Austen El-Osta

Background: Loneliness is a pressing public health concern with wide-ranging impacts on mental, physical and social wellbeing. Building on the Measuring Loneliness in England (INTERACT) Study which represents one of the largest volunteer-based studies of loneliness and social disconnection conducted in the United Kingdom (UK), we explore demographic, social and health-related factors associated with loneliness and social capital, using multiple validated measures. Methods: We analysed cross-sectional data from 135,725 community-dwelling adults across England. Loneliness was assessed using both the University of California, Los Angeles (UCLA) 3-item Loneliness Scale and the Office for National Statistics (ONS) Direct Measure of Loneliness (DMOL). Social capital was measured using a composite scale of neighbourhood trust, cohesion and reciprocity. Multivariable ordinal and binary logistic regression models were fitted to summarise mutually adjusted associations within the responding sample. The models were used as exploratory, sample-conditional descriptions and were not intended to estimate population parameters. Results: Younger age (particularly 16–25 years old), being single, unemployed or living with disability were consistently associated with higher loneliness across both scales. In contrast, respondents reporting nine or more friends had substantially lower odds of loneliness (UCLA: adjusted odds ratio (aOR) = 0.09, 95% model-based interval (MBI): 0.09–0.10; DMOL: aOR = 0.16, 95% MBI: 0.15–0.17). University education was associated with higher loneliness on the UCLA scale but lower loneliness on the DMOL. High social capital was more frequently reported among older, married and retired respondents. Respondents with long-term conditions or disability had reduced odds of high social capital (long-term conditions: aOR = 0.82, 95% MBI: 0.80–0.85; disability: aOR = 0.77, 95% MBI: 0.74–0.80). Conclusions: This study identified several sociodemographic, social and health-related factors associated with loneliness, although some associations varied according to the loneliness measure used. Because participants comprised a non-probability volunteer sample, the estimates should not be interpreted as population parameters, causal effects or confirmatory evidence. The findings are hypothesis-generating and require confirmation in representative, longitudinal and intervention-focused studies.

Background: Understanding how people manage everyday health challenges is vital for developing self-care policies that are inclusive, equitable and effective. Little is known about how demographic characteristics shape self-care confidence, symptom management strategies and health-seeking behaviours across the UK adult population. While the companion paper from the same survey examined healthcare professionals’ attitudes toward self-care and the professional-public interface, the demographic predictors and personal barriers shaping self-care engagement among the general UK public remain poorly understood. Objective: To examine the demographic predictors of self-care engagement among UK adults, focusing on self-care confidence, health information-seeking behaviour, symptom management strategies and perceived barriers to self-care. Design: Cross-sectional online survey conducted from June to September 2024. Setting: Community-dwelling adults across the UK, recruited via online platforms and professional networks. Participants: 3,255 UK adults, including a subset of health and care professionals (HCPs). Interventions: None (observational study). Primary and secondary outcome measures: Self-reported self-care confidence, health information-seeking behaviours, symptom management strategies and barriers to self-care. Results: Regression analyses highlighted marked demographic disparities in self-care engagement. Older adults (65+) were significantly more confident in their self-care knowledge (aOR=3.22, 95% CI 2.06 to 5.03, p<0.001) and healthy lifestyle behaviours (aOR=2.96) and were also more likely to seek health information. Males reported lower self-care confidence than females (aOR=0.79, 95% CI 0.68 to 0.91, p=0.002). Black British participants were more confident in self-care knowledge (aOR=1.99, 95% CI 1.39 to 2.84, p<0.001), but along with Asian British individuals, were significantly less likely to seek health information (aORs=0.56 and 0.70, respectively). People living with disabilities (aOR=0.69) and long-term conditions (aOR=0.76) reported lower confidence across self-care domains. HCPs consistently reported higher self-care confidence (aOR=1.51, p=0.006) and health behaviour engagement (aOR=1.66). Financial constraints (53%), lack of time (47%) and low self-efficacy (22%) emerged as key barriers to self-care, alongside low use of pharmacists (1.3%) and digital resources (9.7%). Conclusion: This study highlights demographic disparities in self-care confidence, information-seeking behaviours and barriers to engagement, urging the need for tailored self-care interventions. Future research should focus on targeted interventions to improve health literacy, enhance pharmacist-led self-care support and promote equitable access to digital health resources, particularly for underserved and demographically diverse population groups.

Background/Objectives: Subtle facial and interactional cues may prompt clinicians to explore possible anxiety, confusion or hesitation, but they do not establish a patient’s internal state. The Micro-Expression Decoder (MED) links cue recognition with tentative interpretation, direct checking and communication adaptation. Methods: This preliminary, uncontrolled, single-group pre–post convergent mixed-methods evaluation involved 60 final-year medical students from three London medical schools. Ten groups of six completed a 270 min simulation-based programme comprising conceptual teaching, video observation, standardised-patient encounters, feedback and reflection. Study-specific self-ratings and a parallel-form recognition task were completed before teaching and immediately after the instructional and simulation components, before the final debrief. Standardised-patient ratings were obtained during the first and final simulated encounters. There was no control group or follow-up. Results: Recognition confidence increased from 2.7 to 4.3 (mean change 1.6, 95% CI 1.39–1.81; dz = 1.98), interpretation confidence from 3.0 to 4.5 (dz = 2.01), standardised-patient-rated attentiveness from 3.2 to 4.6 (dz = 2.02), and satisfaction from 3.5 to 4.8 (dz = 1.94). Anxiety recognition increased from 25/60 (41.7%) to 55/60 (91.7%), and confusion recognition from 29/60 (48.3%) to 52/60 (86.7%). Qualitative accounts described earlier noticing, clarification and checking, alongside difficulty distinguishing cues, distraction, cultural variation and over-interpretation. Nineteen students increased confidence without categorical improvement in anxiety or confusion recognition. Conclusions: MED was associated with immediate improvement across study-specific outcomes in simulation. The uncontrolled design, immediate assessment, investigator-developed measures, expectancy effects and ceiling in post-training satisfaction preclude conclusions about causality, retention, real-patient benefit, empathy or clinical competence.

