Social support and cardiovascular disease risk reducing behaviours for people with severe mental illnesses in primary care

Background People with severe mental illness (SMI) have an increased risk of cardiovascular disease (CVD). Research in the general population suggests that social support may protect against CVD morbidity and mortality, however little is known about social support and cardiovascular health in people with SMI. Objectives For people with SMI: 1. Assess the effectiveness of CVD risk-reducing interventions that involve supportive others 2. Develop and integrate a social support strategy into a CVD risk-reducing intervention in primary care 3. Explore the relationship between social support and cardiovascular health behaviours 4. Describe how existing social support was explored within initial appointments in a CVD risk reducing intervention in primary care. Methods Systematic review, longitudinal and cross-sectional observational study and qualitative thematic analysis of intervention appointments. Results Few studies were identified on effective interventions that used existing support networks to improve cardiovascular health in people with SMI. Recommendations for involving supportive others in CVD risk reduction were identified from focus groups, workshops and UK clinical guidelines These included exploring how to involve supportive others, respecting confidentiality and identifying strategies for those without social support. Higher social support predicted significantly greater appointment attendance in unadjusted but not adjusted analyses and greater medication adherence. There was no association between higher perceived social support and greater physical activity, healthier diet, lower alcohol use or being a non-smoker. Social support was explored in first appointments, with most participants identifying a supportive other. Reasons to involve others included companionship, positive feedback and health improvements for supportive others and participants. Some participants described family or friends as negative influences on their health. Conclusions Perceived social support may be an important facilitator for adherence to CVD medications, but there was limited evidence for an association between perceived social support and other CVD health behaviours in people with SMI. Harnessing positive social relationships within interventions should be considered as a strategy for encouraging uptake of CVD health behaviours in people with SMI. Further work is needed to develop interventions that increase social support and improve health outcomes for people with SMI who have limited social contacts

Crafting the Academy: Writing Sociology and Disciplinary Legitimacy

This thesis is an ethnographic study of the craft of writing in U.K. sociology. Centred around key concepts of consecration and value, the thesis uses Pierre Bourdieu's theory of practice to examine the relationship between the craft of writing and becoming or feeling legitimate within sociology. The thesis sits within a context of debates in sociology which have examined the idea of disciplinarity: what is sociology’s history, practice, and purpose? However, whilst sociologists have paid significant attention to the construction of the discipline and even how ‘the discipline’ writes, no one has yet examined this from the perspective of individual sociologists and the everyday of their writing practices and processes. This thesis addresses the gap in the research. The work here is based on a year-long ethnography of ten academics working in U.K. sociology departments. The thesis contributes significantly to understanding the relationship between macro-level structures of power and domination (institutional power and structural social inequality), and how this is felt and engaged with on a micro/everyday level, through writing. It adds an original perspective to considering how legitimacy is produced in sociological knowledge, and understood to reside in/with sociologists themselves. Crucially, the ethnography adeptly demonstrates that underpinning these consecrated intellectual and institutional positions are structures of ‘race’, class, and gender inequality. As such, the thesis shows how legitimate(d) ideological disciplinary positions interpolate with institutional racism, sexism, and classism in elite and exclusionary fashions. Thus, this study of the craft of writing in sociology gives original access to means by which the reproduction of power and privilege is done on a micro, everyday level. Moreover, the research here gives cause for hope: participants’ accounts show where hegemonic power may be challenged and interrupted. They mark where change may begin

Cellular senescence: immunosurveillance and future immunotherapy

In response to persistent DNA damage, induction into cell senescence promotes an immunogenic program which facilitates immune clearance of these damaged cells. Under physiological conditions, senescent cells can activate both innate and adaptive immune responses, functioning to maintain tissue homeostasis. In addition, emerging findings suggest that programmed induction of cell senescence may be important for regulating reproductive processes, partly facilitated by immune clearance. However, likely owing to ageing of the immune system, a failure to eliminate senescent cells can contribute to their persistence in tissues, leading to the development and progression of age-related diseases. Such immune failure may in part be due to activation of the senescence program in immune cells, leading to their dysfunction. Furthermore, senescent cells under certain biological contexts have been shown to instead promote immune suppression, a response that may reflect differences between an acute verses chronic senescent phenotype. In this review, we provide an overview of the research to date concerning senescence immunosurviellance, including a focused discussion on the mechanisms by which macrophages may recognise senescent cells. Senescence immunotherapy strategies as an alternative to senolytics for the removal of senescent cells will also be discussed

What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) framework

Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities. Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants working in arts in health, we engaged in a three-phase process: 1) scoping review to inform the development of an initial framework; 2) consultation on the initial framework; and 3) analysis and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of  project, people, and  contexts.  Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The  people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation.  Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, ingredients may interconnect or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and articulation of what an arts in health activity entails

Community and cultural engagement for people with lived experience of mental health conditions: what are the barriers and enablers?

