Professor Chris Fife-Schaw

This code includes the statistical analysis for my study on “Clustering of cardiometabolic risk factors and dementia incidence”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and contains code on latent class analysis (LCA) and Cox proportional hazards regression. The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This repository includes three curated datasets used in my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The datasets are in SAV (SPSS) format and contain curated and harmonised data from three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS). Permission for access may be granted on request to panagiota.kontari@gmail.com or p.kontari@surrey.ac.uk or kimberley.j.smith@surrey.ac.uk.

This code includes the statistical analysis for my study on “Mediating effects of depressive symptoms and cardiometabolic health on dementia development”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and Mplus version 8 and contains code on mediation analysis using structural-equation modelling (SEM). The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This code includes the statistical analysis for my study on “Trajectories of depressive symptoms and their relationship with dementia incidence”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and contains code on latent class growth curve analysis (LCGA), logistic regression, and Cox proportional hazards regression.The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This code includes the statistical analysis for my study on “Independent and combined effects of depressive symptoms and cardiometabolic risk factors on dementia incidence”. It was created as part of my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The analysis was performed in Stata version 16 and contains code Cox proportional hazards regression. The code is created using three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

This code includes the data preparation and curation for my PhD research on “The role of depressive symptoms and cardiometabolic risk factors in the prediction of dementia: a cross-country comparison in England, the United States and China”. The scripts are written in SPSS version 27 and include the code and procedures for data preparation, curation and harmonisation across three publicly available population-based databases: the English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS).

Background: There is mixed evidence for an association between cardiometabolic risk factors and dementia incidence. This study aimed to determine whether different latent classes of cardiometabolic conditions were associated with dementia risk in older adults across England, the USA and China. Methods: A total of 4511 participants aged 50 and older were drawn from the English Longitudinal Study of Ageing (ELSA), 5112 from Health and Retirement Study (HRS) and 9022 from China Health and Retirement Longitudinal Study (CHARLS). Latent class analyses were performed across each dataset utilising seven baseline cardiometabolic conditions: obesity, low high‐density-lipoprotein (HDL) cholesterol, systolic and diastolic blood pressure (BP), hyperglycemia, diabetes, and inflammation. Confounder-adjusted Cox proportional hazards regressions were conducted to estimate dementia incidence by cardiometabolic latent classes. Results: Three similar cardiometabolic classes were identified across all countries: 1) ‘relatively healthy/healthy obesity’, 2) ‘obesity-hypertension’ and 3) ‘complex cardiometabolic’. Across the three samples, a total of 1,230 individuals developed dementia over a median of 6.8-12.2 years. Among ELSA and HRS participants, the ‘complex cardiometabolic’ group had a higher dementia risk when compared to the ‘healthy obesity’ groups (England: AdjHR=1.62 [95%CI=1.11–2.37]; USA: AdjHR=1.31 [95%CI=1.02–1.68]). However, in CHARLS participants, the ‘obesity-hypertension’ group had a greater risk of dementia when compared to the ‘relatively healthy’ group (AdjHR=1.28 [95%CI=1.04–1.57]). Conclusion: This study provides evidence that in western populations, complex cardiometabolic clusters are associated with higher rates of dementia incidence, whereas in a Chinese sample, a different cardiometabolic profile seems to be linked to an increased risk of dementia.

This study investigated whether demographic variables, efficacy beliefs, European identifications, future visions, and worries are associated with four forms of (dis)engagement with the European Union. The sample comprised 3,764 young people aged 16 to 25 years living in seven European countries: Albania, Austria, Germany, Italy, Romania, Spain, and the UK. Economic challenges, human rights, and the environment were the most important future visions. Unemployment and poverty, climate change, civil unrests and the collapse of the EU were the most important future worries. The four forms of (dis)engagement with the European Union were differentially associated with the predictors explaining 7.2 to 23.8% of the variance. Internal efficacy and the future vision economic challenges predicted all constructs. Regarding European identifications, the sub-constructs belonging and exploration were most important. Implications for future EU policy are discussed.

