Third-Generation Transcatheter Aortic Heart Valve with Reverse Parachute Sealing Cuff in Patients with Aortic Valve Disease.

BACKGROUND: The Navitor (Abbott Inc, IL, USA) transcatheter heart valve is a novel third-generation self-expanding bioprosthesis with specific features to mitigate paravalvular regurgitation (PVR). Owing to its novelty, there is a paucity of data on its application in clinical practice. METHODS: Consecutive cohort analysis of the use of the Navitor system in an as-treated clinical setting at a quaternary heart hospital. RESULTS: Sixty consecutive non-clinical trial patients treated with Navitor were identified. All patients underwent a successful procedure. The mean age was 79.3 years (±SD 7.82), 56.67% (n=34) were female, and the mean STS score was 4.87 (±SD 5.70). At 30 days post-procedure, all patients were alive with no readmissions for heart failure. One patient had a major vascular complication (1.7%). Four patients (7.14% of patients without a pre-existing pacemaker) received a new permanent pacemaker. Two patients (3.4%) had a non-disabling stroke. PVR at 30 days was trivial or none in 75% of patients, and no patient had worse than mild PVR. CONCLUSIONS: The Navitor system in this as-treated cohort was associated with favourable clinical, haemodynamic, and safety outcomes.

Beside the Seaside: Reflections on Local Green and Blue Spaces from Adults Aged over 50 in a Coastal Community.

This qualitative study examined the perceptions of potential wellbeing benefits of local green and blue spaces for adults aged over 50 years in a coastal town in North West England. At a population level, living close to green and blue spaces is associated with better mental and physical health, with the strength of the benefits being inversely related to the economic prosperity of an area. However, living in economically disadvantaged coastal communities may be associated with poorer health and wellbeing, particularly for older adults, despite the proximity to blue (and often green) space. Exploring this apparent paradox was the aim of the present study. Through semi-structured interviews with members of a community group, we gained insight into lived experiences of local green and blue spaces. The main themes we developed from analysis of the conversations were accessibility, amenities, social connections, quality of environment, and recuperation and escape. Our findings illustrate that participants valued natural spaces that were local and accessible, particularly when they felt connected to them, and were less likely to visit spaces that were further away and that were perceived as being less welcoming or accessible. This study provides insights into the experiences of adults aged over 50 living in coastal areas and suggests that policies and interventions aimed at promoting wellbeing in this demographic should consider the value of hyper-local green and blue spaces and their potential to promote connectedness to nature.

Prevalence of food security in the UK measured by the Food Insecurity Experience Scale.

BACKGROUND: Measurement of UK food insecurity has historically been inconsistent, making it difficult to understand trends. This study contributes by reporting and analysing data from a national survey conducted in line with UN Food and Agriculture Organization (FAO) recommendations and standard methods, providing an internationally comparable pre-coronavirus disease 2019 (COVID-19) snapshot of food insecurity. METHODS: Data came from a nationally representative 2019 UK sample (N = 2000) surveyed by Ipsos-Mori. Prevalence of food insecurity was assessed using the UN FAO Food Insecurity Experience Scale. Logistic regression was used to model food insecurity in relation to geographic and socio-demographic variables. RESULTS: Severe food insecurity was reported by 3% of the sample, an increase of 66.7% over the last directly comparable UK analysis (Gallup World Poll data from 2016 to 2018). Indication of some degree of food insecurity was reported by 14.2% of the sample and tended to be higher amongst younger age groups, those on lower incomes, and home renters (as opposed to owners). No geographic variables were significantly associated with food insecurity prevalence. CONCLUSIONS: The finding that prevalence of severe food insecurity was already increasing before the COVID-19 pandemic, across all areas of the UK, is cause for concern. Our results provide an important benchmark for assessing the impact of COVID-19 on food insecurity.

Beyond building back better: imagining a future for human and planetary health.

