方式响应应用程序并提供最相关的证据；承诺对临时许可证或临时事件通知进行额外审查；维持一个详细的数据库，记录所提出的申请、公共卫生小组是否决定反对以及发牌委员会决定的结果；在申请人提交申请之前与他们进行接触；探访拟持牌/现持牌处所，收集资料；主导当地许可政策的制定；并与许可标准官员密切合作。结论：在与当地酒类经营许可制度相关的六类公共卫生团队活动中，公共卫生团队的做法各不相同，一些公共卫生团队在参与更具创新性或密集性的活动中脱颖而出。尽管该系统存在局限性，但已确定的实例将对公共卫生团队在这一相对较新的工作领域的实践提供有价值的信息。纳入来自英格兰和苏格兰以及许多公共卫生团队的例子将促进公共卫生团队之间的思想和实践的相互融合。资助：本文介绍了由国家卫生和保健研究所（NIHR）公共卫生研究方案资助的独立研究，奖励号为15/129/11。
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引用次数: 0
Interventions to improve mental health and well-being in care-experienced children and young people aged less than 25: the CHIMES systematic review. 改善有护理经验的儿童和25岁以下青少年心理健康和福祉的干预措施：CHIMES系统评价
Public health research (Southampton, England)
Pub Date : 2024-12-01 DOI: 10.3310/MKYP6299
Rhiannon Evans, Sarah MacDonald, Robert Trubey, Jane Noyes, Michael Robling, Simone Willis, Soo Vinnicombe, Maria Boffey, Charlotte Wooders, Asmaa El-Banna, G J Melendez-Torres

Background: Children and young people with experience of being in care (e.g. foster care, kinship care, residential care or at home with a supervision requirement order) are at higher risk of adverse mental health and well-being outcomes compared to the general population. Despite a range of policy recommendations and interventions, it is not clear what approaches are effective in the United Kingdom, or how context factors give rise to facilitators and inhibitors of implementation and acceptability.

Objectives: The CHIMES review is a complex-systems-informed mixed-method systematic review that aimed to synthesise the international evidence base for interventions addressing the mental health and well-being of care-experienced children and young people (age ≤ 25 years) and to assess the potential transportability of this evidence base to the United Kingdom context.

Data sources: We searched 16 electronic bibliographic databases and 22 websites from 1990 to May 2022. We conducted citation tracking, screened relevant systematic reviews and contacted international experts.

Method: We used a convergent synthesis design. We first constructed an evidence map to confirm review scope before undertaking method-level syntheses for outcome evaluations, process evaluations and economic evaluations. These elements were integrated into a review-level synthesis to identify potential evidence-based interventions that may progress to further development, adaptation and evaluation in the United Kingdom. We conducted stakeholder consultations to prioritise intervention theories, types and outcomes.

Results: We identified 64 interventions from 124 study reports. Interventions were primarily evaluated in the United States and targeted young people's competencies or carers' parenting practices. Meta-analysis reported limited evidence that interventions effectively improved mental health in the shorter term (0-6 months): total social, emotional and behavioural problems (d = -0.15, 95% confidence interval -0.28 to -0.02); internalising problem behaviours (d = -0.35, 95% confidence interval -0.61 to -0.08); externalising problem behaviours (d = -0.30, 95% confidence interval -0.53 to -0.08); depression and anxiety (d = -0.26, 95% confidence interval -0.40 to -0.13) and social-emotional