Action for ME

For women with chronic or gestational hypertension who remain well, early term birth (at 37-38 weeks' gestation) may reduce maternal complications, caesareans and stillbirths, but it may increase neonatal morbidity compared with expectant care. Expectant care may increase costs. There are no high-quality data to guide care, which currently involves maternal-fetal surveillance and intervention for maternal or fetal compromise, which may be rapid or unexpected. To investigate optimal timing of birth for women with chronic or gestational hypertension who reach term and remain well. Pragmatic, unmasked, multicentre randomised trial with a health economic analysis. Fifty United Kingdom hospitals. Inclusion: maternal age ≥ 16 years, chronic or gestational hypertension, singleton pregnancy, live fetus, 36+0-37+6 weeks' gestation and able to give documented informed consent. Exclusion: contraindication to either trial arm (e.g. pre-eclampsia), blood pressure ≥ 160/110mmHg until controlled, major fetal anomaly anticipated to require neonatal care unit admission or participation in another timed birth trial. Planned early term birth at 38+0-3 weeks' (intervention) or 'usual care at term' (control, revised from 'expectant care until at least 40+0 weeks', August 2022). Maternal coprimary: composite of 'poor maternal outcome' (severe hypertension, maternal death or maternal morbidity and superiority hypothesis). Neonatal coprimary: neonatal care unit admission ≥ 4 hours (non-inferiority hypothesis). Each coprimary is measured until primary hospital discharge or 28 days post birth (whichever is earlier). Key secondary: caesarean birth. 1 : 1 ratio, minimised for key prognostic variables: site, hypertension type and prior caesarean. It was not possible to mask care providers or participants to the intervention. For the coprimary maternal outcome, there was local site principal investigator/delegate sign-off based on review, masked to allocated group, of primary case notes. From 2019 to 2022, 403 participants were randomised (37% of target 1080) to intervention (n = 201) or control (n = 202). The funder stopped the trial during the coronavirus disease discovered in 2019 pandemic for delayed recruitment. In the intervention (vs. control) group, birth was a median of 0.9 weeks earlier (38.4, interquartile range 38.3-38.6 vs. 39.3, interquartile range 38.7-39.9 weeks). There was no evidence of a difference in 'poor maternal outcome' (13% vs. 12%, respectively; adjusted risk ratio 1.16, 95% confidence interval 0.72 to 1.87). For 'neonatal care unit admission ≥ 4 hours', the intervention was considered to be non-inferior to control, as the adjusted risk difference, 95% confidence interval upper bound did not cross the 8% pre-specified non-inferiority margin (7% vs. 7%, respectively; adjusted risk difference 0.003, 95% confidence interval -0.05 to +0.06), although event rates were lower than estimated. There was no evidence of a difference in caesarean (29% vs. 36%, respectively; adjusted risk ratio 0.81, 95% confidence interval 0.61 to 1.08). Recruitment was 37% of the anticipated sample size (as above). Despite being unable to recruit to target in this study, we observed that most women with chronic or gestational hypertension required labour induction and planned birth at 380-3 weeks (vs. usual care), which resulted in birth an average of 6 days earlier and there were no differences in poor maternal outcome or neonatal morbidity. Our findings provide reassurance about planned birth at 380-3 weeks as a clinical option for these women. An individual participant data meta-analysis is planned to address whether the intervention (vs. control) reduces caesarean; low adverse event rates would make unfeasible mounting another randomised trial. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/167/123.