COVID-19 is disrupting and transforming the world. We argue that transformations catalysed by this pandemic should be used to improve human and planetary health and wellbeing. This paradigm shift requires decision makers and policy makers to go beyond building back better, by nesting the economic domain of sustainable development within social and environmental domains. Drawing on the engage, assess, align, accelerate, and account (E4As) approach to implementing the 2030 Agenda for Sustainable Development, we explore the implications of this kind of radical transformative change, focusing particularly on the role of the health sector. We conclude that a recovery and transition from the COVID-19 pandemic that delivers the future humanity wants and needs requires more than a technical understanding of the transformation at hand. It also requires commitment and courage from leaders and policy makers to challenge dominant constructs and to work towards a truly thriving, equitable, and sustainable future to create a world where economic development is not an end goal itself, but a means to secure the health and wellbeing of people and the planet.

UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting-A critical ethnography.

Although breastfeeding is known to improve health, economic and environmental outcomes, breastfeeding initiation and continuation rates are low in the United Kingdom. The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) aims to reverse declining rates of breastfeeding by shifting the culture of infant feeding care provision throughout hospital maternity settings. In the United Kingdom, the global BFHI has been adapted by UNICEF UK reflecting a paradigm shift towards the experiences of women and families using maternity services. This research used a critical ethnographic approach to explore the influence of the national UNICEF UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. Twenty-one staff and 26 service users were recruited and engaged in moderate-level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. Using Antonovsky's sense of coherence construct, the findings discussed in this paper highlight how the BFI offers 'informational' (comprehensible), 'practical' (manageable) and 'emotional' (meaningful) support for both staff and service users, strengthened by effective, local leadership and a team approach. This is juxtaposed against the tensions and demands of the busy hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balance relational and rational approaches for positive infant feeding care and experiences to flourish.

Conceptualizing the 'whole university' approach: an international qualitative study.

Focusing on the conceptualization of a whole university approach, this paper reports on an international qualitative study that explored vice-chancellors' and network members' understanding of and commitment to Health Promoting Universities, examined perspectives on leadership and investigated the Okanagan Charter's potential to catalyse whole university leadership and change. A multi-method qualitative approach was used: semi-structured interviews and focus groups were conducted face-to-face with vice-chancellors (n = 12) and Health Promoting University co-ordinators who were members of the UK Healthy Universities Network (n = 8); telephone interviews were conducted with a mix of UK and non-UK Health Promoting University co-ordinators (n = 5) and two online questionnaires were distributed to non-UK network co-ordinators (n = 6) and non-UK Health Promoting University co-ordinators (n = 10). Through thematic analysis, a number of key themes emerged that build a new conceptualization of the whole university approach (see Figure 1): building a broad understanding and framing of health; developing a supportive ethos and culture; embedding health into the university and joining up areas of work; focusing on the whole population and facing challenges and seizing opportunities. The study elicited rich and wide-ranging views from multiple stakeholders from universities and networks across four continents, confirming Health Promoting Universities as a truly global movement. Looking ahead, there are clear opportunities and challenges. First, the media narrative of a student mental health 'crisis' has focused universities' attention on 'health', but from a single issue 'illness' perspective. This risks detracting from the whole system Health Promoting Universities approach. Second, even with the Okanagan Charter inspiring individuals and universities, there are still major challenges in translating the rhetoric of whole system approaches into meaningful action within large, complex and culturally diverse organizations.

Mental health and wellbeing benefits from a prisons horticultural programme.

PURPOSE: In the context of current prison safety and reform, the purpose of this paper is to discuss findings of an impact evaluation of a horticultural programme delivered in 12 prisons in North West England. DESIGN/METHODOLOGY/APPROACH: The programme was evaluated using quantitative and qualitative methods, including Green Gym© questionnaires, the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Biographic-Narrative Interpretive Method interviews. FINDINGS: Against a backdrop of high rates of suicide, self-harm and poor mental health, the horticultural programme studied proved beneficial to prisoner participants, the most marked effect was on mental health and wellbeing. In addition to data related to the original mental health outcome indicators, the study revealed multiple layers of "added value" related to mental health arising from horticultural work in a prison setting. RESEARCH LIMITATIONS/IMPLICATIONS: The main research limitations were the limited completion of follow-on questionnaires due to prisoners being released and the inability to conduct longitudinal data collection post-release. There was also concern about response bias and lack of resource to compare with the experience of prisoners not participating in the programme. SOCIAL IMPLICATIONS: Positive impacts on prisoners' mental health and wellbeing included increased confidence, social interactions with staff and other prisoners and gaining skills and qualifications and work experience, increasing potential for post-release employment. ORIGINALITY/VALUE: Benefits of horticulture work on health are well established. However, to date, there is little research concerning the effects this work may have on mental wellbeing of prisoners both within prisons and more so upon their release back into the community.