functioning difficulties (d = -0.18, 95% confidence interval -0.31 to -0.05), but these impacts were not observed in the longer term (> 6 months). Five key context factors potentially explain challenges to implementation and acceptability: lack of system resources; the time, cognitive and emotional burden of delivery or participation; interprofessional tensions; the devaluing of young people, meaning that they felt unable to express dissatisfaction with interventions; and the devaluating of carers' expertise and needs. From the evidence, st

背景：与一般人群相比，经历过照料（例如寄养、亲属照料、寄宿照料或有监督要求令的家庭）的儿童和青少年出现不良心理健康和福祉结果的风险更高。尽管有一系列政策建议和干预措施，但尚不清楚哪些方法在联合王国是有效的，也不清楚环境因素如何促进和抑制实施和可接受性。目的：CHIMES综述是一项复杂系统知情的混合方法系统综述，旨在综合国际证据基础，针对有护理经验的儿童和青少年（年龄≤25岁）的心理健康和福祉进行干预，并评估该证据基础在英国的潜在可移植性。数据来源：检索1990年至2022年5月16个电子书目数据库和22个网站。我们进行了引文跟踪，筛选了相关的系统综述，并联系了国际专家。方法：采用收敛综合设计。在进行结果评价、过程评价和经济评价的方法级综合之前，我们首先构建了一个证据图来确定评价范围。这些要素被纳入审查级综合，以确定潜在的循证干预措施，这些干预措施可能在联合王国进一步发展、适应和评估。我们进行了利益相关者咨询，以确定干预理论、类型和结果的优先顺序。结果：我们从124份研究报告中确定了64项干预措施。干预措施主要在美国进行评估，目标是年轻人的能力或照顾者的育儿实践。荟萃分析报告了有限的证据，表明干预措施在短期内（0-6个月）有效地改善了心理健康：总的社会、情绪和行为问题（d = -0.15, 95%置信区间为-0.28至-0.02）；内化问题行为（d = -0.35, 95%置信区间-0.61至-0.08）；外化问题行为（d = -0.30, 95%置信区间-0.53至-0.08）；抑郁和焦虑（d = -0.26, 95%置信区间为-0.40至-0.13）和社交情绪功能障碍（d = -0.18, 95%置信区间为-0.31至-0.05），但这些影响在较长期（6个月左右）中未被观察到。五个关键的环境因素可能解释实施和可接受性方面的挑战：缺乏系统资源；分娩或参与的时间、认知和情感负担；interprofessional紧张;对年轻人的贬低，意味着他们无法表达对干预措施的不满；以及看护者的专业知识和需求的贬值。根据证据，利益相关者咨询确定了两个优先干预措施：(1)由具有护理知识和经验的个人进行指导；(2)改变系统和精神，以在组织之间建立协调，促进跨专业关系。福祉和与自杀相关的行为与精神卫生一样是优先考虑的结果。局限性：由于缺乏理论和经济评估，该综述受到限制，因此尚不清楚干预措施如何发挥作用或其潜在的成本效益。干预措施的描述不够充分，使得绘制证据基础具有挑战性。结果评估报告不佳。由于COVID-19的持续限制，利益攸关方磋商的进行时间比预期的要晚，与会人数也较少。结论：本综述确定了一些干预措施在短期内影响心理健康的证据。目前缺乏针对主观幸福感和自杀相关结果的系统级干预措施和方法。未来的干预可能会优先考虑指导和针对系统文化。研究注册：本研究注册号为PROSPERO CRD42020177478。资助：该奖项由美国国家卫生与保健研究所（NIHR）公共卫生研究计划（NIHR奖号：NIHR129113）资助，全文发表在《公共卫生研究》上；第十二卷，第14期有关进一步的奖励信息，请参阅美国国立卫生研究院资助和奖励网站。
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引用次数: 0
Clinical and cost-effectiveness of parenting intervention for mothers experiencing psychosocial stress: insights from the early closure of the Mellow Babies RCT. 对经历心理社会压力的母亲进行育儿干预的临床和成本效益：来自“圆润婴儿”随机对照试验早期结束的见解。
Public health research (Southampton, England)
Pub Date : 2024-12-01 DOI: 10.3310/KCVL7125
Lucy Thompson, Jessica Tanner, Matthew Breckons, Naomi Young, Laura Ternent, Thenmalar Vadiveloo, Philip Wilson, Danny Wight, Louise Marryat, Iain McGowan, Graeme MacLennan, Angus MacBeth, James McTaggart, Tim Allison, John Norrie
<p><strong>Background: </strong>Problems in children's early social and emotional development are likely to have major long-term consequences for the individual and society: maternal emotional well-being is associated with better outcomes. Interventions designed to improve both maternal mental health and the mother-child relationship are thus likely to benefit both maternal health and child development.</p><p><strong>Objectives: </strong>To establish the clinical and cost-effectiveness of the Mellow Babies parenting intervention for women experiencing psychosocial stress and their 6- to 18-month-old babies. Secondary aims included understanding the process of recruitment, retention and engagement in both the trial and the intervention.