Oxford Brookes University

This study provides novel evidence on perceptions and use of alcohol-free and low-alcohol (NoLo) products among mid-life women, a group underrepresented in alcohol research. A cross-sectional survey of 497 women aged 40-65 was co-developed with stakeholders to ensure relevance and acceptability. The survey assessed understanding of alcohol by volume (ABV) definitions (low-alcohol ≤1.2%; alcohol-free ≤0.05%), patterns of NoLo use, attitudes, and perceived helpfulness for harm reduction. Most respondents misunderstood ABV terms, with 64% assuming "alcohol-free" meant 0% ABV. Nearly half had used NoLo products in the past year, with uptake more common among participants with higher education levels and, more tentatively, with higher income, raising equity concerns. Bayesian regression identified taste motives as strong positive predictors of NoLo use, while enhancement motives (drinking for pleasure) were negative predictors. Around 75% rated NoLo substitution as helpful for reducing alcohol intake. In adjusted Bayesian regression, enhancement motives and AUDIT scores showed predominantly negative associations with perceived helpfulness, and taste motives showed no clear effect indicating that determinants of use and beliefs about helpfulness may differ. Acceptability varied by context: celebratory scenarios were rated most appropriate, while during pregnancy or in the workplace were least acceptable. Factor analysis revealed three sub-scales of NoLo perceptions; recent users reporting higher social and health benefits and fewer associations with alcohol-related cues. Findings underscore the need for policy to prioritise clear ABV labelling, inclusive messaging, and equitable access to appealing NoLo options that emphasise taste, social usability, and health benefits to maximise harm-reduction impact.

Alcohol use is driven not only by environmental cues but also by individual differences in motivational style. Recent work has demonstrated how memory cues can reduce subsequent desire for alcohol, yet it remains unclear how personality traits shape this effect. To address this, we recruited male and female participants ( N = 169) who completed the behavioural inhibition/approach system (BIS/BAS) scales and were then cued to recall either a previous alcohol drinking episode and estimate the number of alcohol calories consumed (Alcohol Cue, AC) or a control (Neutral Cue, NC). They then rated their desire for alcohol (DAQ). Findings revealed lower desire for those in the AC compared to NC group and separately, a positive association between alcohol desire and BAS and particularly BAS-Drive. We further found that a measure of residual BAS (BAS less BIS) was positively related to desire but did not moderate the effect of memory cue. These findings suggest that being reminded of a previous drinking episode can exert a modest but consistent influence on alcohol desire. • Memory of a recent drinking episode reduced alcohol desire in males and females. • Increases in Behavioural Approach System (BAS) increased alcohol desire. • BAS did not moderate the effect of the alcohol memory cue. • Memory cues could offer a simple method of reducing alcohol desire.

Opioid-induced neurotoxicity (OIN) is a significant complication in palliative care, presenting with symptoms of hypersomnolence, hallucinations, cognitive dysfunction (including delirium), myoclonus and hyperalgesia. Due to limited research studies, a consensus on recognising these clinical manifestations is yet to be reached, complicating both early diagnosis and management. This rapid review aims to synthesise current evidence on the prevalence, clinical manifestations, risk factors and management strategies of OIN in the palliative care setting to enhance clinical practice. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of Medline, Embase and the Cochrane Central Database, complemented by supplementary searches in ten palliative care journals. Studies with five or more palliative care patients were included, excluding those involving minors, animal models or substance misuse. Data were extracted, cross-checked and synthesised narratively. A total of 21 studies met the inclusion criteria. Prevalence of OIN varied widely from 6.4% to 38%, with common symptoms including delirium, myoclonus and hyperalgesia. Identified risk factors included age, renal and liver dysfunction, high opioid doses and concurrent use of specific medications. Opioid rotation and dose reduction emerged as potential management strategies, though patient responses varied significantly. OIN is under-diagnosed due to symptom overlap with other conditions. While opioid rotation and dose reduction show promise in managing OIN, further research is needed to establish standardised diagnostic criteria and effective treatment protocols. Enhanced clinical awareness and an individualised approach to opioid prescribing are crucial for improving patient outcomes in palliative care. CRD42024543988.