ABSTRACT Action learning is becoming increasingly popular as an effective and powerful approach to learning and development. Originally mostly practised in the fields of organisational development and management education, it is now being applied in various contexts where the development of transversal skills such as critical and creative thinking, collaboration and problem-solving is vital. This paper explores how established action learning scholar-practitioners have developed their expertise over time. They examine their personal and professional journeys, reflecting on how they were attracted to the action learning community and how they developed their practice. Through their narratives, the paper aims to enhance action learning by providing valuable insights into its evolution as both theory and practice. Based on a symposium presented at the 9th Action Learning Conference, held in Manchester in April 2025, the four participants engaged in reflective discussions on their careers and contributions to the action learning community. Four themes are identified from these discussions. By sharing their reflections, the authors contribute to the ongoing dialogue in action learning theory and practice. Their insights serve as a resource for emerging scholars, practitioners and organisations seeking to deepen their understanding of action learning and apply it effectively in their respective contexts.

The clinical potential of AI to assist mental health, in particular to help diagnose and treat mental disorders, is increasingly well-researched. However, the wider long-term implications of AI for mental health are less well-researched and raise important policy questions. These include how best to address the potentially harmful effects of social media algorithms, of doomscrolling and technostress, and how to ensure the mental health impact of AI on employment is positive rather than negative. The impact of social media algorithms encouraging eating disorders, self-harm and suicide has already been well publicised. The role of AI in increasing anxiety, for instance through doomscrolling and technostress, is also now being researched. There's also good evidence that job loss is harmful for mental health and evidence that fear of job loss may also be harmful. The pace and nature of change generated by AI can be an issue too, as well as ethical and data privacy concerns. The need for policy to address risks arising from AI has been recognised internationally, as illustrated by the EU’s 2024 AI Act. However, progress elsewhere has been erratic and, as yet, the implications of AI for mental health do not appear to have featured significantly in policy making. This is an important gap that needs to be filled. In the UK there’s currently a policy deficit in this area, only partially addressed by the Online Safety Act. In addition, recent government policy decisions affecting employers have the potential unintended consequence of incentivizing some to use AI to replace staff, with knock-on mental health implications. There’s currently also no powerful national public health government agency in the UK. This leaves a public health policy vacuum regarding the implications of AI for the nation’s health. It will be important to identify those most at risk and to develop strategies and policies to prepare for and cope with the changes ahead. This is important to enable the positive effects of AI to be achieved, while minimising risk. Re-creating a powerful national public health body and ensuring a mental health impact assessment for all proposed AI-related policies would be two useful first steps. Helping create a coalition of willing countries and international bodies to ensure the pursuit of AI is not at the expense of mental health would be another.

Abstract Background Greenspaces-such as parks, woodlands, fields, allotments, green walls-are increasingly recognised for supporting health and wellbeing. Evidence suggests that living in a greener environment is important for improving and protecting health and wellbeing. To improve equitable access, collaboration between public health and planning is essential. This study explored barriers and opportunities for integrating public health and reducing inequalities through greenspace planning policy through focus group discussions with public health professionals and planning officers in England. Methods Focus groups were held with participants from local authority public health and planning departments across eight English regions. Recruitment was via existing networks and OHID regional leads. Discussions followed a topic guide based on the COM-B model and Theoretical Domains Framework. Sessions lasted 45 minutes, were conducted online, recorded, transcribed, and analysed thematically. Ethical approval was granted by the London School of Hygiene and Tropical Medicine (ref: 35706). Results Eight focus groups (4-6 participants each) were held in Sept-Oct 2024. Overall, there was varied knowledge and progress in developing a greenspace strategy and integrating public health. A key barrier was the lack of formalised collaboration between planning and public health colleagues. Physical health benefits from greenspace are increasingly included in planning policy but it is unclear if this translates to action. Capacity, resources, and differing language, processes, and priorities between sectors hinder alignment between planning and public health departments. Conclusions Knowledge gaps, organisational structures, and limited capacity are key barriers to integrating public health into greenspace planning. Local authorities can better address health needs through greenspace policy, while national government should prioritise greenspace in planning to reduce health inequalities. Key messages • Knowledge gaps, structures, and limited capacity hinder effective integration of public health into greenspace planning. • Integrating public health in greenspace planning is a key mechanism to improving wellbeing and tackling health inequalities.