Five Ways to Wellbeing: holistic narratives of public health programme participants.

This paper reports on a study which formed part of a qualitative process evaluation of a wellbeing programme in North West England. The study used the biographic narrative interpretive method (BNIM) to undertake and analyse data from interviews with six participants from diverse projects within the programme. This generated rich case studies and spotlighted cross-case commonalities, building understanding of how the programme achieved its effects. We present findings using the Five Ways to Wellbeing framework, presenting one abridged 'case' and summarising cross-cutting themes. We explore how BNIM gives insight into the psychosocial complexity of wellbeing, building understanding of its holistic and dynamic nature, and then highlight the flexibility, resonance and widespread appeal of Five Ways to Wellbeing. In concluding, we argue that by enabling participants to tell their own stories of participation in the different projects, we gain a more authentic understanding of the 'whole' story of how involvement has affected wellbeing. Such approaches are crucial as wellbeing becomes a central concept in global health policy and promotion.

Growing health in UK prison settings.

Globally, prisoners tend to come from marginalized and socially disadvantaged sections of the society and exhibit a high incidence of ill health, linked to social exclusion and multiple complex needs. Prisons therefore offer an important opportunity to tackle inequality and injustice, through promoting health, reducing reoffending and facilitating community reintegration.This paper reports on and critically discusses findings from an evaluative research study, which aimed to identify and explore impacts of prisoners' participation in an innovative social and therapeutic horticultural programme, 'Greener on the Outside for Prisons' (GOOP), delivered in prisons in North West England. Focus groups with 16 prisoners and semi-structured interviews with six prison staff were conducted at five sites. Presented under three overarching themes (health and well-being; skills development, employability, and work preparedness; and relationships), findings suggest that engagement with and participation in GOOP were important in improving positive mental well-being, increasing physical activity and knowledge about healthier eating; developing skills and work readiness; and building relationships and catalysing and strengthening prosocial behaviours, important for good citizenship and effective resettlement. The paper concludes that - in the context of the current UK prison reform agenda and concern about the high incidence of violence, substance misuse, self-harm and suicide - prison-based horticulture can offer multiple benefits and make a significant contribution to the creation of safe, secure, supportive and health-enhancing environments. Furthermore, it contends that by joining up health and justice agendas, programmes such as GOOP have the potential to serve as powerful catalysts for wider systemic change, thereby helping tackle inequalities and social exclusion within societies across the globe.

Wellbeing: the challenge of 'operationalising' an holistic concept within a reductionist public health programme.

Wellbeing is a concept that, while contested, recognises individual and wider social, economic, political and environmental contextual influences - and is of growing interest and relevance locally and globally. In this article, we report on one aspect of an evaluative research study conducted on a public health programme in North West England. AIMS: Within the context of a process evaluation that explored the delivery of a public health programme and sought to increase understanding of how and why different approaches worked well or not so well, this article focuses specifically on the concept of wellbeing, examining perceptions of multiple stakeholders. METHODS: Interviews and focus groups were undertaken with 52 stakeholders involved in managing and facilitating the programme and its composite projects and with 90 community members involved as project participants. Data were subjected to thematic analysis, cross-check and refining. RESULTS: Results highlight stakeholders' diverse understandings of wellbeing, the complex relationship between health and wellbeing, and the perceived dissonance between the holistic concept of wellbeing and the reductionist design of the programme. CONCLUSIONS: Wellbeing was understood to be 'more than health' and 'more than happiness', concerned with effective functioning, sense of purpose and flourishing. Essentially holistic, wellbeing offers opportunities to transcend clinical/pathogenic conceptions of 'health' and resonate with individuals, communities and local authorities. This raises concerns about how wellbeing can be meaningfully realised without compromising the concept, particularly when programmes are structured in reductionist ways requiring monitoring against discrete outcomes. Implications for practice include the following: utilising wellbeing as a driver for cross-cutting public health in challenging economic and organisational contexts, acknowledging that wellbeing is essentially social as well as individual, appreciating that wellbeing is experienced in relation to contexts and surroundings, and recognising that wellbeing defined in terms of individual happiness risks compromising the future wellbeing of societies and the planet.

