This is a protocol for a Campbell systematic review. This protocol will evaluate and synthesise the empirical evidence, both qualitative and quantitative, regarding the outcomes and impact from undertaking professional doctorates from within any health and social care profession. This review’s objectives are to find out (in relation to health and / or social care): • What is known about the outcomes and impact of completing (or not completing) a professional doctorate in health and / or social care on: o the individual professional o the employing organisation? o the profession? o service users and the wider society? • How do use the findings from this review to inform educators, higher education institutions, professionals, investors in employing organisations and policy makers? • What further research will be needed to answer any knowledge gaps or recommendations • Where possible, we will identify and report on any demographic data and discuss their relevance to the impact and outcomes from professional doctorates.

This small-scale qualitative study explores how children participate in their own child protection/child in need planning within a statutory setting in England. Their experience of participation and the impact that voicing their wishes and feelings had on outcomes are highlighted and discussed against a background of conflicting discourses of statutory safeguarding and empowering participation, barriers to engagement and hearing the child’s voice.

Background Racism, stigma, and discrimination can result in poor experiences, marginalisation, misinformation, and thus detrimental health outcomes for racially and sexually minoritised (Lesbian, Gay, Bisexual, Trans and Queer+ Black Persons of Colour (LGBTQ+ BPoC) identifying) individuals. By considering what culturally safe, sensitive, and inclusive services can look like, we can begin to advocate for better, more appropriate health service development. This study aims to examine the experiences of racially and sexually minoritised individuals in accessing sexual health services to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Design Charmaz's constructivist grounded theory was used to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Fourteen in depth interviews were used to collect data. Broun and Clarke's thematic analysis was used to analyse the data. Results From five fundamental themes, three key factors emerged from the data i) access to credible sexual health information, ii) culturally competent lived experience leadership, and iii) culturally safe environments and conditions. Findings highlight disparities with regards to access, outcomes, and experiences of care for raciosexual minority individuals in England. Factors such as the absence of lived experience practitioners, a lack of sensitivity and privacy, and a lack of diverse prevention options were said to compromise the accessibility and usability of existing sexual health services. Similarly, factors such as practitioner competency, trauma-informed approaches, access to practical information, were all said to optimise this experience, leading to greater openness and likelihood of service user engagement (see Figure 25). Conclusion In line with the recommendations made by the participants of this study, culturally safely, sensitivity, and inclusivity remain key drivers toward the design of more optimal sexual health provision in England. This will be achieved through an improved access to credible sexual health information, an increase in lived experience practitioners, provision of cultural competency training across the workforce, and the curation of culturally safe clinical environments and conditions. While it will require significant changes, where intersectionality is honoured, a shift will be observed toward a more optimal sexual health service delivery model. In turn, improved access, experiences, and overall health and wellbeing outcomes will be noted for raciosexual minorities in England.

Abstract available in hard copy

Background: Haemophilia A (HA; Factor VIII deficiency) is a congenital X-linked bleeding disorder characterized by trauma-related or spontaneous bleeding events, most notably arising within the intraarticular space and resulting in chronic inflammation and degeneration of affected joints. Endogenous clotting factor activity relative to normal levels determines the severity of HA symptoms, as mild (> 5–40%), moderate (1–5%), or severe (< 1%). Within the current environment of rapid evolution in HA management, we seek to understand the interplay of condition severity and health-related quality of life (HRQoL) to characterise and differentiate unmet needs among people with HA (PwHA). Methods: A generalised linear regression model (GLM) was developed to explore the relationship between HA severity and EQ-5D-5 L index score from adult HA patients sampled in the “Cost of Haemophilia across Europe – a Socioeconomic Survey II” (CHESS II) cross-sectional, retrospective burden of illness study among adults with hereditary haemophilia A or B from eight European countries. HA patients of any severity with no active inhibitors during the 12 months prior to data capture and a completeEQ-5D-5 L response were included. A base GLM model was specified with covariates for demographic and clinical characteristics (age, body mass index, country, employment, HA severity, annual bleeding rate, problem joints, and chronic pain). Results: Of 381 evaluable patients, 221 (58.0%) had severe HA, 96 (25.2%) had moderate HA, and 64 (16.8%) had mild HA. Among the covariates included in the GLM model and after controlling for haemophilia-related outcomes, a significant association was observed between mild HA and higher EQ-5D-5 L index score (average marginal effects, 0.084; p = 0.016) relative to severe HA. Patient country of residence and magnitude of HA-related chronic pain were also associated with significant differences in index scores, with the latter showing a negative relationship with HRQoL outcomes. Conclusions: Condition severity and chronic pain are significant predictors of HRQoL in PwHA. Durable bleeding protection and effective management of chronic pain have the potential to address unmet treatment needs in this population.

