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The National Institute for Health and Care Excellence (NICE) was established a quarter of a century ago in 1999 to regulate the cost-effectiveness of pharmaceuticals (and other health technologies) for the NHS. Drawing on medical sociology theories of corporate bias, neoliberalism, pluralism/polycentricity and regulatory capture, the purpose of this article is to examine the applicability of those theories to NICE as a key regulatory agency in the UK health system. Based on approximately 7 years of documentary research, interviews with expert informants and observations of NICE-related meetings, this paper focuses particularly on NICE's relationship with the interests of the pharmaceutical industry compared with other stakeholder interests at the meso-organisational level. Consideration of the interaction between the UK Government and the pharmaceutical industry in relation to NICE is presented together with the analysis of revolving doors and conflicts of interest of NICE experts/advisors. The nature of policy changes over time (e.g. accelerated assessment pathways and industry fees for regulatory appraisals) and how they relate to the relevant stakeholder interests is also investigated. It is concluded that NICE is largely characterised by neoliberal corporate bias, though some elements of its organisation are also consistent with theories of capture, pluralism and polycentricity., (© 2025 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Background: The causal relationship between PM 2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm) and common mental disorders, along with its neuropathological mechanisms, remains unclear., Methods: We used genome-wide association study datasets from the UK Biobank and Psychiatric Genomics Consortium to systematically investigate the causal relationship between PM 2.5 and nine common psychiatric disorders using two-sample Mendelian randomization (TSMR) methods. Subsequently, we used two-step MR to investigate the mediating effect of 108 potential mediators in the association between PM 2.5 and mental disorders., Results: Our findings indicated that PM 2.5 was positively associated with major depressive disorder (odds ratio (OR): 1.33, 95 % confidence interval (CI): 1.11-1.55), anxiety disorder (OR: 2.96, 95 % CI: 2.13-3.79), schizophrenia (OR: 1.55, 95 % CI: 1.29-1.81), and attention deficit hyperactivity disorder (ADHD) (OR: 1.95, 95 % CI: 1.66-2.24). Unexpectedly, PM 2.5 was inversely associated with bipolar disorder (OR: 0.65, 95 % CI: 0.37-0.93). Additionally, PM 2.5 was not significantly associated with autism spectrum disorders (OR: 1.24, 95 % CI: 0.83-1.65), post-traumatic stress disorder (OR: 1.51, 95 % CI: 1.11-1.91), obsessive-compulsive disorder (OR: 0.81, 95 % CI: -0.07-1.69), or anorexia nervosa (OR: 1.42, 95 % CI: 0.86-1.98). Further analysis using two-step MR revealed that Neurotrophin-3 mediated 9.86 % of the PM 2.5 -ADHD association and 5.88 % of the PM 2.5 -schizophrenia association. Sensitivity analyses supported these findings., Conclusions: This TSMR analysis provides a comprehensive examination of the causal relationship between PM 2.5 exposure and nine common psychiatric disorders, with mediation analysis offering insight into the underlying mechanisms. This study aims to raise public awareness of how air quality affects mental health through empirical evidence., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Dogs infected with Leishmania infantum have been increasingly reported in the UK mostly related to imported/travelled dogs. Up-to-date epidemiologic data are essential for a better control of this zoonotic disease in such emerging areas. This study aimed for the first time, to estimate the percentage and temporal variation of dog and cat samples testing positive for L. infantum infection at commercial diagnostic laboratories, and to describe the travel history of positive dogs and cats positive to leishmaniosis in a network of UK veterinary practices. Leishmania infantum serology and PCR data were collected by the Small Animal Veterinary Surveillance Network (SAVSNET) from five UK national veterinary diagnostic laboratories between 2010 and 2022 and were analysed. In addition, electronic health records (EHRs) were collected from 251 veterinary practices across the UK between March 2014 and September 2022. Text mining tools were used to identify cases compatible with clinical leishmaniosis as recorded in the clinical narratives; these were subsequently manually validated. Data from a total of 25,327 diagnostic samples (25,201 from dogs and 126 from cats) were analysed including 20,517 sera tested by either quantitative ELISA or IFAT, and 4810 by PCR. Leishmania infantum antibodies were detected in 39.7 % of tested dog samples and 1.07 % of cat samples. In dogs, seropositivity increased from 2013 to 2022. Leishmania DNA was only detected by PCR in samples from dogs (11.8 %). A total of 368 dogs with canine leishmaniosis (CanL) were identified from clinical narratives. Of these, 189 had either visited, or were rescued/imported from, Spain, Greece, Cyprus and other southern European countries. Among factors associated with CanL in the UK canine population, dogs between 3 and 6 years of age were 4.71 times more likely to have CanL than those two years or younger. In addition, there was an increased risk of having recorded CanL clinical cases from 2017 to 2022, compared to 2014. Southeast of England was the UK region that accounted for the highest number of CanL cases (34.51 %). This study provides recent trends in Leishmania infection in dogs in the UK, identifies risk factors and countries likely associated with imported cases, and provides important insights to help plan and monitor national intervention strategies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Our globalized world means that most public health challenges cannot be tackled alone; they require unified and collaborative working across countries. Overseas fellowships offer an immersive experience that empowers nursing researchers to enhance global collaborations and synergize diverse research expertise from various cultural contexts. This enriched collaboration leads to more innovative solutions to public health issues and significantly enhances the overall impact of their research. This paper presents a self-reflection from the perspective of a community and public health nursing researcher, based in Hong Kong. During a 2-month research secondment at a university in the UK, I explored ways to leverage my fellowship to strengthen global connections, expand collaborations, and enhance my research capabilities in addressing health equity issues among LGBTQ+ populations, particularly concerning sexual violence. By sharing my journey, I aim to inspire more nursing researchers to engage with global academic communities and collectively advance global public health initiatives., (© 2024 Wiley Periodicals LLC.)