In the Houses of Parliament, politicians within the two leading political parties, Conservative and Labour, were split over the issue, and in the country at large, many families were split about whether the UK should remain or leave. The young people’s political and civic values have been found in previous research to play a significant role in driving their political and civic behaviour. Values may be defined as very general beliefs that individuals hold about the desirable goals that should be striven for in life. In contrast to a value, an attitude is traditionally conceptualized as being the overall mental orientation which an individual adopts towards someone or something. One important attitude that has been found to be linked to young people’s civic and political behaviour is internal efficacy.

Background People need high-quality information to make decisions about research participation. Providing information in written format alone is conventional but may not be the most effective and acceptable approach. We developed a structure for the presentation of information using multimedia which included generic and trial-specific content. Our aim was to embed ‘Studies Within A Trial’ (SWATs) across multiple ongoing trials to test whether multimedia presentation of patient information led to better rates of recruitment. Methods Five trials included a SWAT and randomised their participants to receive a multimedia presentation alongside standard information, or standard written information alone. We collected data on trial recruitment, acceptance and retention and analysed the pooled results using random effects meta-analysis, with the primary outcome defined as the proportion of participants randomised following an invitation to take part. Results Five SWATs provided data on the primary outcome of proportion of participants randomised. Multimedia alongside written information results in little or no difference in recruitment rates (pooled odds ratio = 0.96, 95% CI: 0.79 to 1.17, p-value = 0.671, I2 = 0%). There was no effect on any other outcomes. Conclusions Multimedia alongside written information did not improve trial recruitment rates. Trial registration ISRCTN71952900, ISRCTN 06710391, ISRCTN 17160087, ISRCTN05926847, ISRCTN62869767.

The service quality literature has evolved around two schools of thought: the North American and the Nordic European. Although the North American School of thought has received much attention from the practitioners with a five factorial model, it has also generated a great deal of criticism. The Nordic European School of thought, on the conceptualisation of service quality, has remained for the most part at the conceptual level with few attempts at applications. Attempts to test an instrument developed by the North American School. It did not produce the nominated dimensions. In fact the result favours the Nordic European School in that it produced a two factor model.

Depression is common in multiple sclerosis (MS); however, its assessment is complicated by biological processes. In this context it is important to consider the performance of depression screening measures including that their factor structure is consistent with expectation.  This study sought to identify the factor structure of the Center for Epidemiological Study - Depression Scale (CES-D) in people with MS (PwMS). Participants (N = 493) were those who had consented to take part in a large three-phase longitudinal study of depression in PwMS. CES-D questionnaires completed at phase 1 of the study were utilised. An error in the questionnaire meant it was most appropriate to consider data for 19 of the 20 CES-D questionnaire items. The data was split into two samples by a random selection process to create an exploratory, model development sample and a validation sample. The first sample was subject to confirmatory factor analysis. Following examination of model fit and specification errors, the original model was modified. The revised model was tested in the confirmation sample to assess reproducibility. The analysis results supported the original four factor solution for the CES-D, that is: Depressed Affect, Positive Affect, Somatic Complaints/Activity Inhibition, and Interpersonal Difficulties. The CES-D appears to have a coherent structure with which to examine depression in PwMS.

This study aimed to extend our theoretical understanding of how mindfulness-based interventions exert their positive influence on measures of occupational health. Employing a randomised waitlist control study design, we sought to: (1) assess an Internet-based instructor-led mindfulness intervention for its effect on key factors associated with ‘recovery from work’, specifically, work-related rumination, fatigue and sleep quality; (2) assess different facets of mindfulness (acting with awareness, describing, non-judging, and non-reacting) as mechanisms of change; and (3) assess whether the effect of the intervention was maintained over time by following up our participants after three and six months. Participants who completed the mindfulness intervention (N=60) reported significantly lower levels of work-related rumination and fatigue, and significantly higher levels of sleep quality, when compared with waitlist control participants (N=58). Effects of the intervention were maintained at three and six month follow-up with medium to large effect sizes. The effect of the intervention was primarily explained by increased levels of only one facet of mindfulness (acting with awareness). This study provides support for online mindfulness interventions to aid recovery from work and furthers our understanding with regards to how mindfulness interventions exert their positive effects.

