Professor Anne-Marie Bagnall

BACKGROUND: Typical antipsychotic drugs are widely used as the first line treatment for people with schizophrenia. However, the atypical class of antipsychotic drugs is making important inroads into this approach. 'Atypical' is a term widely used to describe some antipsychotics which have a low propensity to produce movement disorders, sedation and raised serum prolactin. There is some suggestion that the different adverse effect profiles of the atypical antipsychotic group make them more acceptable to people with schizophrenia. Molindone has a similar profile to quetiapine (a novel atypical antipsychotic), with very low binding to all receptors. Some authors have suggested that molindone is safer than other 'typical' antipsychotics in that extrapyramidal adverse effects are not usually seen at clinically effective antipsychotic doses and that it should therefore be classed as an atypical antipsychotic. OBJECTIVES: To determine the effects of molindone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1999), PSYNDEX (1977-1999), and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. The manufacturer of molindone and authors of trials were contacted. SELECTION CRITERIA: All randomised controlled trials that compared molindone to other treatments for schizophrenia and schizophrenia-like psychoses were included by independent assessment. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences (WMD) were calculated. All data were inspected for heterogeneity. MAIN RESULTS: Thirteen studies were included in the review. Data for this compound range from very short (10 day) studies of the intramuscular preparation to trials lasting over three months. For measures of global state available data do not justify any conclusions on the comparative efficacy of molindone and placebo. When compared to other typical antipsychotics no difference in effectiveness was evidenced (doctors' RR 1.13, CI 0.69 to 1.86; nurses' RR 1.23, CI 0.82 to 1.86). It is no more or less likely than typical drugs to cause movement disorders, but causes significantly more weight loss (RR 2.78, CI 1.10 to 6.99). REVIEWER'S CONCLUSIONS: The strength of the evidence relating to this compound is limited, owing to small sample size, poor study design, limited outcomes and incomplete reporting. Molindone may be an effective antipsychotic; however, its adverse effect profile does not differ significantly from that of typical antipsychotics, apart from the event of weight loss. At present there is no evidence to suggest that it may have an atypical profile.

To examine four key areas: (1) the effectiveness and cost-effectiveness of spinal fixation surgery, (2) the consequences of immediate versus delayed referral to a spinal injuries unit (SIU), (3) the number of people with a new spinal cord injury (SCI) who are discharged from hospital without ever being transferred to an SIU, and (4) the effectiveness and cost-effectiveness of steroids for people with SCI. Searches were carried out on several databases and also on the Internet. Specialist SCI and spinal injury related websites were searched, specifically the Spinal Injuries Association, the British Association of Spinal Cord Injury Specialists and the National Spinal Cord Injury Association. Three separate search strategies were devised to find studies relating to the four key areas. Two reviewers independently screened all study citations for inclusion. The lists of all retrieved studies were scanned for additional studies. Quality of studies was assessed and data were extracted by one reviewer then checked by the second. Data from included studies were summarised within each key area. For dichotomous data, relative risks were calculated with 95% confidence intervals. Pooled relative risks were calculated as appropriate. For continuous data, mean differences with 95% confidence intervals were calculated and, if data were pooled, weighted mean differences were calculated. Searches were carried out to identify economic evaluations, details of these together with a critical appraisal of quality are presented in structured tables. Quality was assessed using a checklist supplemented with additional comments on the adequacy of methodology where appropriate. For spinal fixation versus no fixation, 68 retrospective observational studies were found that suggested some benefits of fixation surgery. Only four studies were found on fixation surgery in SIUs compared with non-SIU hospitals and no significant differences were seen. All 28 studies concerning delayed referral to a SIU were retrospective observational studies. In most, study details were poorly reported and there was doubt over the comparability of groups at baseline and on confounding factors. Times of referral and transfer were not reported separately. Evidence suggested an effect in favour of the SIU group for neurological improvement. No relevant published studies of any design were found regarding how many people with a new SCI are discharged from hospital without ever being transferred to an SIU. Two systematic reviews were found that assessed the effectiveness of steroids. No studies were identified that considered both costs and the impact on patient outcomes of a given intervention. Although there was evidence to suggest some benefits of fixation surgery and also a benefit of immediate referral to SIUs compared with delayed or no referral, owing to the limitations of the data these should be interpreted with caution. Not enough data were found to assess whether surgery is more beneficial when carried out in SIUs and further research is required in this area. Well-designed prospective observational studies with appropriately matched controls are needed. High-dose methylprednisolone steroid therapy may be effective in promoting some degree of neurological recovery if given within 8 hours of injury. There is a need for more randomised controlled trials (RCTs) of pharmacological therapy for acute SCI. No published studies of any design were found to answer the question of how many people with acute SCI are discharged from hospital without ever being transferred to an SIU. Primary research involving audit of selected hospital records should be commissioned and published. The search strategy did not identify any full economic evaluations. Future research should include full economic evaluations, possibly alongside a large RCT, which fully consider the costs and consequences of implementing interventions.

This review aimed to quantify the benefit of patient-based educational interventions in the management of cancer pain. We undertook a systematic review and meta-analysis of experimentally randomised and non-randomised controlled clinical trials identified from six databases from inception to November 2007.Two reviewers independently selected trials comparing intervention (formal instruction on cancer pain and analgesia on an individual basis using any medium) to usual care or other control in adults with cancer pain. Methodological quality was assessed, and data extraction undertaken by one reviewer with a second reviewer checking for accuracy. We used random effects model to combine the effect estimates from studies. Main outcome measures were effects on knowledge and attitudes towards cancer pain and analgesia, and pain intensity. Twenty-one trials (19 randomised) totalling 3501 patients met inclusion criteria, and 15 were included in the meta-analysis. Compared to usual care or control, educational interventions improved knowledge and attitudes by half a point on 0–5 rating scale (weighted mean difference 0.52, 95% confidence interval 0.04–1.0), reduced average pain intensity by over one point on 0–10 rating scale (WMD −1.1, −1.8 to −0.41) and reduced worst pain intensity by just under one point (WMD −0.78, −1.21 to −0.35). We found equivocal evidence for the effect of education on self-efficacy, but no significant benefit on medication adherence or on reducing interference with daily activities. Patient-based educational interventions can result in modest but significant benefits in the management of cancer pain, and are probably underused alongside more traditional analgesic approaches.

BACKGROUND: Sertindole is an atypical antipsychotic, which is thought to give a lower incidence of extrapyramidal side effects at clinically effective doses than typical antipsychotic drugs. In December 1998, Lundbeck Ltd., the manufacturers of sertindole, voluntarily suspended the availability of the drug due to concerns about cardiac arrhythmia and sudden cardiac death associated with its use. Sertindole has therefore been withdrawn from the market pending discussion with the European Regulatory Authority over cardiac safety. OBJECTIVES: To determine the effects of sertindole compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), EMBASE (1980-1999), LILACS (1982-1996), MEDLINE (1966-1999), PSYNDEX (1977-1995) and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. The manufacturer of sertindole and authors of trials were contacted. SELECTION CRITERIA: All randomised controlled trials that compared sertindole to placebo or other antipsychotic drug treatments were included by independent assessment. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) or numbers needed to harm (NNH) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences (WMD) were calculated. All data were inspected for heterogeneity. MAIN RESULTS: Two large important studies were excluded, because they did not report any usable data. The two that were included suggested that sertindole was more antipsychotic than placebo, as acceptable as placebo and better tolerated than haloperidol (NNT=9, RR 0.63 CI 0.41 to 0.96). Sertindole was associated with fewer movement disorders than haloperidol but was shown to cause more weight gain (NNH=9 RR 6.33, CI 1.92 to 20.92), rhinitis (NNH=8, RR 1.74, CI 1,28 to 2.36) and possibly male sexual dysfunction. Cardiac problems (QTc intervals of at least 500msec) were evident even in the randomised trials (NNH=13 RR 23, CI 1.37 to 386.60). REVIEWER'S CONCLUSIONS: Because of the cardiac problems, even evident within poorly reported studies, at present sertindole should, if possible, be avoided. If sertindole is to be reintroduced, gold-standard evidence of its clinical benefits will need to far outweigh its real risks.

BACKGROUND: Ovarian cancer is the most common gynaecological cancer with an annual incidence of 21.6 per 100,000 in England and Wales. Due to the often asymptomatic nature of the early stages of the disease, most cases are not detected until the advanced stages. Consequently, the prognosis after diagnosis is poor and the 5-year survival rate in the UK is only about 30%. Current recommendations suggest that first-line chemotherapy for ovarian cancer should involve paclitaxel and platinum (Pt)-based therapy (cisplatin/ carboplatin), however, most patients develop resistant or refractory disease and require second-line therapy. Patients may respond to re-challenge with Pt-agents if the treatment-free interval is > 6 months, but an alternative is often required. Topotecan is one of six drugs currently licensed in the UK for second-line therapy, and recent reviews suggest that it has modest efficacy in the treatment of advanced disease and performs favourably against paclitaxel. However, these reviews are based on a limited number of reports mainly consisting of non-randomised Phase I and II studies. OBJECTIVES OF THE REVIEW: To examine the clinical effectiveness and cost-effectiveness of oral and intravenous topotecan (Hycamtin, SmithKline Beecham, UK) for the treatment of all stages of ovarian cancer. SEARCH STRATEGY: Sixteen electronic databases from inception to September 2000 and Internet resources were searched, in addition to the bibliographies of retrieved articles and submissions from pharmaceutical companies. INCLUSION AND EXCLUSION CRITERIA: Two reviewers independently screened all titles/abstracts and included/excluded studies based on full copies of manuscripts. Any disagreements were resolved through discussion. Only randomised controlled trials (RCTs) and full economic evaluations comparing topotecan to non-topotecan regimens were included. All stages of therapy and disease were considered, and the outcomes included were survival, response, symptom relief, quality of life, adverse effects and costs. METHODS: DATA EXTRACTION STRATEGY: Data were extracted into an Access database by one reviewer and checked by a second. Any disagreements were resolved through discussion. METHODS: QUALITY ASSESSMENT STRATEGY: Two reviewers, using specified criteria, independently assessed the quality of the clinical effectiveness studies and the economic evaluations. Any disagreements were resolved through discussion. METHODS: ANALYSIS STRATEGY: Due to the limited number of studies included in the review and the fact that they compared topotecan with different comparators, the out-come data could not be pooled statistically. Clinical effectiveness data are discussed separately under the different outcome subheadings. For time-to-event data, hazard ratios with 95% confidence intervals are presented where available, and for the remaining outcomes, relative risks are reported or calculated where sufficient data were available. Relative risk data are also presented in the form of Forest plots without pooled estimates. Economic data are presented in the form of a summary and critique of the evidence, and a grading (A-I) assigned to each study indicating the direction and magnitude of the cost-effectiveness data. INCLUDED STUDIES: A total of 568 titles/abstracts were identified and screened for relevance. Full copies of 72 papers were assessed and seven published manuscripts reporting details of two studies of clinical effectiveness and one economic evaluation were included. Further details of the two clinical effectiveness studies and two new economic evaluations were identified from confidential company submissions. Overall, two international multicentre RCTs of effectiveness comparing topotecan with paclitaxel (trial 039) and topotecan with caelyx (trial 30-49) were included in the review. The three economic evaluations included in the review comprised one cost-minimisation analysis (CMA) comparing topotecan with caelyx, one cost-consequences analysis (CCA) comparing topotecan with paclitaxel, etoposide and altretamine and one cost-effectiveness analysis (CEA) comparing topotecan with paclitaxel. RESULTS: QUALITY OF CLINICAL EFFECTIVENESS DATA: Both clinical effectiveness studies (trial 30-49 and 039) were of reasonable quality, although it was unclear whether either performed valid intention-to-treat analyses. In addition, trial 30-49 failed to state whether the outcome assessors were blinded to treatment allocation. RESULTS --QUALITY OF ECONOMIC EVALUATIONS: The CCA (comparing topotecan with three comparators) was of poor quality and of little relevance to the UK NHS. The CMA and CEA were of reasonable quality overall and relevant to the UK NHS. However, both, in particular the CEA, suffered from methodological problems, and thus their findings should be interpreted with caution. RESULTS: ASSESSMENT OF CLINICAL EFFECTIVENESS: The assessment of clinical effectiveness was based on limited data. Only two trials with a total of 709 participants were identified. In general, with a few minor exceptions, there were no statistically significant differences between topotecan and paclitaxel, or topotecan and caelyx in survival, response rate, median time to response, median duration of response and quality of life. Significant differences that were reported were mainly identified in subgroup analyses (Pt-sensitive disease and disease without ascites) of questionable validity and their relevance to a general advanced ovarian cancer patient population undergoing second-line chemotherapy is unclear. However, statistically significant differences were observed in the incidence of adverse effects. Topotecan was associated with increased incidences of haematological toxicities (including neutropenia, leukopenia, anaemia and thrombocytopenia), alopecia, nausea and vomiting. Caelyx-treated patients suffered from significantly increased incidences of Palmar-Plantar erythrodysesthesia, stomatitis, mucous membrane disorders and skin rashes. Paclitaxel was associated with significant increases in alopecia, arthralgia, myalgia, neuropathy, paraesthesiae, skeletal pain and flushing. RESULTS: ASSESSMENT OF COST-EFFECTIVENESS: The assessment of cost-effectiveness was also based on limited data, with three evaluations identified, one of which was not relevant. The two remaining studies, comparing topotecan with paclitaxel (CEA) and topotecan with caelyx (CMA), both used effectiveness data from multicentre RCTs and based their costs on 1999/2000 UK sources. The evaluations were conducted from a UK NHS perspective and findings presented in GB pounds/Euros. Topotecan for the second-line treatment of advanced ovarian cancer was shown to be more cost-effective than paclitaxel (32,513 GB pounds versus 46,186 GB pounds per person in terms of any response (complete or partial), incremental cost-effectiveness = 3065 GB pounds) in all respects except cost per time without toxicity or symptoms, but less cost-effective than caelyx (14,023 GB pounds versus 9979 GB pounds per person regardless of whether the patient responded). However, direct comparisons of the cost findings between the two studies is difficult because they used different designs, different time horizons for the cost analyses and the findings were presented as costs per person for only patients who responded in one study (topotecan versus paclitaxel) and costs per person regardless of whether they responded in the other study (topotecan versus caelyx). CONCLUSIONS: This review indicates that there is little evidence in the form of RCTs on which to base an assessment of the effectiveness of topotecan as second-line therapy for advanced ovarian cancer. The evidence suggests there were no statistically significant differences overall between topotecan and paclitaxel, or topotecan and caelyx in clinical outcomes. However, statistically significant differences were observed in the incidence of adverse effects. The clinical significance of the findings is not discussed. Overall, the effects of topotecan could at best be described as modest, but the alternative agents offer no real advantages except fewer side-effects and possibly improved cost-effectiveness. Both of the clinical effectiveness studies on which this evidence is based had methodological flaws, the most serious being the lack of a blinded assessor in the topotecan versus caelyx trial, which is important for unbiased assessment of response outcomes. The economic evaluations also suffered from a number of potential problems. CONCLUSIONS: RECOMMENDATIONS FOR RESEARCH: Further good quality RCTs and CEAs are required comparing topotecan with other licensed and potentially useful (soon to be licensed) second-line treatments for ovarian cancer. At present, it is difficult to make any decisions about topotecan and other drugs for second-line therapy without good quality direct comparisons. In view of the ongoing studies identified, an update of the current review should be considered in approximately 18 months (Summer 2002) or possibly sooner if the recently commissioned National Institute for Clinical Excellence review of caelyx for ovarian cancer identifies additional data relevant to topotecan.

BACKGROUND: Typical antipsychotic drugs are widely used as the first line treatment for people with schizophrenia. However, the atypical class of antipsychotic drugs are making important inroads into this approach. Atypical is a widely used term used to describe some antipsychotics which have a low propensity to produce movement disorders, sedation and raised serum prolactin. There is some suggestion that the different adverse effect profiles of the atypical antipsychotic group make them more acceptable to people with schizophrenia. Ziprasidone is one of the newer atypicals with a high serotonin/dopamine receptor affinity. OBJECTIVES: To determine the effects of ziprasidone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1996), PSYNDEX (1977-1995) and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. Pharmaceutical companies and authors of trials were contacted. SELECTION CRITERIA: All randomised controlled trials that compared ziprasidone to other treatments for schizophrenia and schizophrenia-like psychoses were included by independent assessment. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences were calculated (WMD). All data were inspected for heterogeneity. MAIN RESULTS: Data for this compound range from very short (1 week) studies of the intramuscular preparation, to trials lasting over six months. For measures of mental state ziprasidone seems more effective than placebo (RR 0.8 CI 0.7-0.9) and as effective as haloperidol (RR 0.8 CI 0.7-1). It is less likely than haloperidol to cause movement disorders (RR 0.4 CI 0.2-0.6), but may cause more nausea and vomiting (RR 2.1 CI 1.2-3.8). The injected form of the drug may cause more pain at the injection site than haloperidol (RR 5.3 CI 1.3-22). REVIEWER'S CONCLUSIONS: Currently data are limited. Ziprasidone may be an effective antipsychotic with less extrapyramidal effects than haloperidol. It also may, however, cause more nausea and vomiting than the typical drugs, and, at present, there is no data suggesting that it is different to other atypical compounds. Well planned, conducted and reported long term randomised trials are needed if ziprasidone is to be accepted into everyday use.

BACKGROUND: Risperidone is one of a number of 'atypical antipsychotics' which are currently being marketed for the treatment of those with schizophrenia, largely on the basis of claims of improved tolerability and effectiveness compared to much cheaper conventional antipsychotics. The efficacy of risperidone has already been compared to conventional drugs, but it remains unclear how risperidone compares with other atypical antipsychotic drugs such as clozapine. OBJECTIVES: To determine the effects of risperidone compared with other atypical antipsychotic drugs for schizophrenia. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library (Issue 1, 2000), The Cochrane Schizophrenia Group's Register (January 1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1999), PSYNDEX (1977-1999) and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. Pharmaceutical companies and authors of trials were contacted. SELECTION CRITERIA: All randomised controlled clinical trials that compared risperidone to other atypical antipsychotic treatments for schizophrenia and schizophrenia-like psychoses were included by independent assessment. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, standardised and weighted mean differences were calculated (SMD, WMD). All data were inspected for heterogeneity. MAIN RESULTS: Nine studies were obtained, comparing risperidone with clozapine (five studies - largely amongst treatment resistant patients); olanzapine (three studies); and amisulpiride (one study). The research was beset by problems of high attrition rates and short term follow up. Clozapine does seem equally acceptable to risperidone in the short term (leaving the study early, n=466, RR 1. 00 CI 0.73-1.37). For most other outcomes wide confidence intervals were obtained, which meant that it was impossible to judge whether the two compounds were equally effective, or whether one was in fact superior to the other. Olanzapine and risperidone seem broadly similar according to numbers of patients responding to treatment (40% reduction in PANSS scores: n=339, RR 1.14, CI 0.99-1.32). Olanzapine caused fewer people to leave the study early (n=404, RR 1. 31 CI 1.06-1.60; NNT 8 CI 4-32) and fewer extrapyramidal side effects (n=339, RR 1.67 CI 1.14-2.46; NNH 8 CI 5-33), although comparative doses of risperidone were higher than those recommended in practice. In one single study (n=228) amisulpiride seemed broadly similar to risperidone in most respects. There were no useful data presented relating to service use and costs. Very few data relating to quality of life were presented. REVIEWER'S CONCLUSIONS: The equivalence of clozapine and risperidone for treatment resistant schizophrenia cannot yet be assumed and there seems to be little to chose between risperidone and both olanzapine and amisulpiride. The research is limited in many respects, and longer term studies measuring clinically important outcomes, including service use and quality of life are needed to judge the comparative value of the various atypical drugs.

BACKGROUND: Typical antipsychotic drugs are widely used as the first line treatment for people with schizophrenia. However, the atypical class of antipsychotic drugs is making important inroads into this approach. 'Atypical' is a term widely used to describe some antipsychotics which have a low propensity to produce movement disorders, sedation and raised serum prolactin. There is some suggestion that the different adverse effect profiles of the atypical antipsychotic group make them more acceptable to people with schizophrenia. Molindone has a similar profile to quetiapine (a novel atypical antipsychotic), with very low binding to all receptors. Some authors have suggested that molindone is safer than other 'typical' antipsychotics in that extrapyramidal adverse effects are not usually seen at clinically effective antipsychotic doses and that it should therefore be classed as an atypical antipsychotic. OBJECTIVES: To determine the effects of molindone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1999), PSYNDEX (1977-1999), and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. The manufacturer of molindone and authors of trials were contacted. SELECTION CRITERIA: All randomised controlled trials that compared molindone to other treatments for schizophrenia and schizophrenia-like psychoses were included by independent assessment. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences (WMD) were calculated. All data were inspected for heterogeneity. MAIN RESULTS: Thirteen studies were included in the review. Data for this compound range from very short (10 day) studies of the intramuscular preparation to trials lasting over three months. For measures of global state available data do not justify any conclusions on the comparative efficacy of molindone and placebo. When compared to other typical antipsychotics no difference in effectiveness was evidenced (doctors' RR 1.13, CI 0.69 to 1.86; nurses' RR 1.23, CI 0.82 to 1.86). It is no more or less likely than typical drugs to cause movement disorders, but causes significantly more weight loss (RR 2.78, CI 1.10 to 6.99). REVIEWER'S CONCLUSIONS: The strength of the evidence relating to this compound is limited, owing to small sample size, poor study design, limited outcomes and incomplete reporting. Molindone may be an effective antipsychotic; however, its adverse effect profile does not differ significantly from that of typical antipsychotics, apart from the event of weight loss. At present there is no evidence to suggest that it may have an atypical profile.

Health Technology Assessment Volume: 6, Issue: 13, Published in June 2002

The research evidence on the effectiveness of interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) published in a recent issue of Effective Health Care is reviewed.