Objectives: Low-quality and precarious employment have been associated with adverse mental health and wellbeing. More evidence is needed on how the quality of employment trajectories - including transitions in and out of unemployment, inactivity, and employment of varying quality - are associated with individuals' mental health over time. This paper aimed to derive a typology of multidimensional employment trajectories and assess associations with mental health in the UK., Methods: Data from waves 1-9 of the UK Household Longitudinal Study were used (2009-2019). Individuals aged 30-40 at baseline were included (N=1603). Using multichannel sequence and clustering analyses, we derived a typology of employment trajectories across employment statuses and four employment quality indicators. We assessed associations with subsequent psychological distress, accounting for baseline mental health. Changes in average General Health Questionnaire scores are described., Results: A typology of five trajectory clusters highlighted stable and secure and precarious/low-quality trajectories for both men and women. Women who reported being economically inactive at most waves had higher odds of experiencing psychological distress than did women in 'standard' trajectories, regardless of baseline mental health. Women's scores of psychological distress in the 'precarious' group on average increased along their trajectories characterized by instability and transitions in/out of unemployment, before a move into employment. Men who likely moved in and out of unemployment and economic inactivity, with low probability of paid employment, reported increased psychological distress at the end of follow-up. This may partly be due to pre-existing mental ill-health., Conclusion: This paper shows the importance of high-quality employment for individuals' mental health over time. Researchers need to consider dynamic associations between employment quality and mental health across the life-course.

To investigate the association between chronic high temperature exposure and brain structure and how the association influences mental health, we conducted cross-sectional and prospective cohort studies within a sample of 41,552 UK Biobank participants. Chronic temperature exposure was assessed for each participant based on their residential histories and gridded reanalysis temperature data and defined as the percentage of days with a maximum temperature exceeding 27 °C over the last 20 years. Generalized additive models and difference-in-differences approaches were used to estimate the association between chronic high temperature exposure and neuroimaging outcomes obtained via brain MRI. Mediation analysis was performed to assess whether neuroimaging changes mediated the relationship between chronic high temperature exposure and behavioral decline. We observed chronic high temperature exposure was associated with widespread reduced brain volume, including global grey volume (-5859.32 mm³, 95% CI -6631.82 to -5086.83), white matter volume (-5482.47 mm³, 95% CI -6192.92 to -4772.03), regional grey matter volumes (especially in the cerebellum and brainstem), and subcortical structure volumes (especially in the accumbens, hippocampus, and thalamus). Furthermore, the association mediated depression and declined cognition. Chronic high temperature exposure also enhances age-related brain atrophy. Alterations in white matter tracts were also observed. In conclusion, our study provides multimodal MRI evidence of the adverse effects of chronic high temperature exposure on brain structure and mental health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The burden of diseases attributable to air pollution is comparable to those of global health risks such as unhealthy diets and tobacco smoking, with many air pollution sources also emitting climate heating gases. In this UK study we estimated the co-benefits of Net Zero (NZ) climate policy on the health benefits of air pollution reduction, increased active travel, outdoor exposure inequalities and indoor air pollution changes. The study focused on two of the largest UK sources, road transport and building heating, with comparisons made between NZ and UK existing policy, referred to as Business as Usual (BAU). Particulate matter (PM 2.5 ), Nitrogen Dioxide (NO 2 ) and Ozone (O 3 ) projections were made between 2019 and 2050, with emphasis placed upon the NZ co-benefits in 2030 and 2040. We compared the UK BAU scenarios with the Climate Change Committee's (CCC) Balanced Net Zero Pathway (BNZP) and Widespread Innovation (WI) pathway. Compared to BAU predictions, BNZP assumptions lead to more electric vehicles, reduced vehicle km, more low carbon building heating, and reduced emissions of NO 2 and PM 2.5 . By 2040 under BNZP, relative to BAU, the buildings sector was predicted to be three times more effective at reducing PM 2.5 than road transport. To help reduce the inequality gap the NZ building transition was tailored toward those most in need. Outdoor air pollution exposure inequalities prevailed across the socioeconomic spectrum, especially for NO 2 , but were less pronounced due in part to NZ policies. Core air quality health benefits for the BNZP buildings sector were £21.3 billion (16.4 to 26.2) by 2050 and £98.4 billion (75.7 to 121.1) by 2154. For the transport sector the health benefits were £9.1 billion (7.0 to 11.2) by 2050 and £36.5 billion (28.1 to 44.9) by 2154. NZ building sector operating costs did not achieve break-even via efficiency savings, but with Greenhouse Gas (GHG) (lower benefits) break-even was achieved in 2052. With additional air pollution health benefits, building-sector time to break-even improved by between 3.1 (2.5 to 4.7) and 6.3 (4.7 to 7.6) years to between 2046 and 2049. Analysis found that removing gas cooking at home, for NZ, may result in greater concentration reductions than outdoor air pollution for NO 2 . Net Zero health and economic co-benefits are large, as are the changes needed, requiring political leadership and public engagement. Our findings are relevant to other countries facing the NZ transition., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Current discussions about gender identity are increasingly politicised, particularly in the UK. An individual's body becomes a site of competing interests that attempt to regulate the physical, social and moral boundaries between biological sex and a socially realised gender. Care becomes defined within this context. The emerging biopolitics generates dividing practices that classify and regulate rather than situate a knowing subject, who is creatively and actively responsive. In