</p><p><strong>Design: </strong>This was a single-centre randomised controlled trial, employing 1 : 1 randomisation with participants allocated to receive Mellow Babies plus usual care, or usual care only.</p><p><strong>Setting: </strong>Community settings in the Highland Council region of Scotland.</p><p><strong>Participants: </strong>We aimed to recruit 212 mothers to provide evaluable data for 170 participants (90% power to detect an effect size of 0.5 for the primary outcome). Eligible mothers lived within the Highland Council region; were aged ≥ 16 years; had primary caregiving responsibility of a baby aged 6-18 months and scored above threshold for anxiety (≥ 11) and/or depression (≥ 7) on the Hospital Anxiety and Depression Scale.</p><p><strong>Intervention: </strong>Mellow Babies is a 14-week group-based parenting programme specifically designed for mothers with psychosocial difficulties. Sessions run for 5 hours each and include 4-10 participants.</p><p><strong>Main outcome measures: </strong>Maternal Hospital Anxiety and Depression Scale scores at 8 months post randomisation and when the child reaches 30 months. Health economic (service use and quality of life) and child development (language development and mental well-being) outcomes were also examined.</p><p><strong>Results: </strong>Due to the COVID-19 pandemic, the trial did not recruit to target: 106 women were recruited (53 per arm). It was not possible to explore the clinical and cost-effectiveness of Mellow Babies. Baseline, follow-up and process evaluation data were analysed to allow optimal learning from the study. Direct communication (letter) combined with health visitor referral was a better means of recruitment. Despite relatively low sociodemographic disadvantage, there was a high prevalence of mental ill health. Retention to follow-up and within the intervention was good (75% to study end point), and data were well-completed. Quality-of-life ratings increased at 8 months post randomisation, then decreased somewhat at 30 months of age, but remained above baseline. Qualitative interviews highlighted barriers and facilitators of engagement with the intervention groups. There was no observed difference in baseline characteristics or outcomes b
背景：儿童早期社会和情感发展的问题可能对个人和社会产生重大的长期影响：母亲的情感健康与更好的结果相关。因此，旨在改善产妇心理健康和母子关系的干预措施可能有利于产妇健康和儿童发展。目的：探讨“圆润婴儿”育儿干预对经历心理社会压力的妇女及其6 ~ 18个月大的婴儿的临床和成本效益。次要目标包括了解在试验和干预中招募、保留和参与的过程。设计：这是一项单中心随机对照试验，采用1:1随机化，参与者被分配接受“柔和婴儿”加常规护理，或仅接受常规护理。环境：苏格兰高地议会地区的社区环境。参与者：我们的目标是招募212名母亲，为170名参与者提供可评估的数据（90%的能力检测到主要结局的效应量为0.5）。符合条件的母亲居住在高地理事会区域内；年龄≥16岁；对6-18个月的婴儿负有主要照顾责任，并且在医院焦虑和抑郁量表上的焦虑（≥11）和/或抑郁（≥7）得分高于阈值。干预：温柔婴儿是一个为期14周的以团体为基础的育儿计划，专门为有社会心理困难的母亲设计。每节课5小时，包括4-10名参与者。主要结果测量：随机分组后8个月和孩子30个月时的产妇医院焦虑和抑郁量表评分。还检查了健康经济（服务使用和生活质量）和儿童发展（语言发展和心理健康）结果。结果：由于COVID-19大流行，该试验没有招募目标：招募了106名女性（每组53名）。不可能探索“圆润婴儿”的临床和成本效益。基线，随访和过程评估数据进行分析，以便从研究中获得最佳学习。直接沟通（信函）结合卫生访视员推荐是较好的招聘方式。尽管社会人口劣势相对较低，但精神疾病的发病率很高。随访和干预期间的保留率良好（75%至研究终点），数据完整。生活质量评分在随机化后8个月增加，然后在30个月时略有下降，但仍高于基线。定性访谈强调了与干预群体接触的障碍和促进因素。在大流行前后招募的参与者之间，没有观察到基线特征或结果的差异，尽管对试验的后勤影响是深远的。局限性：该研究没有足够的动力来回答主要的结局问题。COVID-19大流行的发生严重阻碍了目前的试验。结论：该试验不能回答临床和成本效益方面的问题。从该试验中学习可以为新的重新设计的试验提供信息，包括集群随机化，并基于更大、更多样化的人群。未来工作：仍需要对“圆润婴儿”进行明确的试验。最有效的方法可能是进行一项集群随机试验，让主要卫生服务利益相关者和一线从业人员完全接受，以最大限度地招募、参与和参与。试验注册：试验注册号为ISRCTN47575326。资助：该奖项由美国国家卫生与保健研究所（NIHR）公共卫生研究项目（NIHR奖号：15/126/05）资助，全文发表在《公共卫生研究》上；第12卷第17期有关进一步的奖励信息，请参阅美国国立卫生研究院资助和奖励网站。
