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IntroductionThe UK has promoted increased availability of alcohol-free and low-alcohol drinks (no/lo, ≤1.2% alcohol by volume) as a public health strategy. To be effective, no/lo beverages must replace, and not supplement, standard alcoholic drinks. Emerging evidence suggests that the reasons people drink alcohol may be an important determinant of the potential public health impact of these drinks. This study aimed to determine whether alcohol drinking motives were associated with no/lo consumption after accounting for sociodemographic characteristics and alcohol consumption.MethodsA cross-sectional sample of adults residing in Great Britain (aged 16–93) who had drunk alcohol in the past year were recruited via the Alcohol Toolkit Study (N=2555; 49.0% female). The dependent variable was frequency of no/lo consumption (less than vs at least monthly). Five questions captured respondents’ alcohol drinking motives (enhancement, social, conformity, coping-anxiety, and coping-depression), derived from the Drinking Motives Questionnaire-Revised. Sociodemographic characteristics, including age, gender, social grade, education, Index of Multiple Deprivation (a UK-wide measure of relative deprivation for small geographic areas), and hazardous alcohol use (Alcohol Use Disorder Identification Test), were also assessed. Descriptive analysis presents the proportion of respondents drinking no/lo at least monthly among low endorsement (ie, drinking for a motive less than half the time) versus high endorsement (ie, drinking for a motive at least half the time) of each drinking motive. Quasibinomial regression modelling explored relationships between alcohol drinking motives and no/lo consumption, accounting for sociodemographic characteristics and hazardous drinking.ResultsDrinking alcohol to conform was associated with an increased likelihood of at least monthly no/lo consumption after accounting for sociodemographic characteristics and hazardous drinking (OR 1.10, 95% CI 1.00 to 1.21, p=0.041).ConclusionsNo/lo drinks may facilitate reduced alcohol consumption by offering an alternative for individuals wishing to participate in alcogenic environments. However, those who drink alcohol to conform are not typically higher-risk drinkers, which may limit the public health benefit of no/lo drinks. Further research is needed to explicitly explore substitution effects.

Background Food diets are complex and a policy targeting one item of a person’s diet does not affect their nutritional intake in a solely additive or subtractive manner. Policies tackling unhealthy diets are more likely to be adopted by governments if there is robust evidence to support them. To evaluate dietary policies, it is important to understand the correlations and interdependencies between food groups, as these can lead to unintended negative consequences. We aimed to see whether reductions in consumption of a particular group is related to a net improvement in nutritional intake, after taking into account patterns of consumption and substitution across food groups. Methods Detailed dietary data was collected using a 24-h online dietary assessment from the UK Biobank and Oxford Web Q ( n  = 185,611). We used panel data fixed effects methods to estimate changes in energy, saturated fat, total sugar, and fibre following a 100gram reduction across 44 food groups. We compare these estimates against the average nutritional value of that food group from the UK National Diet and Nutrition Survey. Results We find evidence of variation in whether a food is compensated between the main confectionery products. Crisps, savoury snacks, and sugar confectionery are less likely to be compensated, whereas chocolate confectionery, biscuits, and buns/cakes/pastries and pies are compensated. The result is particularly striking for chocolate confectionery which shows that while chocolate confectionery often has a high energy content, eating less chocolate confectionery is not associated with an equal reduction in energy. Instead, we find individuals switch or compensate for their reduction in chocolate confectionery consumption with other high energy food items. Conclusions We find that sugar confectionery and crisps and savoury snacks are less likely to result in substitution than chocolate confectionery. This would suggest that food policies aiming to reduce the consumption of these food groups are more likely to result in overall lower consumption of unhealthy foods.

Background Borderline personality disorder (BPD) is considered to be a challenging condition for clinicians to treat. Clinicians routinely working with individuals who experience severe emotional dysregulation often do not receive appropriate training and support to work with this client group. This article describes an intervention, Clinician Connections (CC), which was developed to support practitioners who work with individuals with BPD. CC aims to increase practitioner’s knowledge of BPD, develop a skillset to work with emotionally dysregulated individuals and enhance practitioner’s self-efficacy with regard to working effectively with this client group. The aim of this study is to investigate the perceived utility and acceptability of CC, and identify areas for further development of the intervention. Method A seven-hour CC workshop was provided to Emergency Department and community mental health clinicians. Three focus groups were completed following completion of the intervention with 13 clinicians (12 female; 1 male) and were audio recorded. The study utilised a thematic analysis framework. Results Six master themes emerged from the focus group data which included 10 subordinate themes. The master themes identified were: the need for training; a new understanding; validation; barriers to applying new skills; overcoming barriers to skill application; and future direction: practical application of skills. Participants reflected on how their new understanding of transactions and their own experiences affects their practice. They also noted improved client interactions and client relationships resulting from the use of validation. While there was an increase in participants’ self-efficacy in working with individuals with BPD, a need for further skills and practice was also highlighted. Conclusion The evidence presented here suggests that CC is both beneficial and feasible. Qualitative feedback suggests there is a need for further support in the strengthening and generalisation of skills. Suggestions were made by practitioners regarding potential improvements to the delivery of the workshop. Future research could evaluate the changes made to CC and focus on a quantitative approach to quantify the impact of CC.