Objective: To evaluate the effectiveness of a print-based intervention supported by Internet tools at improving physical activity in cancer survivors compared to a standard letter recommendation. Pre-diagnosis physical activity and self-efficacy were hypothesised to predict physical activity improvement. Study design: Waiting list randomised control trial and cost-consequence analysis. Methods: Adult cancer survivors who could become physically active without prior medical approval were randomised to receive either a print-based intervention supported by Internet tools (intervention, n=104) or a standard letter recommendation (control, n=103). Physical activity was assessed at 12-weeks with maintenance assessed at 24-weeks in the intervention arm. A number-needed-to-treat was calculated and a cost-consequence analysis completed. Results: Participants in receipt of a print-based intervention supported by Internet tools improved their physical activity by 36.9% over 12-weeks compared to 9.1% in the control arm. Physical activity was maintained at 24-weeks in the intervention arm. Six-point-two-nine cancer survivors needed to receive the intervention for one to improve physical activity over a standard letter recommendation. Intervention delivery cost £8.19 per person. Pre-diagnosis physical activity and self-efficacy did not predict physical activity improvement. Conclusion: A print-based intervention supported by Internet tools offers a promising low-cost means to intervene to improve physical activity in cancer survivors.

The evidence base for 'what works' for patients detained in high secure hospitals has predominantly been established from a clinical perspective, with the voices of those at the centre of care, the expert by experience, absent. Neglecting this voice renders an important source of information for evidence-based practice inaccessible to outcome evaluators. Twelve high secure patients considered 'ready' to be discharged were interviewed to explore what in their view had helped or hindered their progress to this stage. Thematic analysis steps were applied to interviews and eight themes were generated that represented valued elements of high security: temporary suspension of responsibility, collaboration in care, learning from others, supportive alliances, specific interventions (medical and psychotherapeutic), a safe environment and opportunities for work. Narratives demonstrated the complementary and unique contribution of the patient experience in informing 'what works', and are discussed alongside existing theories relevant to promoting clinical change and risk reduction. © 2013 Copyright Taylor and Francis Group, LLC.

This study compared 3 models of association between personality, personal model beliefs, and self-care in a cross-sectional design. These models were as follows: (a) Emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness is a direct predictor of self-care; (b) emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness moderates the association between beliefs and self-care; (c) both emotional stability and conscientiousness determine self-care indirectly through personal model beliefs. Participants (N = 358, aged 12-30 years) with Type I diabetes completed measures of personality, personal model beliefs, and self-care. Structural equation modeling indicated that Model C was the best fit to the data.

Background Current literature highlights higher prevalence rates of sleep difficulties amongst adults with an intellectual disability. However, no synthesis has been conducted to assess the effectiveness of existing interventions in this population. Thus, the aim of this review was to assess the effectiveness of sleep interventions in adults with an intellectual disability (ID). Method Eight databases were searched to identify interventions for sleep difficulties amongst adults with an ID. The study quality was assessed with the Risk Of Bias In Non‐randomised Studies – of Interventions. Nine studies (n = 97) were eligible for inclusion in the review. Results There was a notable study on heterogeneity in terms of the population, study design, intervention studied, sleep assessment and outcome assessments used. Eight of the nine studies reported improvement in sleep following intervention. However, these findings need additional support as only 97 participants involving a variety of interventions and measurement systems were used across all studies. Furthermore, eight of the nine studies had serious to critical risk of bias. The only study identified as having low risk of bias was a placebo‐controlled randomised controlled trial for the use of melatonin. Conclusions This review highlights the need for objective measures such as actigraphy and studies with greater experimental control investigating sleep interventions in adults with ID.

