What are the key influences and challenges around weight management faced by patients in UK adult secure mental health settings? A focused ethnographic approach

Objectives Excess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients’ physical and mental health. This study sought to identify the key influences and challenges around weight management in United Kingdom (UK) adult secure mental health settings. Design Qualitative focussed ethnography. Analysis of written fieldnotes was undertaken through a combined inductive and deductive approach, informed by thematic analysis. Setting Low secure male mental health ward and associated patient activities and events, in a National Health Service (NHS) Trust delivering mental health, intellectual disability and neurorehabilitation services in the UK. Participants Twelve males (primarily White British) on the low secure ward; other male participants from low and medium secure services, who took part in group events and activities; and multidisciplinary low and medium secure services staff. Approximately 23 hours of observation were undertaken over a six-month period from April 2022. Results Secure mental healthcare delivered an overall ‘obesogenic’ environment, predisposing patients to excessive weight gain and sedentary behaviour, which was often perceived as inevitable. Key themes highlighted the heightened salience of food in secure settings; inadequacy of catered hospital food and shortcomings of alternative food options; limited physical activity opportunities; and understaffing. Ward culture was not conducive to healthy behaviours. Perceptions and behaviour towards the ethnographer were primarily positive and accepting. Conclusions Weight management in secure services is a complex challenge. In future, whole settingbased interventions to promote healthy weight are likely to be required. These should integrate physical and mental health, incorporate underpinning determinants such as adequate staffing and a culture promoting weight management, and involve both patients and staff

Understanding weight management in adult secure mental health services: findings from a mixed-methods study in Northern England

Obesity and associated morbidity and mortality are major challenges for people with severe mental illness (SMI, including schizophrenia and bipolar disorder), particularly in secure (forensic) mental healthcare (patients who have committed a crime or have threatening behaviour). This research aimed to explore experiences of obesity in secure mental health settings, through a survey, focus groups and interviews. The survey was delivered to secure mental healthcare staff in a National Health Service (NHS) mental health trust in Northern England, and received 79 responses. Nine focus groups were conducted with current and former patients, carers and multidisciplinary staff in the same trust. Eleven semi-structured interviews were undertaken with multidisciplinary staff in a second NHS mental health trust in Northern England. Through thematic analysis two overarching issues were identified, concerning the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. Overall, secure care was highlighted as an ‘obesogenic’ environment, conducive to excessive weight gain. Seven key influences included: medication, sedentary behaviour, patient motivation and intrinsic factors, catered food and alternatives, role of staff, and service delivery. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact

A study on three dimensional scanning and mapping and implementation key technology of wenge bench parts

The paper mainly applies three-dimensional (3D) scanners to carry out mapping for traditional furniture parts, making a systematic study on the parts size, recognising the application potential of 3D furniture mapping. In the course of the study, firstly an historic wenge bench is selected with its components acting as measurable objects, and then secondly we carry out specific work for the experimental study. Combined with advanced 3D scanning equipment and the measuring process study, details are described using 3D mapping methods, mapping key technologies to acquire a series of data through the mapping experiment on the antique furniture. The purpose of this research is to enable furniture design to be better integrated with advanced technologies; the study and design of traditional furniture can be further developed using high-tech means. It can provide basic design parameters and image data to inform digital furniture development and design systems

Predictors of and reasons for attempts to reduce alcohol intake: A population survey of adults in England

OBJECTIVE: This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption. METHODS: Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so. RESULTS: Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn’t know why they were cutting down (β -0.25, p<0.05). CONCLUSIONS: Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking

Protocol for a national monthly survey of alcohol use in England with 6-month follow-up: 'The Alcohol Toolkit Study'.

Timely tracking of national patterns of alcohol consumption is needed to inform and evaluate strategies and policies aimed at reducing alcohol-related harm. Between 2014 until at least 2017, the Alcohol Toolkit Study (ATS) will provide such tracking data and link these with policy changes and campaigns. By virtue of its connection with the 'Smoking Toolkit Study' (STS), links will also be examined between alcohol and smoking-related behaviour

Use of aids for smoking cessation and alcohol reduction: A population survey of adults in England.

