A large proportion of children are not able to perform age-appropriate fundamental movement skills (FMS). Thus, it is important to assess FMS so that children needing additional support can be identified in a timely fashion. There is great potential for universal screening of FMS in schools, but research has established that current assessment tools are not fit for purpose. To develop and validate the psychometric properties of a FMS assessment tool designed specifically to meet the demands of universal screening in schools. A working group consisting of academics from developmental psychology, public health and behavioural epidemiology developed an assessment tool (FUNMOVES) based on theory and prior evidence. Over three studies, 814 children aged 4 to 11 years were assessed in school using FUNMOVES. Rasch analysis was used to evaluate structural validity and modifications were then made to FUNMOVES activities after each study based on Rasch results and implementation fidelity. The initial Rasch analysis found numerous psychometric problems including multidimensionality, disordered thresholds, local dependency, and misfitting items. Study 2 showed a unidimensional measure, with acceptable internal consistency and no local dependency, but that did not fit the Rasch model. Performance on a jumping task was misfitting, and there were issues with disordered thresholds (for jumping, hopping and balance tasks). Study 3 revealed a unidimensional assessment tool with good fit to the Rasch model, and no further issues, once jumping and hopping scoring were modified. The finalised version of FUNMOVES (after three iterations) meets standards for accurate measurement, is free and able to assess a whole class in under an hour using resources available in schools. Thus FUNMOVES has the potential to allow schools to efficiently screen FMS to ensure that targeted support can be provided and disability barriers removed.

National and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School's (CAS) programme on organisational changes to physical activity provision. In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.

The continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE (Identifying and Mitigating the Individual and Dyadic Impact of COVID-19 and Life Under Physical Distancing on People with Dementia and Carers) component of the IDEAL (Improving the Experience of Dementia and Enhancing Active Life) cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic within the context of the ‘post-vaccine’ period and the national lockdowns in England and Wales; and to determine perceived challenges to and facilitators of ‘living well’ during the COVID-19 pandemic and beyond as restrictions were eased. In addition, the study findings are considered in relation to understandings of identity in dementia which the broader accounts of living through the pandemic have highlighted. Seven people with mild-to-moderate dementia were interviewed and themes were derived using framework analysis. Themes suggest interviewees' stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world. Interviewees managed threats to social identity by striving to maintain social and emotional connections, where the importance of a shared, social identity, particularly for people with young-onset dementia, was also apparent. Unlike in previous studies during the pandemic, the relevance of occupation for identity was observed, where maintaining previous or new activities or occupations was important to facilitate identity as well as to keep a sense of purpose. Therefore, as well as supporting people with dementia as the pandemic eases, future research into occupation and identity in dementia is of potential value.

Aim: This research aims to determine the organizational preventative strategies implemented by dental clinics in Fiji during the COVID-19 pandemic. Methods: This qualitative study was conducted amongst Dental Officers (Dos) and Dental Managers (DMs) who were working at government dental clinics, private dental clinics, and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji. A semi-structured open-ended questionnaire was used for data collection through in-depth interviews via zoom. A manual thematic analysis of the data was conducted. Results: Thirty Dos and 17 DMs participated in this study. 16 themes emerged from data analysis: Major Strategies implemented, Staff perception about strategies in place, Triaging and Screening, Hand hygiene, Waiting room changes, Operational Capacity, Universal precautions, Personal Protective Equipment (PPEs), Disinfection and decontamination protocols, Ventilation, Sterilization, Pre-procedural mouth rinse, Waste management, Vaccination status, Bubbles and Adaptation of Protocols. The Dos were generally satisfied with the strategies implemented by the DMs. The DMs along with other Dos had used various guidance documents to devise tailor-made ones suited for dental clinics in Fiji. Conclusion: Various strategies were adopted from several guidelines and tailor-made Standard Operating Procedures (SOPs) for each workplaces were developed by the various DMs. The majority of Dos were in favor of and satisfied with the protocols in place. Future research can be conducted in other divisions and include other health care professionals as well apart from just Dos and DMs.