Hypertension remains a leading contributor to cardiovascular morbidity and premature mortality worldwide, with increasing prevalence observed among younger populations. Although avoidable lifestyle factors account for a substantial proportion of hypertension risk, prevention efforts depend heavily on adequate awareness and understanding of these factors. This study examines the level of knowledge of avoidable risk factors of hypertension among university students in England and evaluates the relationship between these factors and hypertension status. A cross-sectional quantitative design was employed using a structured questionnaire administered to students at a large English university. Descriptive statistics, chi-square analysis, and multinomial logistic regression were used to analyse the data. Findings indicate a high level of knowledge of avoidable risk factors, including alcohol consumption, obesity, high salt intake, and junk food consumption. Despite this, significant associations were observed between several avoidable risk factors and hypertension status, particularly alcohol use, body mass index, salt intake, and frequent consumption of junk food. The results highlight a clear disjunction between knowledge and health behaviour, suggesting that awareness alone is insufficient to reduce hypertension risk among university students. The study underscores the need for prevention strategies that extend beyond information provision to address behavioural, social, and environmental drivers of risk.

Background: Gastric and gastro-oesophageal junction cancers encompass a heterogeneous group of malignancies with distinct histological and biological characteristics. Histological classification remains central to diagnosis, prognostication, and therapeutic decision-making, particularly in settings where molecular profiling is not routinely available. Objective: This study examined the histological spectrum and classification patterns of gastric and gastro-oesophageal junction cancers diagnosed over a ten-year period in Anambra State, South-East Nigeria. Methods: A retrospective review was conducted of gastric and gastro-oesophageal junction cancer cases diagnosed between January 2011 and December 2020 across four major histopathology laboratories in Anambra State. Archived haematoxylin and eosin–stained slides and paraffin blocks were reviewed. Tumours were classified according to the 2019 World Health Organization classification of gastric tumours, with carcinomas further categorised using the Lauren classification system. Descriptive statistics and chi-square testing were applied, with statistical significance set at p < 0.05. Results: Ninety-three cases met inclusion criteria. Carcinomas constituted the majority of tumours, followed by mesenchymal tumours, lymphomas, and neuroendocrine tumours. Tubular adenocarcinoma was the most frequent carcinoma subtype, while intestinal-type carcinoma predominated under the Lauren classification. Most graded carcinomas were well differentiated. No statistically significant associations were identified between histological subtype and patient age or sex. Conclusion: Gastric and gastro-oesophageal junction cancers in this setting are dominated by epithelial malignancies, particularly tubular and intestinal-type adenocarcinomas. The observed histological profile aligns with patterns reported across Nigeria and other low- and middle-income settings, underscoring the continuing relevance of morphology-based classification in regional cancer practice.

Fatigue is a common problem that significantly affects intensive care unit (ICU) survivors' physical, psychological, and social functioning. ICU survivors often experience a loss of self-worth and identity, struggle to return to their normal roles, and face ongoing challenges with cognitive and emotional recovery. Despite its profound impact, there are limited rehabilitation interventions targeting this population. This research aims to evaluate the acceptability of implementing the Fatigue After CriTical illness (FACT) self-management intervention into usual care for patients experiencing fatigue after critical illness and the feasibility of the intervention for a future clinical trial. This is a multicentre, open-label, feasibility randomised controlled trial (RCT) with an embedded qualitative evaluation, conducted across. Seventy participants recruited from three United Kingdom (UK) National Health Service (NHS) Trusts will be randomised either to the FACT self-management intervention following hospital discharge, which focuses on fatigue management, goal setting, and personal action planning, in addition to usual care, or to a control group receiving usual care alone. The intervention will be accessible for six months and will include a 30-min phone or video call with an ICU follow-up healthcare professional (HCP) in the third month. HCPs will attend an online training session and follow a protocol to guide patients in goal setting. Outcome assessments will occur at baseline, three months, and six months post-randomisation to evaluate feasibility and acceptability. Semi-structured interviews with patients and HCPs will explore their experiences and acceptability outcomes at 6months. This study aims to provide insights into the feasibility and acceptability of the FACT intervention, with the goal of improving fatigue management among survivors of critical illness. Preliminary findings will inform the design of a larger-scale RCT to evaluate its effectiveness in enhancing recovery from critical illness in patients who are experiencing fatigue. Study ID: ISRCTN1381359 . Date registered: 01/04/2025.