response, our paper explores the value of biographical narratives when understanding how young adults negotiate their identity, within the context of social relationships and normative conventions, when experiencing (and articulating) gender questioning. Using testimonial experience from 18 young adults, aged between 19 and 30 years old, our analysis discusses participants' response to gender questioning before engaging with their exploration of gender, from childhood through to the present day. We consider how these young adults resolve gender questioning through reflexive engagement, seek legitimation and negotiate the response of others, as they seek care. Our conclusion, by providing insights into an actively constituted biographical experience, assesses the possibilities associated with more inclusive caring practices, in which an individual can flourish., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Creative well-being is an increasing field of interest to which biomedical and social sciences have made uneven contributions. The instrumental value of culture and its subsequential public investment is grounded in the interplay of social, cultural and economic capital to attain and preserve wellbeing and health and foster social mobility. The current evidence addresses the effectiveness of arts interventions in improving illnesses. Little attention has been paid to the social value of creative wellbeing for the general population. This paper is a rapid review and evidence synthesis that aims to answer the question, 'What is the social value of place-based arts and culture interventions at individual (wellbeing) and community (social inequalities) levels in the UK and Europe?'. After a systematic search of five databases, search engines, and a call for evidence in August 2022, 14 out of 974 sources met the inclusion criteria. Studies were organised into three themes (Community, Events, Museums), and outcomes were analysed considering the indicators and dimensions of wellbeing (Office for National Statistics). The review evidenced that creative wellbeing leads to improvements in wellbeing outcomes and can contribute to alleviating social determinants of health. However, considering their impact on the underlying causes of structural social inequalities requires caution., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Background: Although there is increasing evidence that environmental exposures are associated with the risk of neurodegenerative conditions, there is still limited mechanistic evidence evaluating potential mediators in human populations., Methods: UK Biobank is a large long-term study of 500,000 adults enrolled from 2006 to 2010 age 40-69 years. ICD-10 classified reports of dementia cases up to 2022 (Alzheimer's disease, vascular dementia, dementia in other classified diseases, and unspecified dementia) were identified from health record linkage. Estimates of residential air pollution, traffic noise, and greenspace exposure have been modelled. Structural brain MRI was conducted from 2014 to 2022, with brain volumes relevant to dementia identified a priori. Associations between environmental exposures, brain volumes, and dementia cases (diagnosed post-MRI) were tested using linear and logistic regression and adjusted for age, sex, household income, ethnicity, education, smoking, and area-level deprivation. Mediation of exposure-outcome associations by plausible brain volumes (those associated with both environmental exposure and dementia outcomes) were modelled using the quasi-Bayesian Monte Carlo method (N = 34,817-39,772)., Results: Small but significant mediating effects (2%-8% of relationships mediated) were observed between PM 2.5abs exposure and dementia risk by reduced total brain volume, NOx and Alzheimer's disease risk by reduced peripheral cortical grey matter, PM 2.5abs and vascular dementia risk by reduced peripheral cortical grey matter, PM 2.5abs and other dementia risk by reduced total grey matter, and PM 10 and other dementia risk by reduced total grey matter. Greenspace and noise were not associated with dementia outcomes in the subset of the cohort providing brain imaging data., Conclusions: This study adds to existing evidence of associations between environmental exposures and dementia outcomes. Our findings provide novel evidence that differences in brain volume may mediate these relationships. Future research is required to prove this mechanism and establish the other mechanisms through which exposure to air pollution might increase dementia risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The worldwide population is ageing, alongside an increase in cancer incidence rates. Over the past 10 years, there has been huge progress in the field of oncology with earlier diagnosis and an expansion of treatment options, leading to a growing number of older people living with cancer. That has meant that caring for older patients with cancer is now part of day-to-day oncology practices. This cohort often has geriatric syndromes and a higher prevalence of frailty and complex needs and preparing our clinical services to optimise care for these patients is essential. Whilst it is widely accepted that comprehensive geriatric assessments are of benefit to patients, only a small proportion of patients can access these through specialised teams during their cancer care. In the past few years there has been significant progress in this field throughout the United Kingdom (UK). The goal of this review is to inform other health care systems how to learn from what has been done in the UK. This paper provides an update from our previous review in 2020, detailing the new services being implemented and made available to patients and an expansion in the number of new pilot teams and research projects/trials throughout the four nations of the UK., Competing Interests: Declaration of Competing Interest Mark Baxter reports a relationship with Servier Monde that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Mark Baxter reports a relationship with Ipsen that includes: speaking and lecture fees and travel reimbursement. Mark Baxter reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. Mark Baxter reports a relationship with Merck Sharp & Dohme UK Ltd. that includes: speaking and lecture fees. Kirsty Balachandran reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. Anne Barrell reports a relationship with Roche that includes: travel reimbursement. Anne Barrell reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees. Anne Barrell reports a relationship with Novartis AG that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Pfizer Inc. that includes: