New horizons in hearing conditions.

Hearing conditions such as hearing loss, tinnitus and hyperacusis are highly prevalent in the population and can severely impact communication and quality of life. Hearing is affected by multiple factors, including heredity, noise exposure, age, sex, ear disorders and lifestyle factors. Globally, hearing loss affects over 80% of adults aged 80 years and older, is often experienced in combination with other long-term health conditions and is a mid-life risk factor for dementia. To form a themed collection, we searched Age and Ageing for articles on hearing conditions published from 2000 onwards. This resulted in 22 articles included within the collection. They examined a range of important topics related to hearing healthcare and research, including noise-induced hearing loss, health service quality and safety, psychological and psychosocial consequences of hearing loss and co-morbidities of hearing loss. All articles reported on hearing loss; there were no published articles with a primary focus on other hearing conditions such as tinnitus or hyperacusis, on the health of older people from the Deaf community or on users of Cochlear implants, suggesting key gaps in knowledge and targets for future research. This New Horizons article highlights novel directions in research and practice and takes a forward look at how research into hearing conditions may develop in years to come. It highlights opportunities for the growth of patient-centred research and hearing healthcare supported by the better integration of health and care services as well as cross-speciality working to include common co-morbid health conditions.

The emergence of telehealth in orthotic services across the United Kingdom.

COVID-19 has impacted the National Health Service provision, creating urgency for departments to adapt and adopt new ways of delivering healthcare. The purpose of this service evaluation was to determine the emergence of telehealth in orthotic services across the UK in response to COVID-19. A survey exploring telehealth use was distributed online to orthotists approximately 6 months after the first peak of COVID-19 in the UK. It gathered information on telehealth prevalence, allocated appointment length and waiting times, clinician access to technology and clinicians' opinions on the efficacy of telehealth. The survey received 77 responses with over 90% of respondents reporting using telehealth. Most reported that they expected telehealth to remain part of the service, post COVID-19. Thematic analysis produced two main themes: the impact of COVID-19 and challenges still to overcome. Findings suggest that the pandemic has resulted in a backlog of patients waiting for an orthotic appointment, with services currently understaffed and lacking resources. For telehealth to be effective orthotists must have access to appropriate technology and training on how to use telehealth platforms, be provided with appropriate guidance on which patients are appropriate for telehealth consultations and given appropriate appointment times to enable safe and effective care.

An in-school social norms approach intervention for reducing unhealthy snacking behaviours amongst 11-12-year-olds.

OBJECTIVES: Adolescents tend to overestimate the extent of peers' unhealthy snacking consumption and such misperceptions have been associated with increased personal unhealthy snacking. This study aims to test whether a Social Norms Approach (SNA) intervention which challenges these misperceptions of peers' unhealthy snacking will have a positive effect on students' personal unhealthy snacking behaviours, related attitudes, and behavioural intentions. DESIGN: A quasi-experimental study tested the effectiveness of an in-school SNA intervention (n = 163) compared to a control condition (n = 95) among 11-12-year-old students. METHOD: Both conditions received healthy eating information, while students in the SNA intervention received additional normative feedback (outlining the discrepancies between perceived and actual unhealthy snacking of the majority based on baseline data) delivered through an interactive poster-making session. Students completed self-reported measures of personal unhealthy snacking, related-attitudes, behavioural intentions, and normative perceptions (descriptive and injunctive) at baseline, post-intervention, and at a 3-month follow-up. RESULTS: Students who received SNA feedback were significantly less likely to overestimate peers' unhealthy snacking attitudes post-intervention (F(1,232) = 16.405, p < .001), and at 3-month follow-up consumed fewer unhealthy snacks (F(1,232) = 6.133, p = .014) and had less positive attitudes towards unhealthy snacking (F(1,198) = 8.779, p = .003). The changes in personal snacking attitudes at 3-month follow-up were mediated by changes in normative misperceptions about peers' unhealthy snacking attitudes post-intervention, which indicated that the reductions in normative misperceptions following SNA messages mediated the effect of the intervention. CONCLUSION: The results indicate that in-school SNA interventions which challenge normative misperceptions constitute a promising strategy for reducing unhealthy snacking in young adolescents.