Health Technology Assessment Volume: 6, Issue: 14, Published in December 2002

OBJECTIVES: To examine four key areas: (1) the effectiveness and cost-effectiveness of spinal fixation surgery, (2) the consequences of immediate versus delayed referral to a spinal injuries unit (SIU), (3) the number of people with a new spinal cord injury (SCI) who are discharged from hospital without ever being transferred to an SIU, and (4) the effectiveness and cost-effectiveness of steroids for people with SCI. DATA SOURCES: Searches were carried out on several databases and also on the Internet. Specialist SCI and spinal injury related websites were searched, specifically the Spinal Injuries Association, the British Association of Spinal Cord Injury Specialists and the National Spinal Cord Injury Association. REVIEW METHODS: Three separate search strategies were devised to find studies relating to the four key areas. Two reviewers independently screened all study citations for inclusion. The lists of all retrieved studies were scanned for additional studies. Quality of studies was assessed and data were extracted by one reviewer then checked by the second. Data from included studies were summarised within each key area. For dichotomous data, relative risks were calculated with 95% confidence intervals. Pooled relative risks were calculated as appropriate. For continuous data, mean differences with 95% confidence intervals were calculated and, if data were pooled, weighted mean differences were calculated. Searches were carried out to identify economic evaluations, details of these together with a critical appraisal of quality are presented in structured tables. Quality was assessed using a checklist supplemented with additional comments on the adequacy of methodology where appropriate. RESULTS: For spinal fixation versus no fixation, 68 retrospective observational studies were found that suggested some benefits of fixation surgery. Only four studies were found on fixation surgery in SIUs compared with non-SIU hospitals and no significant differences were seen. All 28 studies concerning delayed referral to a SIU were retrospective observational studies. In most, study details were poorly reported and there was doubt over the comparability of groups at baseline and on confounding factors. Times of referral and transfer were not reported separately. Evidence suggested an effect in favour of the SIU group for neurological improvement. No relevant published studies of any design were found regarding how many people with a new SCI are discharged from hospital without ever being transferred to an SIU. Two systematic reviews were found that assessed the effectiveness of steroids. No studies were identified that considered both costs and the impact on patient outcomes of a given intervention. CONCLUSIONS: Although there was evidence to suggest some benefits of fixation surgery and also a benefit of immediate referral to SIUs compared with delayed or no referral, owing to the limitations of the data these should be interpreted with caution. Not enough data were found to assess whether surgery is more beneficial when carried out in SIUs and further research is required in this area. Well-designed prospective observational studies with appropriately matched controls are needed. High-dose methylprednisolone steroid therapy may be effective in promoting some degree of neurological recovery if given within 8 hours of injury. There is a need for more randomised controlled trials (RCTs) of pharmacological therapy for acute SCI. No published studies of any design were found to answer the question of how many people with acute SCI are discharged from hospital without ever being transferred to an SIU. Primary research involving audit of selected hospital records should be commissioned and published. The search strategy did not identify any full economic evaluations. Future research should include full economic evaluations, possibly alongside a large RCT, which fully consider the costs and consequences of implementing interventions.

Health Technology Assessment Volume: 7, Issue: 13, Published in June 2003

BACKGROUND: Balanced decisions about health care interventions require reliable evidence on harms as well as benefits. Most systematic reviews focus on efficacy and randomised trials, for which the methodology is well established. Methods to systematically review harmful effects are less well developed and there are few sources of guidance for researchers. We present our own recent experience of conducting systematic reviews of harmful effects and make suggestions for future practice and further research. METHODS: We described and compared the methods used in three systematic reviews. Our evaluation focused on the review question, study designs and quality assessment. RESULTS: One review question focused on providing information on specific harmful effects to furnish an economic model, the other two addressed much broader questions. All three reviews included randomised and observational data, although each defined the inclusion criteria differently. Standard methods were used to assess study quality. Various practical problems were encountered in applying the study design inclusion criteria and assessing quality, mainly because of poor study design, inadequate reporting and the limitations of existing tools. All three reviews generated a large volume of work that did not yield much useful information for health care decision makers. The key areas for improvement we identified were focusing the review question and developing methods for quality assessment of studies of harmful effects. CONCLUSIONS: Systematic reviews of harmful effects are more likely to yield information pertinent to clinical decision-making if they address a focused question. This will enable clear decisions to be made about the type of research to include in the review. The methodology for assessing the quality of harmful effects data in systematic reviews requires further development.

Objectives: To evaluate the clinical and cost-effectiveness of quetiapine, olanzapine and valproate semisodium in the treatment of mania associated with bipolar disorder. Data sources: Electronic databases; industry submissions made to the National Institute for Clinical Excellence. Review methods: Randomised trials and economic evaluations that evaluated the effectiveness of quetiapine, olanzapine or valproate semisodium in the treatment of mania associated with bipolar disorder were selected for inclusion. Data were extracted by one reviewer into a Microsoft Access database and checked for quality and accuracy by a second. The quality of the cost-effectiveness studies was assessed using a checklist updated from that developed by Drummond and colleagues. Relative risk and mean difference data were presented as Forest plots but only pooled where this made sense clinically and statistically. Studies were grouped by drug and, within each drug, by comparator used. χ

2

Objectives: To assess the clinical effectiveness of treatments for childhood retinoblastoma. Data sources: Electronic databases were searched from inception to April 2004. Review methods: Studies of participants diagnosed with childhood retinoblastoma, any interventions and all clinical outcomes were eligible for inclusion. Randomised and non-randomised controlled trials and cohort studies with clear comparisons between treatment groups were included. Methodological quality was assessed. A narrative synthesis was conducted. Where possible, studies assessing common interventions were grouped together, with prospective and retrospective studies grouped separately. Emphasis was placed on prospective studies. Results: Thirty-one individual studies, from 42 publications, were included in the review. Apart from one non-randomised controlled trial, only comparative studies of observational design were available for any of the treatments. Four of the included studies were prospective and the remaining 27 were retrospective. Most of the studies were of radiotherapy or chemotherapy, with few studies available on enucleation or focal treatments such as brachytherapy, photocoagulation, cryotherapy and thermotherapy. The methodological quality was generally poor, with a high risk of bias in all included studies. The main problems were in relation to how treatment was allocated and lack of consideration of potentially confounding factors, such as initial disease severity, in the study design and data analysis. The evidence base for effectiveness of treatments for childhood retinoblastoma is extremely limited. Owing to the considerable limitations of the evidence identified, it was not possible to make meaningful and robust conclusions about the relative effectiveness of different treatment approaches for childhood retinoblastoma. Conclusions: In the authors' opinion, the evidence base for the effectiveness of treatments for childhood retinoblastoma is not sufficiently robust to provide clear guidance for clinical practice. Ideally, good-quality randomised controlled trials (RCTs) assessing the effectiveness of different treatment options for childhood retinoblastoma are required. Research is required on all the treatments currently used for this condition. Where RCTs are not feasible, for ethical or practical reasons, only high-quality, prospective, non-randomised studies should be given consideration, owing to the generally higher risk of bias in retrospective studies. To reduce the risk of confounding due to allocation by clinical indication, studies should compare patients with similar disease severity rather than compare patients of mixed disease severities. Standardised outcomes should be agreed for use in studies assessing the effectiveness of treatment. These outcomes should encompass potential important adverse effects of treatment such as loss of visual acuity and cosmetic outcome, as well as beneficial effects. © Queen's Printer and Controller of HMSO 2005. All rights reserved.

Context: A variety of interventions have been used in the treatment and management of chronic fatigue syndrome (CFS). Currently, debate exists among health care professionals and patients about appropriate strategies for management. Objective: To assess the effectiveness of all interventions that have been evaluated for use in the treatment or management of CFS in adults or children. Data Sources: Nineteen specialist databases were searched from inception to either January or July 2000 for published or unpublished studies in any language. The search was updated through October 2000 using PubMed. Other sources included scanning citations, Internet searching, contacting experts, and online requests for articles. Study Selection: Controlled trials (randomized or nonrandomized) that evaluated interventions in patients diagnosed as having CFS according to any criteria were included. Study inclusion was assessed independently by 2 reviewers. Of 350 studies initially identified, 44 met inclusion criteria, including 36 randomized controlled trials and 8 controlled trials. Data Extraction: Data extraction was conducted by 1 reviewer and checked by a second. Validity assessment was carried out by 2 reviewers with disagreements resolved by consensus. A qualitative synthesis was carried out and studies were grouped according to type of intervention and outcomes assessed. Data Synthesis: The number of participants included in each trial ranged from 12 to 326, with a total of 2801 participants included in the 44 trials combined. Across the studies, 38 different outcomes were evaluated using about 130 different scales or types of measurement. Studies were grouped into 6 different categories. In the behavioral category, graded exercise therapy and cognitive behavioral therapy showed positive results and also scored highly on the validity assessment. In the immunological category, both immunoglobulin and hydrocortisone showed some limited effects but, overall, the evidence was inconclusive. There was insufficient evidence about effectiveness in the other 4 categories (pharmacological, supplements, complementary/alternative, and other interventions). Conclusions: Overall, the interventions demonstrated mixed results in terms of effectiveness. All conclusions about effectiveness should be considered together with the methodological inadequacies of the studies. Interventions which have shown promising results include cognitive behavioral therapy and graded exercise therapy. Further research into these and other treatments is required using standardized outcome measures.

Objectives: To determine whether any particular intervention or combination of interventions is effective in the treatment, management and rehabilitation of adults and children with a diagnosis of chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME). Design: Substantive update of a systematic review published in 2002. Randomized (RCTs) and non-randomized controlled trials of any intervention or combination of interventions were eligible for inclusion. Study participants could be adults or children with a diagnosis of CFS/ME based on any criteria. We searched eleven electronic databases, reference lists of articles and reviews, and textbooks on CFS/ME. Additional references were sought by contact with experts. Results: Seventy studies met the inclusion criteria. Studies on behavioural, immunological, pharmacological and complementary therapies, nutritional supplements and miscellaneous other interventions were identified. Graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve function based on evidence from RCTs. For most other interventions, evidence of effectiveness was inconclusive and some interventions were associated with significant adverse effects. Conclusions: Over the last five years, there has been a marked increase in the size and quality of the evidence base on interventions for CFS/ME. Some behavioural interventions have shown promising results in reducing the symptoms of CFS/ME and improving physical functioning. There is a need for research to define the characteristics of patients who would benefit from specific interventions and to develop clinically relevant objective outcome measures.

BACKGROUND: Antipsychotic therapy is the mainstay of treatment for people with schizophrenia. In recent years new or atypical antipsychotics have been introduced. These are less likely to produce movement disorders and raise serum prolactin.Researchers have suggested that molindone should be classified as an atypical antipsychotic. OBJECTIVES: To determine the effects of molindone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: For the original search we searched the following databases: Biological Abstracts (1980-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1999), PSYNDEX (1977-1999), and PsycLIT (1974-1999). We also searched pharmaceutical databases on the Dialog Corporation Datastar and Dialog and the references of all identified studies for further trials. Finally, we contacted the manufacturer of molindone and the authors of any relevant trials.For the update of this review, we searched The Cochrane Schizophrenia Group's Trials Register (August 2005). SELECTION CRITERIA: We included all randomised controlled trials that compared molindone to other treatments for schizophrenia and schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS: We extracted data independently and analysed on an intention to treat basis calculating, for binary data, the fixed effect relative risk (RR), their 95% confidence intervals (CI), and the number needed to treat or harm (NNT or NNH). We excluded data if loss to follow up was greater than 50%. MAIN RESULTS: We included fourteen studies. Duration ranged from very short (10 days) studies of the intramuscular preparation, to trials lasting over three months. For measures of global assessment, available data do not justify any conclusions on the comparative efficacy of molindone and placebo. When compared to other typical antipsychotics we found no evidence of a difference in effectiveness (doctors' 4 RCTs n=150, RR 1.13, CI 0.69 to 1.86; nurses 4RCTs n=146, RR 1.23, CI 0.82 to 1.86). Molindone is no more or less likely than typical drugs to cause movement disorders, but it does cause significantly more weight loss (2RCTs n=60 RR 2.78, CI 1.10 to 6.99, NNH 5 CI 2 to 77). AUTHORS' CONCLUSIONS: The strength of the evidence relating to this compound is limited, owing to small sample size, poor study design, limited outcomes and incomplete reporting. Molindone may be an effective antipsychotic but its adverse effect profile does not differ significantly from that of typical antipsychotics (apart from the event of weight loss). Data from this review suggest, at present, there is no evidence to suggest that it may have an atypical profile.

To determine whether randomised controlled trials (RCTs) lead to the same effect size and variance as non-randomised studies (NRSs) of similar policy interventions, and whether these findings can be explained by other factors associated with the interventions or their evaluation.

Background

The aetiology of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is still unknown. The identification of risk factors for CFS/ME is of great importance to practitioners.

Objectives: The aim of this study was to conduct a systematic review of the evidence for treatments for retinoblastoma in children. Methods: Seventeen electronic databases were searched. Two reviewers independently selected studies. Studies of participants diagnosed with childhood retinoblastoma, any interventions, and all clinical outcomes were eligible. Randomized and nonrandomized controlled trials and cohort studies with clear comparisons between treatment groups were included. Methodological quality was assessed. Results: Thirty-one observational comparative studies were included, of which twenty-seven were retrospective. The methodological quality was generally poor, with a high risk of selection bias in all studies. Although there were high levels of treatment success in many of the studies, due to the limitations of the evidence identified, it was not possible to make meaningful and robust conclusions about the relative effectiveness of different treatment approaches for retinoblastoma in children. Conclusions: Good quality randomized controlled trials are required. Where controlled trials are not feasible, only high quality prospective, nonrandomized studies should be given consideration, due to the generally higher risk of bias in retrospective studies. Copyright © 2006 Cambridge University Press.

BACKGROUND: Typical antipsychotic drugs are widely used as the first line treatment for people with schizophrenia. However, the atypical class of antipsychotic drugs are making important inroads into this approach. Atypical is a widely used term used to describe some antipsychotics which have a low propensity to produce movement disorders and raise serum prolactin. There is some suggestion that the different adverse effect profiles of atypical antipsychotic group make them more acceptable to people with schizophrenia. Ziprasidone is one of the newer atypicals with a high serotonin receptor affinity. OBJECTIVES: To determine the effects of ziprasidone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1996), PSYNDEX (1977-1999) and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. Pharmaceutical companies (Pfizer - the manufacturer of ziprasidone - and the manufacturers of all comparator drugs) and first authors of all included trials were contacted. SELECTION CRITERIA: All randomised controlled trials that compared ziprasidone to other treatments for schizophrenia and schizophrenia-like psychoses were included by independent assessment. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences were calculated (WMD). All data were inspected for heterogeneity. MAIN RESULTS: Data for this compound range from very short (one week) studies of the intramuscular preparation, to trials lasting over six months. For measures of mental state ziprasidone seems more effective than placebo (RR 0.8 CI 0.7-0.9) and as effective as haloperidol (RR 0.8 CI 0.7-1). It is less likely than haloperidol to cause movement disorders (RR 0.4 CI 0.2-0.6), but causes more nausea and vomiting (RR 2.1 CI 1.2-3.8). The injected form of the drug causes more pain at the injection site than haloperidol (RR 5.3 CI 1.3-22). REVIEWER'S CONCLUSIONS: Currently data are limited. Ziprasidone may be an effective antipsychotic with less extrapyramidal effects than haloperidol. It also, however, causes more nausea and vomiting than the typical drugs, and, at present, there is no data suggesting that it is different to other atypical compounds. Well planned, conducted and reported long term randomised trials are needed if ziprasidone is to be accepted into everyday use.

Aim: To assess the cost-effectiveness of peer-based sexual behaviour education interventions in prison settings to prevent primary and secondary HIV infections. Methods: Based on the results of a systematic review of peer-based interventions in prison settings, we developed a Bernoulli model to estimate the number of HIV infections averted, consequent loss of quality-adjusted life years (QALYs) avoided and associated savings in health care costs over a lifetime respectively for a peer-led and a professionally-led education intervention. Results: The economic model showed that peer-led and professionally-led educational interventions prevent future HIV infections among offenders in prison settings, thus saving a significant amount of health care costs compared to a ‘do nothing’ scenario. In addition the peer-led intervention is dominant when compared to the professionally-led intervention (it is more effective and less costly). Whilst the model is surrounded by considerable uncertainty, the dominance scenario is confirmed in the one-way and probabilistic sensitivity analysis conducted. Conclusions: This study adds to previous evidence on the effectiveness of peer based educational interventions in preventing HIV in prison by showing that these are not only more effective but also cost less than the professionally-led alternative.

Background: If the spine is unstable following traumatic spinal cord injury (SCI), surgical fusion and bracing may be necessary to obtain vertical stability and prevent re-injury of the spinal cord from repeated movement of the unstable bony elements. It has been suggested that this spinal fixation surgery may promote early rehabilitation and mobilisation. Objectives: To answer the question: is there a difference in functional outcome and other commonly measured outcomes between people who have a spinal cord injury and have had spinal fixation surgery and those who have not? Search strategy: The following databases were searched: AMED, CCTR, CINAHL, DARE, EMBASE, HEED, HMIC, MEDLINE, NRR, NHS EED. Searches were updated in May 2003 and MEDLINE was searched again in May 2007. The reference lists of retrieved articles were checked. Selection criteria: Randomised controlled trials and controlled trials that compared surgical spinal fixation, with or without decompression, to any other treatment, in patients with a traumatic SCI. Data collection and analysis: Two reviewers independently selected studies. One reviewer assessed the quality of the studies and extracted data. Main results: No randomised controlled trials or controlled trials were identified that compared surgical spinal fixation surgery to other treatments in patients with a traumatic SCI. All of the studies identified were retrospective observational studies and of poor quality. Authors' conclusions: The current evidence does not enable conclusions to be drawn about the benefits or harms of spinal fixation surgery in patients with traumatic SCI. Well-designed, prospective experimental studies with appropriately matched controls are needed. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Abstract

Background: Antipsychotic therapy is the mainstay of treatment for people with schizophrenia. In recent years new or atypical antipsychotics have been introduced. These are less likely to produce movement disorders and raise serum prolactin. Researchers have suggested that molindone should be classified as an atypical antipsychotic. Objectives: To determine the effects of molindone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. Search strategy: For the original search we searched the following databases: Biological Abstracts (1980-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1999), PSYNDEX (1977-1999), and PsycLIT (1974-1999). We also searched pharmaceutical databases on the Dialog Corporation Datastar and Dialog and the references of all identified studies for further trials. Finally, we contacted the manufacturer of molindone and the authors of any relevant trials. For the update of this review, we searched The Cochrane Schizophrenia Group's Trials Register (August 2005). Selection criteria: We included all randomised controlled trials that compared molindone to other treatments for schizophrenia and schizophrenia-like psychoses. Data collection and analysis: We extracted data independently and analysed on an intention to treat basis calculating, for binary data, the fixed effect relative risk (RR), their 95% confidence intervals (CI), and the number needed to treat or harm (NNT or NNH). We excluded data if loss to follow up was greater than 50%. Main results: We included fourteen studies. Duration ranged from very short (10 days) studies of the intramuscular preparation, to trials lasting over three months. For measures of global assessment, available data do not justify any conclusions on the comparative efficacy of molindone and placebo. When compared to other typical antipsychotics we found no evidence of a difference in effectiveness (doctors' 4 RCTs n=150, RR 1.13, CI 0.69 to 1.86; nurses 4RCTs n=146, RR 1.23, CI 0.82 to 1.86). Molindone is no more or less likely than typical drugs to cause movement disorders, but it does cause significantly more weight loss (2RCTs n=60 RR 2.78, CI 1.10 to 6.99, NNH 5 CI 2 to 77). Authors' conclusions: The strength of the evidence relating to this compound is limited, owing to small sample size, poor study design, limited outcomes and incomplete reporting. Molindone may be an effective antipsychotic but its adverse effect profile does not differ significantly from that of typical antipsychotics (apart from the event of weight loss). Data from this review suggest, at present, there is no evidence to suggest that it may have an atypical profile. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Objectives: To examine four key areas: (I) the effectiveness and cost-effectiveness of spinal fixation surgery, (2) the consequences of immediate versus delayed referral to a spinal injuries unit (SIU), (3) the number of people with a new spinal cord injury (SCI) who are discharged from hospital without ever being transferred to an SIU, and (4) the effectiveness and cost-effectiveness of steroids for people with SCI. Data sources: Searches were carried out on several databases and also on the Internet. Specialist SCI and spinal injury related websites were searched, specifically the Spinal Injuries Association, the British Association of Spinal Cord Injury Specialists and the National Spinal Cord Injury Association. Review methods: Three separate search strategies were devised to find studies relating to the four key areas. Two reviewers independently screened all study citations for inclusion. The lists of all retrieved studies were scanned for additional studies. Quality of studies was assessed and data were extracted by one reviewer then checked by the second. Data from included studies were summarised within each key area. For dichotomous data, relative risks were calculated with 95% confidence intervals. Pooled relative risks were calculated as appropriate. For continuous data, mean differences with 95% confidence intervals were calculated and, if data were pooled, weighted mean differences were calculated. Searches were carried out to identify economic evaluations, details of these together with a critical appraisal of quality are presented in structured tables. Quality was assessed using a checklist supplemented with additional comments on the adequacy of methodology where appropriate. Results: For spinal fixation versus no fixation, 68 retrospective observational studies were found that suggested some benefits of fixation surgery. Only four studies were found on fixation surgery in SIUs compared with non-SIU hospitals and no significant differences were seen. All 28 studies concerning delayed referral to a SIU were retrospective observational studies. In most, study details were poorly reported and there was doubt over the comparability of groups at baseline and on confounding factors. Times of referral and transfer were not reported separately. Evidence suggested an effect in favour of the SIU group for neurological improvement. No relevant published studies of any design were found regarding how many people with a new SCI are discharged from hospital without ever being transferred to an SIU. Two systematic reviews were found that assessed the effectiveness of steroids. No studies were identified that considered both costs and the impact on patient outcomes of a given intervention. Conclusions: Although there was evidence to suggest some benefits of fixation surgery and also a benefit of immediate referral to SIUs compared with delayed or no referral, owing to the limitations of the data these should be interpreted with caution. Not enough data were found to assess whether surgery is more beneficial when carried out in SIUs and further research is required in this area. Well-designed prospective observational studies with appropriately matched controls are needed. High-dose methylprednisolone steroid therapy may be effective in promoting some degree of neurological recovery if given within 8 hours of injury. There is a need for more randomised controlled trials (RCTs) of pharmacological therapy for acute SCI. No published studies of any design were found to answer the question of how many people with acute SCI are discharged from hospital without ever being transferred to an SIU. Primary research involving audit of selected hospital records should be commissioned and published. The search strategy did not identify any full economic evaluations. Future research should include full economic evaluations, possibly alongside a large RCT, which fully consider the costs and consequences of implementing interventions.

Objectives: Residents in nursing homes are being isolated to prevent exposure to COVID-19. Many are prone to depression, anxiety and loneliness, and extra isolation leaves them vulnerable to compromised mental health. In this study, trained volunteers providing befriending for residents with symptoms of depression, anxiety and loneliness switched to remote befriending during COVID-19. The purpose of this study was to gauge volunteer perceptions of the switch. Methods: A qualitative phenomenological approach was used to understand how switching to remote befriending impacted on volunteers and residents. A convenience sample of 18 participants responded to questions either in individual or group interviews. Results: Volunteers adapted their befriending visits, switching from face to face visits to remote options. The format was decided collaboratively. Hearing impairments hindered phone calls. Residents sometimes felt uncomfortable with digital technology but on the whole, the change to remote ‘visiting’ was accepted. Conclusions: Further research is being conducted to gauge mental health outcomes for residents. Most volunteers and residents accepted the switch to remote befriending as better than no contact. Clinical implications: Volunteers can provide valuable support for residents living with social isolation during COVID-19. The format for social support needs to be decided collaboratively between volunteer and resident.

