Local Inequalities in Health Behaviours: Longitudinal Findings from the Stockton-On-Tees Cohort Study.

This paper provides a longitudinal examination of local inequalities in health behaviours during a period of austerity, exploring the role of 'place' in explaining these inequalities. Data from the Stockton-on-Tees prospective cohort study of 836 individuals were analysed and followed over 18 months (37% follow-up). Generalised estimating equation models estimated the deprivation gap in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity practices) between the 20% most- and least-deprived neighborhoods (LSOAs), explored any temporal changes during austerity, and examined the underpinning role of compositional and contextual determinants. All health behaviours, except for frequent physical activity, varied significantly by deprivation (p ≤ 0.001). Smoking was lower in the least-deprived areas (OR 0.21, CI 0.14 to 0.30), while alcohol use (OR 2.75, CI 1.98 to 3.82) and fruit and vegetable consumption (OR 2.55, CI 1.80 to 3.62) were higher in the least-deprived areas. The inequalities were relatively stable throughout the study period. Material factors (such as employment, education and housing tenure) were the most-important and environmental factors the least-important explanatory factors. This study suggests that material factors are the most important 'place' determinants of health behaviours. Health promotion activities should better reflect these drivers.

Impact of occupational heat stress on worker productivity and economic cost.

Heat stress is a growing concern in the occupational setting as it endangers worker health, safety, and productivity. Heat-related reductions in physical work capacity and missed workdays directly and indirectly cause productivity losses and may substantially affect the economic wellbeing of the organization. This review highlights the physiological, physical, psychological, and financial harms of heat stress on worker productivity and proposes strategies to quantify heat-related productivity losses. Heat stress produces a vicious-cycle feedback loop that result in adverse outcomes on worker health, safety, and productivity. We propose a theoretical model for implementing an occupational heat safety plan that disrupts this loop, preventing heat-related productivity losses while improving worker health and safety.

Mind the gap from research laboratory to clinic: Challenges and opportunities for next-generation assays in human diseases.

Modern vaccinology has experienced major conceptual and technological advances over the past 30 years. These include atomic-level structures driving immunogen design, new vaccine delivery methods, powerful adjuvants, and novel animal models. In addition, utilizing advanced assays to learn how the immune system senses a pathogen and orchestrates protective immunity has been critical in the design of effective vaccines and therapeutics. The National Institute of Allergy and Infectious Diseases of the National Institutes of Health convened a workshop in September 2020 focused on next generation assays for vaccine development (Table 1). The workshop focused on four critical pathogens: severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and human immunodeficiency virus (HIV)-which have no licensed vaccines-and tuberculosis (TB) and influenza-both of which are in critical need of improved vaccines. The goal was to share progress and lessons learned, and to identify any commonalities that can be leveraged to design vaccines and therapeutics.

"Whatever Did Ever Happen to the Likely Lads"? Social Change, Mobility, Class, and Identity in the UK 1969-2019.

This paper reflects upon issues of class and identity in the UK over the last 50 years. 1969 is a useful starting point, economically and technologically it can be regarded as the high tide of the vision of a Britain remade in what the then Prime Minister Harold Wilson had termed "the white heat of technology." That technology had produced Concord the world's first supersonic airliner which made its debut that year. This successful Anglo French collaboration also showed how Britain was rapidly moving into a different relationship with Europe a process that culminated in the UK's entry into the EEC or the "common market" as it was more usually referred to on January 1st 1973. Sociologically, it marked the publication of Goldthorpe et al. Affluent worker studies, which examined the idea that increasing affluence was breaking down established class structures, roles and attitudes. This debate about whether the changing nature of work brought with it a fundamental change in class structure and identity has been going on ever since. It has subtly changed and this is to be expected, 50 years is a long time. However, it is generally accepted that the change to economic and social policy that had followed the second world, social mobility was increasingly evident by the late sixties and continued into the seventies. Over the years issues of not only social class but de-industrialization, social mobility, regional decline, globalization, and its impact on policy have been added to the mix. Furthermore, "Brexit" is part of this debate and partly a product of it, however this paper doesn't have the space required to examine this. The title of this paper relates to Dick Clement and Ian La Frenais sitcom "Whatever happened to the Likely Lads" (WHTTLL) which was first broadcast by the BBC in 1973. It focusses on the relationship between 2 young men in their late 20's Bob and Terry. They come from the same place, have similar backgrounds and have been friends since childhood. But their lives are now at a crossroads. Whilst Bob is attempting to grasp new opportunities, Terry is skeptical and to some degree baffled by the change going on around him. The future of class in an era of social mobility also raised questions about aspiration and identity. These are questions which are now less prominent within discourse on class. The debate around class today is arguably less concerned with the mainstream and has become focussed on extremes looking at either poverty, criminality, dispossession or sometimes the lifestyles of a superrich elite. In summary then this paper will look at the changing ideas, and narratives that have surrounded social class and social mobility over the past half century within the context of the UK, it will do that by reflecting on my own personal biography and the themes raised in "Whatever happened to the Likely Lads" (WHTTLL).