board membership, speaking and lecture fees, and travel reimbursement. Nicolo Matteo Luca Battisti reports a relationship with Abbott that includes: board membership. Nicolo Matteo Luca Battisti reports a relationship with Sanofi that includes: board membership and speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Astellas Pharma Inc. that includes: board membership. Nicolo Matteo Luca Battisti reports a relationship with Exact Sciences Corporation that includes: travel reimbursement. Nicolo Matteo Luca Battisti reports a relationship with Eli Lilly and Company that includes: speaking and lecture fees and travel reimbursement. Nicolo Matteo Luca Battisti reports a relationship with AbbVie Inc. that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Roche that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Servier Monde that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with Gilead Sciences Inc. that includes: speaking and lecture fees. Nicolo Matteo Luca Battisti reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees. Kwok-Leung Cheung reports a relationship with Roche that includes: consulting or advisory. Kwok-Leung Cheung reports a relationship with Cancers that includes: travel reimbursement. Helen Brown reports a relationship with Roche that includes: funding grants. Fabio Gomes reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees and travel reimbursement. Fabio Gomes reports a relationship with Roche that includes: speaking and lecture fees and travel reimbursement. Fabio Gomes reports a relationship with Boehringer Ingelheim GmbH that includes: speaking and lecture fees and travel reimbursement. Fabio Gomes reports a relationship with Pfizer Inc. that includes: speaking and lecture fees and travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

By focusing on the experiences of employees living with coeliac disease as evidenced in UK employment tribunal cases, this paper interrogates the way practices of exclusion are performed in legal and organisational contexts that purport to promote values of inclusion. In paying attention to how differences are constructed and negotiated, the paper unpacks the way organisational practices mobilise an array of workplace mechanisms to produce complex dynamics of exclusion. Applying Laclau and Mouffe's logics of equivalence and difference, we show how questionable impulses and practices emerge in a workplace environment characterised by unclarity and vagueness. One impulse, for example, involves privatising and individualising the condition of employees with coeliac disease, giving rise to patronising and stigmatising attitudes that can turn them into victims. However, we also identify workplace mechanisms countering these tendencies, which can underpin forms of collective support in the struggle for recognition. Our study thus contributes to the body of sociological literature that pays attention to health-related workplace injustices by challenging the purported promotion of health-based inclusion through a focus on tribunal cases, leading to suggestions for further research into the way medical conditions are theorised and 'lived' at work., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Background: Late side effects of head and neck cancer treatment commonly affect swallowing function. Late radiation-associated dysphagia (late-RAD) often presents years post-treatment when patients have been discharged from their multidisciplinary team. Timely symptom management may provide important physical and emotional support, potentially reducing the overall healthcare burden. Speech and language therapists (SLTs) are key in the assessment and management of dysphagia but there is no current guidance in the late-RAD setting., Aims: The primary objective was to establish how late-RAD is assessed in both existing literature and by UK SLT. The study also aimed to explore UK SLT approaches to management., Methods: A dual methodology approach was taken. A scoping review (SR) of PubMed, Scopus, CINAHL, Web of Science and Embase databases was conducted between November and December 2022. Eligibility criteria included studies reporting dysphagia outcomes >2 years post-treatment with narrative data synthesis. Also, a survey of SLTs working in the United Kingdom was conducted between November 2023 and February 2024. Respondents were questioned about their current pathways and service provision for patients with late-RAD., Main Contribution: The SR included 39 studies. Dysphagia was assessed using three different toxicity grades; five patient-reported outcome measures (PROMs) and five clinical assessments. Five studies were multidimensional in their approach to data collection, whilst nine used PROMs alone and four used a toxicity grade alone. The survey received 56 responses. Only six respondents reported an existing late effect clinic (all tumour sites) in their region. A wide range of measures were used to assess dysphagia including 12 different PROMs. Instrumental assessments were used by most (98% Videofluoroscopy; 82% Fibreoptic Endoscopic Evaluation of Swallowing). Rehabilitation was offered by 86% and this was intensive in 34%. Late-RAD patient information was routinely provided by 35 respondents and usually within 1 year of treatment completion., Conclusion: A wide range of assessment methods and outcome measures were used to report dysphagia in existing literature but often in a unidimensional approach. In the United Kingdom, SLTs also use a variety of assessment tools and regularly offer intensive rehabilitation. Without consensus on how we measure late-RAD, synthesising evidence to guide service provision is challenging., What This Paper Adds: What is already known on the subject Late-RAD significantly affects swallowing function, often necessitating enteral feeding which in turn impacts emotional and health-related quality of life. There is no existing guidance on optimum pathways, assessment methods or effective treatment options. What this paper adds to existing knowledge This study highlights the lack of consensus in the evidence base regarding how to assess and measure late-RAD. In the United Kingdom, referral pathways are not well defined and there is wide variation on provision of information and specialist assessment and management of late-RAD. What are the potential or clinical implications of this work? Challenges in synthesising existing studies translate to variations in practice due to a lack of guidelines. Without a robust evidence base, patients will experience geographical variation in how they are supported with their late-RAD symptoms., (© 2025 Royal College of Speech and Language Therapists.)

