Pulmonary embolism and mortality following total ankle replacement: a data linkage study using the NJR data set

OBJECTIVE: To determine the mortality rate following total ankle replacement (TAR) and incidence of 90 day pulmonary embolism (PE) along with the associated risk factors.  DESIGN: Data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database. Linkage was performed in a deterministic fashion. HES episodes 90 days after the index procedure were analysed for PE. Mortality data were obtained pertaining to all the index procedures from the NJR for analysis.  PARTICIPANTS: All primary and revision ankle replacement patients captured on the NJR between February 2008 and February 2013.  RESULTS: The 90-day mortality following TAR was 0.13% (95% CI 0.03 to 0.52) and 1-year mortality was 0.72% (95% CI 0.40 to 1.30); no deaths were as a result of PE. The incidence of PE within 90 days following primary TAR was 0.51% (95% CI 0.23 to 1.13). There was only one PE following revision surgery. Patients with an Royal College of Surgeons Charlson score greater than zero were at 13 times greater risk of PE (p=0.003).  CONCLUSIONS: There is low incidence of PE following TAR, but multiple comorbidities are a leading risk factor for its occurrence

How do patients with end-stage ankle arthritis decide between two surgical treatments?:A qualitative study

To examine how patients decide between ankle fusion and ankle replacement in end-stage ankle arthritis

Making hospital shops healthier:evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

Background The range of products stocked and their promotions in food retail outlets in healthcare settings can affect food choices by staff, patients and visitors. The innovative Scottish Healthcare Retail Standard (HRS) is a national mandatory scheme requiring all hospital food retail outlets to change the balance of food products stocked and their promotion to comply with nutritional criteria and promotional restrictions. The aim is to facilitate healthier food choices in healthcare settings. This study examined the implementation of HRS and the impact on foods stocked and promoted. Methods The study aimed to examine implementation process and changes to the retail environment in relation to food promotions and choice. A sample of hospital retail outlets (n=17) including shops and trolley services were surveyed using a mixed methods design comprising: (a) structured observational audits of stock, layout and promotions (with a specific focus on chocolate and fruit product lines, and) (b) face-to-face, semi-structured interviews with the shop manager or nominated members of staff (n=32). Data were collected at Wave 1 (2016), at the beginning and during the early stages of HRS implementation; and Wave 2, 12 months later, after the HRS implementation deadline. Results All outlets, both commercial and not-for-profit, in the sample successfully implemented HRS. Implementation was reported to be more challenging by independent shop managers compared to chain store staff. Retail managers identified areas where more implementation guidance and support could have been provided. The number of chocolate product lines and promotions reduced substantially between Waves 1 and 2, but with no substantial increase in fruit product lines and promotions. Despite initial negative expectations of HRS’s impact, managers identified some opportunities in the scheme and positive changes in the supply chain. Conclusions Positive changes in food retail outlets occurred after hospital shops were required to implement HRS. By creating a consistent approach across hospital shops in Scotland, HRS changed the food retail environment for hospital staff, visitors and patients. HRS provides a regulatory template and implementation learning points for influencing retail environments in other jurisdictions and settings

Experience of Wellness Recovery Action Planning in Self-Help and Mutual Support Groups for People with Lived Experience of Mental Health Difficulties

The main aim of this research was to assess the relevance and impact of wellness recovery action planning (WRAP) as a tool for self-management and wellness planning by individuals with mental health problems from pre-existing and newly formed groups, where the possibilities for continued mutual support in the development of WRAPs could be explored. Interviews and focus groups were conducted and pre-post recovery outcome measures completed (Recovery Assessment Scale and Warwick Edinburgh Mental Well Being Scale). 21 WRAP group participants took part in the research. The WRAP approach, used in groups and delivered by trained facilitators who could also share their lived experience, was very relevant and appeared to have a positive impact on many of the participants. The impact on participants varied from learning more about recovery and developing improved self-awareness to integrating a WRAP approach into daily life. The apparent positive impact of WRAP delivered in the context of mutual support groups indicates that it should be given serious consideration as a unique and worthwhile option for improving mental health. WRAP groups could make a significant contribution to the range of self-management options that are available for improving mental health and well-being