Designer benzodiazepines are one of the primary new psychoactive substances (NPS) threats around the world, being found in large numbers in post-mortem, driving under the influence of drugs (DUID) and drug facilitated sexual assault (DFSA) cases. Even though when compared to many other NPS types, such as opioids and cathinones, there are relatively few designer benzodiazepines being monitored. Recently a new NPS benzodiazepine has been reported in Europe, the USA and Canada, desalkygidazepam, also known as bromonordiazepam. This substance is a metabolite of the pro-drug gidazepam, a drug licenced for use in Ukraine and Russia under the name Gidazepam IC®. In the paper we review what is currently known about the use, pharmacology and analytical detection of gidazepam, its metabolite desalkygidazepam, and their other possible metabolites.

Introduction: A significant proportion of healthcare that is delivered is wasteful, harmful and not evidence based. There are many wound care related guidelines, but their implementation in practice is variable. The Society of Tissue Viability (SoTV) published updated seating guidelines in 2017, but there is a lack of theoretical and conceptual clarity about how these guidelines are being utilised to inform clinical practice. Therefore, the aim of this paper is to generate a theory that can be used to incorporate the SoTV seating guidelines into policy and clinical practice. Methods: We critically reflected on data from an evaluation study utilising systems-thinking approach, informed by implementation and safety science using wider literature as well as our expertise to generate a guideline implementation theory. Discussion: Factors that facilitate or hinder the incorporation of the SoTV guidelines into policy and practice were characterised. We conceptualised the implementation of these guidelines into policy and practice into a Translation or Implementation into Policy or Practice (TIPP) theory with distinct stages, that we called liminal spaces. Knowledge of the guidelines, and the agency or authority to effect change, are key factors in the translation of these guidelines into clinical practice. Conclusion: Our theory is that there are liminal spaces in the implementation trajectory of these guidelines into practice, which have their own characteristics. This theory provides a framework that can be used to underpin guidelines strategies to embed skin and wound care guidelines into policy and clinical practice in order to improve patient care.

Understanding patients' perspective to get an insight into cancer, and how best the public health systems can battle with this disease is the way forward in this current world. This study aimed to explore patients' knowledge about common cancers, barriers to assessing cancer information and cancer preventative approaches in Fiji. The study used a qualitative method approach that was conducted among patients who attended Special Outpatients (SOPD) at the four selected health centres in Lautoka Subdivision, Fiji from 1st March to 30th April 2021. A semi-structured open-ended questionnaire was used to guide in-depth interviews. These audio recordings were transcribed and analysed using thematic analysis. All interview transcripts were read and similar words and phrases were assigned numbers which were grouped together to identify themes and sub themes. Twenty-eight patients took part in the in-depth interview and the responses were grouped into four themes including; cancer knowledge, diagnosis of cancer in a close friend/family, barriers of communication and optimizing cancer awareness. Patients' awareness about common cancers and cancer risk factors was low. Many barriers for cancer screening were highlighted including stigmatization, fear, worry, death, lack of information, herbal medicine use, lack of resources and delay in diagnosis. Awareness strategies highlighted by participants included community outreach programs, house to house visits, opportunistic screening, engagement of community health care workers and the concept of a cancer hub centre. It is evident that there is a range of views from patients towards cancer and it is important to understand these perceptions to better guide public health interventions concerning cancer. This puts more focus on the need to invest more in information, education, and communication material for public campaigns that target a variety of people for a wider reach.