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引用次数: 0
Impact of short-term aircraft noise on cardiovascular disease risk in the area surrounding London Heathrow airport: the RISTANCO epidemiological study. 伦敦希思罗机场周边地区短期飞机噪音对心血管疾病风险的影响：RISTANCO流行病学研究。
Public health research (Southampton, England)
Pub Date : 2024-12-01 DOI: 10.3310/UTCE9104
Xiangpu Gong, Nicole Itzkowitz, Calvin Jephcote, Kathryn Adams, Glory O Atilola, John Gulliver, Marta Blangiardo, Anna Hansell
<p><strong>Background: </strong>Long-term exposure to aircraft noise has been associated with small increases in cardiovascular disease risk, but there are almost no short-term exposure studies.</p><p><strong>Objectives: </strong>Research questions were: Is there an association between short-term changes in exposure to aircraft noise and cardiovascular morbidity and mortality? What are the key effect modifiers? Is there variability in risk estimates between areas with consistent versus changing patterns of noise exposure? Do risk estimates differ when using different noise metrics?</p><p><strong>Design: </strong>Descriptive analyses of noise levels and variability at different times of day, analyses of inequalities in noise exposure and case-crossover analyses of cardiovascular events in relation to aircraft noise exposure.</p><p><strong>Setting: </strong>Area surrounding London Heathrow airport.</p><p><strong>Time period: </strong>2014-18.</p><p><strong>Participants: </strong>Whole population in study area.</p><p><strong>Main outcome measures: </strong>Cardiovascular disease hospitalisations and mortality.</p><p><strong>Data sources: </strong>Aircraft noise levels modelled using a standard noise model for: (1) daily equivalent continuous sound levels at different times of day; (2) daily number of events above defined noise thresholds (2018 only). National Health Service digital hospital admission records and Office for National Statistics mortality records for 2014-18 for cardiovascular outcomes, plus individual-level confounders available from healthcare records. Confounder data including road traffic noise (Leicester modelled), rail noise and air pollution (Department for Environment, Food and Rural Affairs), area level deprivation and ethnicity (UK Census).</p><p><strong>Results: </strong>The morning shoulder period (06.00-07.00 hours) was the noisiest of all eight bands (mean: 50.92 dB). The morning shoulder period also had the third highest number of noisy events (flights) > 60 dB per day, with three events across postcodes on average. However, the highest number of noisy events occurred in daytime (highest between 07.00 and 15.00 hours, second highest 15.00 and 19.00 hours). To identify areas with high variability in aircraft noise exposure (due to changes in flight paths because of wind direction and airport operations), we used coefficients of variation (CoV). The period 24.00-04.30 hours had the highest mean CoV (67.33-74.16), followed