Background: Community and cultural engagement can support recovery, help symptom management and increase social connections for people with lived experience of mental health conditions. However, research suggests that people with mental health conditions experience significant barriers to participation. The aim of this study was to explore barriers and enablers of participation in community and cultural activities among people with mental health conditions. Methods: A qualitative interview study with 23 people with mild-to-moderate mental health conditions was undertaken. Data were analysed thematically, and themes were mapped to domains of the Capability, Opportunity and Motivation Model of Behaviour (COM-B). Results: Eleven themes were identified from the analysis. Three themes involved participant Capability: physical skills, psychological traits and physical health limitations and three themes related to Opportunity: affordability and accessibility, structure and nature of the group, and support from others to attend. Five themes mapped to Motivation: creative identity, recovery and coping, enjoyment and fun, connecting with others, and information and planning. Participants were motivated to engage with community and cultural activities through “a creative identity”, belief that engagement would help recovery from mental illness, and a desire to connect with others and make friends. Motivation to participate was sustained by the enjoyable nature of activities. However, participants’ ability to engage was hampered by the expense, inaccessibility and sometimes unstructured nature of activities, and social anxiety associated with attending. Some participants had physical limitations such as fatigue or physical health problems to overcome. Interventions that could address these barriers include peer support, training for social prescribers to account for identity and previous experiences of participation, training for community organisations in providing a welcoming and structured environment, and provision of long-term sustainable funding to community organisations to subsidise attendance, transport or equipment costs. Conclusion: People with mental health conditions may be at risk of experiencing barriers to community and cultural engagement due to existing social inequalities and social anxiety, however believing that involvement will support mental health was an enabler to participation. Future studies are needed to test the effectiveness of potential interventions to address the barriers and harness the facilitators identified here, to enable a more socially inclusive community and voluntary sector, and a potentially more responsive and effective social prescribing service in the UK for people experiencing mental health problems

Socioeconomic and psychosocial adversities experienced by freelancers working in the UK cultural sector during the COVID-19 pandemic:A qualitative study

There are concerns that the socioeconomic consequences of COVID-19, including unemployment and financial insecurity, are having adverse effects on the mental wellbeing of the population. One group particularly vulnerable to socioeconomic adversity during this period are those employed freelance within the cultural industry. Many workers in the sector were already subject to income instability, erratic work schedules and a lack of economic security before the pandemic, and it is possible that COVID-19 may exacerbate pre-existing economic precarity. Through interviews with 20 freelancers working within the performing arts, visual arts, and film and television industries, this article explores the impact of the pandemic on their working lives. Findings suggest the pandemic is affecting the psychological wellbeing of freelancers through employment loss, financial instability and work dissonance, and illustrates the need for urgent economic and psychosocial support for those employed within the cultural sector

Exploring Barriers and Facilitators to Physical Activity during the COVID-19 Pandemic: A Qualitative Study

Quantitative data show that physical activity (PA) reduced during the COVID-19 pandemic, with differential impacts across demographic groups. Qualitative research is limited; thus, this study aimed to understand barriers and facilitators to PA during the pandemic, focusing on groups more likely to have been affected by restrictions, and to map these onto the capability, opportunity, motivation model of behaviour (COM-B). One-to-one interviews were conducted with younger (aged 18–24) and older adults (aged 70+), those with long-term physical or mental health conditions, and parents of young children. Themes were identified using reflexive thematic analysis and were mapped onto COM-B domains. A total of 116 participants contributed (aged 18–93, 61% female, 71% White British). Key themes were the importance of the outdoor environment, impact of COVID-19 restrictions, fear of contracting COVID-19, and level of engagement with home exercise. Caring responsibilities and conflicting priorities were a barrier. PA as a method of socialising, establishing new routines, and the importance of PA for protecting mental health were motivators. Most themes mapped onto the physical opportunity (environmental factors) and reflective motivation (evaluations/plans) COM-B domains. Future interventions should target these domains during pandemics (e.g., adapting PA guidance depending on location and giving education on the health benefits of PA)

Understanding changes to perceived socioeconomic and psychosocial adversities during COVID-19 for UK freelance cultural workers

There is a dearth of qualitative research exploring how freelancers working in the cultural industries have been affected during COVID-19. In particular, there is a lack of research exploring how socioeconomic and psychosocial adversities may have changed or evolved, and how these changes have been perceived and subjectively experienced by freelance cultural workers. This study builds on qualitative interviews carried out in July–November 2020 (n = 20) by exploring findings from follow-up interviews conducted in May–July 2021 (n = 16). It presents an inequality of experiences connected to a range of socioeconomic and psychosocial factors, showing how some freelancers experienced small changes (e.g. to the kind of work carried out), with others experiencing major changes (e.g. leaving the sector completely). It concludes with a call for highly bespoke financial and psychological support, as well as a need to rethink what cultural value is for this workforce in the “new normal”, considering changing valuing processes

Exploring the provision and support of care for long-term conditions in dementia: A qualitative study combining interviews and document analysis

Background: The challenge of managing multiple long-term conditions is a prevalent issue for people with dementia and those who support their care. The presence of dementia complicates healthcare delivery and the development of personalised care plans, as health systems and clinical guidelines are often designed around single condition services. Objective: This study aimed to explore how care for long-term conditions is provided and supported for people with dementia in the community. Methods: In a qualitative, case study design, consecutive telephone or video-call interviews were conducted with people with dementia, their family carers and healthcare providers over a four-month period. Participant accounts were triangulated with documentary analysis of primary care medical records and event-based diaries kept by participants with dementia. Thematic analysis was used to develop across-group themes. Findings: Six main themes were identified from eight case studies: 1) Balancing support and independence, 2) Implementing and adapting advice for dementia contexts, 3) Prioritising physical, cognitive and mental health needs, 4) Competing and entwined needs and priorities, 5) Curating supportive professional networks, 6) Family carer support and coping. Discussion: These findings reflect the dynamic nature of dementia care which requires the adaptation of support in response to changing need. We witnessed the daily realities for families of implementing care recommendations in the community, which were often adapted for the contexts of family carers’ priorities for care of the person living with dementia and what they were able to provide. Realistic self-management plans which are deliverable in practice must consider the intersection of physical, cognitive and mental health needs and priorities, and family carers needs and resources