Food insecurity is acknowledged as a key social determinant of health among older adults. Despite recording significantly higher levels of poverty in comparison to white ethnic groups, older individuals from ethnic minorities are under-represented as recipients of food aid. Thus, there are knowledge gaps in our understanding of older people and their experiences of food insecurity within ethnic minority communities. Through the theoretical lens of Individual and Community Resilience, we empirically advance our understanding of food security and resilience within South Asian communities via in-depth interviews with community stakeholders and older individuals from Bangladeshi and Pakistani communities across the Greater Manchester region. Our findings reveal that the integration of temporal, environmental and social constructs within a resilience framework reveals significant potential for further negative social, cultural and economic impact on older ethnic minorities in the future, especially as current food support services do not appear to cater for ethnic dietary preferences, language accessibility and/or cultural norms regarding asking for help/charity outside the home. We predict therefore, in combination with the identified persistent stressors, that food insecurity issues within older ethnic minority communities are likely to get much worse, resulting in the need for extensive resilient capacities to cope with future cost-of-living challenges. In acknowledging previous limitations within previous resilience frameworks, we propose an incremental contribution to theory and conclude by identifying culturally and operationally appropriate food support system approaches, which can be used to address the increasing prevalence of “silent poverty” within ethnic minority communities.

All mental health Trusts in England were surveyed, using freedom of Information Requests, as part of an enquiry into sexual safety incidents. A response rate of 72 % was obtained. Results revealed that sexual safety incidents and mixed-sex ward breaches are both increasing. Very few Trusts are adhering to the national guidance on sexual safety standards. Only one audit of safety standards was provided with full data. The Minister of Health has ordered an enquiry by the Health Services Safety Investigation Board with findings to be reported in 12 months' time. We argue more urgent action is needed now. [Abstract copyright: Copyright © 2024 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.]

When we accepted the role of guest editors for this special edition on health inequalities, we did not foresee the range and variance of submissions that reflected the lived experience of the health inequalities in people with intellectual disabilities. This is reflected in the diverse and rich mix of studies covering a broad range of topics and methodologies included in this special edition. The pursuit of equity of access to health care is a central objective of many health care systems. These papers collectively illustrate the urgent need to recognise the intersecting influences of gender, disability and other social determinants of health in shaping individuals’ experiences and access to healthcare services. Moreover, these findings highlight the critical importance of incorporating the lived experiences and perspectives of people with intellectual disabilities into research, policy and practice. Looking ahead, it is essential to adopt an intersectional approach that acknowledges diverse and intersecting identities of people with intellectual disabilities, particularly women, in designing and implementing interventions designed to address health inequalities. This requires, not only addressing systemic barriers within healthcare systems, but also challenging societal attitudes and prejudices that perpetuate discrimination and marginalisation.

Statement of the Association of Schools of Public Health in the European Region (ASPHER)

Background: Hemophilia is a congenital disorder characterized by deficiency or absence of clotting factor VIII in hemophilia A (HA) or clotting factor IX in hemophilia B (HB), resulting in frequent, repeated, and prolonged spontaneous or traumatic bleeding into joints or soft tissue. Severity is classified by the patient’s baseline level of clotting factor activity as mild (&gt;5%-40%), moderate (1%-5%), or severe (&lt;1%). In Spain, there is limited information on the societal economic burden of disease. Objective: To estimate the economic and humanistic burden of disease in adult patients with non-inhibitor moderate and severe HA and HB in Spain. Methods: Spanish data from the CHESS II study (2018-2020) on patients’ clinical characteristics, health-related quality of life (HRQoL) and hemophilia-related healthcare resource utilization were analyzed. Economic burden was determined by estimating condition-related annual per-patient direct (medical and nonmedical) and indirect costs, stratified according to hemophilia type and severity and presented as 2022 Euros. HRQoL was assessed via the EQ-5D-5L. Results: Of 341 patients in the Spanish CHESS II cohort, 288 patients met the inclusion criteria: 181 had HA (37% [n = 66] moderate and 63% [n=115] severe) and 107 had HB (26% [n = 28] moderate and 74% [n = 79] severe). Mean annual direct cost was higher in HB than in HA, and higher in severe than in moderate patients, resulting in an annual cost/patient of €17 251 (moderate HA), €17 796 (moderate HB), €116 767 (severe HA) and €206 996 (severe HB). The main direct cost component in all groups except moderate HA was factor replacement therapy. Mean per-patient indirect cost was €4089 (moderate HA), €797 (moderate HB), €8633 (severe HA) and €8049 (severe HB). Finally, the mean total cost (direct and indirect) for moderate and severe patients were €91 017 (HA) and €163 924 (HB). EQ-5D-5L [SD] scores were lower in patients with severe HA (0.77 [0.18]) and severe HB (0.70 [0.22]) compared with patients with moderate HA (0.81 [0.15]) and moderate HB (0.86 [0.17]). Conclusions: Independently of the type of hemophilia, greater condition severity was associated with increased costs and a decrease in HRQoL.