Introduction: Late-night alcohol trading hours are generally associated with increased alcohol-related harm. Since 2018, two Scottish cities have allowed extensions in late-night alcohol trading hours with the aim of revitalising the night-time economy. This is the first study to directly observe whether and how bars and nightclubs use these extensions, and collect rich qualitative data about venue environment and staff behaviour. Methods: Trained, paired fieldworkers, behaving as customers, completed semi-structured observation schedules on mobile devices during repeated visits to 15 purposively sampled venues in 2023-24 (5 venues in Glasgow and 10 in Aberdeen: total of 313 h of observation). In-depth qualitative fieldnotes were completed within 48 h of visits. Results: Half of the venues closed early on at least one fieldworker visit without using all of their later trading hours. Venues using their extended hours were observed to be at low occupancy on at least one visit. Fieldworkers observed bar staff serving alcohol to intoxicated customers in every venue. In half of the venues, 'shot girls' were observed persistently approaching customers, including those who appeared intoxicated. Conclusions: Extensions in late-night alcohol trading hours granted in two Scottish cities were not used consistently by venues due to lack of demand by customers. The late-night sale of alcohol to intoxicated customers was routine. Our findings challenge the assumption that later trading hours benefit the night-time economy and highlight the likelihood of associated alcohol-related harms.

IntroductionAlcohol contributes to at least 16% of ambulance call-outs in Scotland, placing a significant burden on emergency services. This study aimed to explore the circumstances behind these incidents from the perspective of practicing Scottish Ambulance Service (SAS) clinicians.MethodsWe conducted in-depth qualitative interviews (median duration: 81 minutes) with 31 SAS staff, purposively sampled for diversity in gender (10 women, 21 men), region, and length of service (1-50 years; median 10). Interviews were transcribed and thematically analyzed using both deductive and inductive approaches.ResultsAlcohol-related call-outs typically involved either chronic heavy drinking patterns mainly at home with co-existing mental, social, or emotional issues or acute intoxication in social settings. Clinicians reported a large volume of incidents and felt the public underestimated the proportion caused by chronic problems.ConclusionStrategies, policies, and interventions aiming to reduce pressure on emergency services must consider how to provide or improve accessible care for people with chronic alcohol problems, as well as how to reduce acute intoxication to help reduce the amount alcohol related calls SAS staff attend.

BACKGROUND AND AIMS:Many patients with cancer develop heart failure (HF), and many patients with HF develop cancer. Inter-relationships between their natural histories are rarely reported. METHODS:Health records were obtained for a Scottish region. People aged >50 years were classified by the presence or absence of HF, loop diuretics (a pharmacological marker of congestion), and cancer. Incident cancer, mortality, and cause of death were recorded. RESULTS:Of 317 178 people aged >50 years, 11 268 (3.6%) had HF of whom 6276 were prescribed loop diuretics; a further 19 044 (6.0%) received loop diuretics. Thus, 30 312 (9.6%) people met an expanded definition of heart failure (HFexp). Annual cancer incidence was slightly higher for those with HFexp (incidence rate ratio 1.10; P < .001), varying amongst cancer types. For people with neither cancer nor HFexp, mortality was <3% annually; most deaths were cardiovascular. For those with cancer but not HFexp, annual mortality was 6.3% for women and 9.0% for men; most died of cancer. For those with HFexp but not cancer, annual mortality ranged from 6.6% to 18.4% depending on sex and HFexp criteria applied; most deaths were cardiovascular. For those with both cancer and HFexp, annual mortality ranged from 14.5% to 28.4%; cardiovascular and cancer mortality rates were similar. Few patients died at home (∼20%). CONCLUSIONS:Patients with HFexp have a slightly higher risk of cancer overall, but this may vary according to cancer type. Patients with both cancer and HFexp have a poor prognosis with a similar proportion of deaths attributed to cancer and cardiovascular disease.

