BACKGROUND:After acute ischemic stroke, it is uncertain whether the time of atrial fibrillation (AF) diagnosis (before or after stroke) or AF subtype (paroxysmal or permanent) modifies the treatment effect of early versus delayed direct oral anticoagulant (DOAC) initiation. METHODS:OPTIMAS (Optimal Timing of Anticoagulation After Acute Ischemic Stroke) was a randomized, parallel-group, open-label trial with blinded outcome assessment. Participants with acute ischemic stroke and AF were randomized 1:1 to early (within 4 days) or delayed (day 7-14) DOAC initiation. The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, and systemic arterial embolism. In this trial subgroup analysis, the prespecified subgroup of interest was time of AF diagnosis, classified as before or after the qualifying stroke. We also investigated AF subtype classified as persistent or paroxysmal. We fitted mixed effects logistic regression models with interaction terms between each subgroup and treatment allocation. We also investigated associations between AF time of diagnosis or subtype and outcomes using multivariable logistic regression. RESULTS:We included 3619 participants (mean age 78.0±9.9 years; 45.3% women). For AF diagnosed before stroke, 37 of 918 (4.0%) participants allocated to early DOAC had a primary outcome event versus 32 of 920 (3.5%) allocated to delayed DOAC, odds ratio, 1.17 (95% CI, 0.72-1.89), while for AF diagnosed after stroke the respective primary outcome rates were 22 of 895 (2.5%) and 27 of 886 (3.0%; odds ratio, 0.79 [95% CI, 0.45-1.40], Pinteraction=0.312). AF subtype did not modify the treatment effect, with odds ratios (95% CIs) for early versus late DOAC for persistent and paroxysmal AF of 1.06 (0.71-1.58) and 0.66 (0.25-1.72), respectively, Pinteraction=0.377. AF time of diagnosis was not associated with outcome events. Compared with paroxysmal AF, persistent AF was independently associated with an increased risk of the primary outcome (adjusted odds ratio, 2.10 [95% CI, 1.19-3.68]). CONCLUSIONS:We found no evidence that AF time of diagnosis or subtype modify the effects of early DOAC treatment. Persistent AF was independently associated with approximately double the risk of the primary outcome compared with paroxysmal AF. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03759938.

Many socially consequential beliefs, notably political and religious ideologies, consist not of single propositions in isolation from others but as systems of many propositions. Philip Converse, one of the most influential political scientists of the twentieth century, proposed that such systems can be understood as networks of propositions and predicted that they would be highly intercorrelated in those with strong ideological commitments but less so in people who are less ideological. We used recent advances in network psychometrics to test this account in relation to the political beliefs of a representative sample of 2,058 UK adults, who rated themselves on the left-right dimension and then reported their attitudes toward 18 policy issues. We divided participants into equally-sized groups of left-wing, centrist and right-wing participants and found that, as Converse had predicted, the networks of those at either end of the left-right continuum were similar in structure, being significantly more interconnected than the networks of those who identified themselves as centrists, even though the actual beliefs were (for the most part) polar opposites. This finding, which was robust to sensitivity checks, aligns with previous research which has shown that people at the political extremes, compared to those in the centre, are more certain about their beliefs and less likely to change them over time. In each ideological group we also identified the same three communities of beliefs which mapped onto classic accounts of authoritarian attitudes, altruism and cooperativeness, and personal liberty. Attitudes towards gay rights had the highest predictability index in all three networks and was the most central node in the right and centre networks, suggesting that these attitudes play a largely unrecognised but important role in ideological positioning. Our analytical approach has implications for not only political beliefs but all organized belief systems.