The publication of the Delivery plan for tackling the COVID-10 backlog of elective care (NHSE/I, 2022:5) contained a number of ambitions, including that, by March 2024, 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have had cancer ruled out within 28 days. By March 2025, waits of longer than a year for elective care should be eliminated and 95% of patients needing a diagnostic test should receive it within six weeks. The report acknowledged the need to grow the workforce to achieve these ambitions and ensure a timely cancer diagnosis, while also proposing the use of digital technology and data systems to free up capacity. To assist West Yorkshire National Health Service (NHS) organisations to meet these ambitions, this report presents the findings of a ‘deep dive’ that focuses on the role of radiology in meeting the ambitions of providing timely cancer diagnosis. Aims 1. To understand current and projected demand for radiology expertise in cancer diagnosis in West Yorkshire. 2. To understand the current and projected radiology workforce in West Yorkshire and determine the gap between the projected radiology workforce and the required radiology workforce. 3. To identify possible solutions to assist in providing the radiology workforce required for West Yorkshire and explore their acceptability and potential impact. Methods A range of sources of data and methods were utilised. We examined publicly available quantitative data concerning cancer waiting times and diagnostic waiting times and activity and used this to forecast future cancer waiting times and diagnostic waiting times and activity. We examined data from Health Education England (HEE) regarding radiologists’ and radiographers’ workforce profile data for West Yorkshire, the number of radiologists completing training, and the number of radiographers graduating, and data submitted by West Yorkshire Trusts to HEE regarding their plans for growing their radiology and radiographer workforce. Interviews (N=15) conducted with radiology service managers, university academics and key strategic and operational stakeholders delivering radiology services were used to understand the current and future issues around strategic workforce planning, workforce changes and transformation, workforce roles and skills, training and education and service changes. A rapid review of the literature examining the impacts of artificial intelligence (AI) on the workload of radiology services was also undertaken. To put this work in context, we also reviewed relevant policy documents and reports. Alongside this, we consulted with the Yorkshire Imaging Collaborative (YIC) and the West Yorkshire Cancer Alliance (WYCA) and attended a series of workshops run by the Yorkshire Imaging Collaborative. Results Overall, the findings show that demand for radiology services is increasing and that both cancer waiting times and the waiting times for diagnostic tests increased, with a concurrent downward trend in activity that, if all else stays the same, is forecast to continue up to 2025. The cancer waiting times data indicate that patients were waiting longer and that their needs were not being met. Moreover, 3 the proportion of people treated within accepted cancer waiting times decreased both nationally and within the West Yorkshire region from 2013. This was exacerbated by COVID-19 which caused a further decrease nationally and for the West Yorkshire region. National data for waiting times for all diagnostic tests show a significant decline between 2006 and 2008, with a decrease in median waiting times from just under 6.0 weeks to approximately 2.0 weeks. Overall, waiting times remained stable until late 2020 when they started to rise with the longest median waiting times at just over 8.0 weeks in mid-2020. The total number of people waiting for radiology tests nationally is decreasing and is predicted to continue to do so, while in West Yorkshire the number of people waiting for radiology tests decreased until 2020 but has since been on an upward trend which is predicted to continue. Nationally, the total number of radiology tests is on an upward trend that is predicted to continue, while in West Yorkshire activity has been decreasing since well before COVID-19 and is predicted to continue to do so. Data examining the current and future workforce showed that the national figures for the total radiology and radiography workforce are small relative to other health professional groups. In West Yorkshire, 265 radiologists and 926 radiographers were employed, and staff turnover was generally low. Trusts’ forecasts for the number of radiologists and radiographers they believe they need suggest a 16% increase in the number of radiologists in post between March 2022 and March 2027 and a 25% increase in the number of radiographers in post. The numbers of radiographers and radiologists being trained in West Yorkshire suggest that this is feasible. Interview data identified a number of main themes and associated issues: delivering diagnostic cancer targets, strategic workforce planning, workforce roles and skills, service transformation, recruitment and retention, universities, artificial intelligence, collaboration, and international recruitment. Across all themes, some reoccurring issues were identified: a lack of staff, increased demands, a lack of capacity in terms of space and staff, a lack of strategic workforce planning with a focus on operational or financial plans. Respondents proposed potential solutions to some of the issues raised that included: new ways of working, upskilling, developing current and emerging roles, Community Diagnostic Centres (CDCs), greater collaboration between NHS Trusts, universities, CDCs, imaging academies and networks and the private sector, and the international recruitment of radiologists and radiographers to address workforce gaps. The rapid review findings helped to identify a number of potential benefits of use of AI in radiology, including contributing to improved workflow efficacy and efficiency of radiology services. However, this is dependent on the nature of the work and the AI function. As a result of faster AI reading, radiologists may be able to focus more on high-risk, complex reading tasks. AI can support automation of image segmentation and classification and aid the diagnostic confidence of less experienced radiologists. Respondents’ views on AI were mixed. There was acknowledgement that AI was already used to support radiology service delivery and both the benefits and problems associated were identified. The implications of AI for radiologists’ and radiographers’ roles were discussed in terms of changing work, AI being used to support or in some cases substitute radiologists and radiographers, and the need for the radiology workforce to adapt to the technological change whilst maintaining a caring service