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) significantly impacts patients' quality of life and healthcare systems, especially among socio-economically deprived populations. Hospitalisations due to COPD exacerbations are critical events, often indicating declining health and higher mortality risk. This study examines the incidence and outcomes of COPD hospitalisations in National Health Service (NHS) Greater Glasgow and Clyde from 2015 to 2022, with a focus on socio-economic inequalities and the effects of the COVID-19 pandemic on hospitalisation trends. Methods We conducted a retrospective cohort study using routinely collected hospital episode data, linked to mortality records, for a population of 1.2 million. Incident COPD hospitalisations were identified via International Classification of Diseases version 10 (ICD-10) codes, with no prior hospital admission in the preceding three years. Recurrent hospitalisations were those occurring within 3 years of the discharge of an incident event. We employed negative binomial regression to analyse hospital admission rates and Cox regression for time to recurrent hospitalisation and mortality outcomes, adjusting for demographic and comorbidity factors and testing for interactions with socio-economic status. Before getting the study sample, data linkage was done by the oGRE analyst team. Results From 2015–2022, 8,852 incident COPD hospitalisations were recorded. The mean patient age was 70 years, and 61% were female. Incident hospitalisation rates declined by 13–48% from 2017 onwards. Mortality following incident hospital admission increased post-2020 (HR for 2022 vs. 2015 = 1.42, 95% CI 1.19–1.71). Recurrent hospitalisation rates declined significantly over the study period. Socio-economic inequalities were prominent, with the most deprived individuals experiencing higher hospitalisation and mortality rates. Conclusion Our study highlights a reduction in COPD hospitalisations and recurrent admissions in recent years, potentially due to enhanced disease management strategies and pandemic-related healthcare changes. However, increased mortality post-hospitalisation and persistent socio-economic inequalities underscore the need for targeted interventions. Addressing these inequities through innovative care models and community-based support remains crucial to improving outcomes for patients with COPD.

Introduction Alcohol-related harms are prevalent late at night, especially on weekends, when high levels of intoxication contribute to increased rates of injury and violence. Reducing or increasing alcohol trading hours late at night in bars and clubs is generally associated with reduced and increased harms, respectively. This study evaluates the impact of later alcohol trading hours in the Scottish cities of Aberdeen and Glasgow on alcohol-related ambulance call-outs and crimes. Under local policy changes, 38 bars in Aberdeen had trading hours extended between 1 and 3 h up to 3am, and 10 nightclubs in Glasgow had a 1-h extension to 4am.Methods Following a natural experiment evaluation framework, we used a controlled interrupted time series design to compare outcomes before and after policy changes, from May 2015 to March 2020. The primary outcome was a count of total weekend night-time alcohol-related ambulance call-outs. Secondary outcomes included weekend night-time crimes.Results In Aberdeen, the policy led to a significant relative increase of 11.4% (effect size=4.643; 95% CI 0.292 to 8.994; p=0.036) in alcohol-related ambulance call-outs, and 8.5% (effect size=3.442; 95% CI 0.239 to 6.645; p=0.035) in reported crimes, at weekend night-times compared with Edinburgh (control). Findings were not significant and robust across analyses for Glasgow.Conclusion Later alcohol trading hours had a significant negative impact on alcohol-related ambulance call-outs and reported crimes in Aberdeen (where more premises had longer extensions) but not in Glasgow, suggesting the number, capacity and type of premises moderated outcomes. This is important for the design of future national and local licensing policies and regulations.

Background While controlled interrupted time series (CITS) are commonly used to evaluate public health policies, how to incorporate control(s) into their statistical modelling has received limited attention. We aimed to compare the statistical performance of different model formulations for including control groups in various segmented regression model specifications (with a particular focus on CITS and Difference-in-Difference [DiD] designs) under conditions where their assumptions are met, as well as when they are violated.Methods Based on a real-world dataset, we simulated and compared the statistical performance of four model formulations grounded on segmented regressions for including control groups in a pre- and post-evaluation. The compared model formulations were: (1) CITS segmented regression, (2) DiD segmented regression, (3) single ITS of the difference between control and intervention series, and (4) incorporating the control as a covariate in a single ITS. Models were tested across scenarios challenging assumptions around the control group (e.g., non-parallel trends -challenging DiD assumptions-, or inconsistent trend difference over time between groups -challenging CITS assumption-) or regression errors (e.g., heteroscedasticity or autocorrelation). We also included models, including restricted cubic splines of time, which may mitigate distortions from assumption violations. Additionally, we tested for detecting non-parallel trends.Results Standard DiD, CITS, and the ITS of the difference between series yielded the lowest bias whenever their design assumptions were satisfied. Overall, including time splines as covariates into ITS of the difference between series achieved the lowest bias and highest coverage also when design assumptions were violated. This makes it a valuable tool for causal inference in settings with parallel, non-parallel or inconsistent trend patterns between groups. Since violations of the trends assumption are often undetectable, methods robust to such violations are extremely valuable.Conclusions Modelling CITS as an ITS of the difference between series is among the most robust methods to embed control series into model specifications. Incorporating time splines as model covariates within an ITS of the difference has the potential of reducing bias from assumption violations (including parallel trends) without negative impacts when assumptions hold.