Assessing work disability for social security benefits: international models for the direct assessment of work capacity.

PURPOSE: It has been argued that social security disability assessments should directly assess claimants' work capacity, rather than relying on proxies such as on functioning. However, there is little academic discussion of how such assessments could be conducted. METHOD: The article presents an account of different models of direct disability assessments based on case studies of the Netherlands, Germany, Denmark, Norway, the United States of America, Canada, Australia, and New Zealand, utilising over 150 documents and 40 expert interviews. RESULTS: Three models of direct work disability assessments can be observed: (i) structured assessment, which measures the functional demands of jobs across the national economy and compares these to claimants' functional capacities; (ii) demonstrated assessment, which looks at claimants' actual experiences in the labour market and infers a lack of work capacity from the failure of a concerned rehabilitation attempt; and (iii) expert assessment, based on the judgement of skilled professionals. CONCLUSIONS: Direct disability assessment within social security is not just theoretically desirable, but can be implemented in practice. We have shown that there are three distinct ways that this can be done, each with different strengths and weaknesses. Further research is needed to clarify the costs, validity/legitimacy, and consequences of these different models. Implications for rehabilitation It has recently been argued that social security disability assessments should directly assess work capacity rather than simply assessing functioning - but we have no understanding about how this can be done in practice. Based on case studies of nine countries, we show that direct disability assessment can be implemented, and argue that there are three different ways of doing it. These are "demonstrated assessment" (using claimants' experiences in the labour market), "structured assessment" (matching functional requirements to workplace demands), and "expert assessment" (the judgement of skilled professionals). While it is possible to implement a direct assessment of work capacity for social security benefits, further research is necessary to understand how best to maximise validity, legitimacy, and cost-effectiveness.

Personal Protective Equipment for Filovirus Epidemics: A Call for Better Evidence.

Personal protective equipment (PPE) is an important part of worker protection during filovirus outbreaks. The need to protect against a highly virulent fluid-borne pathogen in the tropical environment imposes a heat stress on the wearer that is itself a safety risk. No evidence supports the choice of PPE employed in recent outbreaks, and standard testing procedures employed by the protective garment industry do not well simulate filovirus exposure. Further research is needed to determine the appropriate PPE for filoviruses and the heat stress that it imposes.

Help for heroes? Evaluating a case management programme for ex-service personnel in the United Kingdom.

AIMS: There is increasing recognition of the health and social needs of ex-service personnel, but the UK evidence base on interventions is small. This article presents the findings from an evaluation of a vocational case management programme co-funded by the National Health Service (NHS) to prevent ill health among ex-service personnel. METHODS: Qualitative, semi-structured interviews with 15 ex-service personnel were conducted. Five interviews with case management staff were also undertaken. Data were transcribed, thematically coded and analysed using NVivo. RESULTS: Ex-service personnel valued the service and consistently highlighted 'being listened to', 'being made to feel valued by programme staff', 'having their problems taken seriously' and 'being treated as an individual' as the most valuable aspects of the programme. Respondents particularly valued the personal support that case managers provided and the environment in which the service was delivered. CONCLUSION: Case management is a viable way in which the military, health professionals and support services can provide ongoing support for ex-service personnel in transitioning successfully to civilian life.

