Objective: Dating and relationship violence (DRV) and gender-based violence (GBV) are reported to be common among adolescents internationally and can have significant adverse long-term consequences, including widening gender inequalities in health outcomes. There is evidence that while school-based curriculum programmes can be effective in preventing DRV, whole-school elements such as student/staff action groups are important for preventing GBV. However, the processes of implementing whole-school components may be challenging in schools with limited capacity. We designed THINK AGAIN, a multi-component programme aiming to prevent DRV and GBV in English secondary schools. Design: Non-controlled feasibility study of THINK AGAIN. Setting: State secondary schools in south-east England. The programme targeted all students in year 9 (aged 13-14) in participating schools. Method: We recruited four schools to assess the feasibility and acceptability of THINK AGAIN in the 2024-25 school year. Our embedded process evaluation assessed programme feasibility, processes of implementation and how context influenced these. We conducted 16 interviews with school staff and analysed the data informed by the General Theory of Implementation. Results: We found that the curriculum component was feasible and prioritised for delivery by schools. However, the whole-school component faced challenges to implementation in terms of both workability and context. Conclusion: Study findings support the progression of THINK AGAIN to a phase III trial of effectiveness, pending full assessment of progression criteria and important refinements to the whole-school component.

ABSTRACT Background Young women report feeling dismissed or unheard in healthcare settings. These experiences lead to mistrust, healthcare avoidance and ultimately contribute to gendered health inequalities. Objective This project aimed to co‐produce with young women and key partners (e.g., healthcare professionals, experts in women's health and inequalities, third sector organisations and policymakers), resources to support healthcare professionals to recognise power imbalances and adapt practice to better meet young women's needs. Design and Contributors Using an Experience‐Based Co‐Design (EBCD) framework, we conducted participatory creative workshops (one online and two in‐person) with three groups of young women ( n = 24, aged 16–25). Workshops used arts‐based, accessible activities to explore both positive and negative healthcare interactions. Insights were then presented to 15 healthcare professionals in an online workshop, to co‐design practical resources. Results The co‑design workshops led to the development of two linked resources: a co‑produced 2‑min animation and an accompanying training session for healthcare professionals. Young women identified three priorities for improving their healthcare experiences: (1) feeling heard and respected, (2) having agency and choice, and (3) continuity of care. Healthcare professionals emphasised the need for short, engaging and non‑judgemental resources. These insights informed the animation, which depicts themes drawn from young women's experiences. The training session, delivered and co‑created with young women who received facilitation training, incorporated structured engagement with the animation. Conclusion This project demonstrates the value of co‐design in shaping meaningful, practical resources intended to support young women's healthcare experiences. The final product is now being shared with healthcare educators and services. Patient or Public Contribution This project was co‐produced with young women and healthcare professionals from inception to dissemination via a Steering Committee and co‐production workshops. Interest holders from varying perspectives co‐designed the animation by shaping content and focus. Facilitation skills training was offered to all participating young women, with those who took part supported to remain involved through a young trainers' group. Healthcare professionals contributed insights that informed the resource's design, tone and messaging, ensuring it remained relevant and feasible within busy healthcare contexts. Steering Committee members were also invited to comment on manuscript drafts and support the development of this paper, including through co‐authorship.

Objective: Dating and relationship violence and gender-based violence are common among adolescents globally and can have significant adverse long-term consequences, including widening health inequalities. There is evidence that while school-based curriculum interventions can be effective in preventing dating and relationship violence, whole-school elements are important for preventing gender-based violence. However, implementing whole-school components may be challenging in schools with limited capacity. We designed THINK AGAIN, a multi-component programme aiming to prevent dating and relationship violence and gender-based violence in schools in England. The programme comprised an assessment and report of student needs, relationships and sex education curriculum, student-staff “Action Aware Group” and staff training. Design: We conducted a non-controlled feasibility study of THINK AGAIN. Setting: State secondary schools in south-east England. The programme targeted all students in year 9 (aged 13–14) in participating schools. Method: We recruited four schools in which to pilot and assess the feasibility and acceptability of THINK AGAIN in the 2024/2025 school year. Our embedded mixed-methods process evaluation assessed the fidelity, reach and acceptability of the intervention. Results: We found that the curriculum component was delivered with fidelity across schools. However, the whole-school component was delivered with fidelity in only two of four schools. Accordingly, acceptability and reach of the curriculum component were mostly higher among both students and staff than the Action Aware Group component. Conclusion: Fidelity, reach and acceptability of the curriculum were greater than the Action Aware Group, suggesting that progression of THINK AGAIN to a phase III trial of effectiveness requires important refinements to the whole-school component.