Introduction: Heart failure may be preceded by non-specific symptoms or indicators recorded in primary care, although these records do not necessarily represent heart failure or missed diagnosis. We mapped quantitative evidence on prediagnostic signals, investigation, referral, diagnosis setting and outcomes. Methods: We conducted a systematic scoping review of quantitative observational studies of incident or newly diagnosed adult heart failure that included a primary care, community or ambulatory first-contact component. Databases were searched from January 2000 to 1 May 2026. Two reviewers independently screened records, extracted data and assessed risk of bias using Joanna Briggs Institute tools. Heterogeneous findings were synthesised narratively and organised by dataset family. Results: Eleven reports were included as sources of evidence. Most were UK retrospective linked-record cohorts; six reports used overlapping national English data, and five used independent datasets from Portugal, other UK regions and the USA. Recorded symptoms or indicators before diagnosis occurred in 30.0% to 66.5% of patients. Among 80,824 English patients with prior indicators diagnosed in 2015–19, 12.5% had recorded natriuretic peptide testing, 19.8% echocardiography and 34.4% specialist referral in the six months before diagnosis. Hospital or acute-care diagnosis was common and was associated with poorer mortality, admission or cost outcomes. Repeat consultations and clinicians’ responses to recurrence were rarely measured directly. Conclusion: The evidence describes recorded prediagnostic intervals and pathway gaps, not proven missed or avoidable diagnostic delay. It does not establish repeated or unresolved presentation as a clinical trigger. Primary studies should define recurrence, determine whether earlier records plausibly reflected heart failure, and adjudicate whether repeated presentation identifies preventable diagnostic opportunities.

Objectives: To determine the prevalence of lower urinary tract symptoms (LUTS) and nocturia, public knowledge of associated risk factors, self-management practices and advice-seeking behaviours among community-dwelling adults in the UK, as well as to examine the sociodemographic correlates of these outcomes. Design: A cross-sectional online survey. Setting: Community based, UK. Participants: 2062 UK adults accessed the survey; 2012 provided complete sociodemographic data for analysis (50.2% female, 49.8% male; 81.7% white, 9.4% Asian/Asian British; aged 18–65+ years); convenience sampling via online panels and networks, with informed consent. Interventions: None (observational survey study). Primary and secondary outcome measures: Prevalence of LUTS/nocturia; awareness of symptoms/risk factors; self-management strategies; advice sources; demographic associations. Results: Among all respondents, 52.7% reported experiencing nocturia, with 42.2% having symptoms nightly and 47.1% waking at least twice per night. While 90.5% recognised fluid intake before bed as a cause, knowledge of other risk factors (eg, cardiovascular disease, salt intake, sleep disorders) was limited. Nearly half (43.2%) of those with symptoms had never sought advice; only 27% sought professional input. Online resources (eg, National Health Service website, Google) were consulted more frequently than healthcare professionals. Age, sex, ethnicity, long-term condition status and disability were associated with variations in awareness and advice-seeking behaviours. Conclusions: Nocturia is highly prevalent, but advice-seeking is quite low. While awareness of behavioural contributors is relatively good, several contributing medical conditions and other health-related factors were less known. These findings highlight a need for national health literacy campaigns focused on specific risk factors, evidence-based self-care tools and greater professional engagement. Addressing these gaps can normalise discussions about bladder health, reduce stigma and improve early detection and management of LUTS in the community.

Objectives: To investigate real-world healthcare experiences of individuals in the UK who consulted health and care professionals for nocturia. The study explored the assessments, management strategies, referrals and follow-up patterns received by patients experiencing lower urinary tract symptoms (LUTSs), as well as their level of satisfaction with those. The association of sociodemographic factors with these patterns was also analysed. Design: A cross-sectional online survey. Setting: Community-based, UK. Participants: From 2012 completers, 453 (22.5%) reported consulting healthcare professionals for LUTS (55.0% female, 75.5% White; aged 18–65+ years; convenience sampling via online panels/networks). Interventions: None (observational survey study). Primary and secondary outcome measures: Healthcare provider consulted; assessments (eg, history, bladder diary, examinations, tests); management (eg, behavioural, pharmacological); referrals/follow-up; satisfaction; associations via χ ² tests. Results: Among 453 respondents who sought professional advice for LUTS, 211 reported nocturia and 143 had nocturia confirmed through the survey’s follow-up questions. General practitioners were the most consulted providers (73.1%), but guideline-recommended tools such as bladder diaries were underutilised (13.9%). Only 12.1% were referred to specialists. Satisfaction with care was mixed: 59% were satisfied with assessment and 54% with treatment, but dissatisfaction was common around referrals, follow-up and cause explanation. Long-term conditions and disability were associated with greater unmet needs. Participants consistently called for more accessible information, clinician training and better self-management support. Conclusions: These findings suggest that patients’ reported experiences of assessment and management varied, which may reflect differences in actual practice, recall or communication during consultations, particularly in relation to nocturia. However, because the data are cross-sectional and self-reported, these results should be interpreted cautiously. They highlight areas where patient assessment, communication and follow-up could potentially be improved.