BACKGROUND: It is important for policy planning to chart the methods smokers and high-risk drinkers use to help them change their behaviour. This study assessed prevalence of use, and characteristics of users, of support for smoking cessation and alcohol reduction in England. METHODS: Data were used from the Smoking and Alcohol Toolkit Studies, which involve monthly face-to-face computer-assisted interviews of adults aged 16+ in England. We included data collected between June 2014 and July 2015 on 1600 smokers who had made at least one quit attempt and 911 high-risk drinkers (defined as scores >8+ on the full AUDIT or 5+ on questions 1-3 of the AUDIT-C) who had made an attempt to cut down in the past 12 months. Participants provided information on their socio-demographic characteristics and use of aids during their most recent quit attempt including pharmacotherapy, face-to-face counselling, telephone support, self-help materials (digital and printed), and complementary medicine. RESULTS: A total of 60.3% of smokers used aids in the past year, compared with just 14.9% of high-risk drinkers. Use of pharmacotherapy was high among smokers and very low among drinkers (56.0%versus1.2%). Use of other aids was low for both behaviours: face-to-face counselling (2.6%versus4.8%), self-help materials (1.4%versus4.1%) and complementary medicine (1.0%versus0.5%). Use of aids was more common among smokers aged 25-54 compared with 16-24 year olds (25-34,ORadj1.49,p = 0.012; 35-44,ORadj1.93,p 10 relative to 20,ORadj4.23,p = 0.001), and less common among ethnic minorities (ORadj0.69,p = 0.026). For alcohol reduction, use of aids was higher among ethnic minority groups (ORadj2.41;p = 0.015), and those of social-grade D/E relative to AB (ORadj2.29,p = 0.012&ORadj3.13,p < 0.001). CONCLUSION: In England, the use of pharmacotherapy is prevalent for smoking cessation but not alcohol reduction. Other aids are used at a low rate, with face-to-face counselling being more common for alcohol reduction than smoking cessation

‘The Addiction Was Making Things Harder for My Mental Health’: A Qualitative Exploration of the Views of Adults and Adolescents Accessing a Substance Misuse Treatment Service

The relationship between substance use and mental health is complex, and both constitute a global public health burden. In the UK, the estimated annual financial costs of alcohol-related harm and illicit drug use are GBP 21.5 billion and GBP 10.7 billion, respectively. This issue is magnified in the North East of England, where treatment access is low and a large proportion of individuals experience socioeconomic deprivation. The present study aimed to explore the experiences of adults and adolescents accessing a substance misuse treatment service in the North East, in order to inform policy makers, commissioners, and providers of substance misuse treatment and prevention. Semi-structured qualitative interviews were conducted with an opportunistic sample of n = 15 adult participants (aged 18 years and over) and n = 10 adolescent participants (aged between 13 and 17 years). Interviews were audio-recorded, transcribed, anonymised, and analysed thematically. Five key themes were identified: (1) initiation of substance use, (2) early life experiences, (3) the bi-directional relationship of mental health and substance use, (4) cessation of substance use, and (5) accessing treatment. Future preventative interventions should focus on providing support to individuals who have been exposed to adverse childhood experiences, with treatment provision for individuals experiencing co-occurring mental health and substance use issues taking a more holistic approach

Healthier central England or North-South divide? Analysis of national survey data on smoking and high-risk drinking.

OBJECTIVES: This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics. DESIGN: Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies. MEASURES: Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT. RESULTS: In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p0.05) CONCLUSIONS: In adjusted analyses, smoking and high-risk drinking appear less common in 'central England' than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities

Probing Spin-Charge Relation by Magnetoconductance in One-Dimensional Polymer Nanofibers

Polymer nanofibers are one-dimensional organic hydrocarbon systems containing conducting polymers where the non-linear local excitations such as solitons, polarons and bipolarons formed by the electron-phonon interaction were predicted. Magnetoconductance (MC) can simultaneously probe both the spin and charge of these mobile species and identify the effects of electron-electron interactions on these nonlinear excitations. Here we report our observations of a qualitatively different MC in polyacetylene (PA) and in polyaniline (PANI) and polythiophene (PT) nanofibers. In PA the MC is essentially zero, but it is present in PANI and PT. The universal scaling behavior and the zero (finite) MC in PA (PANI and PT) nanofibers provide evidence of Coulomb interactions between spinless charged solitons (interacting polarons which carry both spin and charge)

The role of training in IBA implementation beyond primary health care settings in the UK

There has been a considerable drive to encourage a wide range of professional groups to incorporate alcohol screening (or identification) and brief advice (IBA) into their everyday practice. This article aims to examine the role of training in promoting IBA delivery in contexts outside primary care and other health settings. The data are drawn mainly from a structured online survey supplemented by illustrative material from nine qualitative interviews and insights from an expert workshop. Findings support the results from other research that issues relating to role relevance and role security continue to act as barriers to professional change. Furthermore, issues of organisational commitment and organisational barriers are insufficiently addressed in strategy to promote wider use of IBA. The article concludes that development of appropriate training for alcohol IBA needs to take account of the role of IBA within a complex interactive system of related services and help seeking pathways and consider how training can contribute to changing both professional attitudes and behaviours and organisational approaches to implementing and sustaining IBA in everyday professional practice