Coastal scientists are increasingly advocating for nature-based coastal solutions (NBCS) to ensure long-term coastal sustainability. Implementing NBCS will change coastal landscapes, necessitating consultation with the wider public as such changes directly affect the socio-cultural values of coastal zone residents and users. We, therefore, investigate public willingness to support, preferences for, and perceived effectiveness of coastal management solutions, nature-based and otherwise, focusing on the UK as a case study. We do this through an online survey of >500 UK residents, capturing their demographics, place of residence, and coastal management perceptions. We apply inductive coding, statistical, and geospatial techniques to analyse our survey data. While we find consensus on the need for coastal management, there are divergent coastal management preferences and perceptions: NBCS are most preferred while hard defences are considered most effective. We find that people with coastal management and/or engineering experience are more convinced by NBCS effectiveness, while coastal residents believe in hard defences. Although NBCS may have several environmental benefits (e.g., coastal protection, carbon sequestration, greater biodiversity), we find that public knowledge on their likely effectiveness is limited. Therefore, if NBCS is deemed to be the way forward for coastal sustainability, more local stakeholder engagement on NBCS will be needed, potentially through systems mapping, in order to facilitate more robust and inclusive coastal management policies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Ensuring sustainable management of water is an indispensable part of sustainable development, however, the limelight on long-term health risk of water hardness is essential but remains inadequate. This study estimated effects of water hardness on the brain system to refine its systemic risk assessment. We assembled a cohort of 397,265 participants from the UK Biobank to investigate the associations of water hardness with neurodegenerative diseases and brain imaging phenotypes through modeling. We found water hardness in 0-120 mg/L elevated the incidence risks of Alzheimer's disease and vascular dementia compared to that in 120-300 mg/L, with hazard ratios of 1.13 (1.01, 1.27) and 1.24 (1.05, 1.46), respectively. Furthermore, the associations with partial cerebral atrophy were also observed, including the caudate nucleus and inferior parietal lobule. Our study provides insights into the importance of enacting more precise guidelines about water hardness and contributes to the achievement of the Sustainable Development Goals., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Osteopenia, osteoporosis, and fragility fractures pose a major public health concern. Population-level clinical and biopsychosocial data may uncover modifiable risk factors to target when developing whole person approaches to managing these conditions. The purpose of this study was to identify personal risk factors associated with osteoporosis, fragility fractures, and osteopenia from the United Kingdom Biobank (UKB) - a large population-level database., Methods: We performed a cross-sectional study using the UKB to evaluate the association between 39 systematically selected explanatory variables with a diagnosis of osteopenia, osteoporosis, or fragility fracture. Bivariate analysis was performed followed by multivariable logistic regression adjusting for multicollinearity using covariance testing., Results: Of 502,507 patients in the UKB, 40,657 had complete bone mineral density information from DEXA scans, and 32,193 had sustained a fragility fracture in the previous five years. In multivariable regression, increased time spent watching television (OR 1.15), living in an area with a high index of deprivation (OR 1.14), infrequent visits from friends and family (OR 1.09), experiencing symptoms of anxiety (OR 1.09), experiencing symptoms of depression (OR 1.08), and decreased exercise frequency (OR 1.03), were associated with increased risk of osteoporosis. Decreased exercise frequency (OR 1.27), increased BMI (OR 1.2), living in an area with a high index of deprivation (OR 1.11), and decreased salary (OR 1.10) were associated with increased risk of fragility fracture. Symptoms of anxiety (OR 1.15), living in an area with a high index of deprivation (OR 1.13), and increased time spent watching television (OR 1.11), living alone (OR 1.08), and symptoms of depression (OR 1.06), were associated with increased risk of osteopenia (p < 0.05 for all variables)., Conclusion: Analysis of population-level datasets reveal a range of modifiable mental, social, and lifestyle/behavioral health factors that can inform multidisciplinary team-based care, including strategies that respond to psychosocial concerns and sustaining healthy lifestyles and behaviors in patients experiencing osteoporosis, fragility fracture, and osteopenia. Future work should assess the impact of integrated, whole person management programs for these conditions on longitudinal outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required. Drawing on a 3-year multi-sited hospital ethnography, this paper examines everyday cultures of care in NHS acute hospital wards to interrogate how ethnicity, gender and social class intersects to shape the care of people living with dementia. Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others. Focussing on walking within the ward, with a large number of people living with dementia classified as 'wandering', we explore ways in which intersectional identities informed who was granted privileges to leave the bedside and 'wander' the ward, and who experienced further control. The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings., (© 2025 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

In this paper, we conceptualize the days of mourning that followed the passing of Queen Elizabeth II. as constituting a liminal occasion, a moment of in-betweenness through which we can explore sense-making in times of transition. How do people navigate through liminal occasions, and are they always transformative? Through a rapid response ethnography (N interviews  = 64, N participants  = 122), we were able to capture the raw moments within which a collective comes together, as part of a national ritual, to transition from 'here' to 'there'. In our data, liminality prompted participants to strategically define British national identity and its future by positioning the Queen as representative of Britishness, her loss as a national identity loss. No longer taken for granted, participants reasserted the value of the monarchy as an apolitical and unifying feature in an otherwise divided society, characterizing the continuity of the institution as an essential part of British identity and society. The analysis illustrates how liminality offers a useful conceptual tool for addressing how temporality and change are negotiated in relation to a shared identity, and how navigating transitional moments brings with it political implications for the future., (© 2024 The Author(s). British Journal of Social Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery., Methods: This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case surgical patients were recruited on the day of surgery. Baseline data including patient characteristics; procedure details; pre-operative analgesic use; pre-existing pain; and quality of life scores were recorded. Patients were followed up through automated short message service messages. Short-term (postoperative days 1, 3 and 7) outcomes included: quality of recovery; pain severity; impact of pain on function; and analgesic use. Longer-term outcomes (postoperative day 97) included: quality of life; analgesic use; incidence of chronic post-surgical pain; and incidence persistent postoperative opioid use. Additional outcomes were completed by those patients with chronic post-surgical pain and persistent postoperative opioid use, with 30 patients recruited to a qualitative semi-structured interview study exploring postoperative expectations, recovery, postoperative pain and opioid use., Results: An embedded pilot study at four sites recruited 129 patients. Responses to the automated short message service were gained from 129 patients (100%) at day 1; 116 (89.9%) at day 3; 108 (83.7%) at day 7; and 77 (59.7%) at day 97 postoperatively. The pilot enabled refinement of the methods and processes before the national roll out., Conclusion: This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery., (© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

This paper explores the application of positionality and reflexivity drawing on the experience of a British Minority Ethnic (BME) group senior nurse researching nurses with the same ethnic heritage in an IPA study. It explores how using IPA informed reflexivity and positionality as a researcher who shared the same ethnicity with the research participants. The IPA study allowed for the exploration of Internationally Educated Nurses' (IENs) perspectives on their integration into British healthcare and their navigation of career progression. The central aims of an IPA study are to understand the participant's world, its description, the development of a clear, and open interpretative analysis with a descriptive focus on the social, cultural and theoretical context, and the participant's sense-making of their lived experience. In this paper, we discuss how the lead researcher employed reflexivity, stated his intentionality and positionality in the conduct of the IPA study. This paper discusses some examples of the effects of positionality and reflexivity in the conduct of research by researchers of different racial background, and explicate the influence of personal and professional experiences of a researcher in using reflexivity and positionality to ensure cross-cultural validity and reliability of an IPA research. This paper concludes that appropriate use of reflexivity and positionality in an IPA study may recognise the personal and professional influence of a researcher's experiences on the research process, including their ethnicity., (© 2024 The Author(s). Nursing Inquiry published by John Wiley & Sons Ltd.)