Background:People leaving prison face significant barriers to reintegration, often resulting in homelessness, which exacerbates health issues and increases recidivism. Critical time interventions aim to support vulnerable individuals during significant life transitions by providing time-limited, emotional and practical support. While effective in other contexts, the impact of housing-led critical time interventions for people leaving prison in the United Kingdom remains unclear. The PHaCT study was a pilot randomised controlled trial of a housing-led critical time intervention for people leaving prison at risk of homelessness. This study aimed to determine whether a full-scale randomised controlled trial of the critical time intervention model in prison leavers at risk of homelessness was feasible. Methods:The pilot was a parallel two-arm, individual-level randomised controlled trial of a pre-existing critical time intervention intervention with an integrated process evaluation and embedded exploratory health economic evaluation. Recruitment occurred in fours male prisons across England and Wales with participants followed up in the communities. Prisons were randomised by site to either receive the critical time intervention or receive usual support, and participants were recruited within 12 weeks of their release. The locations were predetermined by where the intervention was already being delivered by the intervention provider (critical time intervention teams). Critical time intervention included pre-engagement, transition to community, try-out and transfer of care phases, each lasting 3 months. Data collection methods included baseline surveys, follow-up assessments at 3, 6 and 9 months, qualitative interviews, and session observations. Routine data linkage was explored separately to assess feasibility. Progression criteria included recruitment, retention, process evaluation and fidelity. Results:Thirty-four male participants (mean age 38 years) were recruited, with 19 assigned to the intervention and 15 to control. The study achieved a high recruitment rate of 92%, but retention was a significant challenge, with only 18% of participants retained at 9 months follow-up. The process evaluation found critical time intervention was acceptable to staff and participants, but ethical concerns around randomisation and informed consent were raised. Fidelity to the critical time intervention model was generally high, though contextual instability in housing and criminal justice systems posed challenges. Data collection methods for health economics and data linkage were feasible and acceptable. Limitations:The approval to access prisons was lengthy and support provided by Clinical Research Networks was delayed. Contextual instability within the housing and criminal justice systems, including a lack of social housing, high recall rates, the removal of the requirement to have a probation officer and the emergency early release of people in prison, further complicated the trial. Ethical concerns around randomisation and informed consent affected trial acceptability. Conclusions:The trial methodology faced significant challenges. Low retention rates, ethical concerns by intervention delivery staff around randomisation and contextual instability suggest that a full-scale randomised controlled trial is not feasible. Implications/future work:The findings highlight the need for systemic changes within the research support provided to prison-based studies, housing and criminal justice systems to support research in prisons and interventions for people leaving prison. Decision-makers should prioritise policies that increase the availability of affordable housing and provide post-release support. Future research should explore alternative study designs and more intensive recruitment and retention strategies. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR134281.

AIMS:To illustrate a T2DM policy model incorporating socio-economic status. MATERIALS AND METHODS:Using the Scottish Diabetes Research Network (SDRN) national diabetes cohort, we identified individuals newly diagnosed with T2DM between 1 January 2004 and 31 December 2020 and followed from diagnosis until death or end of follow-up. Covariates included sex, Scottish Index of Multiple Deprivation (SIMD) quintiles, ethnicity, HbA1c, systolic blood pressure (SBP), eGFR, total cholesterol, high-density lipoprotein, BMI, smoking status and cardiovascular disease history. Remaining life expectancy was modelled using Gompertz regression, stratified by sex and SIMD. Probabilities of complications were estimated using repeated measure logistic regression, and healthcare costs were modelled using repeated measure linear regression. A parameterised Kaplan-Meier sample-average estimator was used to obtain life expectancy, quality-adjusted life years (QALYs) and costs. RESULTS:We identified 269 759 people newly diagnosed with T2DM. The mean age at diagnosis was 63 years, 56% were male and 24% lived in the most deprived areas. Total follow-up was 2 090 108 patient-years (median 7 years per patient). Approximately one in four patients died during follow-up. The most common T2DM-related complications were coronary heart disease and heart failure. For a man diagnosed at age 50 in the most deprived quintile, with all other covariates at average values, the model predicted a remaining life expectancy of 26.7 years, 21.1 QALYs and healthcare costs of £273 k (undiscounted). For the same profile, the incremental cost-effectiveness ratio for a hypothetical intervention reducing HbA1c by 1% was £7832 per QALY. CONCLUSIONS:We developed a T2DM policy model incorporating socio-economic deprivation, providing estimates of life expectancy, QALYs and healthcare costs to inform health technology assessment.