Interstitial Lung Disease in childhood (chILD) is rare, and little research has been conducted into the experience of fatigue. Fatigue is a complex phenomenon that can be difficult to quantify due to the various physiological and psychological factors involved. However, fatigue can significantly impact a range of quality-of-life areas for those with a respiratory condition. Our aim is to understand if there are any clinical or research needs relating to fatigue for young people with chILD. This qualitative, non-clinical study explores the lived experience of fatigue in young people with chILD. Fifteen participants comprising child-parent dyads (n = 2), young adults (n = 4) and parents (n = 9) were recruited from chILD patient organisations and online communities. We focused on the experience of fatigue in terms of how it is communicated, the symptoms, and their impact. We explored whether any factors led to the young person being motivated to push beyond fatigue. Data was analysed by constructivist grounded theory. There were three main themes of interest: (i) the experience of fatigue that includes reporting abnormal weakness and behavioural affect; (ii) the consequences of fatigue, such as its impact on education, society, and quality-of-life; (iii) motivational strategies and supportive measures that help young people manage their fatigue. Fatigue is a complex, multi-dimensional phenomenon for those living with chILD. For future work, we recommend incorporating the discussion of fatigue into clinic settings to assess any quality-of-life burden factors alongside living with chILD.

Despite patient and public involvement (PPI) in paediatric rare disease research being a challenge, PPI is strongly advocated for clinical research. PPI provides the opportunity for young people to support research for the future of their healthcare and improve their own understanding of their health condition, thus improving health outcomes. The aim of this child-parent dyad survey was to investigate the understanding and preferences of clinical research in 26 young people affected with childhood Interstitial Lung Disease (chILD) (age 6 to 17) and their parents. The survey results captured young people’s understanding of informed consent/assent and confirmed young people and their parents are the main decision-makers in their undertaking research. For clinical research acceptability, parents were more open for their child to participate in clinical research than young people. Parents expressed less preference for their child to participate in research that involved untested medicines and surgery, whereas young people expressed less preference to undertake research that involved untested medicines, surgery, and venepuncture. These novel findings indicate that the survey designed for this study effectively captured young people’s opinions in an online non-clinical setting and found a potential disconnect between the young person’s needs and opinions and parents’ preferences of clinical research. The development of chILD research education and a young person forum is recommended to build and foster clinician/researcher relationships. Ultimately, this will allow for building stronger PPI links and improved chILD clinical research.

Following the 2016 EU Referendum on Britain’s membership of the European Union, many people described themselves as ‘Leavers’ or ‘Remainers’. Here, we examine the emotional responses associated with Brexit identities using survey data collected from two nationally representative samples of the British public in 2019 (N = 638) and 2021 (N = 2,058). Confirmatory factor analysis indicated that many in both samples had coherent Leave or Remain identities. Remain and, to a lesser extent, Leave identities (regardless of how people actually voted in the referendum) predicted distress about Brexit-related events and clinical symptoms of depression and anxiety at both time points. Structural equation models suggested that the effect of identities on symptoms was largely mediated by distress about Brexit-related events. We demonstrate a lasting impact of Brexit on the mental health of UK citizens and that the formation of novel political identities has been more important in this process than voting behaviour.