After cutting social security in recent decades, the UK, Ireland, and Australia expanded income-support programs during the pandemic. Relatively overlooked, this paper investigates policy responses among younger generations, the socioeconomic disparities therein, and whether and which of these policies, now rolled back, were most beneficial. I rely on longitudinal survey data on adolescents and their caregivers. In value-added regressions adjusting for pre-pandemic health reports, I find that children reported better average health in households with access to the relatively generous scheme adopted by Australia. Girls reported better health in households targeted by previous cutbacks, including those with lower incomes (Australia, Ireland) or headed by a single parent (Australia). The more far-reaching programs in Ireland and Australia were associated with better health also among children in well-off households. On the other hand, some children reported worse mental health despite receipt of payments in the UK and Ireland. Further distributional analyses suggest that programs might have reduced adolescent health disparities in Australia, whereas overall effects were negative or mixed in the UK and Ireland. Hence, policy changes during the pandemic did not equally fit the needs of all children. Nonetheless, drawing lessons from that period, changes to existing income-support programs hold some promise to temper distress and associated inequalities across generations., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Evidence suggests that high levels of air pollution and less green space increase depressive symptoms in adults. However, results are mixed and cross-cohort comparisons are scarce, largely due to heterogeneity in exposure assessment. Also, the impact of these exposures on the trajectory of depressive symptoms over time has been less studied. We investigated the association of air pollution and green space with depressive symptoms in adulthood and whether these exposures modify the trajectory of depressive symptoms leveraging harmonized data from four population-based cohorts across the Netherlands and United Kingdom (UK)., Methods: We analyzed data from the Dutch Famine Birth Cohort (DFBC) (n = 840, baseline ages: 56-61), and the Rotterdam Study (RS) (RS-I n = 4,049, baseline ages: 61-101 and RS-II n = 2,861, baseline ages: 55-99), in the Netherlands, and the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 17,100, baseline ages: 18-71) in the UK, each using a different validated instrument for depressive symptoms, with 3-11 repeated measures. European-wide environmental data was linked to participants' addresses at baseline. Linear mixed-models were used to estimate associations of air pollution and green space with standardized cohort-specific depressive symptoms, and whether these exposures modify the trajectory of depressive symptoms., Results: Long-term exposure to fine particulate matter (PM 2.5 ) was positively associated with overall higher standardized depressive symptom scores in ALSPAC and RS-I (β per 10 μg/m 3 increase in PM 2.5 : 0.07 SD, 95%CI 0.02, 0.11 and 0.13 SD, 95%CI 0.02, 0.24, respectively). Exposure to higher normalized difference vegetation index (NDVI) at 300 m buffer was associated with lower depressive symptoms in DFBC (β per 0.1 increase in NDVI: 0.08, 95%CI -0.14, -0.01). In RS-II, the positive effect of higher NDVI at 300-m buffer on depressive symptoms decreased over time, but this effect was very small (β per 0.1 increase in NDVI: 0.01 SD per year, 95%CI 0.00, 0.01)., Conclusion: Air pollution in the form of particulate matter as well as green space were associated with depressive symptoms across multiple cohorts. In the majority of cohorts, depressive symptoms increased with age, but we found little evidence that trajectories of depressive symptoms are influenced by exposure to environmental variables., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Unhealthy sleep patterns and accelerated biological age are frequently associated with multiple chronic respiratory diseases (CRDs), including COPD, asthma, and interstitial lung disease (ILD). However, few studies have explored the role of biological age in the relationship between sleep patterns and CRDs., Objectives: To explore the association between sleep patterns and CRD, and the extent to which biological age mediates the relationship between sleep patterns and CRD., Methods: This was a prospective cohort study based on UK Biobank. The sleep score was derived from five self-reported sleep traits: sleep duration, daytime sleepiness, chronotype, snoring, and insomnia. The score ranged from 0 (least healthy) to 5 (healthiest). Biological age was represented by PhenoAgeAccel., Results: Among 303,588 participants, 11,105 (3.7 %), 9,380 (3.1 %), and 1,667 (0.5 %) were diagnosed with asthma, COPD, and ILD, respectively. Each 1-point increase in the sleep score was associated with a 0.156-year reduction in PhenoAgeAccel, and 14.3 %, 12.4 %, and 6.7 % reduction in asthma, COPD, and ILD, respectively. For each 1-year increase in PhenoAgeAccel, the risk of asthma, COPD, and ILD increased by 2.8 %, 4.3 %, and 5.7 %, respectively. PhenoAgeAccel mediated the associations between the sleep score and asthma, COPD, and ILD, with a mediated proportion (95 % CI) of 2.81 % (2.35 % to 3.27 %), 4.94 % (4.23 % to 5.66 %), and 12.48 % (10.43 % to 14.53 %), respectively., Conclusion: A better sleep score was significantly associated with younger biological age and decreased risk of CRDs, with biological age playing a mediating role in the association between sleep score and CRDs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The Doughnut model's application to determine sustainability outcomes has thus far been primarily based upon indirect quantitative-based approaches. Therefore, the challenge has been how to directly determine and evaluate sustainability outcomes from a Doughnut-based assessment. In this paper, a direct determination and evaluation of the sustainability of the United Kingdom's environment-human system for the period 1992-2015 from a Doughnut-based assessment is conducted, based upon the application of the Sustainability Dynamics Framework (SDF). The fundamental methodology