Objectives: Depression and cognitive impairment are disabling conditions that commonly occur together in older adults. The interaction is challenging when choosing appropriate measurement scales. This review aimed to summarise the scales to measure depression symptoms in older people with cognitive impairment, investigating how cognitive impairment is related to the choice of measurement, and how the setting may affect the choice of measurement. Methods: A scoping review of literature published between 2015-2021. Results: After screening 1580 articles, 26 were included in the review with 11 different measures of depression symptoms identified. The measures mostly commonly used were the Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory (NPI-Q). Most studies did not report on the usability of depression scales used with people with cognitive impairment and only two scales (CSDD and NPI-Q, not GDS) have been validated for use with this population. Conclusions: Severe cognitive impairment was under-represented in the identified studies, and no association was detected between study setting, cognitive impairment and type of measure used. Clinical Implications: Clinicians and researchers should consider both the cognitive status of participants and the setting they live in when choosing a measure of depression symptoms.

BACKGROUND: The world is facing an unprecedented systemic shock to population health, the economy and society due to the devastating impact of the COVID-19 pandemic. As with most economic shocks, this is expected to disproportionately impact vulnerable groups in society such as those in poverty and those in precarious employment as well as marginalised groups such as women, the elderly, Black, Asian and Minority Ethnic (BAME) groups and those with health conditions. The current literature is rich in normative recommendations on plural ownership as a key building block of an inclusive economy rooted in communities and their needs. There is, however, a need for a rigorous synthesis of the available evidence on what impact (if any) plural ownership may potentially have on the inclusivity of the economy. This review seeks to synthesise and compare the available evidence across the three economic sectors (private, public and third). METHODS: We will search eight bibliographic databases (Sociological abstracts, EBSCO Econlit, OVID Embase, OVID Medline, Applied Social Sciences Index and Abstracts (ASSIA), ProQuest Public Health, Web of Science, Research Papers in Economics (Repec) - EconPapers) from the earliest data available in each database until January 2021. Grey literature will be identified from Google (advanced), Google Scholar and 37 organisational websites identified as relevant to the research question. We will include comparative studies of plural ownership from high-income countries that report outcomes on access to opportunities, distribution of benefits, poverty, and discrimination. A bespoke search strategy will be used for each website to account for the heterogeneity in content and search capabilities and will be fully documented. A standardised data extraction template based on the Population-Intervention-Context-Outcome (PICO) template will be developed. We will assess the strength of evidence for different forms of economic ownership identified in relation to the impact of each on the four economic outcomes of interest, paying particular attention to the role of wider contextual factors as they emerge through the evidence. DISCUSSION: The findings of this review are intended to inform policymaking at local, national and international level that prioritises and supports the development of different economic and business models. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework registration DOI: https://doi.org/10.17605/OSF.IO/BYH5A.

BACKGROUND: This protocol describes an ongoing study of the impact of befriending on depression, anxiety and loneliness in older people living in residential aged care facilities in Australia. While systematic reviews of befriending have indicated positive benefits of befriending for people in a range of ages and settings, there have been no randomised controlled trials (RCTs) of befriending for older people living in residential aged care with depression and no studies of the cost effectiveness of befriending in residential aged care facilities (RACFs) in Australia. METHODS AND ANALYSIS: We are conducting a single blind pragmatic RCT comparing two groups of older people living in RACFs, one receiving an intervention consisting of weekly befriending for 4 months from a trained volunteer and the other receiving treatment as usual. Participants undergo eligibility screening for depression (GDS-15 ≥ 4) and cognitive impairment (GPCog ≥ 4) and assessments at three measurement time points: baseline prior to randomisation, 2 months post-baseline and 4 months post-baseline. The primary outcome measure is depression, and secondary outcome measures are anxiety, loneliness, social isolation and quality of life. The economic evaluation will take the form of a cost-utility analysis based on the outcome of quality of life. The primary and secondary outcomes will be analysed using negative binomial and logistic regressions utilizing the Generalised Estimating Equations approach. DISCUSSION: To our knowledge, this is the first RCT evaluating the effectiveness of befriending on older people with depression living in residential aged care. It is expected that the befriending intervention will reduce the severity of depression symptoms experienced by older people living in residential aged care. If the intervention proves effective it may be incorporated into volunteer training programs and adopted as a way of supporting older people's mental health. TRIAL REGISTRATION: Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number: ACTRN12619000676112 , registered 06/05/2019 - retrospectively registered.

The aim of this study was to systematically review lay health worker (LHW)-led self-management interventions for adults with long-term conditions (LTCs) to see how the interventions have been implemented and to compose a synthesis of research findings, taking into consideration the intervention components that have been applied. We conducted systematic searches for articles published between January 2010 and December 2015 in five databases: Cochrane, MEDLINE, CINAHL, PsycINFO and Web of Science. Forty original studies were found that met the inclusion criteria: self-management with diabetes (n = 29), cardiovascular diseases (n = 8), and those at risk of cardiovascular diseases (n = 3). These consisted of 22 randomized controlled trials and 18 other trials, with durations of one day to 24 months. The findings showed that the training of LHWs and the implementation of interventions varied widely. A synthesis of the implementation methods covers the background of the LHWs and the interventions as well as the components applied in each. Eight interventions had effects on physical activity and eight on nutrition behavior. The review also includes preliminary findings on intervention components effective in improving physical activity and nutrition behavior, including self-monitoring as a behavior change technique and group meetings as an intervention format. The same components and behavior change techniques were applied in effective and non-effective interventions. The review found that LHW-led interventions have potential in promoting self-management in LTC. In the future, a qualified and evidence-based structure for LHW-led interventions is suggested in order to improve the systematization of interventions and their effects.

Background: Some authors have suggested that loxapine ismore effective than typical antipsychotics in reducing the negative symptoms of schizophrenia, that extrapyramidal adverse effects are not usually seen at clinically effective antipsychotic doses and that it should therefore be classed as atypical. Objectives: To determine the effects of loxapine compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. Search strategy: For this 2007 update, we searched the Cochrane Schizophrenia Group's Register (January 2007). Selection criteria: We included all randomised controlled clinical trials relevant to the care of schizophrenia that compared loxapine to other treatments. Data collection and analysis: We independently inspected abstracts ordered papers, re-inspected and quality assessed these. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. Main results: We were able to include 41 studies in this review. Compared with placebo, loxapine has an antipsychotic effect (Global effect - not improved at six weeks: n=78, 2 RCTs, RR 0.30 CI 0.1 to 0.6 NNT 3 CI 3 to 5). It is as effective as typical drugs in the short term (4 - 12 weeks) (Global effect: n=580, 13 RCTs, RR 0.86 CI 0.7 to 1.1; mental state: n=915, 6 RCTs, RR 0.89 CI 0.8 to 1.1). Very limited heterogeneous data suggest that, given intramuscularly (IM), loxapine may be at least as sedating as IM haloperidol and thiothixene. Loxapine is also as effective as atypicals (risperidone, quetiapine) (n=468, 6 RCTs, RR mental state not improved 1.07 CI 0.8 to 1.5). Adverse effect profile is similar to typicals but loxapine may cause more extrapyramidal adverse effects when compared with atypicals (n=340, 4 RCTs, RR 2.18 CI 1.6 to 3.1). Authors' conclusions: Loxapine is an antipsychotic which is not clearly distinct from typical or atypical drugs in terms of its effects on global or mental state. Loxapines profile of adverse effects is similar to that of the older generation of antipsychotic drugs. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

BACKGROUND: Typical antipsychotic drugs are widely used as first line treatment for people with schizophrenia. The atypical class of antipsychotic drugs, however, is making important inroads into this approach and zotepine is one such compound. It is a dopamine antagonist and claimed to be to be particularly effective for negative symptoms OBJECTIVES: To determine the effects of zotepine compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), CINAHL (1982-1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), EMBASE (1980-1999), Dialog Corporation Datastar service (1999), MEDLINE (1966-1999), and PsycLIT (1974-1999) were undertaken. References of all identified studies were searched for further trials. Knoll Pharmaceuticals and authors of trials were contacted. SELECTION CRITERIA: All randomised clinical trials that compared zotepine to other treatments for people with schizophrenia or other psychoses were included. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the relative risk (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) and numbers needed to harm (NNH), were calculated on an intention-to-treat basis. For continuous data, weighted mean differences were calculated (WMD). All data were inspected for heterogeneity. MAIN RESULTS: All outcomes were short term (4-12 weeks). Limited data suggest that zotepine is an antipsychotic, at least as effective as typical drugs. Mental state measures of 'no clinically important improvement' favour zotepine when compared to other active drugs (n=356, RR 0.8 CI 0.7-0.9, NNT 7 CI 4-22). About one third of people in both zotepine and control groups left the studies before trial completion. Zotepine may result in less movement disorder adverse effects than typical antipsychotic drugs. Trials have not highlighted clear differences between zotepine and other atypical drugs. REVIEWER'S CONCLUSIONS: Zotepine may be a valuable addition to the increasing ranks of atypical antipsychotic drugs. More data from already existing studies is urgently needed to increase the confidence in the findings of this review. New data from well planned, conducted and reported long term pragmatic randomised trials are necessary. Otherwise clinical use of zotepine will be based on speculation on the meaning of the findings of short explanatory trials for everyday practice.

BACKGROUND: Sertindole is an atypical antipsychotic, which is thought to give a lower incidence of extrapyramidal side effects at clinically effective doses than typical antipsychotic drugs. In December 1998, Lundbeck Ltd., the manufacturers of sertindole, voluntarily suspended the availability of the drug due to concerns about cardiac arrhythmia and sudden cardiac death associated with its use. However, based on the advice of an appointed expert group, the Committee for Proprietary Medicinal Products (CPMP) lifted the suspension of sertindole in October 2001, a decision that was ratified by the European Commission on the 26th of June 2002. Lundbeck have committed to the CPMP to carry out two post-marketing surveillance (PMS) studies (which were initiated in July 2002) to provide additional epidemiological data under conditions of normal drug usage. Initial marketing of the product will be restricted and Lundbeck is currently in discussions with the US health authorities (FDA) to investigate whether, and if so when, it would be possible to launch Serdolect in the US market. OBJECTIVES: To determine the effects of sertindole compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Our Initial searches included electronic searches of Biological Abstracts (1980-1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (August 2000), EMBASE (1980-1999), LILACS (1982-1996), MEDLINE (1966-1999), PSYNDEX (1977-1995) and PsycLIT (1974-1999). In addition, we searched pharmaceutical databases on the Dialog Corporation Datastar and Dialog services. We searched references of all identified studies for further trials. We contacted the manufacturer of sertindole and authors of trials.We updated the literature search by searching the Cochrane Schizophrenia Group's Trials Register in April 2003. SELECTION CRITERIA: All randomised controlled trials that compared sertindole to placebo or other antipsychotic (atypical or typical) drug treatments for patients with schizophrenia or related psychosis . DATA COLLECTION AND ANALYSIS: We independently inspected citations and, where possible abstracts; ordered papers for re-inspection and quality assessment and independently extracted data.For homogeneous dichotomous data, we calculated the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) or number needed to harm (NNH) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). We inspected all data for heterogeneity. MAIN RESULTS: Currently the review includes three studies with a total of 1,104 participants. One was a medium term (eight weeks) placebo controlled study that examined three different doses of sertindole (8, 12 and 20mg/day). The remaining two studies compared the use of sertindole with haloperidol (10mg/day). One was a short term study (six weeks) that looked at four different doses of sertindole (8, 16, 20, 24mg/day) and the other was a long term study (one year) that evaluated the use of sertindole 24mg/day in participants attending outpatients.We excluded two large important studies because they did not report any usable data. (Both had greater than 50% loss to follow-up and data on 'leaving the study early' was inadequately reported). SERTINDOLE VERSUS PLACEBO: Sertindole at 20mg/day was found to be more effective than placebo in terms of BPRS total scores (1 study, n=78, MD 6.2, CI -11.8 to -0.6) and CGI total end point scores (1 study, n=78, MD -0.9, CI -1.6 to -0.2). A marginally statistically significantly greater number of participants that were treated with 20 mg of sertindole were reported to have been 'very much improved' as compared to those taking placebo (1 study, n=102, RR 7.6, CI 1.0 to 57.9, NNT 7.9, CI 4.3 to 41.1). There was no statistically significant difference between sertindole at 8 or 12 mg/day and placebo for these three outcome measures.There were no statistically significant differences between sertindole (8, 12 or 20 mg) and placebo for the incidence of extrapyramidal symptoms, extrapyramidal related events or use of medication to avoid extrapyramidal symptoms. There were no statistically significant differences found between sertindole and placebo for the movement disorders akathisia, cogwheel rigidity, hypertonia and tremor or somnolence.At eight weeks a statistically significant difference between placebo and all sertindole groups (8, 12 and 20 mg) for mean change from baseline in the QT and QTc intervals were observed (p values and SD were not reported).There was a statistically significant greater mean weight gain among participants taking sertindole (20 mg, mean weight gain of 3.3 kg) as compared to placebo (mean weight gain of 0.8 kg; p<0.05). SERTINDOLE VERSUS HALOPERIDOL: At one year, a greater number of participants who were treated with haloperidol as compared to sertindole (24mg/day) were leaving the study early due to any reason (1 study, n=282, RR 0.6, CI 0.4 to 1.0, NNH 8.8, CI 4.7 to 74.0) or non-compliance (1 study, n=282, RR 0.2, CI 0.0 to 0.7, NNH 12.8, CI 7.7 to 37.8). However, at six weeks, there was no statistically significant difference between sertindole (at 8, 16, 20, or 24mg) and haloperidol for this latter outcome.The incidence of EPS was higher among those treated with haloperidol than sertindole at 8, 16, 20 or 24mg/day (8mg: 1 study, n=245, RR 0.1, CI 0.0 to 0.7, NNH 11.4, CI 7.1 to 29.8; 16mg: 1 study, n=252, RR 0.3, CI 0.1 to 1.0, NNH 15.5, CI 8.0 to 217.9; and 20mg: 1 study, n=253, RR 0.2, CI 0.1 to 0.8, NNH 13.7, CI 7.7 to 68.3; 24mg: 2 studies, n=524, RR 0.6, CI 0.4 to 0.8, NNH 8.7, CI 5.4 to 23.0). More participants treated with haloperidol experienced akathisia, tremor and hypertonia than those treated with sertindole (Akathisia - 8mg: 1 study, n=245, RR 0.2, CI 0.1 to 0.5, NNH 6.0, CI 4.1 to 11.2; 16mg: 1 study, n=252, RR 0.1, CI 0.0 to 0.3, NNH 5.4, CI 3.9 9.0; 20mg: 1 study, n=253, RR 0.3, CI 0.2 to 0.7, NNH 7.3, CI 4.6 to 17.9; 24mg: 2 studies, n=524, RR 0.5, CI 0.3 to 0.7, NNH 8.6, CI 5.6 to 18.3. Tremor - 8mg: 1 study, n=245, RR 0.3, CI 0.1 to 0.7, NNH 8.5, CI 5.2 to 24.0; 16mg: 1 study, n=252, RR 0.2, CI 0.1 to 0.5, NNH 7.3, 4.8 to 15.6; 20mg: 1 study, n=253, RR 0.2, CI 0.1 to 0.6, NNH 7.8, CI 4.9 to 18.1; 24mg: 2 studies, n=524, RR 0.4, CI 0.2 to 0.6, NNH 8.2, CI 5.6 to 15.3. For Hypertonic - 24mg: 2 studies, n=524, RR 0.5, CI 0.3 to 0.8, NNH 12.4, CI 7.5 to 35.0; for sertindole 8, 16 and 20mg there was no statistically significant differences between the treatment groups).One study reported that at six weeks, there was a statistically significant greater increase from baseline to final value in mean QTc interval in the sertindole 16, 20 and 24mg groups (20, 26, and 24msec, respectively) than in the haloperidol group (0msec; p value was not reported), but no SD or any other measure of variance for the effect sizes were reported. For one long term study only one participant from the sertindole group (24mg) had a QT interval that exceeded 500msec (1 study, n=282, RR 3.0 CI 0.1 to 73.0), but 11participants treated with Sertindole had QTc intervals of at least 500msec, compared to none in the haloperidol treated group (1 study, n=282, RR 23.0, CI 1.4 to 386.6, NNH 12.8, CI 8.2 to 29.6).At six weeks, fewer participants treated with sertindole at 8mg or 24mg were affected by somnolence than those treated with haloperidol (sertindole 8mg: 1 study, n=245, RR 0.1, CI 0.0 to 0.7, NNH 11.4, CI 7.1 to 29.8; 24mg: 2 studies, n=524, RR 0.6, CI 0.4 to 1.0, NNH 14.8, CI 7.7 to 205.2).The incidence of rhinitis was found to be statistically significantly higher among those taking sertindole at 16 or 24mg as compared to haloperidol (16mg: 1 study, n=252, RR 10.8, CI 1.4 to 82.6, NNH 12.7, CI 7.7 to 36.7; 24mg: 2 studies, n= 524, RR 2.1, CI 1.4 to 3.1, NNH 8.7, CI 5.6 to 18.6).At one year, 33 participants treated with sertindole (24mg) had experienced the sexual adverse event of decreased ejaculatory volume, compared with six participants treated with haloperidol. However the number of included male participants was not reported and therefore the RR could not be calculated.At one year, more participants taking sertindole (24mg/day) had put on weight compared to those taking haloperidol (1 study, n=282, RR 6.3, CI 1.9 to 20.9, NNH 8.8, CI 5.7 to 19.1). At six weeks, all of the sertindole groups showed an increase in body weight from baseline to final evaluation ranging from 1.3kg to 1.9kg, all of which represented a statistically significantly different weight change than that recorded for the haloperidol treatment group (-0.1Kg). However, the actual weight gain for each sertindole dosage group was not reported and no SD or any other measure of variance was given. AUTHORS' CONCLUSIONS: Sertindole at a dose of 20mg/day was found to be more antipsychotic than placebo. When used at 8, 12 or 20mg/day it appears to be as acceptable as placebo (in terms of various adverse events including movement disorders and somnolence), but seems to be associated with more cardiac problems (8, 12 or 20mg/day) and an increase in weight gain (20mg/day) than placebo.Sertindole at a dose of 24mg/day was better tolerated than haloperidol (in terms of participants leaving the study early). It was also found to be was associated with fewer movement disorders (at 8, 16, 20 or 24mg/day) and sedation (8 or 24mg/day) than haloperidol. However, it was shown to cause more cardiac anomalies (16, 20 or 24mg/day), weight gain (all doses combined), rhinitis (16 or 24mg/day), and problems with sexual functioning (24mg/day) than haloperidol. One short term study reported that sertindole 16mg/day was the most optimal dose.

BACKGROUND: Loxapine is a drug with D2/D3 receptor antagonist activity and a higher affinity for D3 than D2. Some authors have suggested that loxapine is more effective than typical antipsychotics in reducing the negative symptoms of schizophrenia, that extrapyramidal side-effects are not usually seen at clinically effective antipsychotic doses and that it should therefore be classed as atypical. OBJECTIVES: To determine the effects of loxapine compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1996), PSYNDEX (1977-1995) and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. Pharmaceutical companies and authors of trials were contacted. SELECTION CRITERIA: All randomised controlled clinical trials relevant to the care of schizophrenia that compared loxapine to other treatments. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted but excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences were calculated (WMD). All data were inspected for heterogeneity. MAIN RESULTS: Compared to placebo, loxapine is antipsychotic (Global effect - not improved at 6 weeks, n=66, RR 0.6 CI 0.4-0.9 NNT 4 CI 2-62) with similar adverse effect profile to typical drugs. Is as effective as typical drugs in the short term (4-12 weeks) (Global effect - not improved, n=411, RR 0.89 CI 0.7-1.2). Very limited heterogeneous data suggest that, given intramuscularly (IM), loxapine may be at least as sedating as IM haloperidol and thiothixene. REVIEWER'S CONCLUSIONS: Loxapine is antipsychotic but its effects are under researched. It is not clearly different from typical drugs in either its positive or adverse effects.

BACKGROUND: The majority of complications in traumatic spinal cord injury (SCI) can occur in the first 24 hours and it has been suggested that spinal injury centres (SICs) may influence the pre-transfer care of people with SCI. The specialist SIC concept has been adopted in a number of high-income countries. However, even in such countries, a potentially significant number of people with SCI do not have the opportunity to access this system and are managed in a non-specialist environment. OBJECTIVES: To answer the question: does immediate referral to an SIC result in a better outcome than delayed referral? SEARCH STRATEGY: The following databases were searched: AMED, CCTR, CINAHL, DARE, EMBASE, HEED, HMIC, MEDLINE, NRR, NHS EED, and PsycLIT. Searches were updated in May 2003 and included the Cochrane Injuries Group Specialist Register. The reference lists of retrieved articles were checked. SELECTION CRITERIA: Randomised controlled trials and controlled trials that compared immediate referral to an SIC with delayed referral in patients with a traumatic SCI. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies. One reviewer was to have assessed the quality of the studies and extracted data. MAIN RESULTS: No randomised controlled trials or controlled trials were identified that compared immediate referral to an SIC with delayed referral in patients with a traumatic SCI. All of the studies identified were retrospective observational studies and of poor quality. REVIEWERS' CONCLUSIONS: The current evidence does not enable conclusions to be drawn about the benefits or disadvantages of immediate referral versus late referral to SICs. Well-designed, prospective experimental studies with appropriately matched controls are needed.

Correction: BMC Geriatr 21, 305 (2021) Following publication of the original article [1], the authors reported incorrect data under the ‘Sample size’ section. The incorrect data ‘272 participants per study arm (total of 544 participants)’ should be corrected to ‘172 participants per study arm (total of 344 participants)’. The original article [1] has been corrected.

To assess the clinical effectiveness of treatments for childhood retinoblastoma. Electronic databases were searched from inception to April 2004. Studies of participants diagnosed with childhood retinoblastoma, any interventions and all clinical outcomes were eligible for inclusion. Randomised and non-randomised controlled trials and cohort studies with clear comparisons between treatment groups were included. Methodological quality was assessed. A narrative synthesis was conducted. Where possible, studies assessing common interventions were grouped together, with prospective and retrospective studies grouped separately. Emphasis was placed on prospective studies. Thirty-one individual studies, from 42 publications, were included in the review. Apart from one non-randomised controlled trial, only comparative studies of observational design were available for any of the treatments. Four of the included studies were prospective and the remaining 27 were retrospective. Most of the studies were of radiotherapy or chemotherapy, with few studies available on enucleation or focal treatments such as brachytherapy, photocoagulation, cryotherapy and thermotherapy. The methodological quality was generally poor, with a high risk of bias in all included studies. The main problems were in relation to how treatment was allocated and lack of consideration of potentially confounding factors, such as initial disease severity, in the study design and data analysis. The evidence base for effectiveness of treatments for childhood retinoblastoma is extremely limited. Owing to the considerable limitations of the evidence identified, it was not possible to make meaningful and robust conclusions about the relative effectiveness of different treatment approaches for childhood retinoblastoma. In the authors' opinion, the evidence base for the effectiveness of treatments for childhood retinoblastoma is not sufficiently robust to provide clear guidance for clinical practice. Ideally, good-quality randomised controlled trials (RCTs) assessing the effectiveness of different treatment options for childhood retinoblastoma are required. Research is required on all the treatments currently used for this condition. Where RCTs are not feasible, for ethical or practical reasons, only high-quality, prospective, non-randomised studies should be given consideration, owing to the generally higher risk of bias in retrospective studies. To reduce the risk of confounding due to allocation by clinical indication, studies should compare patients with similar disease severity rather than compare patients of mixed disease severities. Standardised outcomes should be agreed for use in studies assessing the effectiveness of treatment. These outcomes should encompass potential important adverse effects of treatment such as loss of visual acuity and cosmetic outcome, as well as beneficial effects.