Cardiovascular disease risk communication in NHS Health Checks: a qualitative video-stimulated recall interview study with practitioners.

BACKGROUND: NHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10-year percentage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk. AIM: To explore practitioner understanding, perceptions, and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators. DESIGN & SETTING: Qualitative video-stimulated recall (VSR) study with NHSHC practitioners in the West Midlands. METHOD: VSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n = 7) or JBS3 lifetime CVD risk calculator (n = 8). Data were analysed using reflexive thematic analysis. RESULTS: In total, nine healthcare assistants (HCAs) and six general practice nurses (GPNs) were interviewed. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low-, medium-, or high-risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS3 functions were evident, particularly heart age, risk manipulation, and visual presentation of risk. CONCLUSION: There is a gap between the expectation and reality of practitioners' understanding, competencies, and training in CVD risk communication for NHSHCs. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.

Normative misperceptions of unhealthy snacking amongst 11- to 12-year-old secondary school students.

Younger adolescents are at an age where they have increasing control of their diet, and where peers become an important social reference for acceptable and normative dietary behaviours. These normative perceptions are often inaccurate and can lead to the development of unhealthy eating practices; although, the role of normative misperceptions of peers' unhealthy snacking behaviours in younger adolescents' personal snacking behaviours is not clear. The current study was a cross-sectional analysis of baseline data from a social norms-based healthy eating intervention sampling two secondary schools in deprived areas of England. Students aged 11-12 years (n = 252) completed self-report measures of their demographic characteristics and personal behaviours, attitudes, intentions, and normative perceptions (descriptive and injunctive norms), relating to unhealthy snacking. Results indicated students overestimated peers' daily unhealthy snacks consumption by approximately 3.2 portions, misperceived peers to have more positive attitudes towards unhealthy snacking and more negative attitudes towards reducing snacking. The greater these misperceptions of peers' behaviours and attitudes, the more likely students were to consume unhealthy snacks and have positive attitudes about unhealthy snacking. Girls had a stronger intention to reduce their snacking behaviours if they had more positive attitudes to reducing snacking behaviours and misperceived peers to also have a positive attitude. In summary, 11- to 12-year-olds misperceive the snacking behaviour and attitudes of their peers, and such normative misperceptions are associated with students' own snacking behaviours and attitudes. Interventions which challenge these misperceptions may assist in reducing the social acceptability of unhealthy snacking and in reducing unhealthy snacking amongst young adolescents.

Delivering in-school interventions to improve dietary behaviours amongst 11- to 16-year-olds: A systematic review.

Childhood obesity is a global health concern, which has both short- and long-term health consequences for the individual, and is a potential burden on health care services and the wider economy. The school environment is a setting where changes can be applied to dietary behaviours, as schools have direct and intensive contact with children. This systematic review evaluated school-based interventions designed to improve dietary behaviours among adolescents (11- to 16-year-olds). The aims were to review types of interventions delivered, dietary behaviours targeted, and interventions' effectiveness in improving dietary behaviour and associated intervention components. Twenty-nine school-based interventional studies with this population were identified for review. The data were synthesized by identifying and comparing individual studies' results, intervention components, and characteristics. Interventions appeared more effective when they involved peers, used educational media to deliver health messages, increased availability of healthy foods in school, and incorporated computer-based individualized feedback with normative information on eating behaviours. A limitation of the review was the lack of description in certain reviewed studies and the nonfeasibility of conducting a meta-analysis owing to study heterogeneity. Future interventions with this population could consider including the aforementioned components, gender-specific feedback, and both short- and long-term follow-ups as change may not be apparent immediately and to determine if changes are sustained.