Background The optimal timing of anticoagulation for patients with acute ischaemic stoke with atrial fibrillation is uncertain. We investigated the efficacy and safety of early compared with delayed initiation of direct oral anticoagulants (DOACs) in patients with acute ischaemic stroke associated with atrial fibrillation. Methods We performed a multicentre, open-label, blinded-endpoint, parallel-group, phase 4, randomised controlled trial at 100 UK hospitals. Adults with atrial fibrillation and a clinical diagnosis of acute ischaemic stroke and whose physician was uncertain of the optimal timing for DOAC initiation were eligible for inclusion in the study. We randomly assigned participants (1:1) to early (ie, <= 4 days from stroke symptom onset) or delayed (ie, 7-14 days) anticoagulation initiation with any DOAC, using an independent online randomisation service with random permuted blocks and varying block length, stratified by stroke severity at randomisation. Participants and treating clinicians were not masked to treatment assignment, but all outcomes were adjudicated by a masked independent external adjudication committee using all available clinical records, brain imaging reports, and source images. The primary outcome was a composite of recurrent ischaemic stroke, symptomatic intracranial haemorrhage, unclassifiable stroke, or systemic embolism incidence at 90 days in a modified intention-to-treat population. We used a gatekeeper approach by sequentially testing for a non-inferiority margin of 2 percentage points, followed by testing for superiority. OPTIMAS is registered with ISRCTN (ISRCTN17896007) and ClinicalTrials.gov (NCT03759938), and the trial is ongoing. Findings Between July 5, 2019, and Jan 31, 2024, 3648 patients were randomly assigned to early or delayed DOAC initiation. 27 participants did not fulfil the eligibility criteria or withdrew consent to include their data, leaving 3621 patients (1814 in the early group and 1807 in the delayed group; 1981 men and 1640 women) in the modified intention-to-treat analysis. The primary outcome occurred in 59 (33%) of 1814 participants in the early DOAC initiation group compared with 59 (33%) of 1807 participants in the delayed DOAC initiation group (adjusted risk difference [RD] 0000, 95% CI -0011 to 0012). The upper limit of the 95% CI for the adjusted RD was less than the non-inferiority margin of 2 percentage points (p non-inferiority =00003). Superiority was not identified (p superiority = 0 96 ). Symptomatic intracranial haemorrhage occurred in 11 (06%) participants allocated to the early DOAC initiation group compared with 12 (07%) participants allocated to the delayed DOAC initiation group (adjusted RD 0001, -0004 to 0006; p=078). Interpretation Early DOAC initiation within 4 days after ischaemic stroke associated with atrial fibrillation was non- inferior to delayed initiation for the composite outcome of ischaemic stroke, intracranial haemorrhage, unclassifiable stroke, or systemic embolism at 90 days. Our findings do not support the current common and guideline-supported practice of delaying DOAC initiation after ischaemic stroke with atrial fibrillation.

Inter- and intragenerational relationships are known to be important in maintaining the wellbeing of older people. A key aspect of these relationships is the exchange of both emotional and instrumental social support. However, relatively little is known about how this exchange of support changes in the context of widespread disruption. The COVID-19 pandemic provides an opportunity to examine how older people's family relationships are impacted by such social change. The present qualitative study explores how older people in the United Kingdom experienced changes in inter- and intragenerational support during the COVID-19 pandemic. Participants (N = 33) were recruited through a large-scale nationally representative survey ( https://www.sheffield.ac.uk/psychology-consortium-covid19 ). We asked how life had been pre-pandemic, how they experienced the first national lockdown and what the future might hold in store. The data were analysed using constructivist grounded theory. This paper focuses on the importance of family relationships and how they changed as a consequence of the pandemic. We found that the family support system had been interrupted, that there were changes in the methods of support and that feelings of belonging were challenged. We argue that families were brought into disequilibrium through changes in the exchange of inter- and intragenerational support. The important role of grandchildren for older adults was striking and challenged by the pandemic. The significance of social connectedness and support within the family had not changed during the pandemic, but it could no longer be lived in the same way. The desire to be close to family members and to support them conflicted with the risk of pandemic infection. Our study found support for the COVID-19 Social Connectivity Paradox: the need for social connectedness whilst maintaining social distance. This challenged family equilibrium, wellbeing and quality of life in older people.

The global health emergency of COVID-19 in early 2020 placed much of the population under quarantine. Interstitial Lung Disease in childhood (chILD) was recommended to be a pediatric clinically extremely vulnerable (CEV) group in April 2020 for shielding due to the unknown health consequences of COVID-19 in children with chronic respiratory conditions. This qualitative longitudinal research study explores how chILD parents in the UK experienced COVID-19 lockdown from over two interview time points. Participants (n = 8) were recruited from chILD patient organizations and online communities. Interview one focused on the period between January 2020 to July 2020, gaining personal insight into respondent's experience of lockdowns, which included questions on support systems and media coverage of COVID-19. The second interview enquired how respondents managed further UK lockdowns between September 2020 and May 2021. The main themes were uncertainty and adaptation. Respondents described how they navigated the UK lockdowns and undertook various risk management strategies for pandemic isolation. Once these were established, routine and positive family bonding was reported, along with a reluctant acceptance of the COVID-19 virus and continued shielding. As new COVID-19 information emerged, risk management strategies changed or remained for some respondents, bringing a feeling of living with COVID-19 as a "new normal". (Understanding the unique insights people with rare diseases such as chILD face during a global pandemic adds to policy and healthcare literature. Recommendations include further study of caregiver traits and resilience, essential facets of positive pandemic adaptation.