This summary presents the results of a trial study to estimate the social value for one site taking part in Leeds City Council’s Asset Based Community Development programme.

Introduction Interventions addressing malnutrition (under- and overnutrition) among adolescents have not been developed in The Gambia. We aim to coproduce the first phase of ‘The Health-Secure Partnership’ (HSP) – an innovative multicomponent intervention for adolescents in rural areas of The Gambia. Inference drawn from existing evidence and public contribution suggest that the future intervention would ideally involve nutrition-specific components coupled with changes to wider school and community contexts, delivered in partnerships between schools and local communities. Methods The design of HSP is underpinned by health promoting school and community centred approaches, informed by a systems-thinking lens. The project activities will be conducted in three linked stages. Stage 1: Current nutrition-related activities and environments will be observed in four rural Gambian schools, their local village communities, and one additional village which does not have a school. Around 50 key stakeholders (such as teachers, parents, community members, and wider systems stakeholders) will complete questionnaires on their views on the current nutrition-related context and systems, cultural norms, and actions needed to address adolescent malnutrition. Focus groups and interviews will then be conducted with approximately 70 adolescent girls and boys to understand their experiences and opinions about their intervention needs. Stage 2: Potential intervention components, session content and mode/s of delivery will be explored in meetings and workshops with the consortium and stakeholders (including adolescents) to achieve consensus on the intervention format. Examples of session content, and intervention resources will be made, and a community event held to see what the public think of the ideas and materials. Stage 3: A description of the intervention and a codesigned evaluation plan will be documented. Dissemination will include publications, presentations, song and drama to suit a range of audiences (adolescents and their communities, other stakeholders, academics, and policy makers). Discussion This study protocol presents our plans for the HSP intervention development project, addressing a critical gap in the evidence base. Findings will inform subsequent research phases exploring the feasibility and acceptability of the intervention among adolescents.

BACKGROUND: This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Pain may present in a body part that has been amputated (phantom pain) or at the site of amputation (stump pain), or both. Phantom pain and stump pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for phantom pain and stump pain is currently unknown. OBJECTIVES: To assess the analgesic effectiveness of TENS for the treatment of phantom pain and stump pain following amputation in adults. SEARCH METHODS: For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. SELECTION CRITERIA: We only included RCTs investigating the use of TENS for the management of phantom pain and stump pain following an amputation in adults. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. MAIN RESULTS: In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of phantom pain and stump pain in adults. For this update, we did not identify any additional RCTs for inclusion. AUTHORS' CONCLUSIONS: There were no RCTs to judge the effectiveness of TENS for the management of phantom pain and stump pain. The published literature on TENS for phantom pain and stump pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.

Background: Amputee pain may present in a body part that has been amputated (phantom pain) and/or at the site of amputation (stump pain). Mainstay treatments are pharmacological although the need for non-pharmacological management strategies has been recognized. Transcutaneous electrical nerve stimulation (TENS) is recommended as a treatment option. Objective: The aim of this systematic review was to inform TENS technique and dosages by undertaking an extended descriptive analysis of findings from case reports, non-randomized studies, and uncontrolled studies excluded from our previous Cochrane Review. Methods: A search of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PsycINFO, AMED, CINAHL, PEDro, and SPORTDiscus was performed for randomized controlled trials (RCTs) using any surface electrical nerve stimulation for amputee pain. Two review authors screened potential studies for inclusion. Results: Of the 72 articles identified by the searches, 14 were considered relevant. A descriptive analysis of the 14 studies suggested that TENS was safe and acceptable to the patients. An evaluation of the treatment protocols used to administer TENS found that there was much variation in the location of TENS electrodes, electrical characteristics, and dosing regimens used. Conclusion: Low quality evidence suggests TENS is safe and acceptable to patients for the treatment of phantom limb pain and stump pain. An adequately powered randomized control trial is needed to establish efficacy. Careful consideration should be given to randomization, allocation concealment, blinding, adequacy of TENS, and the timing and appropriateness of the outcome measures.

A critical assessment of health trainer activity, with particular reference to the most deprived social groups, and a focus on mental health and wellbeing.

OBJECTIVE: We hypothesized that educational interventions delivered by pharmacists to patients with chronic pain might improve pain-related outcomes and sought to establish "proof of concept" for this hypothesis. METHODS: We searched electronic databases and published literature for randomized studies that examined an educational intervention in relation to the management of chronic pain that was delivered by a pharmacist to an adult patient. Four studies were included that randomized 400 patients with chronic pain and which followed up patients between 1 and 16 weeks. RESULTS: Patients receiving these interventions experienced statistically significant benefits in the following outcomes compared with controls: a reduction in average pain intensity of 0.5 on a 0 to 10 rating scale, a reduction in adverse effects by more than 50%, and an improvement in satisfaction with treatment equivalent to approximately 1 point on a 0 to 10 rating scale. The interventions neither had effect on reducing interference from pain on daily life, nor on improving self-efficacy. DISCUSSION: Pharmacist-delivered educational interventions seem to reduce adverse events and improve satisfaction, but their clinical benefit on pain intensity is debatable. Our analysis suggests that the role of pharmacists may be important but a deeper understanding and evaluation of the active components of these interventions is needed within clinical trials before wider implementation into clinical practice can be recommended.

Purpose – This article aims to describe an evaluation of a national pilot programme of telephone support services for older people in England and Scotland and is focussed on organisational outcomes. Design/methodology/approach – The “Call in Time Programme” was funded by the national charity Help the Aged and comprised eight telephone support projects in different locations, managed by different voluntary or charitable organisations. Researchers used semi-structured interviews and a Delphi questionnaire to obtain the views of project coordinators. Findings – Although the projects were found to provide a much needed service for socially isolated and lonely older people, the study identified four key areas of concern: operational structure; promotion and publicity; recruitment of volunteers; referral processes. Project coordinators wanted more autonomy and the flexibility to respond to older people's needs. Projects were limited by restrictions imposed by funding bodies or services themselves. Practical implications – Project coordinators recommended more local control over project finances, clear referral pathways linking voluntary and statutory bodies, long-term funding involving project coordinators and older people in planning and delivery, more training for project coordinators, clear record keeping and a coordinated approach to promotion and publicity. Originality/value – While other studies have highlighted the importance of user involvement, this study provides valuable evidence demonstrating that those responsible for managing and delivering telephone support services, and service users, are instrumental in decision making and planning processes. As organisations are streamlined in efforts to increase efficiency and effectiveness, there is a need for a wider cultural change in the way supportive programmes are viewed and funded.

There is increasing policy recognition that the alleviation of social isolation and loneliness in older people should be prioritised. Recently, technology, such as telephone networks and the Internet, has received attention in supporting isolated and lonely older people. Despite lack of evidence, telephone befriending has been considered an effective low-level method to decrease loneliness among older people. This study evaluated the impact of a national befriending scheme for isolated and/or lonely older people, involving eight project sites across the UK 2007-2008. The purpose was to assess the impact of different models of telephone-based befriending services on older people's health and well-being. A mixed methods approach was used. This paper reports on the findings from 40 in-depth interviews with older service recipients. The most important finding was that the service helped older people to gain confidence, re-engage with the community and become socially active again. Three topics were identified: why older people valued the service, what impact it had made on their health and well-being and what they wanted from the service. In addition, nine subthemes emerged: life is worth living, gaining a sense of belonging, knowing they had a friend, a healthy mind is a healthy body, the alleviation of loneliness and anxiety, increased self-confidence, ordinary conversation, a trusted and reliable service, the future--giving something back. In conclusion, the findings present in-depth qualitative evidence of the impact of telephone befriending on older people's well-being. Befriending schemes provide low-cost means for socially isolated older people to become more confident and independent and develop a sense of self-respect potentially leading to increased participation and meaningful relationships.

In May 2005 Help the Aged and Zurich Community Trust launched a two year national programme ‘A Call in Time’. The purpose of the programme was to provide low level support and befriending services via the telephone to older people who are lonely, isolated or vulnerable. Eight projects were funded across the country. Following the launch of the programme, Help the Aged commissioned the Centre for Health Promotion Research at Leeds Metropolitan University to undertake an evaluation of the programme and to investigate the direct impact of low level support on older people who are vulnerable, isolated or lonely using the telephone as a specific tool of befriending. The main objectives of the evaluation were to: * Measure and identify the effectiveness of telephone befriending services for older people with regards to their mental and physical well-being and their quality of life and the extent to which services were of preventive value. * Examine the components parts of each model of telephone befriending and identify ‘models of good practice’. All eight telephone befriending schemes functioning within a variety of different parameters were included in the evaluation. The participants in this research included project co-ordinators, project volunteers and older people who were in receipt of the services.

BACKGROUND: Approaches that engage and support lay health workers in the delivery of health improvement activities have been widely applied across different health issues and populations. The lack of a common terminology, inconsistency in the use of role descriptors and poor indexing of lay health worker roles are all barriers to the development of a shared evidence base for lay health worker interventions. OBJECTIVES: The aim of the paper is to report results from a scoping study of approaches to involve lay people in public health roles and to present a framework for categorisation of the different dimensions of lay health worker programmes. METHODS: Our scoping study comprised a systematic scoping review to map the literature on lay health worker interventions and to identify role dimensions and common models. The review, which was limited to interventions relevant to UK public health priorities, covered a total of 224 publications. The scoping study also drew on experiential evidence from UK practice. RESULTS: Research-based and practice-based evidence confirmed the variety of role descriptors in use and the complexity of role dimensions. Five common models that define the primary role of the lay health worker were identified from the literature. A framework was later developed that grouped features of lay health worker programmes into four dimensions: intervention, role, professional support/service and the community. DISCUSSION AND CONCLUSION: More account needs to be taken of the variations that occur between lay health worker programmes. This framework, with the mapping of key categories of difference, may enable better description of lay health worker programmes, which will in turn assist in building a shared evidence base. More research is needed to examine the transferability of the framework within different contexts.

A theory to explain how changecan happen in communities to improve wellbeing, to inform the What Works Centre for Wellbeing community evidence programme. This Theory of Change describes ways in which community wellbeing can be built. It represents some of the possible pathways for improving community wellbeing and by doing so it simplifies some very complex issues and relationships. It should help to understand how and why interventions might work, what will happen in the short term and how long term change in communities can occur. This resource provides an accessible summary as an introduction to our Theory of Change. It will be used to inform how our researchers collect and interpret evidence during the three year project. As the evidence programme develops we will refine the Theory of Change to represent our growing understanding of what works for community wellbeing. The development of this Theory of Change was informed by some stakeholder engagement activities held across the UK between June and September 2015. This is summarised in a ‘Voice of the Users’ report.

Scope and rationale: This workshop will discuss contemporary issues around developing and sustaining community practice in health promotion in Europe. In 1986, the Ottawa Charter signified the importance of strengthening community action to health promotion. Health 2020 and many other international statements and reviews have since endorsed community empowerment as a core strategy for achieving better population health and reducing the health gap. Despite a shared vision, and an increasing evidence base to support practice, there are challenges for those wishing to build impactful community-centred approaches as an integral part of public health. If we are to sustain and empower resilient and healthy communities, then there is a need for honest reflection on what has been learnt so far, why we are some way from achieving genuinely people-centred health systems and where future directions lie. Objectives: The aim of this workshop is to stimulate discussion on the current ‘state of play’ of community-based health promotion practice in Europe. A key learning objective is for workshop participants to identify how health promotors can best work to support community-led action through planning, programme implementation and capacity building. A further objective is to set the first building blocks of a EUPHA network on the science of community engagement that would also collaborate with the Health Promotion section. Format: A skills building, interactive workshop with a focus on collaborative learning. Those attending will be encouraged to share learning about working within complex systems to build resilient and healthy communities and to reflect on practice within different contexts in Europe. Following an introduction and two brief presentations to stimulate thinking about the realities of community-centred prevention, delegates will be asked to consider key questions on programme theory, empowerment and evaluation: •How to deal with the nature of the properties of complex systems in our community practice and evaluation. •How to describe our actions in the field of community health and health promotion in ways that communicate programme theories and models to others and also that emancipate ourselves from a linear causality perspective. •How to ensure programmes are genuinely community-led and can support emerging community leaders. We will conclude with a summary of workshop themes and actions to take forward to strengthen community-based health promotion practice. An interactive workshop on contemporary issues for community-centred health promotion practice and evaluation Delegates will share learning on obstacles and solutions to building empowered and resilient communities and how to improve programme theory and evidence

Subject: There is a shared interest among public health researchers in tackling methodological issues surrounding community based research, and on moving beyond a focus on individual level change. As part of a project on community empowerment funded by the People’s Health Trust, we have conducted a feasibility study on quantitative and economic evaluation of complex community-based interventions. To understand different quantitative methods that can be used to evaluate community empowerment interventions, we have undertaken a methodological literature review that identified the following sets of challenges: Defining population of interest – interventions taking place at a community level are not specifically targeted at a well-defined group of individuals. Therefore it is challenging to even find those who are affected by an intervention. Diverse and un-prescribed effects – the effect of community empowerment interventions are likely broad, suggesting we need to measure multiple outcomes in order to detect change. This increases the likelihood of detecting spurious change and can require a lot of resource. Furthermore, in many cases these outcomes are not pre-defined by a programme (i.e. communities choose their own foci).

BACKGROUND: Previous research has examined individual-level and place characteristics as correlates of subjective wellbeing, with many studies concluding that individual factors (e.g. health, finances) are more strongly related to wellbeing. However, this 'dualistic' approach has been challenged, with some arguing that it is impossible to disentangle the effects of the two domains, and that wellbeing should be considered as part of a network of mutually reinforcing relationships between individual, community and place characteristics. We used network analysis to explore these complex associations. METHODS: Data were from a large sample of adults from a socioeconomically disadvantaged region of the United Kingdom (N = 4319). Wellbeing was assessed using the 7-item version of the Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Mixed graphical networks were estimated including wellbeing, place and individual-characteristic variables as nodes. RESULTS: We found a densely connected network in which wellbeing was associated, both directly and indirectly, with all of the individual, community and place characteristics assessed. Wellbeing was most strongly connected with individual characteristics, in particular financial difficulty and subjective physical health. However, controlling for all other variables in the network model, wellbeing was positively associated with local greenspace usage, civic agency, and neighbourhood cohesion, and negatively associated with housing disrepair. Greater specificity in these associations was observed when the wellbeing construct was broken down into its constituent parts. CONCLUSIONS: These findings highlight the complex relationships that exist between individual, community and place characteristics in the context of subjective wellbeing, and that all domains need to be considered when developing population-level strategies to improve wellbeing. Further consideration needs to be given to how this might happen in practice, for example through a combination of consistent use of community engagement methodologies alongside Health in All Policy (HiAP) approaches.

The influence of place-based factors on the physical and mental health of residents is well established and acknowledged within the population health approach to addressing health and wellbeing inequalities. The COVID-19 pandemic brought to the fore the issues that global communities face. The current UK policy context of ‘levelling up’ represents these concerns and the need to address them. This research examines perceptions of community wellbeing and its determinants as collected within a city region of the North West Coast of England during COVID restrictions between June and August 2020. The paper aims to establish the structure, construct validity and reliability of a new measure of community wellbeing - the Wellbeing in Place Perceptions Scale. Further, it aims to examine how this measure of community wellbeing correlated with symptoms of common mental health as reported by residents of this relatively disadvantaged city region during this unprecedented time. Results indicate that the WIPPS has a reliable and valid structure, correlating significantly with another widely used measure of sense of community and with the Index of Multiple Deprivation. Its relationship to self-reported common mental distress is also clear. Though in need of replication and longitudinal testing, the findings reported here on this new measure remind us that individual and place-based factors combine to influence wellbeing and that community needs to have an increasingly influential role to sustainably prevent future mental health challenges.

Abstract

The influence of place-based factors on the physical and mental health of residents is well established and acknowledged within the population health approach to addressing health and wellbeing inequalities. The COVID-19 pandemic brought to the fore the issues that global communities face. The current UK policy context of ‘levelling up’ represents these concerns and the need to address them. This research examines perceptions of community wellbeing and its determinants as collected within a city region of the North West Coast of England during COVID restrictions between June and August 2020. The paper aims to establish the structure, construct validity and reliability of a new measure of community wellbeing - the Wellbeing in Place Perceptions Scale. Further, it aims to examine how this measure of community wellbeing correlated with symptoms of common mental health as reported by residents of this relatively disadvantaged city region during this unprecedented time. Results indicate that the WIPPS has a reliable and valid structure, correlating significantly with another widely used measure of sense of community and with the Index of Multiple Deprivation. Its relationship to self-reported common mental distress is also clear. Though in need of replication and longitudinal testing, the findings reported here on this new measure remind us that individual and place-based factors combine to influence wellbeing and that community needs to have an increasingly influential role to sustainably prevent future mental health challenges.

This synthesis brings together insights formed across 12 community-university partnerships funded in Phase One of UKRI’s Mobilising Community Assets to Tackle Health Inequalities programme [1]. Projects began in January 2022, with Phase 1 of the programme funding twelve, 12-month pilot projects up to £180,000. These projects focussed on how to scale up small, local approaches with the view to addressing health inequalities. The research promoted people‑powered change, by amplifying lived experience voices and explored how collaborative community, cultural and nature-based activities could reduce health inequalities in the UK.

This paper reviews how community wellbeing is defined and measured in relation to individual subjective wellbeing, the assumptions underlying the dominant approaches and what gets left out. An important distinction in approaches to community wellbeing concerns the primary purpose. The focus may be on community only in so far as community scale characteristics impact individual subjective wellbeing, or there may be a focus on community scale aspects of living together in which community wellbeing is more than the sum of the individual parts. Most existing frameworks for assessment of community wellbeing are premised on the centrality of an autonomous and independently acting or feeling individual and the primary interest is on how community aspects of life impact on individual wellbeing. Areas of life typically assessed notably omit attention to inequalities, intangible culture, settings and scale, sustainability and inter-generationality. However, social theory offers alternative understandings of individual experience as primarily relational which aligns with an interest in community and demands different ways of thinking about wellbeing and wellbeing assessments. Capturing subjective aspects of local life that are not simply individual but reflect the ways in which people feel and are well together is more challenging. Alternative forms of data collection are needed through deliberative processes or the analysis of narrative and other local culturally shared resources.

The current COVID-19 pandemic confines people to their homes, disrupting the fragile social fabric of deprived neighbourhoods and citizen’s participation options. In deprived neighbourhoods, community engagement is central in building community resilience, an important resource for health and a prerequisite for effective health promotion programmes. It provides access to vulnerable groups and helps understand experiences, assets, needs and problems of citizens. Most importantly, community activities, including social support, primary care or improving urban space, enhance health through empowerment, strengthened social networks, mutual respect and providing a sense of purpose and meaning. In the context of inequalities associated with COVID-19, these aspects are crucial for citizens of deprived neighbourhoods who often feel their needs and priorities are ignored. In this perspectives paper, illustrated by a varied overview of community actions in the UK and The Netherlands, we demonstrate how citizens, communities and organizations may build resilience and community power. Based on in-depth discussion among the authors we distilled six features of community actions: increase in mutual aid and neighbourhood ties, the central role of community-based organizations (CBOs), changing patterns of volunteering, use of digital media and health promotion opportunities. We argue that in order to enable and sustain resilient and confident, ‘disaster-proof’, communities, areas which merit investment include supporting active citizens, new (digital) ways of community engagement, transforming formal organizations, alignment with the (local) context and applying knowledge in the field of health promotion in new ways, focussing on learning and co-creation with citizen initiatives.

This presentation will reflect on the challenges encountered by the Communities Wellbeing Evidence Programme in assessing complex interventions delivered at the level of the community. We will present findings from our systematic review of community infrastructure to improve social relations and reflect on different approaches to assessing the validity of individual studies and the body of evidence across the whole review. We will discuss challenges of synthesising this diverse body of evidence, including a range of study designs with outcomes measured at individual or community levels. The use of the GRADE and CerQUAL tools for summarising the quantitative and qualitative findings of the review will be examined, as well as the potential usefulness of other validity assessment tools and frameworks that are new or in development.

The Issue Type 2 diabetes is a major public health issue across Europe. It is preventable - yet it is estimated that in the UK, prevalence will increase from 3.5 to 5 million by 2025. This paper reports on an evaluation of a preventative programme for those at high risk in Bradford, England. The Practice The innovative Intensive Lifestyle Change Programme (ILCP) was piloted during 2014/15 with disadvantaged and minority ethnic communities. The year-long ILCP consists of 9 group sessions, run in people’s first languages by trained health champions recruited from local communities. Participants are referred by their GP after clinical tests identify that they are at risk. On the ILCP they find out about diabetes and practical ways of improving their health plus they set their own behaviour change goals. The Results In 57 participants included in the evaluation, statistically significant decreases in blood sugar levels were found plus statistically significant increases in; • Knowledge about diabetes • Physical activity • Consumption of fruit and vegetables • Self-rated health The ILCP was positively appraised by participants who liked the referral process, lay people facilitating the group and explaining the condition, the group support and cultural appropriateness. Lessons Learnt Those at risk often need to make major lifestyle changes, yet doing this alone is hard and clinicians lack the time to provide intensive support. This evaluation shows that the ILCP is effective in supporting people from disadvantaged communities to change behaviours and is appreciated by them. The programme has been extended across the city and Bradford is now one of 7 national demonstrator sites. The ILCP could be replicated in other contexts across Europe, provided it was adapted to the needs of the particular communities. This paper shows that the ILCP impacts on type 2 diabetes risk factors and suggests a way to address this serious and growing threat to public health. Main messages: Those at risk of developing Type 2 diabetes can be supported to make lifestyle change and reduce their risk factors, by trained lay champions working intensively with them over a period of one year. Effective programmes working with disadvantaged and minority ethnic communities to change behaviour can be delivered in first languages by lay champions in groups where members can support each other.

Background: Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear. Objective: The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature. Methods: This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies. Results: Of the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery. Conclusions: Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care.