Background We conducted a pilot randomised controlled trial (the PHaCT study), including a process evaluation to assess the acceptability of a housing-led Critical Time Intervention (CTI) for prison leavers and the use of a trial design. This paper presents the process evaluation findings.Objective To explore the acceptability of both the intervention and the trial design to participants and those delivering the intervention, and to assess whether the intervention was delivered with fidelity.Design A process evaluation following Medical Research Council guidelines. Data collection included semi-structured interviews with participants and CTI caseworkers and observations of intervention delivery. A thematic analysis of interviews and observations was conducted to understand the intervention’s implementation and contextual factors as well as the trial process acceptability.Setting Participants for the pilot trial were recruited from three prisons in England and Wales where the intervention was being delivered.Participants While 28 out of 34 trial participants consented to interviews, only one was completed. Seven caseworkers were interviewed.Intervention A housing-led CTI to support people leaving prison at risk of homelessness, involving phased, time-limited support from caseworkers, starting prerelease and continuing postrelease, to help secure stable housing and build independence, without directly providing housing.Results The intervention’s acceptability was primarily reflected through the positive feedback and success stories shared by CTI caseworkers, as well as observational data indicating high acceptance among service users. The trial design’s acceptability was challenged by concerns about randomisation and equipoise, with staff viewing randomisation as unethical due to limited support for vulnerable populations. The fidelity to the CTI intervention housing-led approach was adhered to as best as possible; stable housing was prioritised for service users before addressing other needs. Despite these efforts, both sites encountered significant challenges due to limited housing availability and complex systems for securing social housing, particularly for single men leaving prison.Conclusions This wider study faced significant challenges which impacted the process evaluation. Despite these issues, the evaluation provides important insights into the challenges of conducting trials on interventions for people leaving prison. The challenges experienced should inform future study designs with similar populations and in similar settings.Trial registration number ISRCTN46969988.

Abstract Background Identifying clusters of multiple long-term conditions (MLTCs), also known as multimorbidity, and their associated burden may facilitate the development of effective and cost-effective targeted healthcare strategies. This study aimed to identify clusters of MLTCs and their associations with long-term health-related quality of life (HRQoL) in two UK population-based cohorts. Methods Age-stratified clusters of MLTCs were identified at baseline in UK Biobank (n = 502,363, 54.6% female) and UKHLS (n = 49,186, 54.8% female) using latent class analysis (LCA). LCA was applied to people who self-reported ≥ 2 LTCs (from n = 43 LTCs [UK Biobank], n = 13 LTCs [UKHLS]) at baseline, across four age-strata: 18–36, 37–54, 55–73, and 74 + years. Associations between MLTC clusters and HRQoL were investigated using tobit regression and compared to associations between MLTC counts and HRQoL. For HRQoL, we extracted EQ-5D index data from UK Biobank. In UKHLS, SF-12 data were extracted and mapped to EQ-5D index scores using a standard preference-based algorithm. HRQoL data were collected at median 5 (UKHLS) and 10 (UK Biobank) years follow-up. Analyses were adjusted for available sociodemographic and lifestyle covariates. Results LCA identified 9 MLTC clusters in UK Biobank and 15 MLTC clusters in UKHLS. Clusters centred around pulmonary and cardiometabolic LTCs were common across all age groups. Hypertension was prominent across clusters in all ages, while depression featured in younger groups and painful conditions/arthritis were common in clusters from middle-age onwards. MLTC clusters showed different associations with HRQoL. In UK Biobank, clusters with high prevalence of painful conditions were consistently associated with the largest deficits in HRQoL. In UKHLS, clusters of cardiometabolic disease had the lowest HRQoL. Notably, negative associations between MLTC clusters containing painful conditions and HRQoL remained significant even after adjusting for number of LTCs. Conclusions While higher LTC counts remain important, we have shown that MLTC cluster types also have an impact on HRQoL. Health service delivery planning and future intervention design and risk assessment of people with MLTCs should consider both LTC counts and MLTC clusters to better meet the needs of specific populations.