adopted consisted of: (i). Development of a new scoring criteria framework to convert the indicator-threshold ratios of biophysical boundaries and social threshold indicators into scores; (ii). Determination of the annual indicated values of the Environment (E), Human Needs and Interests (HNI), and Sustainability (S); (iii). Fourier analysis to indicatively determine the dynamics of the UK environment-human system; and (iv). Dynamic modelling of the dynamics of Sustainability (S), Total capital (K), the Earth System (N-A) and dE/dt occurring. The results indicate that the UK's environment-human system was consistent with very weak sustainability throughout the specified period, based upon obtained S-values which were within the range of [+0.075 ≤ S(t) ≤ +0.158] over the specified period. This was due to a declining and fundamentally compromised environmental system caused by the significant exceedance of the biophysical boundaries, and the near-total to total fulfilment of the social thresholds. These outcomes were further supported by the Fourier transformation plots, which indicated increasing dynamic perturbations occurring within the UK environment-human system over the specified period. The paper concludes that the UK will not achieve a state consistent with operating within the safe and just operating space (SJOS), if it continues along its current development pathway. Without fundamental and transformative actions, then there is the realistic possibility of a systemic crisis occurring due to the UK's operating considerably beyond its SJOS., Competing Interests: Declaration of competing interest The author declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Pregnant women and their unborn babies are at an increased risk of hospitalisation, morbidity, and mortality from illness. However, uptake of influenza, pertussis and Covid-19 vaccinations offered during pregnancy is below the desired rate. This research aims to explore UK midwives' experiences of approaching and discussing vaccinations with pregnant women, and their perceived role in pregnant women's vaccination decisions., Methods: Midwives in the West Midlands, UK were recruited via participating hospitals and midwife specific social media groups. Interviews were conducted remotely from April to July 2023 and analysed with a deductive codebook coding strategy using thematic analysis., Findings: Semi-structured interviews were conducted with 16 midwives identifying the following key themes: Recommendations to have vaccinations reported on the contents of recommendations and how they are communicated; Messages and guidance included the importance of up-to-date informational needs for midwives to administer vaccinations and the barriers caused by uncertainty and conflicting messages about the Covid-19 vaccine during pregnancy; Delivery of vaccinations included the convenience of offering vaccinations during standard antenatal appointments; and Midwives' barriers explored the pandemic specific and other barriers midwives face in the administering of vaccinations., Discussion: These findings contribute to the understanding of how midwives discuss the topic of vaccinations with pregnant women. This research highlights the importance for midwives to receive clear and consistent information. A strong emphasis on why vaccines are important when recommending to pregnant women in addition to standard information on the availability and timing may have a bearing in helping women to make informed decisions about accepting vaccinations., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Debra Bick is Editor in Chief of Midwifery, but all editorial decisions from submission to final decision have been undertaken by one of ‘Midwifery's’ associate editors. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Recently, the American Heart Association introduced Life's Essential 8 (LE8) as a new cardiovascular health (CVH) metric, and studies have reported associations between LE8 and CVH outcomes. However, there is limited understanding of LE8's impact on the risk of transitions between different stages of CVH. The current study investigated whether adhering to LE8 during a healthy stage could mitigate the progression from hypertension (HT) to cardiovascular diseases (CVDs), and consequent death., Methods: The study included 107,682 participants in the UK Biobank who were initially free of HT and CVDs. CVH were evaluated using LE8 metrics (diet, physical activity, nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure). Multistate models were used to analyse the impacts of LE8 on the progression of CVDs., Results: During a median follow-up of 12.2 years, 5727 participants developed HT, 7243 developed CVDs, and 1183 died afterwards. LE8 was negatively associated with the dynamic disease progression. A per-10 points increase of CVH scores was significantly associated with the reduced risk [Hazard ratios (95 % confidence intervals)] at 0.71 (0.69, 0.72), 0.83 (0.81, 0.85), 0.79 (0.77, 0.82), and 0.91 (0.86, 0.96) in the transition from healthy to HT, CVDs, death, and from CVDs to death, respectively. Mediation analyses indicated that HT significantly mediated LE8-reduced risks of CVDs and mortality., Conclusions: This study offered evidence that LE8 may influence the stages of CVD progression. The findings underscore the significance of adhering to LE8 in health management and CVDs management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