Background This project arose from discussions between the NHS Intgrated Care Board, Leeds City Council and Universities in West Yorkshire, UK which recognised the need to develop a core outcome set to capture the impact of voluntary and community sector organisations’ (VCSO) activities on health and wellbeing, in a way that can be routinely integrated with existing datasets on health and care activity across the region. This is a public health priority because the reach and impact of community organisations is a crucial mechanism in tackling health inequalities, and the NHS Long term plan includes a shift to health provision in community settings. Methods Following public engagement workshops, and community conversations held between the WYICB Research Engagement Network community research champions and members of the public, a World Café event was held in a community venue to collect views from a range of stakeholders: academic, policy, health and care services, VCSOs and community champions. Discussions were grouped around 6 table themes: Administrative burden; Core data & outcomes; Relationships of trust; What would good look like; Measures into intelligence; Next steps for action and feedback. Discussions were recorded, transcribed and analysed using thematic analysis. Results 71 stakeholders attended from a range of sectors. Following line by line coding the data was organised under the following themes: Administrative burden; Appropriateness of outcome measures; Language issues; Data security concerns; Diversity and inclusiveness; Training; Infrastructure; Community engagement; Power dynamics; Communication; Ownership of the data. Conclusions If a core outcomes set for VCSO activity in West Yorkshire is to be successful, community organisations must be supported to collect, manage and share ownership of the data. The data itself must be relevant, appropriate and of value to communities, and the reasons for collecting it must be clearly explained. Key messages • Involving community organisations as equal partners in developing core outcomes sets to monitor their impact on health and wellbeing gives valuable insights into concerns of underrepresented groups. • Co-developing a core outcome set with community organisations that is relevant, appropriate, shared and easy to explain may increase response rates and fill in knowledge gaps in diverse communities.

Abstract

Yoga offers multiple health and wellbeing benefits and is socially prescribed by clinicians in the NHS as part of health promotion measures in the United Kingdom (UK). However, socially marginalised groups are under-represented and yoga participants, or practitioners, are predominantly white, higher educated women. This research contributes to the knowledge by exploring, for the first time, the yoga access experiences of people with a broad range of marginalised identities in a UK context. It was prompted by my experiences of teaching yoga to diverse groups in a northern British city neighbourhood amongst the 10% most deprived in the country. Purposive sampling was employed to recruit 17 people from four northern UK cities who had practised, or participated in, yoga in the previous six months, but did not consider themselves to be yoga insiders, and who self-identified with one or more of seven marginalised identities, namely: Black, Brown or other people of colour; disabled; older (later life); LGBTQIA+; of a larger body type; from a religious faith or background; or on a low income. Data was collected via 1-1 teleconferencing software interviews during COVID-19 pandemic restrictions and analysed initially using thematic analysis and, subsequently, using a critical theory-based approach. Nine barriers to yoga access were initially identified using thematic analysis: cost, place, discomfort, physicality, appearance, behaviour, people, potential distress, and alien-ness. These were intersectional in impact and experienced across the range of identities studied. Additionally, nine areas of barrier effect were identified using a critical theory-based approach, these were: Inclusion and access; Whiteness/ableism; Postcolonialism and cultural/religious appropriation; Commercialisation/neoliberalism; Unaware of/don’t see; I was lucky; Belief in loveliness; and Power/challenge. These areas arose from practices and norms within the social institution of UK Yoga and could be associated with emerging criticisms in the literature. Findings were that a range of barriers to yoga access were experienced, some of which could be attributed to practices and norms within the social institution of UK Yoga. These barriers could be seen to contribute to the health inequalities faced by marginalised groups and could be associated with the social determinants of health. Recommendations are for appraisal and revision of delivery of yoga in the UK including: teacher training; pedagogy and language; tailored approaches; examination of privilege; and sharing of power. Further research is indicated with yoga ‘insiders’ with marginalised identities.

Amputee pain may present in a body part that has been amputated (phantom pain) or at the site of amputation (stump pain), or both. Phantom pain and stump pain are complex and multidimensional and the underlying pathophysiology remains unclear. The mainstay treatments for phantom pain and stump pain are predominately pharmacological. The condition remains a severe burden for those who are affected by it. There is increasing acknowledgement of the need for non-drug interventions and Transcutaneous Electrical Nerve Stimulation (TENS) may have an important role to play. TENS has been recommended as a treatment option for phantom pain and stump pain. To date there has been no systematic review of available evidence and the effectiveness of TENS for phantom pain and stump pain is currently unknown.

Ten years on from Morgan and Ziglio’s call to revitalise the evidence base for public health through an asset model, there are still gaps in understanding about how best to evaluate asset-based approaches. The demand for better evidence poses some challenges as asset-based working emerges from radically different traditions from the mainstream deficit model in public health. This paper will present findings from a rapid evidence review on the measurement of asset-based approaches. The rapid review aimed to improve understanding of categories of measurement in the evaluation of asset-based approaches for health and wellbeing and to identify indicators and frameworks that can used in practice. The review was part of a project to develop an asset-based theory of change in health, care and wellbeing, funded by the Health Foundation. Rapid Evidence Assessment techniques were used to produce a map of evaluation approaches and measures. The search strategy used strings of common terms (eg Salutogensis, Asset Based Community Development) combined with synonyms of measurement/evaluation. Academic databases were searched from 2005 along with relevant websites. Additionally, the results of a previous search were screened and reference lists mined. Publications were included if they explicitly discussed the asset model and measurement. Data were then extracted across various fields including population, conceptual framework, measurement type and application. Findings were summarised in tables, with some additional thematic analysis. 8689 publications were identified and 91 full text articles assessed for eligibility. In total, 33 publications were included in the review. Many of these flagged up the challenges of evaluation and the need for better outcome measurement. Reported research strategies varied considerably from the practical to the theoretical. Also the purpose, level and specificity of measurement ranged from validated indicators through to broad domain frameworks. Seven clusters were identified: Asset Based Community Development; Asset Mapping; Community-based evaluation; Conceptual frameworks for measurement; Resilience; Salutogensis; Other. One key theme was the importance of communities being involved in the assessment of assets. The review provides an overview of research strategies and measures with application and purpose described. Producing a map of how asset-based approaches are evaluated and articulating key methodological differences helps researchers and practitioners select appropriate evaluation methods. There are a number of limitations, including the use of rapid review methods which may have missed other relevant evaluation approaches. Further methodological development is needed in this field and we welcome debate about ways to evaluate asset-based approaches.

Aims The aim of the evidence check was to find out what the evidence base is relevant to testing the proposal that “being male” is a key consideration for understanding mental health outcomes and service development i.e. that a gender-based approach to mental health programmes is defensible, especially for prevention, early intervention and stigma reduction. Methods Four electronic databases were searched for journal articles, as well as relevant websites and specific journals. Studies were selected if they were about being male, mental health, and inclusive of a broad array of programmes, campaigns and public health initiatives, and not limited to clinical interventions on referral. Once the main themes had been identified, supplemental searches were carried out where themes were felt to lack depth. Two researchers selected studies for inclusion, and one researcher coded the included papers for key information and collated the evidence. Key Findings • It is important that programmes take a gender-based approach to working with men because there is a strong relationship between adherence to traditional masculinity and poorer MH help-seeking, higher levels of MH stigma, suicide attempts and body image concerns • Programmes should pay particular attention to approaches that help men to become emotionally expressive because difficulty in expressing emotions is the element of masculinity most linked to negative MH help-seeking, endorsement of MH stigma and likelihood of suicide. (This holds true amongst different groups of men, including ethnic groups of men and gay men, where discrimination may increase the impact of these negative aspects) • Programmes should also pay attention to approaches that help men develop or sustain feelings of self-esteem, control and responsibility (for example around work and family) as these are linked to more preventative self-care behaviours and to positive coping with stressful life events • Programmes should ensure they view men as positive assets and use male positive approaches (e.g. presenting help-seeking as ‘rational’ and as a strength) and language (e.g. using ‘regaining control’ rather than ‘help-seeking’) as this helps engage and sustain involvement in interventions (though caution should also be taken that these approaches don’t act to reinforce negative traditional male views) • Part of using male positive approaches includes involving men in ‘doing’, in action-based approaches, especially doing traditionally male activities. Such approaches act to create a safe space that generates trust and thus facilitates talking and ‘opening-up’ emotionally. • Furthermore, such action-based interventions also act to facilitate positive male social engagement which affects, and is affected by, the ability to be emotionally open and helps improve self-esteem through feelings of enjoyment and having a valued male identity

This short report explores the key findings from a review1of information on health trainers in 2013/2014 which had a particular focus on mental health and wellbeing. After summarising the key findings of the review, it focuses on mental health, briefly exploring the links between mental and physical health before discussing what differences engagement with a health trainer made to people’s sense of self-efficacy and wellbeing.

Health trainers are a non-clinical workforce introduced in 2004,2who receive training in competencies to enable them to support people in disadvantaged communities to improve their health.3The population groups or settings that health trainers focus on varies from service to service, but all work one-to-one, most spending at least an hour with a client at their first appointment, supporting and enabling them to decide what they want to do. The emphasis is on the client determining their own priorities and how to achieve them. Generally, health trainers see clients for a total of six sessions, where how to achieve goals and progress towards them is discussed.

The Data Collection and Reporting System (DCRS) is used by approximately 60% of Health Trainer Services to record monitoring data. Around 90% of Health Trainer Services using DCRS record ethnographic data on health trainers and clients, plus the issues clients worked on and the progress they made. There is also a wide range of other data which can be recorded, including before and after mental health and wellbeing scores. We were given access to aggregate data in order to conduct an analysis. Descriptive statistics were generated to calculate percentage change pre- to post-intervention.

A total of 1,377 (= 919 full time equivalents) health trainers were recorded in the DCRS system as working with 97,248 clients in England during 2013/2014. The health trainer model embodies the principle of lay support,4and services aim to recruit a high proportion of their staff from similar backgrounds to their clients. They have been reasonably successful with 32% of health trainers coming from the most deprived areas (Quintile 1),iwith a further 20% from Quintile 2. In all, 40% percent of health trainers lived in the same areas as their clients.

This report explores the relationship between volunteering and wellbeing during the pandemic in Wales by analysing practice-based case studies of volunteering.

Community resilience is the ability of communities and groups to adapt and thrive in response to external stressors. Building resilient communities as a strategy for population health requires assessment of personal and collective capacities alongside vulnerabilities. This report examines what quantitative and qualitative methods can be used to measure health-related community resilience at national and local levels. Evidence from a rapid review of 33 studies highlighted various methodological challenges. Measurement strategies, mostly drawn from the field of community disaster resilience, include population-level frameworks, mixed methods assessment tools, and qualitative and participatory case studies. The main conclusions are that measurement of health-related community resilience should cover multiple domains (economic, social, health, skills, political and environment) and consider local context and assets. Three stages of policy development are suggested: selection of a set of key indicators to collect data on community resilience, creation of a learning network to share knowledge and tools, and development of a comprehensive measurement framework.

Despite volunteering being a feature of community life in the UK, differences as to who volunteers are evident. Reporting on a rapid review of the evidence on volunteering and inequalities, the aim of this paper is to provide an overview of the breadth and interconnectedness of barriers to volunteering for potentially disadvantaged groups. Sixty-seven articles were identified, to produce a map of factors affecting volunteer participation. Findings suggest that while different demographic groups experience specific barriers to volunteering, there are areas of commonality. Analysis shifts the onus of volunteering away from the level of individual choice (a dominant emphasis in policy and practical discussions around promoting volunteering) and towards the influence of structural factors related to broader exclusionary processes. Those who potentially have the most to gain from volunteering are the least likely to participate. Whilst the benefits of volunteering are increasingly documented by research and championed by policy, there are questions about the success of this approach given that the underlying social inequalities present substantive barriers to volunteering and must be address to promote greater access.

This article draws on the updated guidance on community engagement from the National Institute of Health and Care Excellence (NICE 2016), and the evidence that informed that guidance, to discuss the role and potential of engaging with the community in primary care, to improve health and wellbeing. In practice, there are several different ways of engaging with communities, and practitioners need to choose the way that is the best fit with their project, community and ways of working. A guide to community centred approaches recently published by Public Health England and NHS England, maps the range of evidence based options, and two examples from the UK are used to illustrate different approaches to community engagement: one in which lay people from the community delivered a diabetes education project, and one in which volunteers worked with a specialist nurse to provide a holistic arthritis support service.

Purpose Living in an area experiencing economic and social disadvantage is a known risk factor to poor mental health and well-being. This paper aims to understand how some communities experiencing disadvantage appear to be more resilient to the enduring challenges they face and display better mental health outcomes. Design/methodology/approach A qualitative case study approach was used. Semi-structured interviews (total = 74) were undertaken remotely with residents (n = 39) and voluntary, community and social enterprise groups, community leaders and other local stakeholders (n = 35) in four case study areas. Data analysis was cross-case, thematic analysis. Community analysis workshops (n = 4) and resilience mapping workshops (n = 4) in each site corroborated emerging insights. Findings Four overlapping and interacting themes support community resilience: community hubs and local voluntary, community and social enterprise (VCSE) networks; opportunities to participate and make connections within communities; open and supportive environments to talk about mental health and well-being; and community identities and collective narratives. Differences in access to these resources was a cross-cutting theme. Originality/value Community resilience can be understood in terms of the amount of resources – articulated in terms of capital – that communities can draw on in response to challenges, and how well these resources are mobilised. A thriving VCSE sector is important for community resilience in communities experiencing disadvantage as a mechanism for both sustainably building and mobilising community resources in the face of daily and enduring challenges.

INTRODUCTION Living in an area experiencing economic and social deprivation is a known risk factor to poor mental health and wellbeing. There is considerable need to prevent poor mental health outcomes through action on the social determinants of health. This paper is concerned with how some communities experiencing disadvantage appear to be more resilient to poor mental health and wellbeing (community resilience). METHODS A qualitative case study approach was used to carry out an in-depth exploration of what factors support community resilience in four communities experiencing disadvantage in the United Kingdom. 74 semi-structured interviews were undertaken remotely with 39 residents and 35 VCSE groups, community leaders and other local stakeholders. Interviews explored resilience narratives, assets and protective factors, and local challenges. Community analysis workshops and resilience mapping workshops in each site further explored insights from interviews. Data analysis was undertaken using cross-case, thematic analysis. RESULTS Communities experiencing disadvantage encounter a range of daily and enduring challenges to good mental health and wellbeing. Four overlapping and interacting themes support community resilience: (i) Community hubs and local VCSE networks enable a community to support one another and respond effectively to challenges; (ii) Opportunities to participate and make connections within communities strengthens social connections, builds local capacity and empowers people; (iii) Open and supportive environments to talk about mental health and wellbeing help reduce stigma and gives people the tools to help one another; and (iv) Community identities and collective narratives that establish a shared sense of belonging help people to feel secure and connected. DISCUSSION & CONCLUSION Community resilience can be understood in terms of the amount of resources – articulated in terms of capital (e.g. financial, social, cultural, human, natural, physical/built) – that communities can draw on in response to challenges and how well they are mobilised. VCSE organisations and networks play a significant role both building and mobilising different capitals in communities experiencing disadvantage. However, communities experiencing disadvantage face enduring challenges (e.g. poor housing, insecure employment, Covid-19). While VCSE organisations can directly support communities at a local level, their ability to affect structural change is limited to campaigning and advocacy. Responsibility for addressing these issues lie with local and national government. A thriving VCSE sector is important for community resilience in communities experiencing disadvantage as a mechanism for both sustainably building and mobilising community resources in the face of daily and enduring challenges.

Abstract

Background Interventions that engage communities have been shown to improve health and wellbeing in disadvantaged groups internationally, but there is little evidence on current community-led practice, particularly in relation to the process of community engagement. This paper presents a qualitative cross-case analysis of barriers & facilitators in six UK community engagement projects, using different models of community engagement. Methods The primary sampling criteria was the type of approach to community engagement, using a conceptual framework with four main groups: Strengthening communities; Volunteer and peer roles; Collaborations and partnerships; Connecting to community resources. Qualitative interview-based methods (semi-structured interviews and focus groups) explored community and professional perspectives in depth. Thematic analysis was used to analyse the data, building within-case studies before comparing findings and using an iterative process to build explanations in a cross-case analysis. Results Fifty-five people took part in the research. Prominent themes included barriers and facilitators to community engagement. Key themes related to successful community engagement were: trust within the community and between community members and service providers; respect for community members’ expertise; allowing sufficient time for relationships to establish and for outcomes to be seen; commitment of key people; and Flexibility. Conclusions This qualitative case study research found that in successful community engagement projects, community expertise is respected and valued, allowing community members to be fully involved and take ownership of the projects. Sufficient time should be allowed for this process. Flexibility and adaptation of project materials, protocols and role descriptions is important in overcoming barriers to community engagement.

Within the UK, there is growing recognition that individuals will need to take increased responsibility for managing their own health for there to be improvements in population health. The current evidence base on self care interventions reflects an interest in enhancing self care knowledge, skills and behaviour in relation to the management of long-term conditions. In contrast, this paper reports on a community-based self care initiative that was designed to promote self care approaches in the general population. The principal component was a self care skills training course delivered to groups of lay people in community and workplace settings. Self Care for People was piloted in three primary care trusts and a process evaluation was undertaken. The aim of this paper is to examine the feasibility, relevance and acceptability of the initiative. Qualitative interviews were conducted with a sample of stakeholders involved in implementation including coordinators, trainers and key informants from organisations hosting the course. In total 40 interviews and two focus groups were conducted from 2006 to 2008 and the data were analysed thematically. The evaluation found that implementation was relatively straightforward with few major barriers reported. Recruitment to the self care skills training course took place in both workplace and community group settings, including in organisations supporting socially excluded groups. The course was seen to provide a valuable space for contemplation on personal health, however, participation could raise sensitive issues that needed to be dealt with by skilled facilitators. Motivations for involvement differed markedly in host organisations and different strategies for marketing were adopted. The paper concludes by suggesting that while Self Care for People was both feasible and relevant to different stakeholder groups, there needs to be flexibility in responding to the needs of participants in different settings. © 2010 Blackwell Publishing Ltd.

Peer interventions delivered for prisoners by prisoners offer a means to improve health and reduce risk factors for this population. The variety of peer programs poses challenges for synthesizing evidence. This paper presents a typology developed as part of a systematic review of peer interventions in prison settings. Peer interventions are grouped into four modes: peer education, peer support, peer mentoring and bridging roles, with the addition of a number of specific interventions identified through the review process. The paper discusses the different modes of peer delivery with reference to a wider health promotion literature on the value of social influence and support. In conclusion, the typology offers a framework for developing the evidence base across a diverse field of practice in correctional health care.

Objectives England’s Health Trainer Service (HTS) aims to reduce inequalities by supporting people from disadvantaged areas to improve their health and wellbeing. As lay people, trained to offer personalised ‘support from next door,’ Health Trainers (HT) assist individuals in setting behaviour change goals and empowering them to improve their lifestyle. This presentation; • summarises evidence on the service’s effectiveness in terms of behaviour change and mental health and wellbeing improvements • identifies successful factors of various HTS models– including how HTs work within Primary Care and communities • explores pertinent issues in relation to how the service is changing in terms of its setting and its approach Methods A range of data gathered by the research team is drawn on; • a synthesis of eight HTS evaluations • a review of outcome data - from 97,248 clients and 1377 HTs • case studies and interviews collected whilst hosting the Yorkshire & Humber Regional HT Hub Results HTs are able to reach people living with disadvantage - 43% of clients come from highly deprived areas. They are successful at enabling clients to make changes - more than 59% develop a personal health plan and 49% of those fully achieve their goals. Self-efficacy, General Health and WHO-5 wellbeing scores also improve. Evaluations reveal that HTs ‘person centred and peer led’ approach, their ability to connect with people and their status as non-clinicians is important. HTS are becoming more closely integrated within Primary Care and an increased emphasis on meeting targets is evident - current debates include how this could impact on reach and affect the service’s holistic ethos. Conclusion The HTS’s holistic, person-centred approach is effective at reaching deprived communities, empowering behaviour change and improving wellbeing. Maintaining this approach within a more target driven culture is challenging but examples of HTS achieving this balance can be identified.

The contribution that housing associations have made to public health in recent years is recognised within research and policy literature. This paper examines a partnership pilot intervention implemented by one housing association and one community healthcare service provider that aimed to improve the health and well-being of people with complex needs living in social housing stock in one area in England. The pilot delivered co-commissioned personalised support using a holistic model of care. This paper describes the pilot intervention and associated findings drawn from a mixed methods evaluation. The findings illustrate positive service user reports, including improved health and well-being, increased independence and reduced social isolation. The intervention was also associated with reduced use of community healthcare services; with an estimated potential local net saving of £20,818 during the year of the pilot. In conclusion, this small-scale pilot intervention supported clients with complex health needs whilst reducing demands on community health care services. Despite more research being needed in this area, particularly from larger and longer-term studies, this paper contributes to the evidence base by illustrating an effective health and housing practice-based partnership approach.

CITY KNOW-HOW: Worrying trends in terms of human health and planetary health are receiving increasing global concern. City leadership, planning and development all place the constraints on urban behaviours and lifestyles, usually accelerating the problems. It is imperative that human health and environmental impacts become core foci in urban policies around the world. Changing our trajectory will require concerted action. Cities & Health aims to be part of that change; it is dedicated to supporting the flow of knowledge, in all directions, to help make this happen. We support better communication between researchers, practitioners, policy-makers, communities, and decision-makers in cities. This is the primary purpose of this City Know-how section of the journal. ‘Research for city practice’ disseminates lessons research, allowing researchers to explain new knowledge and key messages arising from their studies for city leaders, communities, and the professions involved in city policy and practice. ‘City shorts’ provide glimpses of what is being attempted or achieved ‘on the ground’ and ’case studies’ are where you will find evaluations of interventions. Lastly, ‘Commentary and debate’ extends the conversations we are having to develop and mobilise important and innovative thinking. We invite you to join these conversations. In order to strengthen communities of interest, we would like to include many and varied voices, including those from practitioners, politicians and policy-makers and researchers who are supporting health and health equity in everyday urban lives. Whether you are a just starting out on your journey, or an old hand, we would love to hear from you!

The joint housing and health pilot project was set up in September 2015 as a prototype approach aiming to improve the health and well-being of people with complex health needs within the Batley and Spen Valley localities. The project was co-commissioned by Locala, a provider of NHS community services and Connect Housing, a charitable housing association based in the voluntary sector. This report presents the findings from an evaluation of the joint pilot project conducted by the Centre for Health Promotion Research, Leeds Beckett University. It presents evidence about the project’s background, the outcomes for service users, the Health and Support Worker role, multi-agency working, reductions in health service usage costs, and maps the evaluation evidence against Care Closer to Home Key Performance Indicators as well as overall learning from the project.

The contribution that housing associations have made to public health in recent years is recognised within research and policy literature. This paper examines a partnership pilot intervention implemented by one housing association and one community healthcare service provider that aimed to improve the health and well-being of people with complex needs living in social housing stock in one area in England. The pilot delivered co-commissioned personalised support using a holistic model of care. This paper describes the pilot intervention and associated findings drawn from a mixed methods evaluation. The findings illustrate positive service user reports, including improved health and well-being, increased independence and reduced social isolation. The intervention was also associated with reduced use of community healthcare services; with an estimated potential local net saving of £20,818 during the year of the pilot. In conclusion, this small-scale pilot intervention supported clients with complex health needs whilst reducing demands on community health care services. Despite more research being needed in this area, particularly from larger and longer-term studies, this paper contributes to the evidence base by illustrating an effective health and housing practice-based partnership approach.

The Eatwell and Livewell Programme was set up in 2014 to provide support in the malnutrition pathway for older people within two Yorkshire areas. This report presents the findings from an evaluation of the programme conducted by the Centre for Health Promotion Research, Leeds Beckett University. It presents evidence about the project’s background, its progress in relation to target outputs, the outcomes for service users, and learning from both delivery sites.