by 04.30-06.00 hours and 23.00-24.00 hours. Postcodes in the least deprived quintiles of Carstairs index or avoidable death rate had the lowest noise levels. In case-crossover analyses, we observed increased risk for cardiovascular disease hospital admissions for evening noise 19.00-23.00 hours (odds ratio 1.005, 95% confidence interval 1.000 to 1.010 per 5 dB), but not for other periods or mortality. Further analyses suggested that increased risks were occurring in postcodes with low CoV for noise. We fo
背景：长期暴露于飞机噪音与心血管疾病风险的小幅增加有关，但几乎没有短期暴露的研究。目的：研究问题是：暴露于飞机噪音的短期变化与心血管发病率和死亡率之间是否存在关联？什么是关键的效果修饰符？在噪音暴露模式不变与变化的地区之间，风险评估是否存在差异？当使用不同的噪音指标时，风险评估是否不同？设计：对一天中不同时间的噪音水平和变异性进行描述性分析，分析噪音暴露的不平等，并对与飞机噪音暴露相关的心血管事件进行病例交叉分析。环境：伦敦希思罗机场周边地区。时间：2014-18年。参与者：研究区域的全体人口。主要结局指标：心血管疾病住院和死亡率。数据来源：使用标准噪音模型模拟飞机噪音水平：(1)每天不同时间的每日等效连续声级；(2)超过定义噪声阈值的每日事件数（仅2018年）。英国国家卫生局（National Health Service）的数字住院记录和英国国家统计局（Office for National Statistics） 2014-18年心血管疾病死亡率记录，以及医疗记录中可获得的个人水平混杂因素。混杂数据包括道路交通噪音（莱斯特建模），铁路噪音和空气污染（环境，食品和农村事务部），地区贫困和种族（英国人口普查）。结果：早晨肩期（06.00 ~ 07.00）是8个波段中噪声最大的时段，平均为50.92 dB。早上的肩部时段也有第三高的噪音事件（航班），每天bb60 dB，平均每个邮政编码有三个事件。然而，噪声事件发生在白天的次数最多（在07.00 - 15.00时段最多，其次是15.00 - 19.00时段）。为了确定飞机噪声暴露的高变异性区域（由于风向和机场运行导致飞行路径的变化），我们使用了变异系数（CoV）。平均冠状病毒感染率最高的时段为24.00 ~ 04.30 h(67.33 ~ 74.16)，其次为04.30 ~ 06.00和23.00 ~ 24.00；Carstairs指数或可避免死亡率最低的五分之一的邮政编码的噪音水平最低。在病例交叉分析中，我们观察到夜间噪音19.00-23.00小时导致心血管疾病住院的风险增加（优势比1.005,95%置信区间1.000 - 1.010 / 5 dB），但其他时段或死亡率没有增加。进一步的分析表明，在低冠状病毒感染的邮政编码地区，风险增加。我们发现，年龄、性别、种族、剥夺和季节会改变效果。限制：使用的行业标准噪音模型，即航空环境设计工具，没有考虑到风向，这可能导致一些暴露错误分类。结论：我们建立了一个全面的飞机噪声日变化数据集。我们发现心血管住院（但不是死亡）与夜间飞机噪音水平之间存在很小的关联，特别是在噪音变异性较低的地区。未来的工作：需要更多的研究来了解噪音变化和喘息/缓解对心血管疾病的影响。资助：该奖项由国家卫生与保健研究所（NIHR）公共卫生研究方案（NIHR奖号：15/192/13）资助，全文发表在《公共卫生研究》上；第十二卷，第13号有关进一步的奖励信息，请参阅美国国立卫生研究院资助和奖励网站。
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引用次数: 0
Public engagement to refine a whole-school intervention to promote adolescent mental health. 公众参与完善促进青少年心理健康的全校干预措施。
Public health research (Southampton, England)
Pub Date : 2024-12-01 DOI: 10.3310/JWGT4863
Chris Bonell, Steven Hope, Neisha Sundaram, Oliver Lloyd-Houldey, Semina Michalopoulou, Stephen Scott, Dasha Nicholls, Russell Viner
<p><strong>Background: </strong>Despite high rates of adolescent mental health problems, there are few effective school-based interventions to address this. Whole-school interventions offer a feasible and sustainable means of promoting mental health, but few have to date been evaluated. Previously we trialled the Learning Together intervention comprising local needs assessment, student and staff participation in decision-making, restorative practice, and a social and emotional skills curriculum. This was effective not only in preventing bullying (primary outcome), but also in promoting mental well-being and psychological functioning (secondary outcomes).</p><p><strong>Objective: </strong>We aimed to adapt Learning Together to develop Learning Together for Mental Health, focused on promoting mental health. This paper reports on how we refined and elaborated intervention materials to produce the Learning Together for Mental Health intervention including through patient and public involvement and engagement.