This paper uses qualitative comparative analysis to understand why some school-based interventions for dating and relationship violence and gender-based violence are more effective than others. Results indicate that a central condition for the reduction of victimization is the reduction of perpetration. However, a number of other pathways to the reduction of victimization exist, generally characterized by the implementation of single-gender components or a critical mass of girls. Absence of parental involvement and of narrative components was important as well. These findings underscore the importance of both simple content (clearly connecting victimization to perpetration) and complex influences (such as the role that participant gender and single-gender activities may play) in understanding pathways through which interventions effectively reduce all forms of DRV and GBV.

Teenagers account for high proportion of food insecure and need targeted support, says expert

Background:Schools have a duty of care to prevent violence between students but a significant amount of dating and relationship violence and gender-based violence occurs in schools. These are important public health issues with important longitudinal consequences for young people. Objectives:To understand functioning and effectiveness of school-based interventions for the prevention of dating and relationship violence and gender-based violence. Review methods:We undertook a mixed-methods systematic review to synthesise different types of evidence relating to school-based interventions for the prevention of dating and relationship violence and gender-based violence to understand if, how and in what ways these interventions are effective. We searched 21 databases and 2 trial registers and undertook forwards and backwards citation chasing, author contact and other supplementary search methods. Searches identified all literature published to June 2021. All screening was undertaken in duplicate and independently, and we quality appraised all included studies. Results:We included 247 reports (68 outcome evaluations, 137 process evaluations). Synthesis of intervention components produced an intervention typology: single-component, curricular, multicomponent, and multilevel programmes. Synthesis of intervention theories suggested that interventions aiming to increase students' sense of school belonging and sense of safety in the school building could encourage increased learning of prosocial skills and increased prosocial peer norms, and so potentially reducing dating and relationship violence and gender-based violence. Synthesis of factors affecting delivery highlighted school organisation and leaders who believed in the importance of addressing dating and relationship violence/gender-based violence, along with time and resources to deliver the interventions. The ease with which the intervention could be delivered and modified was also important. Meta-analysis found stronger evidence for intervention effectiveness in reducing dating and relationship violence than for gender-based violence, with significant long-term impacts on dating and relationship violence victimisation and perpetration, and some evidence that interventions in high-income countries could be effective for reducing victimisation and perpetration of gender-based violence in the long-term. Impacts on knowledge and attitudes were primarily short-term. Network meta-analysis did not suggest superiority of any intervention type. Moderation evidence suggested interventions reduced dating and relationship violence perpetration in boys more than girls, but reduced gender-based violence perpetration more in girls. Metaregression by intervention component did not explain heterogeneity in effectiveness, but qualitative comparative analysis suggested that reducing perpetration was important to reducing victimisation, and that perpetration could be reduced via focus on interpersonal skills, guided practice and (for gender-based violence) implementation of social structural components. Limitations:Despite an exhaustive search, trials may have been missed and risk of publication bias was high for several analyses. Conclusions:This is the most comprehensive systematic review of school-based interventions for dating and relationship violence and gender-based violence to date. It is clear that the prevention of dating and relationship violence and gender-based violence in schools will require longer-term investment to show benefit. Future work:Future research is needed to understand why intervention effectiveness appears stronger for dating and relationship violence than gender-based violence. Study registration:The study is registered as PROSPERO CRD42020190463. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR130144) and is published in full in Public Health Research; Vol. 12, No. 3. See the NIHR Funding and Awards website for further award information.

Adolescent interpersonal violence, particularly gender-based violence (GBV) and dating and relationship violence (DRV), are important public health issues frequently addressed through school-based interventions. This brief report systematically reviews the published evidence on mediational pathways for school-based interventions to effectively reduce GBV and DRV. As part of a larger systematic review funded by the National Institute for Health and Care Research, we identified six randomized trials in which mediation analyses of either DRV or GBV perpetration or victimization outcomes for four different interventions were conducted. We synthesize findings narratively by outcome, type of mediator, and follow-up period (short term or longitudinal). A total of eight mediators were analyzed across all studies. We found clear support for mediation through violence acceptance and delinquent behaviors; inconsistent support for mediation through knowledge, school belonging, belief in the need for help, and gender-inequitable beliefs; and no support for mediation through conflict management skills or bystander actions. These findings provide helpful suggestions on effective pathways for intervention efficacy. Overall, however, there is a need for mediation analyses to be conducted more often in GBV/DRV intervention evaluations. We discuss implications of these findings and suggest areas for future research on mediated pathways for GBV/DRV reduction.