Literature showed that the link between right-wing attitudes and ethnocentric attitudes gets stronger under existential threats, but the role exerted by an impersonal threat – as COVID-19 – on right-wing attitudes is still unclear. This study aimed to highlight the role of anxiety exerted by the impersonal COVID-19 threat on the relationship between right-wing attitudes and ethnocentric attitudes, as nationalism and anti-immigrants’ sentiments. As part of an international project to evaluate the impact of COVID-19, this study administered an online survey to a representative sample (n 1038). The anxiety generated by an impersonal threat as COVID-19 – thus not exerted by any outgroup – can moderate the relationship among personal Right-Wing Authoritarianism, social dominance orientation, and ethnocentric attitudes. This is the first study demonstrating that existential threat is effective also when exerted by an impersonal agent (as COVID-19) rather than by an outgroup. Second, these findings disclose useful implications for preventive psychological interventions and for social policy makers.

AbstractThere has been concern about adolescent mental health during the pandemic. The current study examined adolescent mental health during the initial phase of the COVID-19 pandemic in the UK. Using indicator of psychological distress, wellbeing and resilience, latent profile analysis was used to identify homogeneous mental health groups among young people aged 13–24 (N = 1971). Multinomial logistic regression was then used to examine which sociodemographic and psychosocial variables predicted latent class membership. Four classes were found. The largest class (Class 1, 37.2%) was characterised by moderate symptomology and moderate wellbeing. Class 2 (34.2%) was characterised by low symptomology and high wellbeing, while Class 3 (25.4%) was characterised by moderate symptomology and high wellbeing. Finally, Class 4 was the smallest (3.2%) and was characterised by high symptomology and low wellbeing. Compared to the low symptomology, high wellbeing class, all other classes were associated with less social engagement with friends, poorer family functioning, greater somatic symptoms, and a less positive model of self. A number of unique associations between the classes and predictor variables were identified. Although around two-thirds of adolescents reported moderate-to-high symptomology, most of these individuals also reported concurrent moderate-to-high levels of wellbeing, reflecting resilience. Furthermore, these findings demonstrate how a more comprehensive picture of mental health can be gained through adopting a dual-continua conceptualisation of mental health that incorporates both pathology and well-being. In this way, at-risk youth can be identified and interventions and resources targeted appropriately.

Objectives Relatively little is known about the lived experiences of older adults during the COVID-19 pandemic. We systematically review the international literature to understand the lived experiences of older adult’s experiences during the pandemic. Design and methodology This study uses a meta-ethnographical approach to investigate the included studies. The analyses were undertaken with constructivist grounded theory. Results Thirty-two studies met the inclusion criteria and only five papers were of low quality. Most, but not all studies, were from the global north. We identified three themes: desired and challenged wellbeing; coping and adaptation; and discrimination and intersectionality. Overall, the studies’ findings were varied and reflected different times during the pandemic. Studies reported the impact of mass media messaging and its mostly negative impact on older adults. Many studies highlighted the impact of the COVID-19 pandemic on participants' social connectivity and well-being including missing the proximity of loved ones and in consequence experienced an increase in anxiety, feeling of depression, or loneliness. However, many studies reported how participants adapted to the change of lifestyle including new ways of communication, and social distancing. Some studies focused on discrimination and the experiences of sexual and gender minority and ethnic minority participants. Studies found that the pandemic impacted the participants’ well-being including suicidal risk behaviour, friendship loss, and increased mental health issues. Conclusion The COVID-19 pandemic disrupted and impacted older adults’ well-being worldwide. Despite the cultural and socio-economic differences many commonalities were found. Studies described the impact of mass media reporting, social connectivity, impact of confinement on well-being, coping, and on discrimination. The authors suggest that these findings need to be acknowledged for future pandemic strategies. Additionally, policy-making processes need to include older adults to address their needs. PROSPERO record [CRD42022331714], (Derrer-Merk et al., Older adults’ lived experiences during the COVID-19 pandemic: a systematic review, 2022).