Objective: A waiting list randomised control trial has shown the Move More Pack, a print-based intervention supported by Internet tools, to improve physical activity levels in cancer survivors; however, one-third do not improve from the intervention. The objective of this process evaluation is to understand intervention use, the mechanisms of impact, the perceived benefits, and the contextual factors influencing these, identifying for whom it is a useful resource. Methods: A mixed methods process evaluation, based on guidance from the UK Medical Research Council, including 181 questionnaire responses on intervention use and physical activity improvement over 12-weeks, 56 open text responses and 17 semi-structured interviews. Results: The Move More Pack was suggested to be most useful when delivered towards the start of the cancer journey to those with a positive attitude to fighting cancer but with a low level of physical activity, capitalising on a teachable moment. It was suggested that healthcare professionals could support the effective distribution of the Move More Pack. The intervention’s printed components were more popular and well used than the Internet tools. The printed intervention components were positively correlated with physical activity improvement but the Internet tools were not. Females were more likely to use the intervention’s printed components than males. Cancer survivors using the intervention reflected that they had increased confidence and motivation for physical activity and other lifestyle behaviours. Conclusion: The Move More Pack should be offered by healthcare professionals, during cancer treatment, when health is salient, to those with a positive attitude to fighting cancer but with low levels of physical activity. Use of the intervention’s printed components are more likely to improve physical activity than the Internet tools and are more likely to be used by females. The use of Internet tools to support physical activity improvement in cancer survivors requires further investigation.

Public familiarity with basic scientific concepts and principles has been proposed as essential for effective democratic decision-making ( Miller, 1998). Empirical research, however, finds that public 'scientific literacy' is generally low, falling well short of what normative criteria would consider 'acceptable'. This has prompted calls to better engage, educate and inform the public on scientific matters, with the additional, usually implicit assumption that a knowledgeable citizenry should express more supportive and favourable attitudes toward science. Research investigating the notion that 'to know science is to love it' has provided only weak empirical support and has itself been criticised for representing science and technology as a unified and homogenous entity. In practice, it is argued, how knowledge impacts on the favourability of attitudes will depend on a multiplicity of factors, not least of which is the particular area of science in question and the technologies to which it gives rise ( Evans P Durant, 1992). This article uses a new method for examining the knowledge-attitude nexus on a prominent area of 21st century science - biotechnology. The idea that greater scientific knowledge can engender change in the favourability of attitudes toward specific areas of science is investigated using data from the 2000 British Social Attitudes Survey and the 1999 Wellcome Consultative Panel on Gene Therapy. Together the surveys measure public opinion on particular applications of genetic technologies, including gene therapy and the use of genetic data, as well as more general attitudes towards genetic research. We focus our analysis on how two different measures of knowledge impact on these attitudes; one a general measure of scientific knowledge, the other relating specifically to knowledge of modern genetic science. We investigate what impact these knowledge domains have on attitudes towards biotechnology using a regression-based modelling technique (Bartels, 1996; Althaus, 1998; Sturgis, 2003). Controlling for a range of socio-demographic characteristics, we provide estimates of what collective and individual opinion would look like if everyone were as knowledgeable as the currently best-informed members of the general public on the knowledge domains in question. Our findings demonstrate that scientific knowledge does appear to have an important role in determining individual and group attitudes to genetic science. However, we find no support for a simple 'deficit model' of public understanding, as the nature of the relationship itself depends on the application of biotechnology in question and the social location of the individual.

Objectives. The self-regulatory model proposes that an individual's cognitive representations of illness threat (illness representations) influence the selection and performance of strategies to cope with that illness (Leventhal, Meyer, & Nerenz, 1980). Also implicit in the model is the proposal that such coping strategies influence illness outcomes. These relationships represent a mediational model (Baron & Kenny, 1986). The aim of the present study is to test the hypothesis that coping strategies partially mediate the relationship between illness representations and illness outcome in women with rheumatoid arthritis. Design and methods. The study is an observational cross-sectional design. Self-report measures of illness representations, coping strategies, and illness outcome were collected from 125 women with rheumatoid arthritis attending rheumatology outpatient clinics. Clinical measures of disease activity and severity were obtained from hospital records. Results. Avoidant and resigned coping were found to partially mediate the relationship between symptom identity and the illness outcome measures of disability and psychiatric morbidity. As in other studies, strong relationships were found between illness representations and illness outcome. Conclusions. The finding that avoidant and resigned coping partially mediated the relationships between the illness representation dimension of symptom identity and two of the illness outcome measures (disability and psychiatric morbidity) provided some support for the hypothesis. However, the hypothesis was not fully supported, as coping did not partially mediate the relationship between any of the other illness representations and illness outcomes.