The UK Healthy Universities Self-Review Tool: Whole System Impact.

Over recent years, there has been growing interest in Healthy Universities, evidenced by an increased number of national networks and the participation of 375 participants from over 30 countries in the 2015 International Conference on Health Promoting Universities and Colleges, which also saw the launch of the Okanagan Charter. This paper reports on research exploring the use and impact of the UK Healthy Universities Network's self review tool, specifically examining whether this has supported universities to understand and embed a whole system approach. The research study comprised two stages, the first using an online questionnaire and the second using focus groups. The findings revealed a wide range of perspectives under five overarching themes: motivations; process; outcomes/benefits; challenges/suggested improvements; and future use. In summary, the self review tool was extremely valuable and, when engaged with fully, offered significant benefits to universities seeking to improve the health and wellbeing of their communities. These benefits were felt by institutions at different stages in the journey and spanned outcome and process dimensions: not only did the tool offer an engaging and user-friendly means of undertaking internal benchmarking, generating an easy-to-understand report summarizing strengths and weaknesses; it also proved useful in building understanding of the whole system Healthy Universities approach and served as a catalyst to effective cross-university and cross-sectoral partnership working. Additionally, areas for potential enhancement were identified, offering opportunities to increase the tool's utility further whilst engaging actively in the development of a global movement for Healthy Universities.

Healthy universities: an example of a whole-system health-promoting setting.

The health-promoting settings approach is well established in health promotion, with organisational settings being understood as complex systems able to support human wellbeing and flourishing. Despite the reach and evident importance of higher education as a sector, 'healthy universities' has not received high-level international leadership comparable to many other settings programmes. This study explores how the concept of a healthy university is operationalised in two case study universities. Data collection methods included documentary analysis, observation field notes and semi-structured interviews with staff and students. Staff and students understood the characteristics of a healthy university to pertain to management processes relating to communication and to a respectful organisational ethos. Enhancers of health and wellbeing were feeling valued, being listened to, having skilled and supportive line managers and having a positive physical environment. Inhibitors of health and wellbeing were having a sense of powerlessness and a lack of care and concern. The concept of the healthy university has been slow to be adopted in contrast to initiatives such as healthy schools. In addition to challenges relating to lack of theorisation, paucity of evidence and difficulties in capturing the added value of whole-system working, this study suggests that this may be due to both their complex organisational structure and the diverse goals of higher education, which do not automatically privilege health and wellbeing. It also points to the need for a whole-university approach that pays attention to the complex interactions and interconnections between component parts and highlights how the organisation can function effectively as a social system.

Healthy Cities and the Transition movement: converging towards ecological well-being?

This commentary identifies similarities, differences and opportunities for synergy and mutual learning between the Healthy Cities and the Transition movements. We outline what we consider to be the 'pressing issues' facing humanity and the planet in the early 21(st) century; consider the extent to which health promotion has engaged with and addressed these issues; compare Healthy Cities and the Transition movement; and conclude by suggesting possibilities for moving forward.

Theorizing healthy settings: a critical discussion with reference to Healthy Universities.

UNLABELLED: The settings approach appreciates that health determinants operate in settings of everyday life. Whilst subject to conceptual development, we argue that the approach lacks a clear and coherent theoretical framework to steer policy, practice and research. AIMS: To identify what theories and conceptual models have been used in relation to the implementation and evaluation of Healthy Universities. METHODS: A scoping literature review was undertaken between 2010 and 2013, identifying 26 papers that met inclusion criteria. FINDINGS: Seven theoretical perspectives or conceptual frameworks were identified: the Ottawa Charter; a socio-ecological approach (which implicitly drew on sociological theories concerning structure and agency); salutogenesis; systems thinking; whole system change; organizational development; and a framework proposed by Dooris. These were used to address interrelated questions on the nature of a setting, how health is created in a setting, why the settings approach is a useful means of promoting health, and how health promotion can be introduced into and embedded within a setting. CONCLUSIONS: Although distinctive, the example of healthy universities drew on common theoretical perspectives that have infused the settings discourse more generally this engagement with theory was at times well-developed and at other times a passing reference the paper concludes by pointing to other theories that offer value to healthy settings practice and research and by arguing that theorization has a key role to play in understanding the complexity of settings and guiding the planning, implementation and evaluation of programmes.