BACKGROUND:NICE guidelines recommend GPs use the kidney failure risk equation (KFRE) to identify people with chronic kidney disease (CKD) at higher risk of kidney failure. Albuminuria results are required to calculate KFRE. AIM:Analyse the implementation of KFRE into clinical practice and investigate if albuminuria testing varied amongst patients with CKD, particularly for underserved groups. DESIGN AND SETTING:Retrospective cohort study of 23,063 adults in Glasgow from 2013 to 2022. METHOD:We evaluated albuminuria testing rates and the predictive performance of KFRE in estimating 5-year kidney failure risk amongst people with CKD. Logistic regression models quantified associations between demographic/clinical variables and albuminuria testing. Amongst people who developed kidney failure, we retrospectively assessed the impact of KFRE on the timing of meeting criteria for referral to renal services. RESULTS:Albuminuria testing was performed in 44.5% of 10,874 adults with CKD. Females (adjusted odds ratio (aOR) 0.86: 95% CI 0.79-0.93) and those with hypertension (aOR 0.69: 95% CI 0.63-0.77) were less likely to have albuminuria testing. Those aged 40-50 years (aOR 1.83: 95% CI 1.15-2.91), with diabetes (aOR 2.35: 95% CI 2.14-2.58) and living in the least socioeconomically deprived areas (aOR 1.11: 95% CI 1.00-1.23) were more likely to have albuminuria testing. Of 1,352 individuals with incident kidney failure, incorporating KFRE into referral guidelines helped identify high-risk patients early. CONCLUSION:KFRE could be calculated for less than half of people due to lack of albuminuria testing. Focus should be given to improving albuminuria testing and inequities identified to allow wider implementation of KFRE.

Background Inflammation contributes to development and progression of cardiovascular disease (CVD) and cancer. Whether the neutrophil-to-lymphocyte ratio (NLR), routinely available from blood counts, predicts prognosis in the general population is uncertain. Objectives The purpose of this study was to evaluate the association of NLR with mortality in people with and without CVD or cancer. Methods In this retrospective cohort study, we used National Health Service records from the Greater Glasgow & Clyde region for people aged >50 years in 2012. Participants were classified hierarchically into 5 exclusive groups: history of cancer, heart failure (HF, or dispensed loop diuretics), CVD, CV risk factors only, or none. Mortality was tracked until December 2019. Results We identified 223,388 people with NLR measured between 2014 and 2015: 106,973 (48%) with CV risk factors only, 14,490 (7%) with CVD, 23,009 (10%) with HF or dispensed loop diuretics, 8,677 (4%) with cancer, and 70,239 (31%) none of these features. Median NLR was lowest in the latter group (2.0 [1.5-2.7]) and highest in those with HF or dispensed loop diuretics (2.7 [1.9-3.9]) or cancer (2.7 [1.9-4.1]). Median follow-up was 5.0 years (IQR: 4.4-5.0). In models adjusted for age, sex, estimated glomerular filtration rate, and hemoglobin, the highest NLR quartile predicted higher mortality across all groups (HR [95% CI] 2.07 [1.98-2.17] for CV risk factors and 2.18 [2.02-2.36] for none; 1.87 [1.70-2.04] for CVD, 2.10 [1.98-2.24] for HF or loop diuretics, and 2.30 [2.10-2.52] for cancer). Conclusions Higher NLR is associated with greater mortality in adults with and without CVD, HF or cancer, suggesting it could enhance population risk scores.