Although research shows that acceptance, trust, and risk perception are often related, little is known about the underlying patterns of causality among the three constructs. In the context of a waterborne disease outbreak, we explored via zero-order/partial correlation analysis whether acceptance predicts both trust and risk perception (associationist model), or whether trust influences risk perception and acceptance (causal chain model). The results supported the causal chain model suggesting a causal role for trust. A subsequent path analysis confirmed that the effect of trust on acceptance is fully mediated by risk perception. It also revealed that trust is positively predicted by prior institutional trust and communication with the public. Implications of the findings for response strategies to contamination events are discussed. © 2013 Wiley Periodicals, Inc.

Temperate zones including the UK and mainland Europe continue to be exposed to increasing temperatures and more frequent heatwaves as global warming continues. The built environment can mitigate the public health risk of overheating and recommendations for precautionary actions on homes have been published by government and industry. A key player in improving resilience is the householder, who can determine whether precautionary measures will be installed in their home. Previous research on flooding has applied Protection Motivation Theory to examine determinants of householder response to risk. However, flooding risks differ from those of overheating in several ways. The current study builds on this work to address the gap on understanding householder propensity to install precautionary measures against overheating. A large-scale survey (n = 1007) of householders was conducted in the south of England and regression analyses applied to the data. While threat appraisal (perception of threat risk and severity) had an influence on motivation to take action, coping appraisal (perception of ability to make changes, of the effectiveness of the changes and of convenience) was a stronger predictor, particularly for flat dwellers. Previous experience of overheating did not directly influence protection motivation. Age was negatively related to intentions to act but income was not a significant factor. Recommendations for policy and practice include focusing on enhancing coping appraisal, targeting older citizens, customising initiatives by type of property and occupancy, and framing mitigating actions in ways other than protection from overheating.

Like other self-conscious emotions, shame takes on particular significance during late childhood and adolescence because of a developing capacity for self-reflection, self-other comparisons, and sensitivity to the views of others. Shame is a potentially important variable in adolescent well-being given its established associations with depression, reduced feelings of self-worth, and problematic anger. Three studies are reported that describe the development and validation of the Adolescent Shame-Proneness Scale (ASPS), a novel semi-idiographic measure of shame-proneness. The ASPS is a 19-item measure assessing 3 components of shame-proneness-negative self-evaluation, externalization, and emotional discomfort. Taken together, the studies support the reliability and validity of the ASPS as a semi-idiographic measure of shame-proneness in adolescents aged 11 to 18 years. ASPS scores correlate as expected with scores on existing measure of shame-proneness and with measures of anger, negative affect, and self-esteem. More important, the data suggest that ASPS scores are related to, but distinct from, guilt. Confirmatory factor analysis supported the validity of the ASPS factor structure (RMSEA = .08, SRMR = .05, CFI = .97, NNFI = .97). The ASPS represents a unique contribution to existing options for measuring shame-proneness in research and clinical contexts. Further work is required to assess the ASPS' temporal stability and its viability and psychometric properties in more culturally diverse samples. (PsycINFO Database Record

Mindfulness interventions have been shown to be effective for health and wellbeing, and delivering mindfulness programmes online may increase accessibility and reduce waiting times and associated costs; however, research assessing the effectiveness of online interventions is lacking. We sought to: (1) assess the effects of an online mindfulness intervention on perceived stress, depression and anxiety; (2) assess different facets of mindfulness (i.e. acting with awareness, describing, non-judging and non-reacting) as mechanisms of change and (3) assess whether the effect of the intervention was maintained over time. The sample was comprised of 118 adults (female, n = 95) drawn from the general population. Using a randomised waitlist control design, participants were randomised to either an intervention (INT) or waitlist control (WLC) group. Participants completed the online intervention, with the WLC group starting after a 6-week waitlist period. Participants completed measures of depression (PHQ-9), anxiety (GAD-7) and perceived stress (PSS-10) at baseline, post-treatment, 3- and 6-month follow-up. Participants who completed the mindfulness intervention (n = 60) reported significantly lower levels of perceived stress (d = − 1.25 [− 1.64, − 0.85]), anxiety (d = − 1.09 [− 1.47, − 0.98]) and depression (d = − 1.06 [− 1.44, − 0.67]), when compared with waitlist control participants (n = 58), and these effects were maintained at follow-up. The effect of the intervention was primarily explained by increased levels of non-judging. This study provides support for online mindfulness interventions and furthers our understanding with regards to how mindfulness interventions exert their positive effects.