Probation as a setting for building well-being through integrated service provision: evaluating an Offender Health Trainer service.

INTRODUCTION: The NHS Health Trainer Programme was launched in England and Wales in 2005 with the aim of tackling health inequalities. While initially focusing on geographical communities, the initiative has extended its reach to particular population groups, such as offenders and their families, who experience high levels of physical and mental health needs and wider social exclusion. This paper reports on the evaluation of the Offender Health Trainer service delivered in probation settings in Bury, Rochdale and Oldham (Greater Manchester). This service has sought to improve the health of offenders, improve their access to mainstream services, and help reduce health inequalities - as well as facilitate rehabilitation and improve job prospects for ex-offenders through employment as health trainers. AIMS: This evaluative research study aimed to explore the delivery of the Offender Health Trainer service and examine its impact on service users. The study design and limited time frame meant that the research was focused on the journeys of service users rather than on long-term outcomes. METHODS: The evaluation used a mixed-methods approach, comprising two key elements: the interrogation and analysis of routinely collected quantitative data extracted from the National Health Trainer Data Collection Recording System (DCRS); and in-depth qualitative research using interviews and focus groups with clients and health trainers. RESULTS: The evaluation points to the overall success of the service in meeting its aims and impacting positively on the lives of offenders. It reveals promising trends in behaviour change and self-perceived health and well-being, articulating a rich narrative detailing how the service has helped probation clients tackle multiple interwoven problems and build hope and self-belief. Of particular importance was the health trainers' experience of the criminal justice system, which resonated with and inspired clients, developing trust and motivation to change. CONCLUSIONS: While the research inevitably had limitations, this study suggests that the health trainer model can be effectively implemented within the probation setting, making a valuable contribution to the improvement of offenders' health and well-being by working in ways that acknowledge the connections between personal lifestyle and wider determinants of health. Within the context of forthcoming probation reforms, it will be increasingly important to develop services that highlight these links and to invest in appropriate evaluation that can generate further learning about 'what works and why'.

Expert voices for change: bridging the silos-towards healthy and sustainable settings for the 21st century.

The settings approach to health promotion, first advocated in the 1986 Ottawa Charter for Health Promotion, was introduced as an expression of the 'new public health', generating both acclaim and critical discourse. Reflecting an ecological model, a systems perspective and whole system thinking, the approach has been applied in a wide range of geographical and organisational contexts. This paper reports on a qualitative study undertaken through in-depth interviews with key individuals widely acknowledged to have been the architects and pilots of the settings movement. Exploring the development of the settings approach, policy and practice integration, and connectedness 'outwards', 'upwards' and 'beyond health', it concludes that the settings approach has much to offer-but will only realise its potential impact on the wellbeing of people, places and the planet if it builds bridges between silos and reconfigures itself for the globalised 21st century.

Non-rheumatic streptococcal myocarditis - warm hands, warm heart.

Acute myopericarditis in the developed world is ascribed predominantly to viral infections. Enteroviruses and adenoviruses are commonly implicated but are not routinely tested for, as the condition is self-limiting and has a good prognosis. However, we recently encountered two cases of acute myopericarditis associated with concomitant Streptococcus pyogenes [group A Streptococcus (GAS)] pharyngotonsillitis. A microbiological aetiology was pursued because of the severity of the upper respiratory tract infection and associated systemic illness rather than to explain the myopericarditis per se. We report these two cases and review the literature of this potentially under-recognized condition. In the absence of features of rheumatic fever, we hypothesize a toxin-mediated process as opposed to an immune-mediated one. We suggest that perhaps all patients with myopericarditis be assessed for GAS pharyngitis.