Southampton City Council

Physical activity (PA) improves health and well-being, and helps prevent long-term conditions. Yet opportunities to be active are not evenly distributed, with social, economic, and environmental disadvantages constraining access to PA among populations who may benefit most. Since the extent to which PA interventions incorporate equity considerations remains insufficiently characterised, risking exacerbation of health inequity, this scoping review aims to synthesise trial evidence on interventions of PA to improve health outcomes in populations at risk of health inequity as defined by the PROGRESS-Plus and CORE20PLUS5 frameworks. PubMed, Web of Science, and Scopus were searched for randomised controlled trials of PA interventions with at-risk populations published between 2020 and 2025. Study characteristics, intervention design, and equity-relevant factors were extracted. Two reviewers independently screened and synthesised findings narratively. Results indicate that of 2,480 articles identified, 23 trials met eligibility criteria. Most reported positive effect of PA on health outcomes amongst at-risk populations, including weight loss, improved motor skills and gait speed, reduced anxiety and PTSD, and fewer fractures or hospital visits. Interventions commonly included strength and balance training, group exercise, stretching, and aerobic fitness. UK-based studies and subgroup analyses by e.g. sex or age were largely absent, and many populations at risk of health inequity were underrepresented. Explicit equity considerations throughout design, implementation, or evaluation were rare across trials and few assessed differential effects between social or economic groups. Integrating equity frameworks and engaging with at-risk populations is recommended in future physical activity interventions to mitigate exacerbation of health inequity.

ABSTRACTFace masks and coverings are often encountered by facial examiners (‘examiners’) in forensic case work. Examiners are skilled at unconcealed face identifications, but their accuracy for masked face identifications is unknown, yet can be used as evidence in court. Here we test performance of an international sample of 61 examiners, 39 professional teams, and 6 face identification algorithms for 20 image pairs. Pairs consisted of one unconcealed face image and one mask wearing face image. Examiners and professional teams outperformed controls, but professional teams made the least errors of all groups. The algorithms achieved high accuracy on the task. The findings back the notion that examiners use feature‐based comparison strategies, and these are successful for matching images where one face wears a mask. Our results support the use of examiners for the identification of masked faces and suggest a role for teams and human‐machine working in applied practice.

Low back pain is highly prevalent and a leading cause of disability. Internet-delivered interventions may provide rapid and scalable support for behavioural self-management. There is a need to determine the effectiveness of highly accessible, internet-delivered support for self-management of low back pain. To determine the clinical and cost-effectiveness of an accessible internet intervention, with and without physiotherapist telephone support, on low back pain-related disability. A multicentre, pragmatic, three parallel-arm randomised controlled trial with parallel economic evaluation. Participants were recruited from 179 United Kingdom primary care practices. Participants had current low back pain without indicators of serious spinal pathology. Participants were block randomised by a computer algorithm (stratified by severity and centre) to one of three trial arms: (1) usual care, (2) usual care + internet intervention and (3) usual care + internet intervention + telephone support. 'SupportBack' was an accessible internet intervention. A physiotherapist telephone support protocol was integrated with the internet programme, creating a combined intervention with three brief calls from a physiotherapist. The primary outcome was low back pain-related disability over 12 months using the Roland-Morris Disability Questionnaire with measures at 6 weeks, 3, 6 and 12 months. Analyses used repeated measures over 12 months, were by intention to treat and used 97.5% confidence intervals. The economic evaluation estimated costs and effects from the National Health Service perspective. A cost-utility study was conducted using quality-adjusted life-years estimated from the EuroQol-5 Dimensions, five-level version. A cost-effectiveness study estimated cost per point improvement in the Roland-Morris Disability Questionnaire. Costs were estimated using data from general practice patient records. Researchers involved in data collection and statistical analysis were blind to group allocation. Eight hundred and twenty-five participants were randomised (274 to usual primary care, 275 to usual care + internet intervention and 276 to the physiotherapist-supported arm). Follow-up rates were 83% at 6 weeks, 72% at 3 months, 70% at 6 months and 79% at 12 months. For the primary analysis, 736 participants were analysed (249 usual care, 245 internet intervention, 242 telephone support). There was a small reduction in the Roland-Morris Disability Questionnaire over 12 months compared to usual care following the internet intervention without physiotherapist support (adjusted mean difference of -0.5, 97.5% confidence interval -1.2 to 0.2; p = 0.085) and the internet intervention with physiotherapist support (-0.6, 97.5% confidence interval -1.2 to 0.1; p = 0.048). These differences were not statistically significant at the level of 0.025. There were no related serious adverse events. Base-case results indicated that both interventions could be considered cost-effective compared to usual care at a value of a quality-adjusted life-year of £20,000; however, the SupportBack group dominated usual care, being both more effective and less costly. The internet intervention, with or without physiotherapist telephone support, did not significantly reduce low back pain-related disability across 12 months, compared to usual primary care. The interventions were safe and likely to be cost-effective. Balancing clinical effectiveness, cost-effectiveness, accessibility and safety findings will be necessary when considering the use of these interventions in practice. This trial is registered as ISRCTN14736486. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/111/78) and is published in full in Health Technology Assessment; Vol. 29, No. 7. See the NIHR Funding and Awards website for further award information.

Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation.

Abstract BackgroundFood clubs are a higher-agency food aid intervention that charge a small fee for a set number of items. Some incorporate longer-term solutions such as budgeting support and cooking skills. These are in place in England to help address inadequate reliable access to affordable, nutritious food. We used a convergent parallel mixed methods design to describe the food insecurity households accessing food clubs experience and to assess diet quality and wellbeing at the start and after at least three months of using food clubs in the South of England.MethodsParticipants accessing food clubs in Wessex from March 31 to November 3, 2022 were recruited after providing informed consent. They completed a survey at recruitment that collected data on diet and health. Food security was assessed using the modified six-item US Department of Agriculture (USDA) food security survey module, and wellbeing using the short form Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Follow-up surveys were conducted after participants used the clubs for at least three months. Participants were invited to take part in a semi-structured interview.ResultsOf the 90 participants recruited at baseline, 52% were aged 35–54 years, 74% were female, 81% were of White ethnicity, and 71% reported having at least one dependent child. Food security status was calculated in 69 participants who answered all six questions of the USDA module, with 42% reporting low and 43% very low food security. Among participants with follow-up (n=52), low food security was 41% and very low food security was 18% at follow-up.Eleven participants were interviewed. Two themes explored impact and experiences of food club. Impact illustrated how participants consumed a more varied diet, experienced less financial pressure, and improved health, wellbeing and social interaction. Experiences of food clubs explored limitations of time and food range at clubs, developing a sense of community and overcoming stigma.ConclusionThis study is the first in the UK to explore potential diet, food security and wellbeing impacts of food clubs. Ongoing impact evaluation will enable optimisation of interventions for the populations they serve, such as inviting other organisations/groups to attend/be available for members.

<bold>Background:</bold> Treatment with prednisolone following interleukin-5 (IL-5) inhibition with mepolizumab further reduced Th2 inflammation but had limited clinical benefits in stable severe eosinophilic asthma. <bold>Aim:</bold> To investigate the effects of prednisolone treatment after IL-5 inhibition on observed asthma metabotypes. <bold>Methods:</bold> Urine was collected as part of the MAPLE study; a randomised placebo-controlled crossover trial (Yang et al. J Allergy Clin Immunol Pract 2022;10(11):2925.e12). 30 mepolizumab-treated severe asthmatics underwent 2-week interventions of placebo and prednisolone. Metabolomic data were acquired using mass spectrometry and analysed using univariate and multivariate statistics. <bold>Results:</bold> 158 metabolites were identified, with 25 being altered following prednisolone (p<0.05, FDR<0.05) and 0 being altered following placebo intervention. Multivariate modelling corroborated these findings. The metabotypes of pre-intervention and post-placebo timepoints were similar, and the post-prednisolone timepoint was significantly different (p<0.05). Acylglycines (biomarkers of beta-oxidation deficiency, FC=1.55-2.06) increased while medium chain acylcarnitines and citric acid (central energy, FC=0.66-0.77), taurine (anti-inflammatory and antioxidant, FC=0.25), and imidazoleacetic acid (catabolic product of histamine, FC=0.85) decreased following prednisolone intervention. <bold>Conclusion:</bold> Metabolomics revealed significant changes to fatty acid beta-oxidation and central energy metabolism after 2 weeks of prednisolone. Results suggest altered mitochondrial function as a potential mechanism through which corticosteroids mediate airway inflammation following IL5 inhibition.

<bold>Background:</bold> The COVID-19 pandemic escalated the need for remote study procedures in clinical trials. Adaptations to the BenRex Study (Benralizumab Exacerbation Study) allowed for validation of video supported home spirometry against on site face-to-face sessions in severe asthma patients. <bold>Methods:</bold> At screening, participants received a Micro spirometer [Vitalograph, Buckingham, UK] and education on its use. A spirometry session was performed on site with face-to-face coaching from study staff, followed by a remote spirometry session within 24 hours, with coaching over video link at 3 visits. All Spirometry sessions had an over-read for quality assessment, by Respiratory Physiologists at Vitalograph, using the grading system per the ATS-ERS 2019 Standardisation of Spirometry Guidelines. Statistical summaries were produced to compare the acceptability grade of FEV₁ and FVC at each session. McNemar tests were used to compare acceptability. <bold>Results:</bold> There were 166 sessions in total with clinic and off site spirometry readings, from 82 subjects. An FEV1 grade of A or B (as per ATS/ERS 2019 guidelines) was achieved in 161 sessions (97%) conducted on site and 156 (94%) conducted at home (p=0.32). An FVC grade of A or B was achieved in 152 sessions (91.5%) on site and 148 (89.1%) conducted at home (p=0.68). <bold>Discussion:</bold> The results from the BenRex cohort suggest that there is a high level of reproducibility of technical quality for remote spirometry [FEV₁ and FVC] conducted via video coaching. This has implications for study design and may support remote decentralised asthma trials in broader populations limited by geographical or time constraints.

Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID-19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face-to-face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described.