OBJECTIVES: To investigate the validity and reliability of the Geriatric Anxiety Inventory in screening for anxiety in older inpatients post-stroke. DESIGN: Longitudinal. SUBJECTS: A total of 81 inpatients with stroke aged 65 years or older were recruited at four centres in England. MAIN MEASURES: At phase 1 the Geriatric Anxiety Inventory and the Hospital Anxiety and Depression Scale were administered and then the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 4th edition (phase 2). The Geriatric Anxiety Inventory was repeated a median of seven days later (phase 3). RESULTS: Internal reliability of the Geriatric Anxiety Inventory was high (α = 0.95) and test-retest reliability acceptable (τB = 0.53). Construct validity was evident relative to the Hospital Anxiety and Depression Scale - Anxiety subscale (τB = 0.61). At a cut off of 6/7, sensitivity of the Geriatric Anxiety Inventory was 0.88, specificity 0.84, with respect to the Structured Clinical Interview anxiety diagnosis. Hospital Anxiety and Depressions Scale - Anxiety subscale sensitivity was 0.88, specificity 0.54 at the optimum cut off of 5/6. A comparison of the areas under the curve of the Receiver Operating Characteristics for the two instruments indicated that the area under the curve of the Geriatric Anxiety Inventory was significantly larger than that of the Hospital Anxiety and Depressions Scale - Anxiety subscale, supporting its superiority. CONCLUSIONS: The Geriatric Anxiety Inventory is an internally consistent, reliable (stable) and valid instrument with acceptable sensitivity and specificity to screen for anxiety in older inpatients with stroke.

© 2015 Wiley Publishing Asia Pty Ltd. The purpose of this study is to examine the link between the reputational components of efficacy and moral reliability of institutions, and citizens' compliance with institutional recommendations. Research on bureaucratic reputations highlights the significance of positive political reputations based on credibility and legitimacy, but the impact of these components is not systematically isolated and studied. We draw insights from political psychology to move beyond a positive-negative valence-based approach of reputation, and highlight the different effect of efficacy and moral reliability components of reputation on citizens' cooperation, engagement in water saving activities, and levels of complaints. We use the Cypriot Water Authority as a case study and inquire how its institutional reputation influences Cypriot citizens' behavior regarding water use. Our data was collected via a representative national survey administered to a random sample of 800 Cypriots in the spring of 2009 and show that favorable perceptions of particular components of institutional reputation shape the levels of satisfaction with specific organizational outputs.

This study investigated whether demographic variables, efficacy beliefs, visions and worries are associated with four different forms of (dis)engagement with the European Union: intended voting in the 2019 EU elections, non-conventional political engagement, psychological engagement, and the wish that one’s own country should leave the EU. The sample comprised 3.764 young people aged 16 to 25 years living in seven European countries: Albania, Austria, Germany, Italy, Romania, Spain and UK. Economic challenges, human rights and the environment were the most important future visions; unemployment and poverty, climate change, civil unrests and the collapse of the EU were the most important future worries. The four forms of (dis)engagement with the European Union were differentially associated with predictors, although internal efficacy and future vision of economic challenges predicted all forms. Implications for future EU policy are discussed.