This essay explores the complex entanglement of new reproductive technologies, genetics, health economics, rights-based discourses and ethical considerations of the value of human life with particular reference to representations of Down’s syndrome and the identification of trisomy 21. Prompted by the debates that have occurred in the wake of the adoption of non-invasive prenatal testing (NIPT), the essay considers the representation of Down’s syndrome and prenatal testing in bioethical discourse, feminist writings on reproductive autonomy and disability studies and in a work of popular fiction, Yrsa Sigurdardóttir’s Someone To Look Over Me (2013), a novel set in Iceland during the post-2008 financial crisis. It argues that the conjunction of neo-utilitarian and neoliberal and biomedical models produce a hostile environment in which the concrete particularities of disabled people’s lives and experiences are placed under erasure for a ‘genetic fiction’ that imagines the life of the ‘not yet born’ infant with Down’s syndrome as depleted, diminished and burdensome. With close reference to the depiction of Down’s syndrome and learning disability in the novel, my reading explores the ways in which the generic conventions of crime fiction intersect with ideas about economics, politics and learning disability, to mediate an exploration of human value and social justice that troubles dominant deficit-led constructions of disability.

AbstractThis essay explores the kind of cultural and ideological work effected by the concept of dementia in contemporary popular culture in the global north through a critical reading of three ‘genre’ texts: Renny Harlin’s action movie meets sci-fi, Deep Blue Sea (1999), Vernor Vinge’s speculative fiction Rainbows End (2007) and Rupert Wyatt’s sci-fi drama, Rise of the Planet of the Apes (2011), all of which engage with the possibility of neural regeneration and a cure for dementia. Dominant epistemologies of dementia and ageing often focus on the potentially unsustainable social and economic burden presented by an ageing population and the obligation to meet the needs of older people living with impairments. Exploring the articulation of these economic and political arguments alongside an analysis of the promissory discourses of bio-gerontology and neuroscience, this essay considers the ways in which dementia has emerged as an over-determined point of tangency upon which particular ideas about ageing, mortality, human value, sustainability and futurity are played out. The analysis of the cultural texts presented here exposes the limits of market and individual oriented responses to dementia and ageing within the broader context of what Nick Srnicek and Alex Williams have described as the ‘emerging crisis of work and surplus populations’. This paper argues that an exploration of the ideological fault-lines, imaginary resolutions and forms of wish fulfilment that emerge in the films and novel, enable us to identify the ideological limitations of the neoliberal discourses that circumscribe the ways in which we currently understand dementia and our imaginative investments in the promise of its cure.

The immediate context of this paper is the so-called ‘crisis in social care’ that finds its most prolific and unsettling expression in news reports about the verbal, emotional and physical abuse of elderly people with dementia in care homes. In April 2014, BBC One’sPanoramareported on the abuse of residents at the Old Deanery care home in Essex and Oban House in Croydon.¹ In June 2014, one care worker was jailed and two others were given suspended sentences and community service for the ill treatment of women with dementia at the Granary Care Home near Bristol.² In the following

This is the first volume to comprehensively introduce the ways in which interdisciplinary thinking across the humanities and social sciences might contribute to, critique and develop medical understanding of the human individually and collectively.

Patients with advanced cancer do not report all symptoms, so assessment is best done systematically. However, for such patients, completion rates of some symptom instruments are <50%. Symptoms can be quantified by various scales including the Categorical Response Scale (CRS), Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Patient preferences for CRS, NRS and VAS in symptom assessment and their clinical utility in 3 cancer symptoms: pain, tiredness and appetite loss were determined. A prospective survey was conducted involving cancer admissions to a 36-bed palliative care unit. 100 inpatients were recruited, aged 38-93 years (x̅ =71 years; SD=11.6), with median Eastern Cooperative Oncology Group (ECOG) scores of 2 (range 0-4). VAS was the least preferred measure. 52% of patients choose the same scale for all 3 symptoms and 44% for 2, with 4% choosing a different individual scale per symptom. There was moderate agreement between participant scale preference and observer determined ease of scale completion (loss of appetite: κ=0.36; pain: κ=0.49; tiredness: κ=0.45). Participants preferred CRS for appetite loss (48%) and tiredness (40%) and NRS for pain (44%). VAS was the least favoured scale and should be used cautiously in this population. Most participants had a scale preference with high intrapatient consistency between scales. CRS was preferred for appetite loss and tiredness and NRS for pain. Consideration should be given to individualised cancer symptom assessment according to patient scale preference.