</p><p><strong>Design: </strong>We reviewed evidence to inform choice of the curriculum component and the contents of our needs assessment survey. We conducted patient and public involvement and engagement with school staff and students, and children and young people from the National Children's Bureau to adapt the intervention. We also conducted a systematic review of reviews to inform a menu of evidence-based actions, but this is reported separately.</p><p><strong>Setting: </strong>Southern England.</p><p><strong>Participants: </strong>Patient and public involvement and engagement was conducted with four staff and five students from one secondary school, and a group of two school senior leadership team members from different schools, and about eight children and young people who were members of the Young National Children's Bureau.</p><p><strong>Interventions: </strong>None.</p><p><strong>Results: </strong>We refined and elaborated our initial plans for Learning Together for Mental Health to generate an intervention supported by full materials, training and external facilitation. We focused needs assessment on mental health, added a menu of evidence-based whole-school mental health actions, and switched to a different social and emotional skills curriculum. We retained restorative practice and staff/student involvement in decisions. No further refinements were made to the intervention theory of change or overall approach. Patient and public involvement and engagement was useful, but not all suggestions were acted on either because some participants suggested dropping pre-determined elements (e.g. needs survey) or because suggestions (e.g. to include aromatherapy) lacked evidence of effectiveness.</p><p><strong>Limitations: </strong>Not all of our engagements with patient and public involvement and engagement stakeholders were sustained over time. Our patient and public involvement and engagement work was affected by its having occurred within t
背景：尽管青少年心理健康问题的发生率很高，但很少有有效的学校干预措施来解决这一问题。全校干预为促进心理健康提供了一种可行和可持续的手段，但迄今为止尚未对其进行评估。之前，我们尝试了“一起学习”干预，包括当地需求评估、学生和员工参与决策、恢复性实践以及社交和情感技能课程。这不仅在防止欺凌（主要结果）方面有效，而且在促进精神健康和心理功能（次要结果）方面也有效。目的：采用“一起学习”模式发展“一起学习促进心理健康”，以促进心理健康为重点。本文报告了我们如何完善和阐述干预材料，以产生包括患者和公众参与和参与在内的“共同学习精神健康”干预措施。设计：我们审查证据，以告知课程组成部分的选择和我们的需求评估调查的内容。我们对学校员工、学生、国家儿童局的儿童和年轻人进行了耐心和公众参与，以适应干预措施。我们还对评估进行了系统的评估，以告知基于证据的行动菜单，但这是单独报告的。背景：英格兰南部。参与者：来自一所中学的四名员工和五名学生，来自不同学校的两名学校高级领导团队成员，以及大约八名全国青少年局成员的儿童和青少年，进行了耐心和公众参与和参与。干预措施:没有。结果：我们对“一起学习促进心理健康”的初步计划进行了完善和阐述，以产生一个由完整的材料、培训和外部促进支持的干预措施。我们将需求评估的重点放在了心理健康上，增加了一个基于证据的全校心理健康行动菜单，并转向了不同的社交和情感技能课程。我们保留了恢复性实践和员工/学生参与决策。对改变的干预理论或整体方法没有进一步的改进。病人和公众的参与和参与是有用的，但并非所有的建议都被采取行动，因为一些参与者建议删除预先确定的元素（例如需求调查），或者因为建议（例如包括芳香疗法）缺乏有效性的证据。局限性：并非我们与患者和公众参与以及参与利益相关者的所有接触都能长期持续。我们的病人和公众参与和参与工作受到影响，因为它发生在学校比平时压力更大的COVID-19恢复期。我们原本计划让参与耐心和公众参与的学校在学生免费校餐资格方面高于平均水平，但最初招募的学校在最后一刻退出了。取而代之的是低于平均水平的免费校餐。结论：本文报告了适应过程，并反思了参与和证据审查在适应过程中有用的各种方式。我们发现，通过证据审查、患者和公众参与和参与的过程，可以改进和详细阐述干预措施，提供全面的材料和支持。后者在确保其可行性、可接受性和包容性方面为改进“共同学习促进心理健康”提供了宝贵的信息。然而，我们认为，并非所有来自患者和公众参与和参与的建议都可以或应该采取行动，特别是当它们与证据基础不一致时。未来的工作：一项可行性研究，以优化干预措施，并评估是否有理由进行全面试验。资助：本文介绍了由国家卫生与保健研究所（NIHR）公共卫生研究计划资助的独立研究，奖励号为NIHR131594。
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