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Abstract Background Public involvement in health and social care research improves relevance, transparency, and impact. Since their launch in 2018, the UK Standards for Public Involvement have provided a practical, values-based framework to support meaningful public involvement across all stages of research. Methods This Comment article draws on three applied case examples at national, regional, and study-level to illustrate how the Standards are being implemented across the UK. The authors reflect on lessons learned through implementation and identify emerging challenges and opportunities for embedding the Standards in evolving research contexts. Results The UK Standards for Public Involvement have been applied to evaluate public involvement quality in NIHR research centres, to assess the role of contributors in clinical trials, and to inform feedback, practice, and collaboration. The Standards underpin the Shared Commitment to Public Involvement and have contributed to shifting public involvement from aspiration to expectation, providing a consistent reference point for improvement and accountability. Conclusions The UK Standards for Public Involvement promote inclusive, ethical, and impactful involvement. We call on the health and social care research community to promote, apply, and build upon the UK Standards for Public Involvement to support high-quality public involvement into the future.
Ambient heat is an escalating climate-related hazard, yet its implications for menstruation and adolescent and young adult mental health remain understudied. Menstruating individuals face unique physiological and psychosocial challenges that may be intensified in the presence of heat stress. These challenges can be further shaped by stigma, period poverty, and developmental vulnerability, with potential implications for depression, anxiety, and psychological wellbeing. Heat exposure may disrupt thermoregulation, exacerbate menstrual symptoms, and heighten psychological stress, but the combined effects of these processes remain poorly understood. In this critical narrative review, we: draw together evidence from multiple disciplines on biological, psychological, and structural pathways linking heat exposure, menstruation, and mental health. We identify important research gaps and propose a conceptual framework and gender-responsive research agenda to inform equitable climate-resilient health strategies.
OBJECTIVES:Shared decision-making is widely advocated in policy and practice, but how it is to be applied in a high-stakes clinical decision such as major lower limb amputation due to chronic limb-threatening ischaemia or diabetic foot is unclear. The aim of this study was to explore the communication, consent, risk prediction and decision-making process in relation to major lower limb amputation. DESIGN:A qualitative study (done as part of a broader mixed-methods study) using semi-structured interviews. Interview transcriptions were analysed using thematic analysis. SETTING:Vascular centres in three large National Health Service hospitals in Wales and England, UK, between 1 October 2020 and 30 September 2022. PARTICIPANTS:A purposive sample of 18 patients for whom major lower limb amputation was considered as a treatment option/carried out, with interviews conducted before or within 4 months of amputation and 4-6 months after amputation. A further purposive sample of 20 healthcare professionals (including eight surgeons) involved in supporting or conducting major lower limb amputation decision-making. FINDINGS:Five major categories were identified that highlighted the challenges of ensuring shared decision-making associated with major lower limb amputation: (i) patients' limited understanding, (ii) variable patient attitudes to decision-making, (iii) healthcare professionals' perceived challenges to sharing decision-making, (iv) surgeons' paternalism and (v) patients' and healthcare professionals' decisional regret/possible consequences of challenges. CONCLUSION:Amputation is a life-changing decision for both patients and healthcare professionals, with huge consequences. Despite being considered the gold standard, our findings highlight several challenges to effective shared decision-making for major lower limb amputation. Shared decision-making training for healthcare professionals is paramount if these limitations are to be addressed and patients are to feel confident in being adequately informed about the treatment decisions that they make. TRIAL REGISTRATION NUMBER:NCT04903756.
The moral panic surrounding trans, non-binary, and gender diverse (TGD) lives in the United Kingdom (UK) has been incited by high-level political and government actors and exacerbated by pervasive misinformation in social and press media. This hostile environment contributes to increasing interpersonal violence and social exclusion experienced by TGD people. Structural and interpersonal discrimination—conceptualised as minority stress—is understood to elicit physiological and psychological stress responses that predispose TGD individuals to a range of adverse health outcomes, including cardiovascular disease, and risk behaviours such as alcohol use. Health disparities among TGD people in the UK are driven by a combination of minority stress, barriers to general healthcare, and disadvantage across multiple social determinants of health. Limited access to gender-affirming healthcare compounds these disparities, contributing to stark differences in morbidity and mortality relative to cisgender populations. Preventive healthcare engagement is also disproportionately low among TGD individuals, further exacerbating long-term health risks. The intersection of social exclusion, policy-driven discrimination, and systemic healthcare inequities places TGD people at significant and potentially increasing risk of poor health outcomes. The health disparities faced by TGD people in the UK constitute a real-time public health crisis that demands urgent and sustained intervention. TGD people must be central to shaping the strategic direction of a coordinated and adequately resourced response to these harms.