Despite comprising over half of Canadian medical graduates, women remain underrepresented within surgery. Strategies to address this gap have largely focused on increasing numbers or targeting individual women, overlooking subtle, systemic gender inequities that may deter women from the field. 67 ​h of participant observation with six surgeons and semi-structured interviews with six women surgeons were conducted at a Canadian academic hospital to explore how gendered processes shape surgical life. Data was analyzed iteratively and thematically. Gender influenced women surgeons' lives across three levels: organizationally, their surgical status was questioned and undermined; individually, they navigated a double bind of being both a woman and a surgeon; and environmentally, their bodies conflicted with cultural and physical norms of surgical spaces. This study suggests that gender inequities are deeply ingrained in surgical structures and practices, highlighting the need for systemic transformations to ensure women are fully included and valued within surgery.

BackgroundCambodia aims to eliminate malaria latest by 2030 applying the 1–3-7 malaria reactive surveillance and response (RASR) strategy which involves malaria case notification, investigation and classification on the same day as diagnosis, reactive case detection within three days, and investigation and classification of new active focus within seven days of case notification. This study investigates the implementation of the RASR strategy in terms of its timeliness, facilitators and barriers, and acceptability for implementation, thereby providing recommendations to improve the strategy in the context of the national health system.MethodsA mixed-methods study of secondary data analysis of aggregated routine malaria datasets, and cross-sectional survey, in-depth interviews and focus group discussions with malaria programme stakeholders, frontline health workers and mobile and migrant populations was conducted in Ratanakiri and Stung Treng provinces. Quantitative and qualitative data were analysed descriptively and thematically.ResultsIn 2020 and 2022, 72% and 59% of malaria cases were notified and investigated within one day after diagnosis. Timeliness of reactive case detection was 89% and 45% in 2020 and 2022 respectively. Despite having challenges including minimal community participation in reactive case detection, poor mobile phone network coverage and road conditions, a heavy workload at the commune health centre level, inadequate surveillance technical knowledge among village malaria workers and insufficient budget to execute RASR, the existing RASR strategy was deemed acceptable among all levels of health personnels.ConclusionThe RASR strategy implemented in northeast Cambodia was generally functioning well despite some challenges. To improve the RASR strategy to achieve 100% timeliness and progress towards malaria elimination in Cambodia, allocating sufficient budget, capacity building to frontline health workers and better community engagement strategies are required.

ABSTRACTAlternative ready‐to‐use therapeutic foods (RUTF) formulations provide an opportunity to lower costs, facilitate local or national ingredient use, and enhance the availability and acceptability of RUTF. This scoping review aimed to identify and categorise the available evidence on alternative RUTF formulations developed and tested globally, assess their compliance with international standards and summarise evidence on acceptability, cost, effectiveness, cost‐effectiveness and adverse events, highlighting evidence gaps to guide future research. Searches of three databases and extensive grey literature were conducted covering the period from 1999 to June 2023. Fifty‐four articles, 42 peer‐reviewed articles and 12 grey literature sources were included. Fifty‐three RUTF formulations at various development stages for the treatment of severe acute malnutrition (SAM) without medical complications in children 6–59 months were identified. Numerous ingredients have undergone testing to replace primarily peanuts and/or milk, demonstrating consistent acceptance and promising results in terms of effectiveness. Evidence on outcomes beyond anthropometric recovery, such as higher iron status, and effects on cognitive and developmental outcomes or gut microbiome, is also limited. Few studies evaluated the cost implications, revealing potential savings in production costs while no significant differences were found in terms of safety. Additional evidence is required on how reduced or milk‐free formulations within the innovation and novel categories can achieve compliance with the required protein digestibility‐corrected amino acid score (PDCAAS) recommendations. Further research is also needed with specific focus on outcomes beyond anthropometric recovery such as cost‐effectiveness, accessibility, macro and micronutrient deficiencies, sustainability of recovery and longer term health outcomes.