Aims For many young people with Type 1 diabetes, transition from paediatric to adult care can result in a marked deterioration in glycaemic control. A systematic review assessed the effectiveness of transition models, or components of models, for managing the transition process in young people with long-term conditions, including Type 1 diabetes. This involved identifying (i) the main barriers and facilitators in implementing a successful transition programme, and (ii) the key issues for young people with long-term conditions and professionals involved in the transition process. Methods The following databases were searched from inception to August 2012: MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, Social Services Abstracts, Academic Search Complete, Social Science Citation Index, Cochrane and Campbell Libraries. Selected studies included young people aged 11 to 25 diagnosed with long-term conditions who were in transition from paediatric to adult secondary health care services. Results 16 systematic reviews and 13 primary studies were included from 9992 records retrieved. No single transition model was uniquely effective. The most successful transitions centred around: young person-focused; age and developmentally appropriate content and delivery; self-management education; family participation; paediatric and adult collaboration; designated transition clinics; transition co-ordinator; young person’s portfolio; specific professionals training; multidisciplinary approach; structured process embedded in service delivery. There were no distinctive characteristics of condition-specific Type 1 diabetes services. Conclusion This important and timely review summarises the key factors that need to be considered for the development of transition programmes for young people with long-term conditions, including those with Type 1 diabetes.

Aims: For many young people with Type 1 diabetes, transition from paediatric to adult care can result in a marked deterioration in glycaemic control. A systematic review assessed the effectiveness of transition models, or components of models, for managing the transition process in young people with long-term conditions, including Type 1 diabetes. This involved identifying (i) the main barriers and facilitators in implementing a successful transition programme and (ii) the key issues for young people with long-term conditions and professionals involved in the transition process. Methods: The following databases were searched from inception to August 2012: MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, Social Services Abstracts, Academic Search Complete, Social Science Citation Index, Cochrane and Campbell Libraries. Selected studies included young people aged 11 25 diagnosed with long-term conditions who were in transition from paediatric to adult secondary healthcare services. Results: Sixteen systematic reviews and 13 primary studies were included from 9,992 records retrieved. No single transition model was uniquely effective. The most successful transitions centred around the following factors: young personfocused; age and developmentally appropriate content and delivery; selfmanagement education; family participation; paediatric and adult collaboration; designated transition clinics; transition coordinator; young person’s portfolio; specific professionals’ training; multidisciplinary approach; structured process embedded in service delivery. There were no distinctive characteristics of condition-specific Type 1 diabetes services. Conclusion: This important and timely review summarises the key factors that need to be considered for the development of transition programmes for young people with long-term conditions, including those with Type 1 diabetes.

Practice-based case studies that describe learning from implementation are a useful source of evidence for policy makers, practitioners and researchers. Despite the value of narratives developed in context as a form of experiential or applied evidence, little is known about appropriate qualitative review and synthesis methods to deal with multiple practice-based case studies. This paper reports on a methodological study to develop and pilot a synthesis method using a sample of community wellbeing case studies focused on interventions to improve community infrastructure. The study was conducted in four interlinked phases: (i) literature review to scope synthesis methods (ii) piloting search and selection methods to identify a sample of relevant practice-based case studies that reported experiential learning (iii) undertaking cross case analysis and qualitative synthesis based on framework analysis methods (iv) review and reflection to produce a summative account of the method and agreed definition. The main output from the study was a staged approach to qualitative synthesis of practice-based case studies based on seven steps, which move from identification of a conceptual framework through to producing a narrative report. The potential transferability of this approach and its application in research and policy are critically discussed. Synthesis of case studies derived from community-based interventions could address knowledge gaps in the formal evidence base. While further methodological development is warranted, it is argued that study results form a credible qualitative framework for synthesising practice-based evidence.

Introduction The rise of Type 2 Diabetes is a major public health issue. Bradford, a city with high rates of deprivation and a large South Asian community (both factors being associated with a higher risk of developing diabetes), has piloted a programme that aims to tackle this issue. This paper reports on an evaluation of this Intensive Lifestyle Change Programme (ILCP). Targeted at high-risk individuals, the year-long, group-based ILCP is facilitated by health champions, from local communities. Beneficiaries receive advice on lifestyle changes, information and support and are encouraged to set behaviour change goals. 587 people have started the ILCP since it started in 2014. Methods The evaluation comprised of; pre and post clinical tests and questionnaires to measure changes in behaviour and health and wellbeing plus focus groups to ascertain participants’ views of the ILCP. The Results 57 people completed pre and post data. Statistically significant decreases in blood sugar levels were found plus statistically significant increases in; knowledge about diabetes, moderate physical activity, fruit and vegetable consumption and self-rated health. The programme was very positively appraised in eight focus groups. Key success factors include; the referral process, non-clinical people facilitating, group support, language diversity and culturally appropriate advice. Conclusion This evaluation demonstrates the effectiveness of a programme to prevent Type 2 diabetes in a disadvantaged community and its acceptability to beneficiaries. Learnings can be utilised elsewhere provided programmes are adapted to suit communities’ specific needs.

The cost-of-living crisis has led to many people across the UK struggling to pay for essentials such as heating or eating. For those who were already living in poverty, increasing costs have brought additional challenges. Calderdale Council recognised the added challenges local people are facing and implemented a number of initiatives to support them. One initiative funded Voluntary, Community and Social Enterprise (VCSE) organisations to provide Warm Spaces. Warm Spaces, or warm hubs, are safe and friendly places where someone can go to keep warm during the day, throughout the winter months.

The cost-of-living crisis has led to many people across the UK struggling to pay for essentials such as heating or eating. For those who were already living in poverty, increasing costs have brought additional challenges. Calderdale Council recognised the added challenges local people are facing and implemented a number of initiatives to support them. One initiative funded Voluntary, Community and Social Enterprise (VCSE) organisations to provide Warm Spaces. Warm Spaces, or warm hubs, are safe and friendly places where someone can go to keep warm during the day, throughout the winter months.

Abstract

Abstract

Stakeholder engagement for the What Works Centre for Wellbeing’s (WWCW) Community Wellbeing Evidence Programme identified ‘boosting social relations’ in communities as a priority policy-related topic. A scoping review of 34 reviews identified evidence gaps relating to social relations in the following areas: community infrastructure (places and spaces); interventions to reduce or prevent social isolation in adults <60 years; community engagement and volunteering; social network analyses. We developed ‘community infrastructure (places and spaces)’ as a systematic review, as this can be addressed at a local or regional level and has potential to produce immediate practical impact. We searched 11 bibliographic databases from 1997–2017, performed reference and citation checking, searched the websites of relevant organisations, and issued a call for evidence through the WWCW. We included studies which reported: interventions to improve or make alternative use of physical places and spaces at community or neighbourhood level; outcomes of social relations, community wellbeing and related concepts; quantitative, qualitative and mixed methods studies, and process evaluations. Two reviewers undertook study selection. One reviewer undertook data extraction and validity assessment, with a random 20% checked by a second reviewer. Validity of included studies was assessed using established checklists. Following thematic synthesis of qualitative data, a narrative synthesis was produced for each of eight intervention categories. The GRADE and CERQual approaches were used to rate the overall strength of evidence for each outcome. 51 studies, mostly of poor to moderate quality, were included. The better quality evidence was qualitative, and most of the review’s findings come from the thematic synthesis of qualitative evidence There was moderate evidence that Community hubs may promote social cohesion, increase social capital and build trust between people, widen social networks and increase interaction between people, and increase people’s knowledge or skills; Changes to neighbourhood design may positively affect sense of belonging and pride in a community; Green and blue space interventions that provide the opportunity to participate in activities or meetings improve social interactions, increase social networks, bonding and bridging social capital, physical activity and healthy eating, and improve people’s skills and knowledge. There were also common themes relating to facilitators and barriers to successful interventions. The review found moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Future research should prioritise high quality evaluations using repeated measures and validated tools, with robust and credible qualitative evidence.

Resilience is a dynamic process of coping, adaptation and growth in response to threats and can be an attribute of individuals, communities or systems. ‘Creating resilient communities’ is a Health 2020 priority, reflecting the importance of the social environment as a determinant of population health. This is an emergent field for research, with questions of how best to define and measure this complex concept at a community level. This presentation reports on a rapid review and synthesis of measurement strategies conducted for WHO Europe Health Evidence Network (HEN). The review question was: ‘What quantitative and qualitative methods can be used to measure health-related community resilience at a national level?’ The rapid review used HEN Evidence Synthesis guidance. A systematic search of academic and grey literature databases and 73 websites combined key terms for community resilience and measurement. Included languages were English, French and German, and Russian (via an independent search). Study selection was in 2 phases, with an initial focus on Europe. Inclusion criteria were articles that reported outcomes involving measurement of health-related community resilience in all population groups, study designs and settings. Studies on individual/system resilience and those not specifying health and wellbeing measurement were excluded. Data extraction fields included theoretical framework, methods and indicators. Findings were summarised in tables and a narrative synthesis. In total, 3,753 publications were identified and following screening, 33 studies were included; 27 from WHO European Region. The map of literature showed various measurement frameworks in use, however most related to community disaster resilience. We grouped measurement strategies into: Frameworks providing population profiles of resilience factors, using quantitative data Mixed method assessments incorporating stakeholder views, used mostly for local planning & evaluation Qualitative and participatory approaches, which involved marginalised communities. There was a dearth of validated measures and insufficient evidence on national-level indicators, but socioeconomic measurement domains were categorised. Key methodological challenges were highlighted, including definitional issues, data aggregation and lack of attention to equity. Notwithstanding these challenges, the review identified some common principles for measuring community resilience. This review contributes to new understandings of health-related community resilience and its measurement. Using rapid review methods limited the scope of the search, and the focus was mainly on European literature. While there is learning from community disaster resilience methods, transferability to population health needs to be tested.Based on review gaps, recommendations are made for future research topics.

Background: Forty per cent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. It has been claimed that acupuncture has a role in management of cancer pain and guidelines exist for treatment of cancer pain with acupuncture. This is an updated version of a Cochrane Review published in Issue 1, 2011, on acupuncture for cancer pain in adults. Objectives: To evaluate efficacy of acupuncture for relief of cancer-related pain in adults. Search methods: For this update CENTRAL, MEDLINE, EMBASE, PsycINFO, AMED, and SPORTDiscus were searched up to July 2015 including non-English language papers. Selection criteria: Randomised controlled trials (RCTs) that evaluated any type of invasive acupuncture for pain directly related to cancer in adults aged 18 years or over. Data collection and analysis: We planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors (CP, OT) independently extracted data adding it to data extraction sheets. Data sheets were compared and discussed with a third review author (MJ) who acted as arbiter. Data analysis was conducted by CP, OT and MJ. Main results: We included five RCTs (285 participants). Three studies were included in the original review and two more in the update. The authors of the included studies reported benefits of acupuncture in managing pancreatic cancer pain; no difference between real and sham electroacupuncture for pain associated with ovarian cancer; benefits of acupuncture over conventional medication for late stage unspecified cancer; benefits for auricular (ear) acupuncture over placebo for chronic neuropathic pain related to cancer; and no differences between conventional analgesia and acupuncture within the first 10 days of treatment for stomach carcinoma. All studies had a high risk of bias from inadequate sample size and a low risk of bias associated with random sequence generation. Only three studies had low risk of bias associated with incomplete outcome data, while two studies had low risk of bias associated with allocation concealment and one study had low risk of bias associated with inadequate blinding. The heterogeneity of methodologies, cancer populations and techniques used in the included studies precluded pooling of data and therefore meta-analysis was not carried out. A subgroup analysis on acupuncture for cancer-induced bone pain was not conducted because none of the studies made any reference to bone pain. Studies either reported that there were no adverse events as a result of treatment, or did not report adverse events at all. Authors' conclusions: There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

Background Cancer-related pain is a significant and debilitating problem. Non-pharmacological treatments such as acupuncture may have an adjunctive role in controlling pain without the undesirable side effects of drug regimens and yet the evidence base remains limited. Objectives The main objective of this systematic review was to evaluate the effectiveness of acupuncture in the management of cancer-related pain in adults. Subgroup analyses were planned for acupuncture dose and for the outcome of studies investigating acupuncture for cancer-induced bone pain. Methods Six electronic databases were searched, including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, AMED and SPORTDiscus. Studies included in the review were randomised controlled trials investigating the use of acupuncture for cancer pain using pain as a primary outcome measure. In total, 253 published references were identified but only three studies met the inclusion criteria and were included in the final review. Results Of the three included studies, only one was judged to be of high methodological quality and showed auricular acupuncture to be superior to placebo acupuncture and ear seeds at placebo points. However, the study was relatively small and blinding was compromised. The two low-quality studies gave positive results in favour of acupuncture for cancer pain, but these results should be viewed with caution due to methodological limitations, small sample sizes, poor reporting and inadequate analysis. Conclusion There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

BACKGROUND: Forty percent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. It has been claimed that acupuncture has a role in management of cancer pain and guidelines exist for treatment of cancer pain with acupuncture. OBJECTIVES: To evaluate efficacy of acupuncture for relief of cancer-related pain in adults. SEARCH STRATEGY: CENTRAL, MEDLINE, EMBASE, PsycINFO, AMED, and SPORTDiscus were searched up to November 2010 including non-English language papers. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating any type of invasive acupuncture for pain directly related to cancer in adults of 18 years or over. DATA COLLECTION AND ANALYSIS: It was planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors (CP, OT) independently extracted data adding it to data extraction sheets. Quality scores were given to studies. Data sheets were compared and discussed with a third review author (MJ) who acted as arbiter. Data analysis was conducted by CP, OT and MJ. MAIN RESULTS: Three RCTs (204 participants) were included. One high quality study investigated the effect of auricular acupuncture compared with auricular acupuncture at 'placebo' points and with non-invasive vaccaria ear seeds attached at 'placebo' points. Participants in two acupuncture groups were blinded but blinding wasn't possible in the ear seeds group because seeds were attached using tape. This may have biased results in favour of acupuncture groups. Participants in the real acupuncture group had lower pain scores at two month follow-up than either the placebo or ear seeds group.There was high risk of bias in two studies because of low methodological quality. One study comparing acupuncture with medication concluded that both methods were effective in controlling pain, although acupuncture was the most effective. The second study compared acupuncture, point-injection and medication in participants with stomach cancer. Long-term pain relief was reported for both acupuncture and point-injection compared with medication during the last 10 days of treatment. Although both studies have positive results in favour of acupuncture they should be viewed with caution due to methodological limitations, small sample sizes, poor reporting and inadequate analysis. AUTHORS' CONCLUSIONS: There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

Background: Interventions that engage communities have been shown to improve health and wellbeing in disadvantaged groups internationally, but there is little evidence on current community-led practice, particularly in relation to the process of community engagement. This paper presents a qualitative cross-case analysis of barriers & facilitators in six UK community engagement projects, using different models of community engagement. Methods: The primary sampling criteria was the type of approach to community engagement, using a conceptual framework with four main groups: Strengthening communities; Volunteer and peer roles; Collaborations and partnerships; Connecting to community resources. Qualitative interview-based methods (semi-structured interviews and focus groups) explored community and professional perspectives in depth. Thematic analysis was used to analyse the data, building within-case studies before comparing findings and using an iterative process to build explanations in a cross-case analysis. Results: Fifty-five people (28 community stakeholders and 27 professional stakeholders) from six selected case study projects took part in the research. Key themes related to successful community engagement were: trust within the community and between community members and service providers; respect for community members’ expertise; allowing sufficient time for relationships to establish and for outcomes to be seen; commitment of key people; and flexibility. Conclusions: This qualitative case study research found that in successful community engagement projects, community expertise is respected and valued, allowing community members to be fully involved and take ownership of the projects. Sufficient time should be allowed for this process. Flexibility and adaptation of project materials, protocols and role descriptions is important in overcoming barriers to community engagement. Keywords: Community engagement, health and wellbeing, cross-case analysis, health equity, health inequalities, public health, health promotion, qualitative research

Background The National Institute for Health and Care Excellence (NICE) in the UK commissioned a mapping review of current and emerging UK community engagement practice to inform their updated guidance. Methods Given the difficulties of identifying studies via traditional electronic database searches we focused on: Specialised research registers and websites; search results and forwards and backwards citations from recent relevant systematic reviews; website searches of relevant organisations; and direct calls for evidence via networks of contacts with community practitioners and groups. Records were screened independently by more than one reviewer, and included if published after 2000, relevant to the UK and evaluated or described community engagement in public health. Included records were coded for type, level and extent of community engagement, indicators of disadvantage, health issues and outcomes. Results 316 articles (227 research/ evaluation studies) were included. Evidence was dominated by: qualitative and mixed methods studies; initiatives targeting health inequalities via socioeconomically deprived areas and groups, and via “hard to reach” groups. Community level outcomes (e.g. improved housing) and wellbeing outcomes (e.g. improved self-esteem) were most commonly addressed, and community mobilisation/ action and community partnerships/ coalitions were the types of community engagement most commonly employed. Community engagement initiatives for “hard to reach” populations were most likely to use targeted and/ or peer or volunteer approaches. Conclusions Community engagement initiatives in the UK include a substantial proportion who are at risk of health inequalities but who are not routinely fully represented in health equity profiles/ audits. Consideration should continue to be given to these “marginalised” groups, in terms of both initial engagement and measurement of impact. Key messages: Community engagement initiatives in the UK go beyond targeting the most obvious indicators of inequality and seek to engage some of the most marginalised, disadvantaged or excluded population groups Different approaches are used for different health issues and population groups e.g. peer involvement for individual behaviour change; community mobilisation for community level outcomes © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Although there is existing evidence on what works to treat burnout and work-related stress, there is less on what works to prevent it from occurring in the first place. This report provides an overview of literature covering how to prevent burnout and work-related stress in individuals and within organisations.

Background Peer interventions involving prisoners in delivering peer education and peer support in a prison setting can address health need and add capacity for health services operating in this setting. This paper reports on a qualitative synthesis conducted as part of a systematic review of prison-based peer interventions. One of the review questions aimed to investigate the positive and negative impacts of delivering peer interventions within prison settings. This covered organisational and process issues relating to peer interventions, including prisoner and staff views. Methods A qualitative synthesis of qualitative and mixed method studies was undertaken. The overall study design comprised a systematic review involving searching, study selection, data extraction and validity assessment. Studies reporting interventions with prisoners or ex-prisoners delivering education or support to prisoners resident in any type of prison or young offender institution, all ages, male and female, were included. A thematic synthesis was undertaken with a subset of studies reporting qualitative data (n=33). This involved free coding of text reporting qualitative findings to develop a set of codes, which were then grouped into thematic categories and mapped back to the review question. Results Themes on process issues and wider impacts were grouped into four thematic categories: peer recruitment training and support; organisational support; prisoner relationships; prison life. There was consistent qualitative evidence on the need for organisational support within the prison to ensure smooth implementation and on managing security risks when prisoners were involved in service delivery. A suite of factors affecting the delivery of peer interventions and the wider organisation of prison life were identified. Alongside reported benefits of peer delivery, some reasons for non-utilisation of services by other prisoners were found. There was weak qualitative evidence on wider impacts on the prison system, including better communication between staff and prisoners. Gaps in evidence were identified. Conclusions The quality of included studies limited the strength of the conclusions. The main conclusion is that peer interventions cannot be seen as independent of prison life and health services need to work in partnership with prison services to deliver peer interventions. More research is needed on long-term impacts.

A recent systematic review found that initiatives with high levels of community engagement may produce more positive health outcomes than those with lower engagement. Systematic reviews in this area risk publication bias because (i) literature on community based health initiatives is widely dispersed and poorly indexed; and (ii) professionally-led (top down) interventions are more likely than community-led (bottom up) interventions to be formally evaluated and published. An opportunity to examine the gap between research and practice arose in a systematic scoping review commissioned by the UK National Institute of Health and Care Excellence (NICE), of current practice in community engagement. We searched specialised research registers and websites; literature searches and citations from recent relevant systematic reviews; and direct calls for evidence via networks of community practitioners and groups. Records were screened independently by more than one reviewer, and included if published after 2000, relevant to the UK and evaluated or described community engagement in public health. Included records were coded for type, level and extent of community engagement, indicators of disadvantage, issues and outcomes. 316 articles were included, 72% were research or evaluation studies (7% were randomised controlled trials; most were mixed methods or qualitative studies). 26% were found through website searches and the calls for evidence. The issues addressed most frequently were social capital or social cohesion (41%) and community wellbeing (35%). Indicators of health inequality observed most frequently were socioeconomic (39%) and “other” (39%), including people with disabilities; refugees and asylum seekers; mental health service users. Only 33 initiatives reported a high extent of community engagement; a comparatively high proportion were in the non-research literature (20% of non-research articles, compared to 8% of research articles). This may indicate a gap between organisations which usually write and publish research articles, and organisations which fully involve community members, and/or may indicate challenges in the evaluation or publication process of high community engagement initiatives. Using conventional systematic review methods to examine community based approaches risks overlooking community-led “bottom up” initiatives, which may have the highest potential to reduce health inequalities. Reviewers should therefore make every effort to find reports of such initiatives, and consider broadening their definition of “evidence”.

Background This scoping review was undertaken as part of an NIHR-commissioned study, APPRAISE, to develop a patient-reported outcome measure (PROM) and experience measure (PREM) to assess outcomes relevant to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI) and pelvic mesh complications surgery, with cross-cultural applicability. Objectives To identify PROMs and PREMs used to assess POP, SUI and mesh complication surgery; to compare the length, recall periods, response options of these tools and the outcomes/experiences assessed. Search Strategy Three databases searched from inception to September 2023 were screened by two independent reviewers. Selection Criteria Primary studies using subjective measures to assess POP, SUI and mesh complication surgery for women aged 16+ years were eligible for inclusion. Related systematic reviews were also reviewed. Data Collection and Analysis Data were extracted into a piloted electronic form by one reviewer and checked by a second. A narrative synthesis of the data was performed. Main Results Of the 2079 included primary studies, 1607 (77%) used a PROM with evidence of psychometric testing. Five hundred and twenty-two (25%) studies used one PROM; 1082 studies (52%) used two or more PROMs. One hundred and fifty-one measures were extracted; of these, condition-specific measures were the most highly cited. There was limited use of PROMs specific to surgery, mental health, body image and PREMs. Some outcomes (e.g., urinary symptoms, emotional wellbeing) are measured in a significantly higher proportion of PROMs than other outcomes. Conclusions Currently, no existing validated PROM evaluates all patient-reported outcomes relevant to surgery for POP, SUI or mesh complications.