Although the COVID-19 pandemic has impacted the psychological wellbeing of some people, there is evidence that many have been much less affected. The Ecological Model of Resilience (EMR) may explain why some individuals are not resilient whilst others are. In this study we test the EMR in a comparison of UK survey data collected from the COVID-19 Psychological Research Consortium (C19PRC) longitudinal study of a representative sample of the United Kingdom (UK) adult population and data from an Italian arm of the study. We first compare data from the third wave of the UK arm of the study, collected in July/August 2020, with data from an equivalent sample and stage of the pandemic in Italy in July 2020. Next, using UK longitudinal data collected from C19PRC Waves 1, 3 and 5, collected between March 2020 and April 2021 we identify the proportion of people who were resilient. Finally, we examine which factors, drawn from the EMR, predict resilient and non-resilient outcomes. We find that the 72% of the UK sample was resilient, in line with the Italian study. In the cross-sectional logistic regression model, age and self-esteem were significantly associated with resilience whilst death anxiety thoughts, neuroticism, loneliness, and Post Traumatic Stress Disorder (PTSD) symptoms related to COVID-19 were significantly associated with Non-Resilient outcomes. In the longitudinal UK analysis, at Wave 5, 80% of the sample was Resilient. Service use, belonging to wider neighbourhood, self-rated health, self-esteem, openness, and externally generated death anxiety were associated with Resilient outcomes. In contrast, PTSD symptoms and loneliness were associated with Non-Resilient outcomes. The EMR effectively explained the results. There were some variables which are amenable to intervention which could increase resilience in the face of similar future challenges.

Background and objectives: Trans people around the world represent one of the most marginalized and stigmatized groups in society and who are at high risk of discrimination, violence, and abuse. In Colombia, older adults face a persistent situation of vulnerability and poverty. This situation is even more marked for older people with diverse gender identities. This study aims to understand the challenges that a group of Colombian trans women experienced in the process of aging. Methods: An exploratory qualitative research project was carried out using constructivist grounded theory. Twenty five trans-women aged 50-67 years old living in Bogotá, Colombia participated. The data were collected using semi-structured interview. Results and discussion: The findings show that older trans women faced a variety of barriers such as stigmatization, violence, and political erasure. In addition, this study identified the resources of trans women in overcoming their many challenges. These included personal strengths, activism, and mobilization.

Interstitial Lung Disease in childhood (chILD) is rare and no longer solely a childhood issue. Many are surviving into adult life. Therefore, many affected with chILD need to transition from paediatric to adult healthcare services. Transition is a significant life event that has the potential to impact on physical and mental health outcomes and across Europe this is a haphazard process for chILD. This qualitative study explores how young people and parents in the United Kingdom experienced transition from paediatric to adult healthcare services for chILD. Participants (n = 7) were recruited from chILD patient organisations and online communities. We focused on the experience of transition and whether there were any information packs or support provided for the transition. The data was analysed by constructivist grounded theory. The study presents a lived experience of transition with themes of lack of transition preparation and planning, challenges of learning how to adapt to adult services and a changing healthcare scene. Due to the complexity of ChILD, parents discussed their need to remain, in part, as an advocate for the young person. Respondents provided recommendations for how transition could be improved along with tips for young people who are new to the transition process, which include educating oneself about the condition and learning medical terminology, being open if there are issues and reaching out for support.