Introduction The night-time economy comprises various sectors, including hospitality, transportation and entertainment, which generate substantial revenues and contribute to employment opportunities. Furthermore, the night-time economy provides spaces for leisure activities, cultural expression and social interaction. On-trade alcohol premises (places where consumers can buy and consume alcohol such as bars, pubs, clubs and restaurants) are a significant component of this night-time economy, functioning as focal points for socialising, entertainment and cultural events. However, when on-trade alcohol premises stay open later at night, this can be associated with negative public health impacts including increased alcohol consumption, intoxication, assaults, injuries and burden on public services including ambulance call outs, hospitalisations and increased impacts on criminal justice services. The evidence on the societal impact of policies to ‘later’ trading hours for bars and clubs in the night-time economy is limited. This protocol details the design of an economic evaluation of policy to later trading hours for bars and clubs in the night-time economy alongside the ELEPHANT study (National Institute for Health and Care Research (NIHR) Public Health Research, ref:129885).Methods and analysis The research design is an economic evaluation alongside a natural experiment within the ELEPHANT study carried out in Glasgow and Aberdeen. The economic evaluation has been designed to identify, measure and value prospective resource impacts and outcomes to assess the costs and consequences of local policy changes regarding late night trading hours for bars and clubs. A number of economic evaluation frameworks will be employed. A cost-effectiveness analysis (CEA) is appropriate for assessing the effectiveness of complex interventions when the impacts of policy are measured in natural units. Therefore, a CEA will be conducted for the primary consequence, alcohol-related ambulance call-outs, using a health service sector perspective. Since this outcome is essentially a cost, the CEA will also be reported as a cost-analysis. A cost-consequence analysis will also be performed for the primary and secondary consequences including all ambulance call-outs and reported crimes to evaluate the full economic impacts of later trading hours for bars and clubs in the night-time economy. The analysis will be conducted from a wider societal perspective, including health sector, criminal justice system, business and third sector perspectives and will be in line with the recent National Institute for Health and Care Excellence guidance and recommendations.Ethics and dissemination The economic evaluation of the ELEPHANT study will be conducted using secondary data. Thus, no ethical approval is required for this economic evaluation. However, ethical approval for the ELEPHANT study has been granted from the University of Stirling’s General Research Ethics Committee, and prior consent has also been obtained from the participants, if involved. The results of this study will be disseminated through peer-reviewed publications in journals and national and international conferences.

Objective To determine whether a full-scale randomised control trial (RCT) assessing the efficacy and cost-effectiveness of a housing led Critical Time Intervention (CTI) is feasible and acceptable.Design Pilot parallel two-arm individual level RCT, including process evaluation and embedded exploratory health economic evaluation.Setting Four prisons for men across England and Wales, UK.Participants Men leaving prison at risk of homelessness and intervention delivery staff.Intervention CTI has four components: (1) pre-engagement phase: assessing the needs of the client and implementing a plan pre-discharge; (2) transition to community: forming relationships and goal setting; (3) try out: encouraging problem-solving and managing practical issues and (4) transfer of care: developing long-term goals and transferring responsibilities to community providers.Outcome measures Progression criteria: recruitment, retention, acceptability of the processes (CTI and trial method) and fidelity of intervention delivery. We also assessed the completeness of primary, secondary and exploratory outcome measures and estimated intervention costs.Results The recruitment progression criterion was met, with 92% (34/37) of approached individuals consenting to participate (target: 50%). However, the overall recruitment target of 80 was not achieved, and retention was low, only 18% (6/34) provided follow-up data, well below the 60% threshold. Retention was hindered by systemic challenges, including changes to prison release policies and reduced probation support. While the CTI model was acceptable to staff and service users, the trial design, particularly randomisation, was not. Intervention fidelity met the progression criteria. Baseline data collection for health economics and resource use was feasible, and intervention costs were estimated.Conclusion This pilot trial identified significant challenges to conducting a full-scale RCT of CTI in this context, particularly around retention, trial acceptability and systemic instability. While CTI remains a promising model, a traditional RCT design may not be viable in this setting without substantial structural and ethical adaptations.Trial registration number ISRCTN46969988.

