The impact of time spent in natural outdoor spaces on children’s language, communication and social skills : a systematic review protocol

There has been increasing interest over the past decade with regard to the health and wellbeing implications of time spent outdoors in nature for children. Universal systematic reviews of evidence report benefits to physical health, social-emotional mental health and wellbeing, cognition and academic learning. Internationally, there is indicative evidence to suggest outdoor engagement with nature may also impact children’s language and communication skills, skills that are critical to development, education, social relationships and life opportunities. Yet, at present such evidence has not been synthesised. Despite evidence for the benefits of the outdoors, the amount of time children are spending outdoors is in rapid decline, and has been further exacerbated by the COVID- 19 pandemic. Alongside this are increasing numbers of children starting primary education with significant speech, language and communication needs (SLCN) which remain persistent over time. With established wide-reaching benefits of nature to children’s physical and mental health and psychological development, there is a need to further explore the more specific impacts of the natural environment on children’s language, communication and social skills, which could provide a unique opportunity to consider nature as a universal public health intervention for SLCN. The current review will aim to synthesise existing qualitative and quantitative evidence of the impact of time spent in natural outdoor spaces on the language, communication and social skills of 2–11-year-old children. Literature will be searched across seven databases and considered for inclusion against inclusion and exclusion criteria. Potential implications of the review include informing public health practice and policy for child development and education, informing priorities for speech, language, and communication interventions, and providing directions for future international research

The impact of Covid-19 restrictions and changes to takeaway regulations in England on consumers’ intake of, and method of accessing out-of-home foods:a longitudinal, mixed-methods study

COVID-19 restrictions significantly impacted the operations of Fast Food and Full Service retail-ers. Full Service retailers were permitted to operate as takeaway outlets without needing to seek formal changes in planning permissions. We conducted a study to determine consumers’ intake of, and mode of accessing foods from Fast Food and Full Service retailers during various Covid-19 restrictions and changes to takeaway/delivery regulations, and their experiences of this. Methods: We conducted a longitudinal, mixed-methods study comprising three surveys examining intake frequency and modes of accessing retailers, and two rounds of qualitative focus groups exploring related experiences. Data were collected from May 2021 – March 2022. Participants were adults living in Northern England (n = 701 at T1); a sub-sample participated in focus groups (n = 22). Intake data were presented descriptively; an ordered logit regression explored factors associated with intake frequency. Focus group data were analysed using Framework Analysis. Results: Mean weekly intake frequency from Fast Food retailers at T1, T2 and T3 was 0.96 (SD 1.05), 1.08 (SD 1.16) and 1.06 times (SD 1.12), respectively. For Full Service retailers, this was 0.36 (SD 0.69), 0.75 (1.06) and 0.71 (SD 0.99) times, respectively. Food access issues (OR (SE): T1 = 1.65 (0.40), T2 = 2.60 (0.66), T = 2.1 (0.62)) and obesity (T1 = 1.61 (0.31), T2 = 2.21 (0.46), T3 = 1.85 (0.42)) were pos-itively associated with intake from Fast Food, but not Full Service retailers. Delivery services were commonly used to access Fast Food (30–34% participants), but not Full Service retailers (6-10% participants). As Covid-19 restrictions eased, participants were eager to socialise on-premises at Full Service retailers. Conclusions: Takeaway/delivery services were seldom used to access Full Service retailers; use of delivery services to access Fast Food was high. Policy-makers must rec-ognise delivery services as a growing part of the food environment, and the challenges they pose to planning policies for obesity prevention. Keywords: Food delivery service

Socio-economic status has a limited association with knowledge and attitudes towards bystander cardiopulmonary resuscitation: a cross-sectional study in North England

Background: Bystander cardiopulmonary resuscitation (BCPR) is a critical link in the ‘Chain of Survival’, yet in the UK, is undertaken in only 40% of out of hospital cardiac arrests (OHCAs). Lower rates of BCPR have been correlated with lower socio-economic status (SES). This study aimed to explore how knowledge and attitudes about BCPR linked to SES across North East and North Cumbria in England. Methods: Cross-sectional study between July-December 2021 surveying individuals from areas of varying SES. Results: Six hundred and one individuals completed the survey instrument (mean age=51.9 years, range=18-95, standard deviation=17.7; 52.2% (n=313) female). Increased age was associated with being less willing to call 999 (p<0.001) and follow call handler advice (p<0.001). Female respondents were less comfortable performing BCPR than male respondents (p=0.006). Individuals from least deprived areas were less likely to report comfort performing CPR, (p=0.016) and less likely to know what a Public Access Defibrillator (PAD) is for, (p=0.025). Higher education level was associated with increased ability to recognise OHCA (p=0.005) and understanding of what a PAD is for (p<0.001). Individuals with higher income were more likely to follow advice regarding BCPR (p=0.017) and report comfort using a PAD (p=0.029). Conclusion: SES is a poor indicator of knowledge, willingness, and perceived competency to perform BCPR. Policy makers should avoid using SES alone to target interventions and focus more on individual characteristics such as age and ethnicity. Future research should examine how cultural identity and social cohesion intersect with these characteristics to influence willingness to perform BCPR

The Birchwood Junk Food Cafe, Skelmersdale

The University of Manchester conducted an evaluation of the Birchwood Junk Food Cafe, Skelmersdale, to assess the additional benefits of their adapted approach. A mixed methods evaluation was conducted, including interviews and questionnaires with both customers and those running the cafe. This highlighted benefits of the cafe and the impact of the cafe on its volunteers and customers. Key messages: Junk Food Cafes have the potential to have a positive impact on public health. Junk Food Cafes have the potential to help combat food poverty and social isolation in deprived communities