Background This systematic scoping review was commissioned by NHS Health Scotland as one of a number of projects to investigate reasons behind ‘excess’ mortality in Scotland compared to other parts of the UK. It aimed to identify explanations for (1) the high mortality in Scotland, or parts of Scotland relative to comparable populations (2) excess mortality between otherwise comparable populations. Methods Ten electronic databases were searched in November 2014, plus searches of relevant websites and a structured internet search. Potentially relevant records were screened by one reviewer with a random 10% double screened. Data was extracted into the categories: Countries compared; Study design; Outcomes reported; Hypotheses proposed (if any). Results 27,723 articles were screened and 837 included (1) Half of the 305 included studies mentioned deprivation or deprivation-related artefacts as an explanation for excess mortality in Glasgow or Scotland. The next largest category (29%) related to health behaviours. Other significant explanations related to political attack, effects of policies, health services supply and demand, deindustrialisation, different culture of substance misuse, possible mechanisms, migration, lower social capital, poor housing, life course effects, artefacts of measurement and the external physical environment. (2) In the international literature (n = 532), the largest category related to health behaviours (37%), with deprivation featuring in 32%. Other significant explanations related to health services supply and demand, income inequalities, artefacts of measurement, political attack or effects, social capital, different culture of substance misuse, and genetic differences. Conclusions There is a great deal of relevant literature offering explanations for “excess” mortality. Further research that includes validity assessment of these studies would be necessary to understand the reasons more fully and to ascertain which are the most robust. Key messages: Further research might focus on the links between “downstream” (e.g. health behaviours), “midstream” and “upstream” levels of explanations for excess mortality both in Scotland and internationally It would be of interest to explore similarities and differences between upstream influences, health behaviours and linked outcomes in Scotland and in eastern European countries © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

This guidance provides a step by step approach to synthesising practice-based case study evidence. The rationale is the opportunity presented by combining case studies, in order to make the most of the data case studies contain, whilst also producing robust, potentially transferable findings. Findings from the synthesis of a number of individual cases may allow for translation to other settings and the generalisability of the findings from the synthesis of a number of practice-based case studies may also be increased by linking back to theory. This guide follows a full review of synthesis approaches that might be appropriate for practice-based case study evidence. The review included testing one approach, which has been used as the basis for this guide, to illustrate how synthesis can be done in practice.

This briefing presents results from a synthesis and review of practice based case studies on how community hubs and green spaces can enhance wellbeing in a place. Case study evidence provides important and rich detail on these projects and activities, and how they are delivered. This research identified community wellbeing outcomes that support the findings from systematic review evidence, as well as describing additional and unforeseen outcomes, including those that arise from the benefits of more informal spaces that may not have been the subject of formal evaluations, as well as benefits to the organisations responsible for the delivery of the interventions.

Practice-based case studies are recognised as an important source of knowledge and learning and one that is complementary to research-based evidence. There is a knowledge gap about how to synthesise this evidence. This study addressed this knowledge gap by identifying the most robust methods to collate, review and synthesise practice-based case study evidence and by carrying out a pilot synthesis on practice-based community wellbeing case studies. The pilot focused on community-based interventions (projects, initiatives, services or programmes) that aimed to improve social relations and community wellbeing through better community infrastructure (places and spaces).

Introduction: There are many scales and measures of individual wellbeing, but community wellbeing is less well defined. Indicators measuring a community’s wellbeing may not be described as such. To address this knowledge gap, the What Works Wellbeing Communities Evidence Programme conducted a rapid scoping review of indicators, frameworks and measures of community wellbeing used by UK agencies in the last 5 years. Methods: Five electronic databases were searched from 2010 – 2016, plus relevant organisations’ websites. We included policy documents, evaluations and research studies if they measured community wellbeing in the UK. Electronic search results were uploaded to systematic reviewing software, screened and data extracted by one of five reviewers, with a random 10% double checked. Results: 6,494 records were screened and 47 included, containing 43 indicators currently or recently in use in the UK. Governmental organisations were more likely to use indicator frameworks or sets; non-governmental or academic organisations were more likely to use conceptual frameworks. Academic organisations were the most likely to use validated measures or scales. A wide range of synonyms or proxy terms relating to community wellbeing were used; we have begun to map these against their included domains. Conclusion: This is the first iteration of a working document compiling and indexing UK community wellbeing indicators. The review is intended to grow throughout the life of the What Works Wellbeing Centre; as further measures are identified in systematic reviews or by stakeholder engagement, they will be added.

As part of the Communities of Place (CoP) Evidence Programme, at the What Works Centre for Wellbeing, we are conducting a scoping review and qualitative synthesis of the methods and approaches of community-based practices in supporting community wellbeing. This ‘Community Wellbeing Case Study Synthesis’ will have two areas of focus (i) development of a method to synthesise learning and outcomes from community-based wellbeing projects (ii) collection and review of a sample of projects that are focused on promoting wellbeing through a place or neighbourhood. There is considerable interest in the knowledge and learning that can be obtained from practice-based case studies, but no consensus on how to synthesise that evidence. This study will therefore aim to provide a ‘proof of concept’, laying the foundations for synthesising learning from community wellbeing practice. This protocol sets out the process that we will use to develop the methods and then apply them with a small set of community wellbeing case studies.

Background: Stakeholder engagement for the What Works Centre for Wellbeing’s (WWCW) Community Wellbeing Evidence Programme identified ‘boosting social relations’ in communities as a priority policy-related topic. A scoping review of 34 reviews identified evidence gaps relating to social relations in the following areas: community infrastructure (places and spaces); interventions to reduce or prevent social isolation in adults <60 years; community engagement and volunteering; social network analyses. We developed “community infrastructure (places and spaces)” as a systematic review, as this can be addressed at a local or regional level and has potential to produce immediate practical impact. Methods: We searched 11 bibliographic databases from 1997-2017, performed reference and citation checking, searched the websites of relevant organisations, and issued a call for evidence through the WWCW. We included studies which reported: interventions to improve or make alternative use of physical places and spaces at community or neighbourhood level; outcomes of social relations, community wellbeing and related concepts; quantitative, qualitative and mixed methods studies, and process evaluations. Two reviewers undertook study selection. One reviewer undertook data extraction and validity assessment, with a random 20% checked by a second reviewer. Validity of included studies was assessed using established checklists. Following thematic synthesis of qualitative data, a narrative synthesis was produced for each of eight intervention categories. The GRADE and CERQual approaches were used to rate the overall strength of evidence for each outcome. Results: 51 studies, mostly of poor to moderate quality, were included. The better quality evidence was qualitative, and most of the review’s findings come from the thematic synthesis of qualitative evidence There was moderate evidence that: (i) Community hubs may promote social cohesion, increase social capital and build trust between people, widen social networks and increase interaction between people, and increase people’s knowledge or skills; (ii) Changes to neighbourhood design may positively affect sense of belonging and pride in a community; (iii) Green and blue space interventions that provide the opportunity to participate in activities or meetings improve social interactions, increase social networks, bonding and bridging social capital, physical activity and healthy eating, and improve people’s skills and knowledge. There were also common themes relating to facilitators and barriers to successful interventions. Conclusions: The review found moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Future research should prioritise high quality evaluations using repeated measures and validated tools, with robust and credible qualitative evidence.

Issue: Strengthening community action, as proposed in the Ottawa Charter, is key to achieving public health goals within a whole-of society approach to health. Community engagement is not a simple intervention as it is shaped by community contexts and policy agendas that can either constrain or enable local action. This has implications for developing an evidence base. Description of problem: Changes in UK policy and programme funding have led to a fragmented evidence base and many participatory models not achieving sustainability. To inform an update of public heath guidance, the National Institute for Health and Care Excellence commissioned an independent, systematic scoping review to understand UK community engagement policy and practice. This paper presents findings from the documentary analysis of policy themes and concepts. Results: After systematic searching and screening, 40 policy and 30 conceptual publications were included and extracted data then mapped onto a matrix. We found that UK policy interest in community engagement in health threads through multiple sectors including health, local government and volunteering. Policy focus was not static; new concepts (eg social action) have emerged since 2000, while others (eg health inequalities) have less prominence. Local government was identified as a key policy actor. Community empowerment was a common theme but concepts were not used consistently. Lessons: Community engagement in health has policy significance but can lack visibility because it is applied across multiple policy areas and is cross referenced to different concepts. This is important for promoting intersectoral action involving communities and for building healthy public policy. Our conclusions are that community engagement is best used as a broad organising concept as it covers a range of policy areas and terms. This needs to be accounted for in building an evidence base for participatory methods within and between countries. Message 1 A mapping of UK policy since 2000 shows that community engagement in health can be promoted through a range of policy initiatives and sectors; however there is change through policy cycles Message 2 The evidence base on community engagement can appear fragmented, results from this policy analysis help identify related concepts and terms.

Growing policymaker interest in community wellbeing puts a premium on knowledge about existing community-level challenges and possible policy responses. If evidence-based policy and practice is foregrounded in these developments, there is a risk that lived experience is seen to lack validity in policy-making decisions and that knowledge from and about underrepresented groups is underemphasised. In consequence, the best available evidence on which to make policy decisions affecting these groups might be missed, thus potentially increasing health inequalities. This paper extends debate on this dilemma in this journal by using the lens of ‘pragmatic complexity’ as an alternative view on what works as evidence for policy and practice in community wellbeing. We present an empirical analysis of two expert hearings about community wellbeing. The events used a deliberative approach, allowing participants to probe evidence and consider from multiple perspectives ideas of how to address identified issues. Two overarching themes from the hearings - a perceived gap between the rhetoric and reality of wellbeing evidence, and proposals on ‘what works’ in the (co)-production of knowledge about wellbeing – are articulated and explored. We develop specific features emerging from the hearings that have wider resonance for community wellbeing research and suggest potential responses: what counts as ‘good’ or good-enough evidence about community wellbeing; system responses requiring thinking and engaging with complexity; reflections on the collective and collaborative process of an expert hearing approach. The combination of analysis of knowledge generated deliberatively through an expert hearing approach and a pragmatic complexity lens, delimits our contribution.

The work was done to support the Yorkshire Dales National Park (YDNP) Authority’s Access & Engagement team in developing and refining their Theory of Change (ToC) and to produce an evaluation framework. This should enable the Authority to better understand and articulate the impact of their work and assist with the planning of their future delivery.

This paper responds to challenges around how to generate robust evidence in keeping with the principles of an asset-based approach based on mobilization of community strengths. The design of a collaborative evaluation of a multi-site Asset Based Community Development program is described and emergent learning discussed. A qualitative mixed method design was used to capture changes at community and program level drawing on diverse sources of evidence. Shared principles on the conduct of the evaluation were developed with program leads and community practitioners and opportunities for shared learning were built in. The paper distils learning on evaluation into six design features including the asset-based model as a framework, understandings of evidence and outcomes, ethical conduct, and the centrality of a collaborative and developmental approach. The paper concludes that these features form a coherent approach to asset-based evaluation which can link the theory and practice of Asset Based Community Development.

The RNIB Eye Health Champion project, funded by the Department for Health’s Health & Social Care Volunteering Fund (HSCVF), aimed to reduce the rates of sight loss caused by diabetic eye disease. The Centre for Health Promotion Research (CHPR) at Leeds Beckett University (LBU) was commissioned to evaluate the project, starting in January 2015. This is the final report, covering the context of the project, the intervention, the evaluation methodology and findings reported thematically. The project ended in November 2017.

During Spring/Summer 2025, the Centre for Health Promotion Research are leading a series of discussions for local and national partners about the voluntary sector, learning disabilities, and digital inequalities. These discussions are for academics, community and civil society organisations, local authorities, and service users to discuss current research and priorities for the future. The first event was a webinar on Wednesday 21st May 2025, 12:00-13:00. Kris Southby, Anne-Marie Bagnall, Danielle Varley, and Jo Trigwell will share the results of an NIHR School for Social Care study about how community organisations can effectively use digital technology to delivery services to adults with learning disabilities and/or autism. The webinar was attended by 44 people from universities, local and national government, the voluntary sector, and NHS

An evaluation of the Outreach activity conducted by YDNPA in Inner East Leeds.

Community participation is a central concept for health promotion, covering a breadth of approaches, purposes and activities. This paper reports on a national knowledge translation project in England, UK, which resulted in a conceptual framework and typology of community-based approaches, published as national guidance. A key objective was to develop a conceptual framework linked to sources of evidence that could be used to support increased uptake of participatory methods across the health system. It was recognised that legitimacy of community participation was being undermined by a scattered evidence base, absence of a common terminology and low visibility of community practice. A scoping review, combined with stakeholder consultation, was undertaken and 168 review and conceptual publications were identified and a map produced. A ‘family of community-centred approaches for health and wellbeing’ was then produced as way of organising the evidence and visually representing the range of intervention types. There are four main groups, with sub-categories: (i) Strengthening communities (ii) Volunteer and peer roles (iii) Collaborations and partnerships and (iv) Access to community resources. Each group is differentiated using key concepts and theoretical justifications around increasing equity, control and social connectedness. An open access bibliography is available to accompany the framework. The paper discusses the application of the family of community-centred approaches as a flexible planning tool for health promotion practice and its potential to be used as a framework for organising and synthesising evidence from a range of participatory methods.

Background: Low rates of health service usage by men are commonly linked to masculine values and traditional male gender roles. However, not all men conform to these stereotypical notions of masculinity, with some men choosing to attend health services on a frequent basis, for a variety of different reasons. This study draws upon the accounts of male frequent attenders of the General Practitioner's (GP) surgery, examining their help-seeking preferences and their reasons for choosing services within general practice over other sources of support. Methods: The study extends thematic analysis of interview data from the Self Care in Primary Care study (SCinPC), a large scale multi-method evaluation study of a self care programme delivered to frequent attenders of general practice. Data were collected from 34 semi-structured interviews conducted with men prior to their exposure to the intervention. Results: The ages of interviewed men ranged from 16 to 72 years, and 91% of the sample (n= 31) stated that they had a current health condition. The thematic analysis exposed diverse perspectives within male help-seeking preferences and the decision-making behind men's choice of services. The study also draws attention to the large variation in men's knowledge of available health services, particularly alternatives to general practice. Furthermore, the data revealed some men's lack of confidence in existing alternatives to general practice. Conclusions: The study highlights the complex nature of male help-seeking preferences, and provides evidence that there should be no 'one size fits all' approach to male service provision. It also provides impetus for conducting further studies into this under researched area of interest. © 2011 WPMH GmbH.

A mixed methods evaluation of a Leeds youth organisation. Methods included; qualitative interviews, a survey of young people attending plus an SROI.

Background The prisoner population has poorer health and worse health inequalities than the general population. Peer-based interventions may be an effective way of reaching this vulnerable group. Methods The systematic review aimed to answer the following questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prisons? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prisons? In addition to grey literature identified and searches of websites, 19 electronic databases were searched from 1985 to present. Quantitative, qualitative and mixed method evaluations were included. Results 57 studies were included in the effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment, have a positive effect on deliverers and recipients and can impact positively on the prison as an organisation. There was only one study on cost-effectiveness of peer-based interventions. Conclusions Being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients, although research into cost-effectiveness is sparse. Peer-based interventions can be considered a valuable mechanism to maintain or improve health and wellbeing in the prison setting. Funding: NIHR HS&DR programme Project 10/2002/13

Background The prisoner population has a higher prevalence of poor health and health inequalities compared to the general population. Peer based interventions may be an effective way of reaching this vulnerable group. Methods Review questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prison settings? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prison settings? 19 electronic databases were searched from 1985 to present, plus relevant websites. Inclusion criteria: prisoners, or children in Young Offender Institutions; delivering or receiving peer-based interventions; outcomes relating to health or its determinants, organisational or process outcomes; Quantitative, qualitative and mixed method evaluations. Results 58 studies were included in the review; most were methodologically poor. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and peer support services are acceptable within the prison environment, having a positive effect on recipients. Consistent evidence from many studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. Conclusions There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse.

Background The prisoner population has a higher prevalence of poor health and health inequalities compared to the general population. Peer based interventions may be an effective way of reaching this vulnerable group, but to date the evidence has not been systematically reviewed. Methods The systematic review aimed to answer the following questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prison settings? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prison settings? In addition to grey literature identified and searches of websites, 19 electronic databases were searched from 1985 to present. Two reviewers selected studies using the following criteria: prisoners resident in adult prisons or children resident in Young Offender Institutions; delivering or receiving peer-based interventions; outcomes relating to prisoner health or its determinants, organisational or process outcomes or views of prison populations. Quantitative, qualitative and mixed method evaluations were included. Results 57 studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. Conclusions There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. Main messages This comprehensive systematic review of peer interventions in prisons found positive effects for peer deliverers and recipients, particularly in mental health and reducing risky behaviours.

To determine the effects of a community-based training programme in self-care on the lay population.

‘People in Public Health’ is a study about approaches to develop and support lay people in public health roles. The use of participatory approaches in public health programmes, both in national and international contexts, is well established and seen as necessary to deliver sustainable improvements in public health (Bracht and Tsouros, 1990; Rifkin et al., 2000; World Health Organization, 2002). Indeed a central argument in the Wanless reviews was that a ‘fully engaged scenario’ with high levels of public engagement in health would result in lower levels of public expenditure and better health outcomes (Wanless, 2002; Wanless, 2004). Government policy supports greater community engagement in health as a means of addressing public health priorities and tackling health inequalities (Department of Health, 2003). The health agenda on community involvement resonates with arguments for citizen empowerment and greater democratisation of services, not only in the NHS but across the public sector, in national agencies and local authorities (Campbell et al., 2008). Recent national guidance on community engagement noted the wide variety of approaches, indicating that those approaches based on higher levels of participation and greater community control were more likely to lead to increased health and social outcomes1 (National Institute for Health and Clinical Effectiveness, 2008). There was a recommendation to recruit what were termed ‘agents of change’ in communities who become involved ‘to plan, design and deliver health promotion activities and to help address the wider social determinants of health’ by taking on roles such as peer educators, health champions or neighbourhood wardens (National Institute for Health and Clinical Effectiveness, 2008:28). The concept of empowerment, the process of individuals and communities being enabled to undertake local action to effect change, is seen as core to health promotion (Tones and Tilford, 2001; World Health Organization, 1986; Wallerstein, 2006). Government policy on community empowerment advocates increased citizen involvement in planning and running services (Secretary of State for Communities and Local Government, 2008) and this agenda is linked to the personalisation of health and social services and patient and public involvement (Department of Health, 2005b; Department of Health, 2006; Secretary of State for Health, 2006). More evidence is required, however, about effective mechanisms for lay engagement and how public services can best enhance, support and sustain community involvement.

Background: Offender health is deemed a priority issue by the Department of Health. Peer support is an established feature of prison life in England and Wales; however, more needs to be known about the effectiveness of peer-based interventions to maintain and improve health in prison settings. Objectives: The study aimed to synthesise the evidence on peer-based interventions in prison settings by carrying out a systematic review and holding an expert symposium. Review questions were (1) what are the effects of peer-based interventions on prisoner health and the determinants of prisoner health?, (2) what are the positive and negative impacts on health services within prison settings of delivering peer-based interventions?, (3) how do the effects of peer-based approaches compare with those of professionally led approaches? and (4) what are the costs and cost-effectiveness of peer-based interventions in prison settings? Data sources: For the systematic review, 20 electronic databases including MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature and EMBASE were searched from 1985. Grey literature and relevant websites were also searched. To supplement the review findings 58 delegates, representing a variety of organisations, attended an expert symposium, which provided contextual information. Review methods: Two reviewers independently selected studies using the following inclusion criteria: population – prisoners resident in prisons and young offender institutions; intervention – peer-based interventions; comparators: review questions 3 and 4 compared peer-led and professionally led approaches; outcomes – prisoner health or determinants of health, organisational/process outcomes or views of prison populations; study design: quantitative, qualitative and mixed-methods evaluations. Two reviewers extracted data and assessed validity using piloted electronic forms and validity assessment criteria based on published checklists. Results from quantitative studies were combined using narrative summary and meta-analysis when appropriate; results from qualitative studies were combined using thematic synthesis. Results: A total of 15,320 potentially relevant papers were identified of which 57 studies were included in the effectiveness review and one study was included in the cost-effectiveness review; most were of poor methodological quality. A typology of peer-based interventions was developed. Evidence suggested that peer education interventions are effective at reducing risky behaviours and that peer support services provide an acceptable source of help within the prison environment and have a positive effect on recipients; the strongest evidence came from the Listener scheme. Consistent evidence from many predominantly qualitative studies suggested that being a peer deliverer was associated with positive effects across all intervention types. There was limited evidence about recruitment of peer deliverers. Recurring themes were the importance of prison managerial and staff support for schemes to operate successfully, and risk management. There was little evidence on the cost-effectiveness of peer-based interventions. An economic model, developed from the results of the effectiveness review, although based on data of variable quality and a number of assumptions, showed the cost-effectiveness of peer-led over professionally led education in prison for the prevention of human immunodeficiency virus (HIV) infection. Limitations: The 58 included studies were, on the whole, of poor methodological quality. Conclusions: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health. Peer support services can also provide an acceptable source of help within the prison environment and can have a positive effect on recipients. This was confirmed by expert evidence. Research into cost-effectiveness is sparse but a limited HIV-specific economic model, although based on a number of assumptions and evidence of variable quality, showed that peer interventions were cost-effective compared with professionally led interventions. Well-designed intervention studies are needed to provide robust evidence including assessing outcomes for the target population, economic analysis of cost-effectiveness and impacts on prison health services. More research is needed to examine issues of reach, utilisation and acceptability from the perspective of recipients and those who choose not to receive peer support. Study registration: This study was registered as PROSPERO CRD42012002349. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

BACKGROUND: Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings. METHODS: A mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were: Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs). INTERVENTION: Peer-based interventions Comparators: Review questions 3 and 4 compared peer and professionally led approaches. OUTCOMES: Prisoner health or determinants of health; organisational/ process outcomes; views of prison populations. STUDY DESIGNS: Quantitative, qualitative and mixed method evaluations. RESULTS: Fifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. CONCLUSIONS: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ref: CRD42012002349 .

To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients.

Background: Social relations are recognized as an important determinant of individual & community wellbeing. The UK What Works Wellbeing Centre chose “boosting social relations” as a priority topic for systematic review. First, a scoping review was undertaken to identify evidence gaps. Methods: We searched: Cochrane database of systematic reviews, DARE, Campbell Library, DoPHER (EPPI-Centre), Joanne Briggs Institute, MEDLINE, IDOX, CINAHL, PsycINFO, Social Policy & Practice, Social Care Online; relevant websites. Inclusion criteria: Population – communities in OECD countries; Intervention - Any community-based intervention, change in policy, organisation or environment that were designed to boost social relations within the community; Outcomes – social relations, community wellbeing or related synonyms; Study design – systematic & non-systematic reviews published between 2005 and 2016. Studies were selected & data extracted by 3 reviewers, and summarised narratively. Results: 11,257 titles and abstracts were screened, 182 obtained in full & 29 included. Existing evidence tells us: Targeted group interventions that foster social networks & provide meaningful roles can reduce social isolation and/ or loneliness in older people; Volunteering can improve physical & mental health & wellbeing in older people; Effective community engagement produces sustainable improvements in community health & individual wellbeing. Evidence gaps: Interventions for social isolation &/ or loneliness in adults aged up to 65 years; Volunteering in people aged up to 65 years; Social network analyses; Community infrastructure (places & spaces). Stakeholder consultations identified community infrastructure (places & spaces) as the most useful topic for systematic review. Conclusions: A systematic scoping review of reviews, with stakeholder consultation, identified community infrastructure (places & spaces) as an evidence gap. Early findings from the resulting systematic review will be presented.