Different front-of-pack (FOP) labelling systems have been developed in Europe by industry and organisations concerned with health promotion. A study (n 2068) was performed to establish the extent to which inclusion of the most prevalent FOP systems--guideline daily amounts (GDA), traffic lights (TL), GDA+TL hybrid (HYB) and health logos (HL)--impact consumer perceptions of healthiness over and above the provision of a FOP basic label (BL) containing numerical nutritional information alone. The design included within- and between-subjects factors. The within-subjects factors were: food (pizzas, yogurts and biscuits), healthiness of the food (high health, medium health and low health) and the repeated measurements under BL and test FOP label conditions. The between-subjects factors were: the system (GDA, TL, GDA+TL hybrid, HL), portion size (typical portion size and a 50% reduction of a typical portion) and country (the UK, Germany, Poland and Turkey). Although the FOP systems tested did result in small improvements for objective understanding under some conditions, there was little difference between the provision of an FOP label containing basic numerical nutritional information alone or between the various systems. Thus, any structured and legible presentation of key nutrient and energy information on the FOP label is sufficient to enable consumers to detect a healthier alternative within a food category when provided with foods that have distinctly different levels of healthiness. Future research should focus on developing greater understanding of the psychological and contextual factors that impact motivation and the opportunity to use the various FOP systems in real-world shopping settings.

Models approaching consumer expectations of their water supplier from a risk perspective suggest that consumers primarily and overwhelmingly want safe drinking water supply. In this study consumer preferences in the water sector are investigated in two contrasting case studies: Cyprus, where there have been significant quantity and continuity of supply issues, and Riga, where there have been water quality issues. While water quality is undoubtedly the main priority of water consumers in Riga, in Cyprus consumers indicate that they prioritise a more reliable service even though many are sufficiently dissatisfied with water quality that they do not drink the tap water. The analysis of consumer attitudes in the two case studies suggests that when water supply is unreliable, reliability takes precedence; once it is reliable quality issues come to the fore.

Background: Physical activity can improve many common side effects of cancer treatment as well as improve physical function and quality of life (QOL). In addition, physical activity can improve survival rate and reduce cancer recurrence. Despite these benefits, only 23% of cancer survivors in England are active to recommended levels. Cancer survivors are interested in lifestyle behavior change. Home-based interventions offer a promising means for changing physical activity behavior. Prediagnosis levels of physical activity and self-efficacy have been reported to be predictors of physical activity behavior change. The Move More Pack, which has undergone revision, is a printed resource with supporting Internet-based tools that aims to increase the physical activity of cancer survivors in the United Kingdom. The revised Move More Pack is underpinned by the theory of planned behavior and the social cognitive theory. Objective: The aim of this proposed study was to investigate the effect of the revised Move More Pack, supported by Internet-based tools, on physical activity, self-efficacy, and health-related QOL (HRQOL) of cancer survivors in the United Kingdom. Methods: This study is a two-arm waiting list randomized control trial with embedded process evaluation. A sample of 99 participants per arm will be recruited by invitation through an email database of cancer survivors held by UK charity Macmillan Cancer Support and an advert placed on the Macmillan Cancer Support Facebook page. Each participant is randomized to receive brief physical activity information and the UK guidelines for physical activity, or brief physical activity information and the revised Move More Pack with supporting Internet-based tools. The intervention and control arm will be followed up at 12 weeks to identify changes in self-reported physical activity, self-efficacy, and HRQOL based on Web-based questionnaires. The control arm will receive the revised Move More Pack at 12 weeks with follow-up at 24 weeks. The intervention arm is followed up at 24 weeks to determine maintenance of reported changes. Subgroup analyses will be completed based on participants' prediagnosis level of physical activity and baseline self-efficacy as possible predictors of positive changes. Use of each component of the revised Move More Pack will be assessed using a 4-point Likert scale. Semistructured phone interviews will evaluate the use and perceived usefulness of the revised Move More Pack. Results: Participant recruitment started in March 2017. Projected completion of this study is October 2018. Conclusions: This study's findings will identify if the proposed low-cost broad reach intervention improves physical activity, self-efficacy, and the HRQOL of cancer survivors. The process evaluation is designed to contextualize the use and perceived usefulness of the revised Move More Pack, help augment its efficient distribution, and identify potential improvements to its design.