The high prevalence of food insecurity in the United Kingdom has been exacerbated by the cost-of-living crisis. In high-income countries, those experiencing food insecurity struggle to buy and consume foods that meet Government healthy eating recommendations, and are at increased risk of obesity, linked to poor diet quality. Individuals in high-income countries purchase most of their food to consume at home from supermarkets, making this an important context within which healthier and environmentally sustainable food purchasing should be supported. However, the lived experience of supermarket food purchasing in people living with obesity and food insecurity has not been explored in depth. Adults, living in England and Scotland, who self-identified as living with obesity and food insecurity and looking to reduce their weight, were recruited to take part in semi-structured interviews (n = 25) or focus groups (n = 8) to explore their experience of shopping for food in the supermarket. Using thematic analysis, four main themes were generated: 1) the Restricted Consumer; restrictions around the type of food purchased, where food can be purchased and the resulting emotional toll, 2) the Conscious Consumer; decision making and effortful practices both in preparation of and during the shopping trip, 3) Mitigating the Rising Cost of Food; agency and actions taken to mitigate high food prices, 4) Stigma; instances of perceived and/or experienced weight and poverty-related stigma and the physical actions and cognitive social comparisons used to minimise stigma. Findings provide insights for evidence-based policy on the need for upstream changes within the wider food system to address the social determinants of health and support people living with obesity and food insecurity to eat healthier and more sustainable diets., Competing Interests: Declaration of competing interest CAH declares research funding from the American Beverage Association (paid to institution), primary supervision of a PhD studentship funded by Coca-Cola, and personal honoraria from International Sweeteners Association and International Food Information Council for work unrelated to the submitted paper. EH, FD, RAS, AJ, HG and MD report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background & Aims: Plant-based diets benefit human health, while the deficient in some nutrients limits its application. We aimed to examine whether balanced diets could be better in reducing diabetes risk than plant-based diets., Methods: In cross-sectional analysis of Environment-Inflammation-Metabolic-Diseases Study (EIMDS), we used a questionnaire to investigate the habit of balanced and plant-based diets. In the prospective analysis of UK Biobank, we used the plant-based diet index of health (hPDI) and unhealth (uPDI) to evaluate the plant-based diets, and defined the balanced diet as a daily intake of 5 categories and at least 12 types of food. After analyzing proteomic data in UK Biobank, we explored the causal relationship between signature proteins of balanced diets and incident diabetes based on summary-data-based Mendelian randomization (SMR)., Results: Compared to participants who had plant-based diets, those who had balanced diets showed a lower risk of diabetes in EIMDS (Odd Ratio 0.65, 95%CI 0.44-0.95). In UK Biobank, after excluding participants with unhealthy plant-based diets, participants with balanced diets still showed a lower diabetes risk than participants with plant-based diets (Hazard Ratio 0.86, 95%CI 0.77-0.95). Proteomic analysis identified 107 downregulated and 2 upregulated proteins that were associated with higher and lower risk of diabetes, respectively. In SMR analyses, the downregulated signature proteins of balanced diets (AGR2, DBI, IL17RA and SERPINH1) were causally associated with diabetes incidence., Conclusion: Adhered to a balanced diet is associated with a lower risk of diabetes compared to plant-based diet, which might be attributed to signature proteins such as AGR2, DBI, IL17RA and SERPINH1., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The purpose of this paper is to assess whether the COVID-19 pandemic affected the health behaviours of men and women differently, and to estimate whether the associations between health behaviours and mental health differed by gender. By employing nationally representative panel data (UKHLS) and a difference-in-differences strategy, we provide evidence that the pandemic adversely affected health behaviours among women more than men in the UK. Compared to men, women were 3.2 percentage points less likely to adopt a healthy lifestyle and reported 0.09 fewer healthy behaviours (corresponding to 7.0 per cent of a standard deviation) during the pandemic. These changes are primarily driven by smaller improvements rather than absolute declines in health behaviours for women compared to men. The changes in health behaviours among women appear to persist over time when lockdown policies were relaxed. Importantly, we find that the pandemic considerably weakened the protective effect of health behaviours on mental health for women but not for men. For women, adopting a healthy lifestyle was strongly correlated with mental health before the pandemic, but this relationship was no longer significant during the pandemic. This loss in significance corresponds to a 0.61-points decline in the GHQ-12 Likert score, equivalent to 10.5 per cent of a standard deviation. However, we observe a partial return of the protective effect of health behaviours on mental health once lockdown measures had eased., Competing Interests: Declaration of competing interest No conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Decisions about ethnic groups studied in health research shape recommendations. If a group is not included in research, its ability to call for policy change is limited. Despite health inequalities for the Irish in Britain in the 20th century, recent research on health is likely to combine the White Irish with White British, whereas Irish people of colour are not mentioned at all. This paper aims to understand why the interest in this group has declined. A state-of-the-art literature review of 140 papers on Irish health in Britain from 2001 to 2023 was conducted. Findings show the Irish are still disadvantaged in mortality, mental health and suicide, with important socioeconomic status and gender disparities. The shifting way the Irish are constructed over time is critically examined, paying attention to historical depictions and postcolonial identities. Sociological theories of migration are challenged by the Irish because this migrant group does not conform to theoretical assumptions. The Irish may have dropped from the agenda because of incorrect assumptions about assimilation and the relationship between Ireland and the UK. Given that the health outcomes of the Irish in Britain differ from those of the White British population, they should be recognised in health research as a distinct group., (© 2025 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)