Background: The current study argues that population prevalence estimates for mental health disorders, or changes in mean scores over time, may not adequately reflect the heterogeneity in mental health response to the COVID-19 pandemic within the population.Methods: The COVID-19 Psychological Research Consortium (C19PRC) Study is a longitudinal, nationally representative, online survey of UK adults. The current study analysed data from its first three waves of data collection: Wave 1 (March 2020, N=2025), Wave 2 (April 2020, N=1406) and Wave 3 (July 2020, N=1166). Anxiety-depression was measured using the Patient Health Questionnaire Anxiety and Depression Scale (a composite measure of the PHQ-9 and GAD-7) and COVID-19 related PTSD with the International Trauma Questionnaire. Changes in mental health outcomes were modelled across the three waves. Latent class growth analysis was used to identify subgroups of individuals with different trajectories of change in anxiety-depression and COVID-19 PTSD. Latent class membership was regressed on baseline characteristics.Results: Overall prevalence of anxiety-depression remained stable, while COVID-19 PTSD reduced between Waves 2 and 3. Heterogeneity in mental health response was found, and hypothesised classes reflecting (i) stability, (ii) improvement, and (iii) deterioration in mental health were identified. Psychological factors were most likely to differentiate the improving, deteriorating and high-stable classes from the low-stable mental health trajectories. Conclusions: A low-stable profile characterised by little-to-no psychological distress (‘resilient’ class) was the most common trajectory for both anxiety-depression and COVID-19 PTSD. Monitoring these trajectories is necessary moving forward, in particular for the ~30% of individuals with increasing anxiety-depression levels.

Age influences the experience of widowhood and the likelihood of adverse outcomes. This review synthesizes 13 qualitative studies that explored adjustment following the death of a partner at a younger age, within a Western-cultural context. Thematic synthesis identified six analytical themes: unique challenges; identity changes; levels of distress; coping; support; and adapting following the loss. Bereavement challenges younger widow(er)'s life expectations, identity, and friendships. Social support, faith, and access to age-specific support may facilitate positive adjustment. The findings inform the development of effective interventions to support positive adjustment in younger widowhood.

AbstractObjectives: The experienced benefit of the COVID-19 pandemic by adults has not attracted many research studies and lacks longitudinal studies. The purpose of this study is to improve understanding of the lived experiences of adults during the COVID-19 pandemic over time in the UK, with a national representative sample.Design: Using a longitudinal approach, this study examined people's lived experiences twice over one year of the pandemic (Wave 1 n=26, Wave 2 n=17). We analysed the data with a constructivist grounded theory from Wave 1 and Wave 2.Findings: This study found three themes: intrapersonal growth, interpersonal relationship, and social cohesion. The benefit of the sudden lifestyle change was evident for many. Many people enjoyed having more time for self-care and family, and experienced a sense of solidarity within the community. As the time went on many participants mentioned they experienced groundhog days and that they felt boredom. Despite many participants enjoying the closeness to family members, others talked about tensions. Concerns were raised about future relationships with friends due to the lack of face to face meetings. The feeling of social cohesion and solidarity waned with the progress of the pandemic when people adhered less to the safety rules. The experience of COVID-19 pandemic impacted people’s intrapersonal growth, interpersonal relationships and the sense of cohesion over time. This evidence can inform future pandemic planning.

BackgroundProlonged Grief Disorder (PGD) is a new disorder included in ICD-11 (WHO, 2018). There is a growing body of literature surrounding the prevalence and correlates of ICD-11 PGD symptoms as assessed using various measures. This study was the first to assess levels of ICD-11 PGD symptoms as measured by the International Prolonged Grief Disorder Scale (IPGDS), a self-report scale directly aligned with the ICD-11 definition of PGD, among the United Kingdom adult general population, and identify correlates.MethodParticipants included 2025 adults who participated in Wave 5 of the COVID-19 Psychological Research Consortium Study (C19PRC-UK). Prevalence rates of PGD were estimated based on two commonly used algorithms defined as 'strict' and 'moderate'. Sociodemographic, loss-related, and mental health correlates (i.e., anxiety, depression, mental health treatment seeking, loneliness) of strict and moderate PGD were then examined using multinomial logistic regressions.ResultsIt was found that 2.4% (n = 43) of participants met probable caseness for PGD using the strict criteria while 7.9% (n = 140) met probable caseness for PGD using the moderate criteria. Multinomial logistic regression analysis results showed, as predicted, that income, time since bereavement, death of a child, religiosity, and depression were associated with both moderate and strict PGD. Correlates of moderate PGD included country of residence, urbanicity, younger age of bereaved, and loneliness.ConclusionsThis study highlights that some symptoms of PGD are commonly reported in the general population, although relatively few meet the criteria for clinical significance. The routine assessment for PGD following a bereavement is discussed and the development of appropriate interventions are recommended.