School-based interventions for the prevention of dating and relationship violence (DRV) and gender-based violence (GBV) take advantage of universal opportunities for intervention. Information on differential effectiveness of interventions is important to assess if they ameliorate or worsen social gradients in specific outcomes. This is especially important in DRV and GBV prevention given the gendered context of these behaviours and their common aetiologies in patriarchal gender norms, and social acceptance in school contexts of sexual harassment, such as catcalling or unwanted groping. We undertook a systematic review of moderation analyses in randomised trials of school-based interventions for DRV and GBV prevention. We searched 21 databases and used supplementary search methods without regard to publication type, language or year of publication, and synthesised moderation tests relating to equity-relevant characteristics (principally sex and prior history of the outcome) for DRV and GBV perpetration and victimisation. Across 23 included outcome evaluations, programme effects on DRV victimisation were not moderated by gender or prior experience of DRV victimisation, but DRV perpetration outcomes were greater for boys, particularly for emotional and physical DRV perpetration. Findings for GBV outcomes were counterintuitive. Our findings suggest that practitioners should carefully monitor local intervention effectiveness and equity to ensure that interventions are working as intended. However, one of the most surprising findings from our analysis—with clear relevance for uncertainties in practice—was that differential impacts by sexuality or sexual minority status were not frequently evaluated.

Objective In 2021, centres across all seven NHS-England regions were selected to develop pilot clinics with the aim of treating children and young people (CYP) living with complications relating to excess weight (CEW). We led a process to develop core outcomes to enable the evaluation of these clinics. Methods A two-round Delphi process, virtual steering group meetings and two patient representation workshops were used to agree the most important outcomes for both clinicians/allied professionals and representative prospective service users. Results A total of 119 clinicians/allied professionals were invited to contribute to the Delphi process: 62 (52%) agreed and completed round 1 and 47 of these (76%) went on to complete round 2. Six young people (age range 13-17 years) and six parents were involved in two patient representation workshops and their experiences fed into virtual steering group meetings, via a representative. There were 44 outcomes assessed in round 1 and 21 outcomes assessed in round 2. There were 16 core outcomes selected: anthropometric, glucose tolerance/insulin resistance/type 2 diabetes, blood pressure, lipid profile, breathing problems, identification of aetiology, non-alcoholic fatty liver disease, idiopathic intracranial hypertension, anxiety, depression, self-esteem, quality of life, school attendance, dietary habits including disordered eating, exercise and activity habits. Conclusions Use of an online Delphi process, patient representation workshops and virtual steering group meetings has enabled the development of core outcomes for clinical obesity services with eight physical health, five mental health and three self-management outcomes. Further work is needed to develop outcome measures to complete a core outcome set. These will be used to guide the evaluation of novel regional clinics for the treatment of complications of excess weight.

Adolescents are at an increased risk for experiencing dating and relationship violence (DRV) and gender-based violence (GBV). School-based interventions remain an important and frequently used method for DRV/GBV prevention. A clear understanding and description of the different components of school-based interventions specific to DRV/GBV is needed to organize and advance the array of prevention efforts being utilized in school settings. We conducted an intervention component analysis to create a taxonomy for school-based interventions addressing DRV and GBV. We searched 21 databases in July 2020 and updated searches in June 2021, alongside extensive supplementary search methods. We included randomized controlled trials (RCTs) in adolescents of compulsory school-age that were implemented within the school setting which partially or wholly focused on DRV and GBV topics. Our analysis included 68 studies describing 76 different school-based interventions. Through an iterative coding process we identified 40 intervention components organized within 13 activity categories, including both student-directed components and non-student-directed components such as activities for school personnel and family members of students. We also identified components addressing higher levels of the social-ecological model including structural-social and structural-environmental aspects of DRV/GBV which prior reviews have not considered. This taxonomy of components and synthesis of intervention efficacy for DRV/GBV school-based interventions provides a framework for comparing past intervention evaluations and constructing new interventions to address these issues at multiple levels within a community.