“It's like sludge green”: Young people's perceptions of standardised tobacco packaging in the UK

Background and Aims Standardised tobacco packaging was introduced in the United Kingdom (UK) in May 2016, together with larger graphic warnings. This study explored young Scottish people's awareness of and perceptions about standardised tobacco packaging in the UK Design Qualitative study using 16 focus groups conducted February‐March 2017. Setting Four schools in Scotland based in areas of differing socioeconomic status (high vs medium/low) and two levels of urbanity (large urban vs small town/other urban). Participants Eighty‐two S2 (13‐14 years) and S4 (15‐16 years) students who were smokers or at‐risk non‐smokers. Measurements Focus groups explored perceptions of standardised packaging and health warnings. The qualitative data underwent thematic analysis. Findings Views about standardised packaging were generally negative. Packs were described as being unattractive, drab and less appealing than non‐standardised versions. The new health warnings generated negative affective, often aversive, responses. These varied depending on the image's perceived ‘gruesomeness' and authenticity. Most participants thought that the impact would be greatest on young non/occasional smokers. There were divergent views about whether established smokers would be affected. Conclusions The introduction of standardised tobacco packaging and new larger graphic health warnings in the United Kingdom seems have reduced the perceived attractiveness of cigarette packs among young people in the UK who smoke or are at elevated risk of becoming smokers, disrupting positive brand imagery (the brand heuristic), increasing the salience of health warnings, and contributing to denormalising smoking

Changes in physical activity following total hip or knee arthroplasty: a matched case-control study from the EPIC-Norfolk cohort

Objective: To assess self-reported physical activity changes pre- compared to post-operatively in patients undergoing total hip or knee arthroplasty, and to compare this to an age- and gender-matched cohort of people who have not undergone arthroplasty.  Design: Population-based prospective cohort study.  Setting: Norfolk, UK  Subjects: People who had undergone hip or knee arthroplasty, compared to an age- and gender-matched non-arthroplasty cohort.  Intervention: Primary total hip or knee arthroplasty.  Main measures: Physical activity, measured using the EPIC Physical Activity Questionnaire (EPAQ2).  Results: 400 people from the EPIC-Norfolk community cohort were identified who had undergone hip or knee arthroplasty. 767 people were identified to form an age- and gender-matched non-arthroplasty cohort. Mean post-operative follow-up was 43 months post-total hip and 41 months post-total knee arthroplasty. There was a statistically significant reduction from pre- to post-arthroplasty in the number of flights of stairs climbed weekly (hip: mean difference (MD): 6.8; p<0.01; knee: MD: 10.2; p<0.01); duration of walking (hip: MD: 1.4 hours/week; p=0.02; knee: MD: 2.2 hours/week; p<0.01) and duration of total recreational activity (hip: MD: 1.1 hours/week; p=0.02). Compared to the non-arthroplasty cohort, duration of physical activity was lower post-total hip arthroplasty (MD: 1.8 hours/week; p=0.01). The number of flights of stairs climbed weekly (MD: 12.0; p<0.01), total recreational activity (MD: 1.7 hours/week; p=0.04) and physical activity energy expenditure (MD: 5.7 Mets-hours/week; p=0.05) was lower for people post-total knee arthroplasty compared to the matched controls.  Conclusions: Physical activity did not increase, and in instances decreased, following total hip or knee arthroplasty

Are Retail Outlets Complying with National Legislation to Protect Children from Exposure to Tobacco Displays at Point of Sale? Results from the First Compliance Study in the UK