Background Previous research indicated a high prevalence of disordered sleep among adults with learning disabilities, however issues with design impacted findings. The current systematic review aims to: (a) present how disordered sleep and sleep disorders amongst adults with learning disabilities are described in the literature, and (b) report on the prevalence of disordered sleep and sleep disorders among adults with learning disabilities. Methods Five databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO and PubMed) were searched for articles published from 1900 to October 2021 that examined the prevalence of disordered sleep and/or sleep disorders in adults aged 18 or older with learning disabilities. The Joanna Briggs Institute critical appraisal checklist for prevalence studies was used to assess study quality and prevalence is described and reported as ranges. The study was registered on PROSPERO (ID: CRD42019134550). Findings A total of 27 studies were selected. Twenty studies (n = 8043 participants) examined the prevalence of disordered sleep and identified prevalence ranging from 6.1% to 74.2% across a range of sleep parameters. Twelve studies examined sleep-related breathing disorders (n = 2558 participants) and identified prevalence which ranged from 0.5% to 100%. There was notable heterogeneity between studies in terms of quality, definition of disordered sleep, measurement of sleep, and study design. Conclusion There was a variable prevalence of disordered sleep among people living with learning disabilities. There were problems in meaningfully synthesising results due to heterogeneity in measurement, diagnosis, study design and study quality. Based on these limitations, we suggest that future studies should seek to utilise objective, replicable and consistent measures of sleep in this population and control for physical health factors which could influence prevalence such as epilepsy and iatrogenic effects.

Animal rights extremists have carried out a number of campaigns in the past in order to protect animals. The actions they carry out as part of these campaigns are often described as acts of intimidation, however little has been done to explore how these groups use intimidation on the whole. Past research has focused mainly on specific animal rights campaign types (Donovan & Coupe, 2013; Munro, 2005) or action types (Monaghan, 1999). The current research aimed to explore the types of intimidating behaviours carried out by animal rights extremists in the UK across all campaign types. Literature reviews were carried out in order to understand more about the current knowledge of animal rights extremism and intimidation. Study 1 aimed to catalogue incidents carried out by animal rights extremists in the UK, and to identify any regular patterns of behaviour across and between distinct campaign groups. The results of this study demonstrated that animal rights extremists show patterns in their choice of actions and targets both across the campaigns, and more specific patterns emerged for the main five campaigns. Having identified that threats are closely associated with intimidation, both from the literature reviews and the findings of Study 1, the second study aimed to explore the type of language used by animal rights extremists when making threats. The findings of Study 2 indicate that animal rights extremists are extremely confident when making their threats, although they might not be truthful when doing so. Overall, the findings of this research have important practical implications for potential targets of animal rights extremists.

The large response to our 2017 patient survey, 2,000 in all, speaks to the need for people living with haemochromatosis to have a voice. Whilst our knowledge of the biological mechanisms at work in haemochromatosis continues to develop, little research is published on the impact of the condition on people’s lives. This report is the result of an independent expert analysis of the 2017 survey responses. It highlights the wide array of symptoms experienced by people with haemochromatosis. You will read that most of the people who responded reported debilitating symptoms including fatigue and pain, particularly those for whom diagnosis was delayed. Yet, treatment is relatively simple. The report provides support for its effectiveness in reducing some of the symptoms although for some patients, treatment is a difficult and unpleasant experience. In the report you will read about haemochromatosis patients’ experiences of healthcare. Whilst most patients are satisfied with the information and support provided by medical specialists, this is not the case with regard to their GPs. Greater awareness of recent guidelines for screening for haemochromatosis is recommended by the report authors, and we strongly support implementation of these guidelines in order to avoid delays in treatment and prevent irreversible tissue damage. At HUK, our aims are to support those with haemochromatosis and those at risk, to educate patients, families, the wider public and healthcare community about the condition in order to raise awareness of haemochromatosis, and to stimulate research into the condition and its impact on people’s lives. We hope that this report will contribute to all of these aims and, in particular, that it will encourage earlier diagnosis and stimulate much needed new research.

This study asks whether the Trust, Confidence and Co-operation model, proposed by Earle and Siegrist (2006), can be applied to the question of whether trust and confidence in the OSD will affect the public’s intention to attend the 2012 London Olympic Games.