Background: Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be.  Aim: This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs’ engagement in smoking cessation and the factors that influence their engagement.  Method: Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills.  Results: The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs’ engagement in smoking cessation include GPs’ own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs’ engagement in smoking cessation.  Conclusion: Strategies to improve the frequency and quality of GPs’ engagement in smoking cessation need to address the multifaceted influences on GPs’ practice and to reflect the widely differing contexts across Europe.Co-authored by the PESCE European Research Tea

Purpose – By applying ecological models of health behaviour to marketing communications to achieve behaviour change, this paper aims to illustrate the importance of taking into account various economic, environmental and social influences. Design/methodology/approach – A two-part study was undertaken. Part one involved exploring the lived worlds of the targeted population. Part two explored how the needs of the target audience informed a social marketing communications strategy. This was illustrated through Childsmile, a Scottish Government funded oral health institution. Findings – A variety of intra- and inter-personal influences where identified that encouraged or discouraged oral health. Complementing this was how these needs are incorporated into an ecological social marketing communications campaign. Although the long term effects of the ecological social marketing campaign will not become evident for a number of years, initial results indicate its important role in changing behaviour. Practical implications – The importance of engaging with various groups within social marketing is shown. Specifically, the need to understand and encourage interaction between individuals, their community, health institutions and the Government. Social implications – Behaviour change, through social marketing communications, is possible among socio-economic deprived groups. Change supported with face to face interactions with health professionals. Originality/value – Previous criticisms of social marketing research being American-centric, and avoiding issues around socio-economic deprivation are addressed. In addressing this, the paper also answers calls for research into ecological models of social marketing communications to understand how influences affect its applicability.

BackgroundHospital emergency admissions have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical units. These pressures have an adverse impact on patient experience and potentially lead to suboptimal clinical decision-making. In response, a variety of innovations have been developed, but whether or not these reduce inappropriate admissions or improve patient and clinician experience is largely unknown.AimsTo investigate the interplay of service factors influencing decision-making about emergency admissions, and to understand how the medical assessment process is experienced by patients, carers and practitioners.MethodsThe project used a multiple case study design for a mixed-methods analysis of decision-making about admissions in four acute hospitals. The primary research comprised two parts: value stream mapping to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers and 282 practitioners of different specialties and levels. Additional data were collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources.FindingsPatients’ experiences of emergency care were positive and they often did not raise concerns, whereas carers were more vocal. Staff’s focus on patient flow sometimes limited time for basic care, optimal communication and shared decision-making. Practitioners admitted or discharged few patients during the first hour, but decision-making increased rapidly towards the 4-hour target. Overall, patients’ journey times were similar, although waiting before being seen, for tests or after admission decisions, varied considerably. The meaning of what constituted an ‘admission’ varied across sites and sometimes within a site. Medical and social complexity, targets and ‘bed pressure’, patient safety and risk, each influenced admission/discharge decision-making. Each site responded to these pressures with different initiatives designed to expedite appropriate decision-making. New ways of using hospital ‘space’ were identified. Clinical decision units and observation wards allow potentially dischargeable patients with medical and/or social complexity to be ‘off the clock’, allowing time for tests, observation or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams linked with community services; specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing ED activity.ConclusionsThis research shows how hospitals under pressure manage complexity, safety and risk in emergency care by developing ‘ground-up’ initiatives that facilitate timely, appropriate and safe decision-making, and alternative care pathways for lower-risk, ambulatory patients. New teams and ‘off the clock’ spaces contribute to safely reducing avoidable admissions; frontline expertise brings value not only by placing senior experienced practitioners at the front door of EDs, but also by using seniors in advisory roles. Although the principal limitation of this research is its observational design, so that causation cannot be inferred, its strength is hypothesis generation. Further research should test whether or not the service and care innovations identified here can improve patient experience of acute care and safely reduce avoidable admissions.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 10/1010/06). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

Test-day data for daily milk yield and fat, protein, and lactose content were sampled from the years 1988 to 2003 in 17 flocks belonging to 2 genetically well-tied buck circles. In total, records from 2,111 to 2,215 goats for content traits and 2,371 goats for daily milk yield were included in the analysis, averaging 2.6 and 4.8 observations per goat for the 2 groups of traits, respectively. The data were analyzed by using 4 test-day models with different modeling of fixed effects. Model [0] (the reference model) contained a fixed effect of year-season of kidding with regression on Ali-Schaeffer polynomials nested within the year-season classes, and a random effect of flock test-day. In model [1], the lactation curve effect from model [0] was replaced by a fixed effect of days in milk (in 3-d periods), the same for all year-seasons of kidding. Models [2] and [3] were obtained from model [1] by removing the fixed year-season of kidding effect and considering the flock test-day effect as either fixed or random, respectively. The models were compared by using 2 criteria: mean-squared error of prediction and a test of bias affecting the genetic trend. The first criterion indicated a preference for model [3], whereas the second criterion preferred model [1]. Mean-squared error of prediction is based on model fit, whereas the second criterion tests the ability of the model to produce unbiased genetic evaluation (i.e., its capability of separating environmental and genetic time trends). Thus, a fixed structure with year (year, year-season, or possibly flock-year) was indicated to appropriately separate time trends. Heritability estimates for daily milk yield and milk content were 0.26 and 0.24 to 0.27, respectively.

Irish society went into one of the most stringent lockdowns in March 2020 due to the COVID-19 pandemic, and barring a few weeks, remains highly restricted at time of writing. This has produced a wide range of challenges for those affected by eating disorders, as well as treatment services and Bodywhys, The Eating Disorders Association of Ireland. Current research indicates that COVID-19 has impacted across three key areas—the experience of those with an eating disorder, the experience of service provision, and the impact on the family situation. Drawing on monitoring and evaluation data gathered by Bodywhys, this paper details the challenges faced by those affected by eating disorders in Ireland and how the organisation responded to these challenges, providing support in various forms to people with eating disorders and their families.