BACKGROUND:Cumulative deficit frailty indices from randomised controlled trials (RCT) are increasingly used to assess whether trial findings are applicable to people living with frailty. The aim of this paper was to examine the range and type of deficits included in these frailty indices and compare these to those from cohort studies. METHODS:We identified RCTs assessing treatment effect modification using the cumulative deficit frailty index, as well as cohort studies assessing mortality risk associated with frailty, from recent systematic reviews. We extracted the deficits included in the frailty index from each RCT and cohort study. We compared the number of deficits, data sources (e.g. medical history, physical measurements, questionnaires, etc.) and physiological domain (e.g. cardiometabolic, neuro-cognitive, physical function, etc.) of the deficits from each source. RESULTS:The number of deficits was similar between RCT frailty indices (median 41 deficits, interquartile range [IQR] 35-50) and cohort studies (median 35, IQR 31-45). Broadly similar data sources were used to identify deficits. However, in RCTs of cardiovascular conditions, cardiometabolic deficits made up a greater proportion of deficits (median 47% of included deficits, IQR 38%-51%, compared to 19%, 14%-24%, in cohort studies). Cardiovascular RCTs included fewer physical function measures (median 4% [3%-9%], compared to 16% in other RCTs of other conditions [13%-17%], 17% in cohort [13%-23%]). CONCLUSION:In many cardiovascular RCTs, frailty indices focus on cardiometabolic deficits rather than measures of function. These frailty indices need to be validated against outcomes important to people living with frailty before being used to inform treatment. Until then, we would emphasise caution.

Clinical guidelines recommend use of (1) antiplatelet, (2) lipid-lowering, and (3) beta blocker medication, and (4) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) for secondary prevention following myocardial infarction (MI). This study examines whether sociodemographic factors and comorbidity were associated with receipt of guideline-recommended medication, and whether receipt was associated with all-cause mortality. A cohort study was conducted on West of Scotland patients aged 53 years or above who were discharged from hospital alive after an incident MI between 2014 and 2022. Receipt of guideline-directed therapy was defined as relevant medications dispensed within 3 months of discharge. Age, sex, area-deprivation, care/nursing home residence, year of incident MI, and pre-existing conditions were included as predictors of non-receipt and covariates in the analysis of the association between non-receipt and death. Among 12,204 MI survivors, 7898 (64.72

Background: Late-night opening of alcohol venues is associated with increased intoxication, social disorder and burden on public services. From 2017, two Scottish cities—Aberdeen and Glasgow—extended venue trading hours, to 3am and 4am, respectively. This study aimed to explore (i) public perceptions of harms and benefits of later trading hours, and (ii) how related public health evidence is assessed and used by the public. Methods: Eight groups of residents and venue-goers (n = 42) participated in two deliberative focus groups over a two-week period. Evidence on the pros and cons of later hours was presented and discussed. Reflexive thematic analysis was used to analyze data. Results: Participants associated later hours with increased alcohol consumption and increased harms such as violence, antisocial behavior, crime and public disturbance. Harms were discussed more frequently than benefits. Venue-goers highlighted cultural and social benefits and suggested staggered closing times might reduce harms. Following consideration of public health evidence, participants’ focus shifted from individual to societal impacts, such as increased burden on police, ambulance, and hospital services. Conclusion: Exposing lay participants to public health evidence fostered more reflection on societal impacts of later trading hours, potentially providing policy-makers with strategies to increase public support for alcohol policies.

There has been a substantial increase in the conduct of natural experimental evaluations in the last 10 years. This has been driven by advances in methodology, greater availability of large routinely collected datasets, and a rise in demand for evidence about the impacts of upstream population health interventions. It is important that researchers, practitioners, commissioners, and users of intervention research are aware of the recent developments. This new framework updates and extends existing Medical Research Council guidance for using natural experiments to evaluate population health interventions. The framework was developed with input from three international workshops and an online consultation with researchers, journal editors, funding representatives, and individuals with experience of using and commissioning natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project had a funder-assigned oversight group and an advisory group of independent experts. The framework defines key concepts and provides an overview of recent advances in designing and planning evaluations of natural experiments, including the relevance of a systems perspective, mixed methods and stakeholder involvement throughout the process. It provides an overview of the strengths, weaknesses, applicability and limitations of the range of methods now available, identifies issues of infrastructure and data governance, and provides good practice considerations. The framework does not provide detailed information for the substantial volume of themes and material covered, rather an overview of key issues to help the conduct and use of natural experimental evaluations. This updated and extended framework provides an integrated guide to the use of natural experimental methods to evaluate population health interventions. The framework provides a range of tools to support its use and detailed, evidence-informed recommendations for researchers, funders, publishers, and users of evidence. This methodological project was not registered. This project was jointly funded by the Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR), with project reference MC_PC_21009. The work is published in full in Public Health Research; Vol. 13, No. 3.