Go slow: an umbrella review of the effects of 20 mph zones and limits on health and health inequalities.

BACKGROUND: Transport is an important determinant of health and there is a well-established association between socio-economic status (SES) and risk of road accidents. Effective traffic calming interventions such as 20 mph zones and limits may therefore improve health and reduce health inequalities. METHODS: Systematic review methodology was used to identify systematic reviews of the effects of 20 mph zones (including speed limits and road humps) and 20 mph limits on health and SES inequalities in health amongst adults and children. RESULTS: Five systematic reviews were included. Overall, they provide convincing evidence that these measures are effective in reducing accidents and injuries, traffic speed and volume, as well as improving perceptions of safety in two of the studies. There was also evidence that such interventions are potentially cost-effective. There was no evidence of the effects on SES inequalities in these outcomes. CONCLUSION: Twenty mile per hour zones and limits are effective means of improving public health via reduced accidents and injuries. Whilst there was no direct evidence on the effects of interventions on health inequalities, targeting such interventions in deprived areas may be beneficial. Further controlled evaluations that specifically examine SES effects are required.

'We are volunteers and that sometimes gets forgotten': exploring the motivations and needs of volunteers at a healthy living resource centre in the North East of England.

AIMS: This article explores the motivations and needs of volunteers in the delivery of community health services at a healthy living resource centre in the North East of England, United Kingdom. METHODS: Four focus groups involving a total of 16 participants were conducted between March and May 2013. All sessions were digitally recorded with prior consent from participants. Data were then transcribed, thematically coded and analysed using NVivo software. RESULTS: Relevant training tailored to individual needs is required in order to avoid alienating volunteers. Successful communication is also central to fostering positive relationships between volunteers and staff members within organisations. Finally, it is vital that the contribution volunteers make is fully recognised and appreciated. CONCLUSION: The place of volunteers within public services and their role in delivery have become increasingly prominent in recent years. Training, alongside clear communication and recognition of the contribution volunteers make, can help improve the experiences of those choosing to volunteer within the health services.

Working group consultation: alloimmunity as a vaccine approach against HIV/AIDS: National Institutes of Health Meeting Report, May 24, 2012.

Alloimmunization vaccine strategies propose to avoid the problem of the extreme antigenic variability of human immunodeficiency virus (HIV) by instead focusing on the cellular antigens incorporated into HIV virions as they bud from infected cells. This report summarizes a Consultation meeting convened by the National Institute of Allergy and Infectious Diseases, National Institutes of Health on May 24, 2012. The objectives of the meeting were to (1) reach a consensus on the essential questions surrounding alloimmunization as a strategy for vaccine design against HIV, and (2) determine the experimental elements that might be needed for addressing these questions in an optimized pilot framework nonhuman primate (NHP) protocol for allogeneic immunization. The Consultation revisited the rationale and concerns of vaccination to induce allogeneic immunity, one of the most potent natural immune responses. The panelists' consensus was that a carefully designed skin graft transplant pilot experiment, in major histocompatibility complex (MHC) disparate male Mauritian cynomolgus macaques (MCM; Macaca fascicularis), would be useful for initially evaluating if alloimmunization results in an effective or even a partially effective safe AIDS vaccine. A successful NHP study for allogeneic immunization would provide further opportunities to explore vaccine-elicited immune and genetic correlates of protection against the acquisition of viral infection.

Preclinical AIDS vaccine research: survey of SIV, SHIV, and HIV challenge studies in vaccinated nonhuman primates.

This current supplementary and systematic survey of 237 preclinical AIDS vaccine challenge/protection studies in nonhuman primates enumerates and broadly describes the recent status of different vaccine strategies in macaque and chimpanzee experimental models. Published studies since the previous survey were compiled and categorized by their vaccine types, challenge parameters, and challenge results. These models have supportively verified that some prophylactic vaccine approaches, though rarely preventing infection (which is observed in these models with some passively administered antibody-based vaccines), can control to some degree primate lentivirus replication and disease development, and this is encouraging because it places more potentially effective immunogens on the precipice for early clinical studies. Many of these promising approaches may benefit from more testing in mucosal challenge models, and resources will be needed to follow more of these partially protected vaccinees for longer periods.