BackgroundMobile health (mHealth) technologies are increasingly used in paediatric oncology to promote physical activity, with growing evidence supporting their feasibility and effectiveness. Augmented reality (AR) is emerging as a promising addition, offering interactive features that may enhance participation in exercise for young people. As mHealth tools evolve, understanding user experiences and implementation challenges is essential to inform wider adoption in healthcare. The FORTEe clinical trial evaluates an individualised exercise programme designed for children, adolescents and young adults with cancer (CAYA). This sub-study explores the perspectives of CAYA and exercise and healthcare professionals involved in delivering the exercise intervention (exercise professionals) on the use of a novel AR application (app), designed to facilitate home-based exercise as part of the broader intervention. Key app features include personalised exercise programmes, AR demonstrations using a child-like avatar, and an integrated exercise diary.MethodsCAYA (9–21 years), and exercise professionals from the FORTEe trial's technology sub-study (six centres) were eligible. To explore experiences and perceptions of the AR app, half-structured interviews were conducted with CAYA and an anonymous online survey administered to exercise professionals. Interview data and open-ended text from survey was analysed using inductive qualitative content analysis. Survey data was analysed using descriptive statistics.ResultsA total of 46 CAYA (mean age 13.6 ± 2.7 years, 39% female) provided feedback on the AR app via interviews, and 31 exercise professionals completed the survey. CAYA and exercise professionals reported generally positive experiences, finding the AR demonstrations novel and engaging. The personalised workouts were valued by both groups. However, both groups reported some technical difficulties that impacted reliability, and that some features, such as the exercise diary, lacked usability. Exercise professionals emphasised the app should complement rather than replace face-to-face sessions. To enhance the app further, both groups suggested incorporating gamification and avatar customisation.ConclusionThis study emphasises the potential of AR technology to increase engagement in exercise among CAYA and highlights ways to optimise the technology. While AR shows promise in paediatric oncology care, it should complement in-person exercise interventions. Future development should prioritise user-friendly design, personalised approaches, and equal access for young patients.

Evidence regarding the dynamics of the longitudinal reciprocal associations between maternal and paternal depression over time is lacking. The current study examines reciprocal longitudinal associations between maternal and paternal depressive symptoms (DS) from pregnancy (18weeks-gestation) to 11years 2months (study child's age) to gain insights into the joint course of DS. The study sample comprised 6296 mothers and fathers from the UK-based birth cohort, the Avon Longitudinal Study of Parents and Children. Reciprocal longitudinal associations between maternal and paternal DS, assessed at nine time-points (Edinburgh Postnatal Depression Scale; continuous scores), were examined using random intercept cross-lagged panel models to differentiate between stable covariance (between-person differences in DS) and dynamic processes (within-person level). Analyses were adjusted for parental and socioeconomic confounders. There were strong correlations between random intercepts of maternal and paternal DS (β=0.305, SE=0.015, p≤0.001), suggesting positive associations between the overall mean levels of parental DS (i.e., a between-person association). There were strong stability effects for maternal and paternal DS across all nine measurement occasions (i.e., within-person associations), with larger effects evident for both maternal and paternal DS later in childhood (between ages 5 and 11years). There was evidence for bidirectional longitudinal within-person effects between maternal and paternal DS at some but not other measurement occasions. These findings have important implications for screening, prevention and intervention programmes. Depression in one parent may require screening efforts directed at the other parent, with prevention and intervention programmes focused on the family, rather than one parent.

ABSTRACT This study examines the effect of entrepreneurial under- and overconfidence on small and medium-sized enterprises’ (SMEs) external financing decisions and outcomes. In addition to the conventional wisdom that overconfidence leads to suboptimal financing decisions and higher financing costs, we contend that moderate overconfidence induces entrepreneurs to commit costly efforts, which is seen as a favorable signal by financiers. We test this trade-off hypothesis using a large sample of UK SMEs and a novel measure of overconfidence. We find significant nonlinear relationships between overconfidence and alternative measures of financial demand and supply. Specifically, we show that mildly overconfident entrepreneurs are less likely to receive the loans applied for than both unconfident and extremely overconfident ones.