Background. Schools are sites of dating and relationship violence (DRV) and of gender-based violence (GBV) victimization and perpetration. School-based interventions can reach a broad range of students, targeting both individual and group processes that may underpin DRV and GBV. Considering DRV and GBV jointly is important because of their shared etiologies. Comparing the effectiveness of interventions using network meta-analysis (NMA) can support decision-making on optimal resource use. Objectives. To evaluate the comparative effectiveness of school-based interventions for children aged 5 to 18 years on DRV and GBV victimization, perpetration, and related mediators. Search Methods. We searched 21 databases in July 2020 and June 2021, alongside extensive supplementary search methods, including gray literature searches, forward and backward citation chasing, and searches on first and last author names. Selection Criteria. We included randomized-controlled trials of interventions for children of compulsory school age implemented within the school setting, and either partially or wholly aimed at changing DRV or GBV outcomes. Data Collection and Analysis. Pairwise meta-analyses using random-effects robust variance estimation considered intervention effectiveness on DRV and GBV victimization and perpetration using odds ratios, and on mediators (e.g., knowledge and attitudes) using standardized mean differences. Effects were divided into short-term (< 12 months postbaseline) and long-term (≥ 12 months postbaseline). NMAs on victimization and perpetration outcomes compared interventions categorized by breadth of mechanism and complexity of delivery and implementation. Meta-regression tested sensitivity to percentage of girls in the trial sample and country context. Main Results. Our analysis included 68 trials. Evidence was stronger overall for effects on DRV than for GBV, with significant long-term impacts on DRV victimization (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.68, 0.99) and DRV perpetration (OR = 0.78; 95% CI = 0.64, 0.94). Knowledge and attitudinal effects were predominantly short-term (e.g., for DRV-related violence acceptance, d = 0.16; 95% CI = 0.08, 0.24). NMAs did not suggest the superiority of any intervention type; however, most analyses for GBV outcomes were inconsistent. A higher proportion of girls in the sample was associated with increased effectiveness on long-term victimization outcomes. Author's Conclusions. Evidence is stronger for DRV than for GBV, despite considerable heterogeneity. Certainty of findings was low or very low overall. Public Health Implications. Violence reductions may require more than 1 school year to become apparent. More extensive interventions may not be more effective. A possible reason for stronger effectiveness for DRV is that whereas GBV is ingrained in school cultures and practices, DRV is potentially more open to change via addressing individual knowledge and attitudes. (Am J Public Health. 2023;113(3):320-330. https://doi.org/10.2105/10.2105/AJPH.2022.307153).

Conventional systematic reviews offer few insights into for whom and how interventions work. ‘Realist reviews’ examine such questions via examining ‘context‐mechanism‐outcome configurations’ (CMOCs) but are insufficiently rigorous in how evidence is identified, assessed and synthesised. We developed ‘realist systematic reviews’, addressing similar questions to realist reviews but using rigorous methods. We applied this to synthesising evidence on school‐based prevention of dating and relationship violence (DRV) and gender‐based violence (GBV). This paper reflects on overall methods and findings, drawing on papers reporting each analysis. Drawing on intervention descriptions, theories of change and process evaluations, we developed initial CMOC hypotheses: interventions triggering ‘school‐transformation’ mechanisms (preventing violence by changing school environments) will achieve larger effects than those triggering ‘basic‐safety’ (stopping violence by emphasising its unacceptability) or ‘positive‐development’ (developing students' broader skills and relationships) mechanisms; however, school transformation would only work in schools with high organisational capacity. We used various innovative analyses, some of which aimed to test these hypotheses and some of which were inductive, drawing on available findings to augment and refine the CMOCs. Overall, interventions were effective in reducing long‐term DRV but not GBV or short‐term DRV. DRV prevention occurred most effectively via the ‘basic‐safety’ mechanism. ‘School‐transformation’ mechanisms were more effective in preventing GBV but only in high‐income countries. Impacts on long‐term DRV victimisation were greater when working with a critical mass of participating girls. Impacts on long‐term DRV perpetration were greater for boys. Interventions were more effective when focusing on skills, attitudes and relationships, or lacking parental involvement or victim stories. Our method provided novel insights and should be useful to policy‐makers seeking the best interventions for their contexts and the most information to inform implementation.

Dating and relationship violence (DRV) and gender-based violence (GBV) among children and young people incur a high cost to individuals and society. School-based interventions present an opportunity to prevent DRV and GBV early in individuals' lives. However, with school resources under pressure, policymakers require guidance on the economics of implementing interventions. As part of a large systematic review funded by the National Institute for Health and Care Research (NIHR), we searched for economic evaluations and costing studies of school-based interventions for DRV and GBV. No formal economic evaluations were identified. Seven studies reporting costs, cost savings, or resource use for eight interventions were identified. The largest costs of implementing interventions were related to staff training and salaries but savings could be made by implementing interventions on a large scale. The potential cost savings of avoided DRV and GBV far outweighed the costs of implementation.