Background&nbsp; &nbsp;From April 6th2015, all small shops in the UK were required to cover up tobacco products at point of sale (POS) to protect children from exposure. As part of a larger 5-year study to measure the impact of the legislation in Scotland, an audit was conducted to assess level and nature of compliance with the ban immediately following its introduction.&nbsp; Materials and Methods&nbsp; &nbsp;A discreet observational audit was conducted 7&ndash;14 days post implementation which took measures of physical changes made to cover products, server/assistant practices, tobacco signage and advertising, and communication of price information. The audit was conducted in all small retail outlets (n = 83) selling tobacco in four communities in Scotland selected to represent different levels of urbanisation and social deprivation. Data were analysed descriptively.&nbsp; Results&nbsp; &nbsp;Compliance with the legislation was high, with 98% of shops removing tobacco from permanent display and non-compliance was restricted almost entirely to minor contraventions. The refurbishment of shops with new or adapted tobacco storage units resulted in the removal of nearly all commercial brand messages and images from POS, dropping from 51% to 4%. The majority of shops stored their tobacco in public-facing storage units (81%). Most shops also displayed at least one generic tobacco message (88%).&nbsp; Conclusions&nbsp; Compliance with Scottish prohibitions on display of tobacco products in small retail outlets was high immediately after the legislation implementation date. However, although tobacco branding is no longer visible in retail outlets, tobacco storage units with generic tobacco messages are still prominent. This points towards a need to monitor how the space vacated by tobacco products is utilised and to better understand how the continuing presence of tobacco storage units influences people&rsquo;s awareness and understanding of tobacco and smoking. Countries with existing POS bans and who are considering such bans should pay particular attention to regulations regarding the use of generic signage and where within the retail setting tobacco stocks can be stored

A “step too far” or “perfect sense”? A qualitative study of British adults’ views on mandating COVID-19 vaccination and vaccine passports

BACKGROUND: Debate is ongoing about mandating COVID-19 vaccination to maximise uptake. Policymakers must consider whether to mandate, for how long, and in which contexts, taking into account not only legal and ethical questions but also public opinion. Implementing mandates among populations who oppose them could be counterproductive. METHODS: Qualitative telephone interviews (Feb-May 2021) with British adults explored views on vaccine passports and mandatory vaccination. Participants (n=50) were purposively selected from respondents to a probability-based national survey of attitudes to COVID-19 vaccination, to include those expressing vaccine-hesitancy. Data were analysed thematically. FINDINGS: Six themes were identified in participants’ narratives concerning mandates: (i) mandates are a necessary and proportionate response for some occupations to protect the vulnerable and facilitate the resumption of free movement; (ii) mandates undermine autonomy and choice; (iii) mandates represent an over-reach of state power; (iv) mandates could potentially create ‘vaccine apartheid’; (v) the importance of context and framing; and (vi) mandates present considerable feasibility challenges. Those refusing vaccination tended to argue strongly against mandates. However, those in favour of vaccination also expressed concerns about freedom of choice, state coercion and social divisiveness. DISCUSSION: To our knowledge, this is the first in-depth UK study of public views on COVID-19 vaccine mandates. It does not assess support for different mandates but explores emotions, principles and reasoning underpinning views. Our data suggest that debate around mandates can arouse strong concerns and could entrench scepticism. Policymakers should proceed with caution. While surveys can provide snapshots of opinion on mandates, views are complex and further consultation is needed regarding specific scenarios

Assessing Change in Tobacco Visibility at Point-of-sale Following a Display Ban

Objectives:  In this paper, we describe a point-of-sale (POS) tobacco visibility tool and examine its utility for assessing changes in visibility following legislation banning tobacco displays.  Methods:  An observational tool was developed as part of DISPLAY, a multimodal, longitudinal study evaluating the impact of the tobacco POS display ban in Scotland. Measures were taken of product and storage unit visibility, over 5 years, pre- and post-implementation in all retail outlets selling tobacco in 4 contrasting study areas (N = 103).  Results:  Data generated by the visibility tool illustrated that whereas the display ban had reduced product visibility, it had little impact on reducing visibility of tobacco storage units. However, it did narrow the inequality gap in storage visibility. It also found some shop types reduced product visibility before legally required to do so.  Conclusions:  The DISPLAY visibility tool provides a reliable method for measuring visibility of tobacco displays before and after implementation of POS legislation. Tobacco product visibility reduced as expected following implementation of the legislation, but storage unit visibility persisted, providing residual cues of tobacco availability which may confound the effects of the legislation. The DISPLAY tool has the potential to be utilized in countries planning POS display bans