The report shows the impact of the community project since its inception in 2017, during its early growth, through the pandemic and looking to the future. By consulting with the local community, partners and co-workers this report shows the project’s impact on local people’s health and wellbeing, the growth of strong partnership working and the solid financial footing The Old Fire Station demonstrates. The trustees intend that this report shows the clear advantages of the investment made, the return given and the power of partnership working.

Background: Stakeholder engagement for the What Works Centre for Wellbeing’s (WWCW) Community Wellbeing Evidence Programme identified ‘boosting social relations’ in communities as a priority policy-related topic. A scoping review of 34 reviews identified evidence gaps relating to social relations in the following areas: community infrastructure (places and spaces); interventions to reduce or prevent social isolation in adults <60 years; community engagement and volunteering; social network analyses. We developed “community infrastructure (places and spaces)” as a systematic review, as this can be addressed at a local or regional level and has potential to produce immediate practical impact. Methods: We searched 11 bibliographic databases from 1997-2017, performed reference and citation checking, searched the websites of relevant organisations, and issued a call for evidence through the WWCW. We included studies which reported: interventions to improve or make alternative use of physical places and spaces at community or neighbourhood level; outcomes of social relations, community wellbeing and related concepts; quantitative, qualitative and mixed methods studies, and process evaluations. Two reviewers undertook study selection. One reviewer undertook data extraction and validity assessment, with a random 20% checked by a second reviewer. Validity of included studies was assessed using established checklists. Following thematic synthesis of qualitative data, a narrative synthesis was produced for each of eight intervention categories. The GRADE and CERQual approaches were used to rate the overall strength of evidence for each outcome. Results: 51 studies, mostly of poor to moderate quality, were included. The better quality evidence was qualitative, and most of the review’s findings come from the thematic synthesis of qualitative evidence There was moderate evidence that: (i) Community hubs may promote social cohesion, increase social capital and build trust between people, widen social networks and increase interaction between people, and increase people’s knowledge or skills; (ii) Changes to neighbourhood design may positively affect sense of belonging and pride in a community; (iii) Green and blue space interventions that provide the opportunity to participate in activities or meetings improve social interactions, increase social networks, bonding and bridging social capital, physical activity and healthy eating, and improve people’s skills and knowledge. There were also common themes relating to facilitators and barriers to successful interventions. Conclusions: The review found moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Future research should prioritise high quality evaluations using repeated measures and validated tools, with robust and credible qualitative evidence.

The aim of this systematic review is to synthesise the available evidence, and describe the quality of that evidence, in relation to interventions that improve or create the community infrastructure that impacts on social relations and/ or community wellbeing. For this review, we are defining community infrastructure as the physical places and spaces where people can come together, formally or informally, to interact and participate in the social life of the community. We intend to produce a synthesis which is accessible and will inform practice and future research in the area.

Health education has changed in numerous ways since the inception of this journal, with many developments moving the discipline forward in ways that perhaps were not envisaged 75 years ago. Whilst there have been reported concerns about the decline of the discipline of health promotion and therefore associated worries about education, the contemporary evidence base has grown (Woodall et al 2017 in press), which we argue supports the delivery of quality education and the development of capable, skilled practitioners. Pedagogy has further developed too, and technology now enables health education to have a broader global reach through online teaching, social media and open-access publications. Many global challenges remain, and the UK context is one in which both health education and indeed practice faces major trials despite the traditions and approaches to health education developed by those educated and trained in this setting over a period of many years. We argue that the broader UK policy environment remains a challenge to current health promotion education, research and practice.

BACKGROUND: Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. METHODS: A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. RESULTS: The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. CONCLUSIONS: By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement.

A summary of the evidence on neighbourhood-based Asset Based Community Development (ABCD). It includes information from scientific journals and evaluation reports. The evidence review was done for Leeds City Council as part of Leeds Beckett University’s evaluation of the ABCD programme in the city.

A summary presenting findings from Leeds Beckett University’s evaluation of an Asset Based Community Development programme in Leeds.

This report presents findings from the Leeds Asset Based Community Development (ABCD) programme evaluation. ABCD is a neighbourhood-based community building approach that uses community organising methods to identify, mobilise and strengthen the capacities or asset of individuals, families and communities (Kretzmann and McKnight, 1993). At the time of the evaluation. 12 ABCD pathfinder sites operated in Leeds neighbourhoods, the majority established in 2019. The model consists of: • Community Builders - paid workers hosted by Neighbourhood Organisations • Community Connectors - individuals living locally who may organise and support local activities • ‘Small Sparks’ grants - funds for groups and individuals to support local activity. Using mainly qualitative and participatory methods, this collaborative evaluation involved working with Leeds City Council and the Community Builders to gather evidence of what works and how. The findings show that the pioneering Leeds ABCD pathfinder model is still relatively new in its development and shifting to citizen-led activity takes time. Nonetheless the evaluation presents strong evidence on how ABCD works and the mechanisms of change thus demonstrating how a city-wide approach can be implemented. There is strong evidence for better social connections and the pathway to community change. Promising evidence for increased friendships, the social value of the pathfinder model, change in communities and other additional outcomes also exists. A series of recommendations and issues for consideration are presented to inform programme development.

Background A community empowerment programme in the UK aims to enable people to have greater collective control over area-based decision making, improved health and wellbeing and reduce health inequalities, by providing small grants to support residents of deprived neighbourhoods and communities of interest to come together to take action on issues of importance to them. Methods A survey was conducted at 4 6-month intervals as part of a mixed methods evaluation, to collect data about participant demographics, level of involvement, opinions of the project, and impacts. The survey was self-completed online or on paper, and distributed by local project leads. Outcome questions were adapted from the UK Government Community Life Survey to facilitate comparison with national statistics. Data were analysed using SPSS to produce descriptive statistics, supported by inferential statistical tests where appropriate. Regression analysis using multi-level modelling was used to estimate the conditional correlation between health outcome and Local People project participation. Results 1053 people from 29 local areas responded to the survey over the 4 time points; only 93 responded more than once. 43% took part in project activities, 36% were local project committee members and 19% were volunteers. The analysis found positive impacts on confidence, control, friendships, skills, happiness, life satisfaction, feelings of worth (p < 0.05), and that greater length and degree of involvement in the projects were associated with greater positive impacts on all of these outcomes. Conclusions The survey provides tentative evidence that participation in a community empowerment initiative may result in improved wellbeing, feelings of power and control, sense of belonging and trust. People who are involved for longer or more deeply involved are more likely to see these impacts. More community-based survey research is needed to gather people's views on neighbourhood initiatives. Key messages An evaluation of a community empowerment programme found positive impacts on control, wellbeing, belonging and trust. Greater length or degree of involvement were associated with greater impact.

An important consideration that needs adding to discussions of patient choice and whether or not men are reluctant to use primary care services is that many frequent attenders are male. The aim of this article is to explore how male frequent attenders construct decisions to use or not use health-care services. This is achieved through secondary analysis of baseline interviews with male frequent attenders from the Self Care in Primary Care study. As this was a complex study, a three-step analytic process was employed to incorporate the involvement of multiple researchers working together over a number of years. First, the interviewer summarised each interview and second, the summaries were read as a group to find themes across them. Subsequently, we returned to the interviews to add detail that would further illustrate or challenge the analysis. Participants talked of ‘engaging health and avoiding ill-health’, constructing themselves as embodied, health conscious and rational in a similar vein to constructions of feminine interactions with health. While participants talked of ‘choosing health services’ as if they were drawing upon a range of choices, the dominance of the image of the GP was such that seeing a GP was the only legitimate health choice.

This summary focuses on information from the Leeds Beckett ABCD evaluation about the effect of Covid-19 on the Leeds ABCD programme and how ABCD sites responded to the crisis.

This report reviews recent research on Asset Based Community Development (ABCD). ABCD is part of a broader group of asset-based approaches which have been applied in different types of community and settings. This report focuses on evidence about neighbourhood-based ABCD practice, which is the approach being taken in Leeds. Recent research studies are reviewed, building on previous reviews on asset-based approaches. The report summarises the evidence on key topics around ABCD theory, how the approaches work, implementation, evaluation and outcomes.

Background Despite growing interest in understanding complex systems and public health interventions, research methodologies that take account of system-wide action are relatively underdeveloped. Community-based participatory research (CBPR) is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of CBPR in complex public health intervention evaluations. The ‘Local People’ and ‘Local Conversations’ programmes use a community empowerment approach in 50 communities across the UK experiencing social disadvantage to increase social connections and collective control, improve health and wellbeing, and reduce inequalities (linked to SDG 3 and 11). Methods Evaluation of the programmes followed a mixed-methods design, including qualitative case studies, longitudinal survey, process appraisal, and CBPR. Residents from 10 communities across the programmes each undertook 2 rounds of CBPR. These projects resulted in written reports, which were analysed thematically alongside other data sources. Results There was some variation in the scope and design of the 20 completed CBPR projects. Whilst projects did not generally extend beyond the scope of the overall evaluation, peer research provided information from residents that were inaccessible to other data collection streams. Gathering community (lay) knowledge improved understanding of local priorities and actions within the programmes. However, the utility of CBPR was less consistent for community-researchers and local communities, often failing to support project development. Some community-researchers felt unprepared for the activity despite support from the academic team. Conclusions Conducted appropriately, CBPR can elicit data that would be less accessible through externally led research. This study highlights the value of CBPR in complex programme evaluations, enabling a deeper understanding of social context in which interventions occur.

Background Technology is seen as a way to improve quality and reduce the cost of social care services. Voluntary and community sector organisations (VCSOs) are also becoming more involved in delivering social care services to adults with intellectual disabilities and/or autism. However, there is not enough information to help VCSOs use technology in the best way to deliver services. The aim of this research is to explore how VCSOs can appropriately use digital technologies alongside or instead of in-person activity (hybrid delivery) to provide services to different adults with intellectual disabilities and/or autism. Methods We conducted a participatory realist review. Workshops were held with service users and VCSOs to refine the scope of the review and develop preliminary theories. A systematic search of academic and grey literature was then carried out, including academic databases, website searches, and a call for evidence. Following screening, extraction, and synthesise, a deliberative hearing was held with service users and VCSOs to discuss emergent findings, refine theories, and develop conclusions. Results 141 papers were included in the review, although very few were specifically about how VCSOs use technology as part of their service delivery with people with learning disabilities and/or autism. Different technologies can have specific benefits for adults with learning disabilities and/or autism in different contexts. ‘Good’ hybrid service delivery requires co-production of services between users and VCSOs, and support that goes beyond just providing access to equipment. Conclusions VCSOs can use technology in a myriad of ways but there is limited guidance about how to do this appropriately with adults with learning disabilities and/or autism. We propose six ‘top tips’ as a starting point to help VCSOs.

Background During the Covid-19 pandemic there was a significant rise in health and care services delivering services remotely, including by voluntary and community sector organisations (VCSOs) to adults with learning disabilities and/or autistic people. However, there was not enough research evidence of how different technologies are used, what works well or not well, for whom, and in what circumstances to support the diverse needs of adults with learning disabilities and/or autistic people. To address this evidence gap, Leeds Beckett University carried out a participatory realist review in partnership with 100% Digital Leeds, Pyramid and the Autism and Learning Disabilities Digital Inclusion Network (ALaDDIN) to explore how VCSOs can appropriately use digital technologies alongside or instead of in-person activity (hybrid delivery) to provide social care services to different adults with learning disabilities and/or autistic people. Methods This briefing is based on the findings of the participatory realist review. The research involved: • Five workshop and focus group discussions with people with learning disabilities and/or autistic people and representatives from VCSOs who worked with them, • A comprehensive review of relevant published research, guidance and policy, and • A deliberative hearing event to bring together findings from research and lived experience Results Everyone has the right to choose how they engage with the digital world! The workshop discussions and preliminary literature review produced 13 areas of interest that we explored in the realist review. The review included 141 articles in total and, following our discussions of the findings with service deliverers and users at the deliberative hearing event, led to six top tips for VCSOs using digital technology for delivering services to people with learning disabilities and/or autistic people.

Background Community organisations started using technology like video conferencing and social media more during the Covid-19 pandemic to keep doing activities with adults with learning disabilities and autism. They are now trying to figure out the best ways to combine technology and face-to-face activities. We wanted to find out the different ways that these community organisations combine technology and face-to-face activities and what works well. Methods We looked at published research about how community organisations use technology to provide services for adults with learning disabilities and autism. We held an event for community organisations and adults with learning disabilities and autism. We talked about what we had found out and heard peoples’ experiences of using technology. Results There is lots of research that includes community organisations using technology. Having a choice about whether to use technology is really important. Using technology can make it easier for people with learning disabilities and autism to join in if they have the right equipment, skills, and support. But there is no information about what community organisations need to use technology to delivery services for adults with learning disabilities and autism. Conclusion Supporting people with learning disabilities and autism to use technology can improve their independence and life skills. But there is not a lot of information for community groups to help them do this. We have applied for funding to do more research about this.

Background Delivery of health and care services using a combination of remote and/or in-person channels and digital and/or traditional tools (Hybrid Service Delivery, HSD) is increasingly seen as a way of improving quality and affordability, improving access, personalisation and sustainability, and reducing inequalities. Across the voluntary, community and social enterprise sector (VCSE), using a combination of remote and/or in-person channels and digital and/or traditional tools (HSD) has enabled the essential provision of services for people who have learning disabilities and/or autistic (LDA). However, it is unclear how different tools and channels have been used, what worked well or not well, for whom, and in what circumstances. The aim of this realist review is to explore how VCSE organisations can effectively use digital technologies alongside or instead of in-person activity to provide social care services to adults with learning disabilities and/or autism. This review protocol is presented in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). Methods We will conduct a participatory realist review. Following realist review methodology, and involving people with LDA and organisations who deliver services to them, we will define the scope of the review/theory development, search for and appraise evidence, extract and synthesise findings, and develop the narrative. Using a developed strategy, electronic databases (Academic Search Complete, CINAHL, MEDLINE, PsycInfo, SCOPUS, Social Science Citation Index and Social Policy and Practice) will be searched. A data extraction table will be used to assist in sifting, sorting and organising relevant information from identified studies. For each proposition statement, relevant data from the identified literature will be synthesised and compared with the proposed theory to develop an understanding of how, why and when hybrid delivery works in different settings with different populations. Discussion This review aims to collate and synthesise evidence relating to hybrid service delivery in VCSE organisations to provide social care services to LDA adults. By conducting a participatory realist review, we anticipate that the findings will lead to a greater understanding of contextual factors and therefore more relevant recommendations.

Background aims Community organisations started using technology like video conferencing and social media more during the Covid-19 pandemic to keep doing activities with adults with learning disabilities and autism. They are now trying to figure out the best ways to combine technology and face-to-face activities. We wanted to find out the different ways that these community organisations combine technology and face-to-face activities and what works well. Methods We looked at published research about how community organisations use technology to provide services for adults with learning disabilities and autism. We held an event for community organisations and adults with learning disabilities and autism. We talked about what we had found out and heard peoples’ experiences of using technology. Results There is lots of research that includes community organisations using technology. Having a choice about whether to use technology is really important. Using technology can make it easier for people with learning disabilities and autism to join in if they have the right equipment, skills, and support. But there is no information about what community organisations need to use technology to delivery services for adults with learning disabilities and autism. Conclusion Supporting people with learning disabilities and autism to use technology can improve their independence and life skills. But there is not a lot of information for community groups to help them do this. We have applied for funding to do more research about this.

Background Hybrid service delivery (HSD), involving the utilisation of both in-person and remote delivery for service provision, has been noted as a way of improving quality and affordability, increasing access and reducing inequalities. While HSD has facilitated the provision of services for people with learning disabilities and/or autism across the voluntary, community and social enterprise sector (VCSE), it is not apparent how HSD has been used, what worked well or not well, for whom, and in what circumstances. This study aimed to explore how VCSE organisations could effectively use digital technologies alongside or instead of in-person activity to provide social care services to adults with learning disabilities and/or autism. Methods A participatory realist review methodology was utilised. Programme theories and propositions about the phenomenon and related concepts were identified utilising preliminary literature searches and co-production workshops with service providers and service users. The developed statements were used to guide the database and the identification of evidence. This evidence was used to test and refine the statements. Results 141 records were used to produce 13 areas of interest. While there was strong evidence supporting the use of digital technology to improve social connections and independence, this was only the case when the technology was used correctly, implemented in a suitable setting and ‘fit’ the person using it. Evidence indicated that the development or adaptation of technology which were co-produced with adults with learning disabilities and/or autism were associated with better service delivery. Conclusions Supporting adults with learning disabilities and autism to use technology can improve their independence and life skills. However, the technology needs to be implemented in the right setting, as well as co-production being used to ensure the technology and the delivery is suitable and accessible. Key messages • There is evidence that digital technologies can be used to support people with learning disabilities and autistic people, but only if it is used correctly and in the right setting. • Utilise co-production to shape tech-enabled services. Consider language use, visuals and technology delivery. Listen to their ideas, so the technology delivers what they want and need.

Background Peer-research is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of peer-research in two complex public health intervention evaluations in the UK. Methods Reports from 18 peer research projects, completed by residents from 12 communities in the UK taking part in two community empowerment interventions, were analysed using cross-case analysis. Results Undertaking peer research helped to build the evaluation and research skills within individual projects as well as providing data on other outcomes related to the programmes Theory of Change. Some peer researchers, however, felt unprepared for the activity despite support from the academic team and were unsatisfied with project outcomes. While peer research projects provided more opportunities for local residents to engage with the overall evaluations, there was an overreliance on people closely connected to the programmes to be peer researchers. The peer research projects explored topics that were broader than the aims and objectives of the overall programme evaluations. All provided insight into the context in which projects occurred, while some also informed understanding of programme change mechanisms. Conclusions Including peer research as part of complex public health intervention evaluations can help uncover important contextual and ecological details beyond the reach of more traditional evaluation data collection. Peer research can also empower and build research/evaluation capacity within communities, which is particularly pertinent for community empowerment interventions.

Community champions (also known as health champions) are community members who volunteer to promote health and wellbeing or improve conditions in their local community. Champions use their social networks and life experience to address barriers to engagement and improve connections between services and disadvantaged communities. Findings from this rapid review show that community champion approaches have high relevance to reducing health inequalities, whether the context is one of an emergency, or of longer term prevention. Community champions can be key connectors in communities but these roles do not operate in isolation and need to be embedded in effective community engagement strategies. As public health interventions, community champion approaches can be applied flexibly dependent on local needs and community assets. This review identifies different models and ways of building champion programmes

Background The ‘Local People’ programme operates in 29 UK communities experiencing disadvantage and economic stressors that impact on population wellbeing. The programme uses a community empowerment approach to increase social connections, and collective control, improve health, and reduce inequalities. This links to SDGs 3 and 11. Mechanisms include a decision-making group led by residents, a project lead, funding, and support from a national charity. Methods A mixed method evaluation was conducted (2017-19) to identify processes and assess outcomes and impacts. This presentation outlines the findings from five in-depth qualitative case studies (c140 interviews) with emphasis on one post-industrial UK town suffering from the effects of industrial decline. A within case and cross case qualitative analysis was undertaken using a thematic framework. Results Priorities set by local areas focused on increasing community involvement and connections between people. A wide range of activities took place including regular classes and community events. The five case studies found strong qualitative evidence of increased social connectedness, community spirit and a sense of purpose, along with the area becoming a better place to live. People involved in project delivery gained confidence and skills, improved their wellbeing and gained a sense of control. There is, as yet, limited evidence that increased involvement has influenced the wider determinants of health. In the post-industrial town, people’s social networks expanded, enriching their lives and providing missed companionship. Participants in the programme reported improved mental and physical health, as well as increased confidence and skills. Involvement gave a voice to marginalised older people in the area. Conclusion Empowering communities and putting residents in control can lead to improvements in connectedness and some aspects of health and wellbeing, even in post-industrial towns facing considerable and complex challenges.

Community empowerment interventions, which aim to build greater individual and community control over health, are shaped by the community systems in which they are implemented. Drawing on complex systems thinking in public health research, this paper discusses the evaluation approach used for a UK community empowerment programme focused on disadvantaged neighbourhoods. It explores design choices and the tension between the overall enquiry questions, which were based on a programme theory of change, and the varied dynamic socio-cultural contexts in intervention communities. The paper concludes that the complexity of community systems needs to be accounted for through in-depth case studies that incorporate community perspectives.

Background: Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. Methods: Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results: 65 articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions: Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

The Centre for Health Promotion at Leeds Beckett University were commissioned to review existing literature on the impacts of mega-sporting event volunteering and to undertake a qualitative study to investigate the experiences of volunteers at the Glasgow 2014 Commonwealth Games (known as ‘clyde-siders’). The study also set out to explore the experiences of those who applied to be a clyde-sider but were not successful with their application (referred to as non-clyde-siders). The literature review identified process issues as significant factors in the delivery of a mega-sporting event that results in a positive experience for volunteers. The review also found that mega-sporting event volunteering yields health and social outcomes both for individual volunteers and the host community. The weight of evidence in this review suggests that the process of mega-sporting event volunteering is relatively well understood. However, gaps remain with regard to the longer-term outcomes of mega-sporting event volunteering for individual volunteers (and those who apply but do not go on to become volunteers) and for communities. Qualitative exploration with clyde-siders and non-clyde-siders identified important assets that they brought to the Glasgow 2014 Commonwealth Games. Existing skills and experiences from their professional life or other volunteering roles; a personal touch reflecting commitment and approachability; and local knowledge of the city were important attributes that were highlighted. The research highlighted that while volunteers added to the success of the Games and its delivery, they were also able to draw on the event for their own personal benefit. Positive outcomes included increased confidence and knowledge, and the development of skills for future employment. These outcomes were often more pronounced in clyde-siders than non-clyde-siders, but this was not always the case as some non-clyde-siders drew benefits from applying for the role. The development of friendships and the value that people placed on meeting new people was a particularly prominent finding for both clyde-sider and non-clyde-siders. This included ‘bridging’ with others across social and cultural boundaries. The link between place, participation and the social impacts of volunteering at the Glasgow 2014 Commonwealth Games is a distinctive finding from the research. For clyde-siders, benefits were derived from the formal volunteering role and from being part of the collective experience in the city during the Games. These benefits could not be solely attributed to being a volunteer, as non-clyde-siders also reported gaining from being part of the friendly atmosphere generated by hosting the Games. Implications for strategic planning for mega-sporting events are outlined in the report.

Issues presented by COVID-19 to community resilience are located at individual, community and system level. In this paper, we reflect on WHO Europe propositions on what makes resilient communities, and explore how communities and systems with varying capacity have responded to the pandemic by absorbing and adapting to challenges. In our research we are seeing local responses at all three levels, which challenge current assumptions about the respective roles of citizen, local voluntary sector and state. This paper presents opportunities and challenges to translating this reactive social movement into proactive resilience-transforming change in how local systems work in the future.