Responding to recent calls for geography, especially urban and public geography, to engage more fully with the concept of dignity, this paper shows how feminist participatory arts-based approaches can facilitate the reclaiming of dignity among migrant women survivors of violence, an issue which has received surprisingly limited attention to date. We argue for feminist cultural geography to engage more fully with conceptualisations of dignity and especially how working through participatory arts is key to building it among migrant women. Drawing on ongoing research with a community arts organisation, Migrants in Action (MinA), run by and working with Brazilian migrant women in London, the paper proposes the notion of ‘creative dignity encounters’. These entail generating safe and compassionate spaces for women to engage in artistic engagements that allow them to reclaim their dignity conceived relationally as respect and recognition, self-respect and autonomy. We identify three types of ‘creative dignity encounters’ revolving around these three dimensions; the first, facilitates migrant women’s reinterpretation of and additional contributions to prior social science research as an act of respect and recognition; the second, engenders self-respect through healing and belonging and the third, builds autonomy through acknowledging and challenging wider structural oppressions that underpin gendered violence. Such encounters create different outcomes depending on the artistic medium and how they are sustained over time. Furthermore, they are not a panacea for bringing about social transformation and recovery, yet they can allow migrant women to begin their journeys towards reclaiming dignity in affective, relational and embodied ways.

Placental growth factor (PlGF)-based testing has high diagnostic accuracy for predicting pre-eclampsia needing delivery, significantly reducing time to diagnosis and severe maternal adverse outcomes. The clinical benefit of repeat PlGF-based testing is unclear. We aimed to determine whether repeat PlGF-based testing (using a clinical management algorithm and nationally recommended thresholds) reduces adverse perinatal outcomes in pregnant individuals with suspected preterm pre-eclampsia. In this multicentre, parallel-group, superiority, randomised controlled trial, done in 22 maternity units across England, Scotland, and Wales, we recruited women aged 18 years or older with suspected pre-eclampsia between 22 weeks and 0 days of gestation and 35 weeks and 6 days of gestation. Women were randomly assigned (1:1) to revealed repeat PlGF-based testing or concealed repeat testing with usual care. The intervention was not masked to women or partners, or clinicians or data collectors, due to the nature of the trial. The trial statistician was masked to intervention allocation. The primary outcome was a perinatal composite of stillbirth, early neonatal death, or neonatal unit admission. The primary analysis was by the intention-to-treat principle, with a per-protocol analysis restricted to women managed according to their allocation group. The trial was prospectively registered with the ISRCTN registry, ISRCTN 85912420. Between Dec 17, 2019, and Sept 30, 2022, 1253 pregnant women were recruited and randomly assigned treatment; one patient was excluded due to randomisation error. 625 women were allocated to revealed repeat PlGF-based testing and 627 women were allocated to usual care with concealed repeat PlGF-based testing (mean age 32·3 [SD 5·7] years; 879 [70%] white). One woman in the concealed repeat PlGF-based testing group was lost to follow-up. There was no significant difference in the primary perinatal composite outcome between the revealed repeat PlGF-based testing group (195 [31·2%]) of 625 women) compared with the concealed repeat PlGF-based testing group (174 [27·8%] of 626 women; relative risk 1·21 [95% CI 0·95-1·33]; p=0·18). The results from the per-protocol analysis were similar. There were four serious adverse events in the revealed repeat PlGF-based testing group and six in the concealed repeat PlGF-based testing group; all serious adverse events were deemed unrelated to the intervention by the site principal investigators and chief investigator. Repeat PlGF-based testing in pregnant women with suspected pre-eclampsia was not associated with improved perinatal outcomes. In a high-income setting with a low prevalence of adverse outcomes, universal, routine repeat PlGF-based testing of all individuals with suspected pre-eclampsia is not recommended. Tommy's Charity, Jon Moulton Charitable Trust, and National Institute for Health and Care Research Guy's and St Thomas' Biomedical Research Centre.