Background: Early booking or registration into Antenatal Care (ANC) can be defined as initiation of ANC before 12 weeks of gestation and is important for the best health outcome of the mother and the baby. Delayed initiation of ANC has been linked to increased rate of maternal and fetal mortality. There is international consensus that ANC should begin within first trimester yet pregnant women delay initiation of ANC. Health Care Workers (HCWs) understanding of reasons for this can improve patient provider relationship. Objectives: This study aims to explore the perception of the HCWs in Fiji towards early antenatal booking. Methods: A qualitative study was employed using four Focus-Group Discussions (FGDs)with the HCWs who provide health care service for pregnant women in Ba Mission Hospital (BMH) in 2020. Each group comprised of medical officers, mid-wives and registered nurse who were chosen purposively. A semi-structured open ended questionnaire was used to guide the discussion. Data was transcribed and analyzed manually using thematic content analysis using the following process: familiarization, coding, identifying themes, reviewing and refining, integration and interpretation. Results: There was a total of 18 HCWs for the FGDs. The mean age of the participants was 37.4±11.8years. The three themes identified were: knowledge of HCWs on early booking, their perceived barriers and perceived enabling factors to early antenatal booking. The FGDs identified that the HCWs had adequate knowledge on early initiation of ANC and that there were a range of barriers to early initiation of ANC. The HCWs also suggested factors that could enable women to book early. Conclusion: Based on the study it can be concluded that the HCWs have a positive perception of early antenatal booking, however, there are various factors that contribute to delayed antenatal booking. The barriers to early ANC are both an opportunity and a challenge to strengthen and review the maternal services offered. The enabling factors should be reinforced from an individual level to the health system and the general context. The implications of the barriers and enabling factors identified in this study is to implement evidence-based policies to improve early antenatal booking in Ba, Fiji.

Background: Individuals with type 2 diabetes play a pivotal role in their health. Enhancing the self-management of diabetes can improve blood glucose control, and quality of life, and reduce diabetes-related complications. We have identified factors influencing the self-management of type 2 diabetes to inform strategies that may be applied in the long-term management of blood glucose control. Methods: We conducted a systematic literature review of recent studies published between January 2010 to December 2020 to identify the available evidence on effective self-management strategies for type 2 diabetes. The databases used for the searchers were Scopus, PubMed, Science Direct, CINAHL, and Google Scholar. We assessed English language publications only. The screening of titles was duplicated by two researchers. We then conducted a thematic analysis of the key findings from eligible publications to identify reoccurring messages that may augment or abate self-management strategies. Results: We identified 49 relevant publications involving 90,857 participants. Four key themes were identified from these publications: Individual drive, social capital, Knowledge base, and Insufficient health care. High motivation and self-efficacy enabled greater self-management. The importance of family, friends, and the health care professional was salient, as were the negative effects of stigma and labelling. Enablers to good self-management were the level of support provided and its affordability. Finally, the accessibility and adequacy of the health care services emerged as fundamental to permit diabetes self-management. Conclusions: Self-management of type 2 diabetes is an essential strategy given its global presence and impact, and the current resource constraints in health care. Individuals with type 2 diabetes should be empowered and supported to self-manage. This includes awareness raising on their role in self-health, engaging broader support networks, and the pivotal role of health care professionals to inform and support. Further research is needed into the capacity assessment of healthcare systems in diabetes medicine, targeted low-cost resources for self-management, and the financial requirements that enable self-management advice to be enacted.