Measurement Instruments for Integration within Children and Young People Healthcare Systems and Networks: A Rapid Review of the International Literature

Introduction: Robust measures of integration are essential for assessment of the development, design and implementation of integration within healthcare systems. This review aimed to identify measurement instruments for integration within children and young people’s (CYP) healthcare systems (PROSPERO registration number CRD42021235383). Methods: We searched electronic databases (PubMED and Ovid Embase) using three main concepts: ‘(integrated care) AND (child population) AND (measurement)’, along with additional searches. Results: Fifteen studies describing 16 measurement instruments were eligible for inclusion. The majority of studies were conducted in the USA. There was a diversity of health conditions included in the studies. The most frequent type of assessment used was a questionnaire (11 identified), but interviews, patient data and healthcare records, and focus groups were also used. Integration outcomes assessed were quality of care coordination, quality of collaboration, continuity of care, completeness of care, structure of care, quality of communication, and local implementation of integrated care. Conclusion: A variety of instruments for the measurement of integration within CYP healthcare systems were identified. Further work on the standardisation of integrated care measures would be valuable; however, it is important that instruments and measures meet the needs of specific settings, populations and conditions being studied

Measurement Instruments for Integration within Children and Young People Healthcare Systems and Networks: A Rapid Review of the International Literature

Introduction: Robust measures of integration are essential for assessment of the development, design and implementation of integration within healthcare systems. This review aimed to identify measurement instruments for integration within children and young people’s (CYP) healthcare systems (PROSPERO registration number CRD42021235383).Methods: We searched electronic databases (PubMED and Ovid Embase) using three main concepts: ‘(integrated care) AND (child population) AND (measurement)’, along with additional searches.Results: Fifteen studies describing 16 measurement instruments were eligible for inclusion. The majority of studies were conducted in the USA. There was a diversity of health conditions included in the studies. The most frequent type of assessment used was a questionnaire (11 identified), but interviews, patient data and healthcare records, and focus groups were also used. Integration outcomes assessed were quality of care coordination, quality of collaboration, continuity of care, completeness of care, structure of care, quality of communication, and local implementation of integrated care.Conclusion: A variety of instruments for the measurement of integration within CYP healthcare systems were identified. Further work on the standardisation of integrated care measures would be valuable; however, it is important that instruments and measures meet the needs of specific settings, populations and conditions being studied

Food insecurity in adults with severe mental illness living in Northern England: A co-produced cross-sectional study

This study aimed to explore food insecurity prevalence and experiences of adults with severe mental illness living in Northern England.MethodsThis mixed-methods cross-sectional study took place between March and October 2022. Participants were adults with self-reported severe mental illness living in Northern England. The survey included demographic, health, and financial questions. Food insecurity was measured using the US Department of Agriculture Adult Food Security measure. Quantitative data were analysed using descriptive statistics and binary logistic regression; and qualitative data using content analysis.ResultsIn total, 135 participants completed the survey, with a mean age of 44.7 years (SD: 14.1, range: 18–75 years). Participants were predominantly male (53.3%), white (88%) and from Yorkshire (50.4%). The food insecurity prevalence was 50.4% (n = 68). There was statistical significance in food insecurity status by region (p = 0.001); impacts of severe mental illness on activities of daily living (p = 0.02); and the Covid pandemic on food access (p &lt; 0.001). The North West had the highest prevalence of food insecurity (73.3%); followed by the Humber and North East regions (66.7%); and Yorkshire (33.8%). In multivariable binary logistic regression, severe mental illness' impact on daily living was the only predictive variable for food insecurity (odds ratio = 4.618, 95% confidence interval: 1.071–19.924, p = 0.04).ConclusionThe prevalence of food insecurity in this study is higher than is reported in similar studies (41%). Mental health practitioners should routinely assess and monitor food insecurity in people living with severe mental illness. Further research should focus on food insecurity interventions in this population

“I’ll meet you at our bench”: adaptation, innovation and resilience among VCSE organisations who supported marginalised and minoritised communities during the Covid-19 pandemic in Northern England – a qualitative focus group study

Background: The Covid-19 pandemic has exacerbated pre-existing inequalities and increased adversity and challenges for vulnerable and marginalised communities worldwide. In the UK, the Voluntary Community and Social Enterprise (VCSE) sector play a vital role in supporting the health and wellbeing of people who are marginalised or experiencing multiple complex needs. However, only a small number of studies have focused on the impact that Covid-19 had on the VCSE sector. Methods: As part of a Health Inequalities Impact Assessment (HIIA), we conducted qualitative focus groups with staff and volunteers from five organisations to examine short, medium and longer-term impacts of Covid-19 upon the VCSE sector in Northern England. Nine online focus groups were conducted between March and July 2021. Findings: Focus group transcripts were analysed using Framework Analysis and yielded three central themes: (1) exacerbation of pre-existing inequalities, adversity and challenges for vulnerable and marginalised populations; (2) the ‘price’ of being flexible, innovative and agile for VCSE staff and volunteers; and (3) the voluntary sector as a ‘lifeline’ - organisational pride and resilience. Conclusions: While the voluntary sector ‘adapted at pace’ to provide support during Covid-19 and in its continued aftermath, this resilience has potentially come at the cost of workforce and volunteer wellbeing, compounded by political obstacles and chronic shortage in funding and support. The VCSE sector has a vital role to play in the post-lockdown ‘levelling up’ agenda. The expertise, capacity and resilience of VCSE organisations, and their ability to respond to Covid-19, should be celebrated, recognised and supported adequately to maintain its resilience. To not do so threatens the sector’s sustainability and risks jeopardising attempts to involve the sector in addressing the social determinants of health