Meaningful inclusion of young people’s perceptions and experiences of inequalities is argued to be critical in the development of pro-equity policies. Our study explored young people’s perceptions of what influences their opportunities to be healthy within their local area and their understandings of health inequalities. Three interlinked qualitative focus group discussions, each lasting 90 to 100 min, with the same six groups of young people (n = 42) aged 13–21, were conducted between February and June 2021. Participants were recruited from six youth groups in areas of high deprivation across three geographical locations in England (South Yorkshire, the North East and London). Our study demonstrates that young people understand that health inequalities are generated by social determinants of health, which in turn influence behaviours. They highlight a complex interweaving of pathways between social determinants and health outcomes. However, they do not tend to think in terms of the social determinants and their distribution as resulting from the power and influence of those who create and benefit from health and social inequalities. An informed understanding of the causes of health inequalities, influenced by their own unique generational experiences, is important to help young people contribute to the development of pro-equity policies of the future.

We present the Herschel Extragalactic Legacy Project (HELP). This project collates, curates, homogenizes, and creates derived data products for most of the premium multiwavelength extragalactic data sets. The sky boundaries for the first data release cover 1270 deg(2) defined by the Herschel SPIRE extragalactic survey fields; notably the Herschel Multi-tiered Extragalactic Survey (HerMES) and the Herschel Atlas survey (H-ATLAS). Here, we describe the motivation and principal elements in the design of the project. Guiding principles are transparent or 'open' methodologies with care for reproducibility and identification of provenance. A key element of the design focuses around the homogenization of calibration, meta data, and the provision of information required to define the selection of the data for statistical analysis. We apply probabilistic methods that extract information directly from the images at long wavelengths, exploiting the prior information available at shorter wavelengths and providing full posterior distributions rather than maximum-likelihood estimates and associated uncertainties as in traditional catalogues. With this project definition paper, we provide full access to the first data release of HELP; Data Release 1 (DR1), including a monolithic map of the largest SPIRE extragalactic field at 385 deg(2) and 18 million measurements of PACS and SPIRE fluxes. We also provide tools to access and analyse the full HELP data base. This new data set includes far-infrared photometry, photometric redshifts, and derived physical properties estimated from modelling the spectral energy distributions over the full HELP sky. All the software and data presented is publicly available.

The 2019 NHS England Long Term Plan set out the ambition to work across the 0–25 age range to support children and young people as they make the transition to early adulthood. Within this broad age bracket, how do we ensure we get health services right for 16–25 year-olds including the transfer to adult services? In this paper, we explore the evidence supporting youth-friendly and developmentally appropriate healthcare approaches and what these mean in practice for young people and healthcare professionals. Examples from primary and secondary care, as well as the perspectives of a young person, illustrate the challenges and solutions.

Autoantibodies against phospholipase A2 receptor 1 (PLA2R1) and thrombospondin type 1 domain-containing 7A (THSD7A) are emerging as biomarkers to classify membranous nephropathy (MN) and to predict outcome or response to treatment. Anti-THSD7A autoantibodies are detected by Western blot and indirect immunofluorescence test (IIFT). Here, we developed a sensitive enzyme-linked immunosorbent assay (ELISA) optimized for quantitative detection of anti-THSD7A autoantibodies. Among 1012 biopsy-proven MN patients from 6 cohorts, 28 THSD7A-positive patients were identified by ELISA, indicating a prevalence of 2.8%. By screening additional patients, mostly referred because of PLA2R1-unrelated MN, we identified 21 more cases, establishing a cohort of 49 THSD7A-positive patients. Twenty-eight patients (57%) were male, and male patients were older than female patients (67 versus 49 years). Eight patients had a history of malignancy, but only 3 were diagnosed with malignancy within 2 years of MN diagnosis. We compared the results of ELISA, IIFT, Western blot, and biopsy staining, and found a significant correlation between ELISA and IIFT titers. Anti-THSD7A autoantibodies were predominantly IgG4 in all patients. Eight patients were double positive for THSD7A and PLA2R1. Levels of anti-THSD7A autoantibodies correlated with disease activity and with response to treatment. Patients with high titer at baseline had poor clinical outcome. In a subgroup of patients with serial titers, persistently elevated anti-THSD7A autoantibodies were observed in patients who did not respond to treatment or did not achieve remission. We conclude that the novel anti-THSD7A ELISA can be used to identify patients with THSD7A-associated MN and to monitor autoantibody titers during treatment.