'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK

OBJECTIVE: To explore the perspectives of young people in the UK on obesity, body size, shape and weight. DESIGN: Systematic review of qualitative studies using thematic synthesis. DATA SOURCES: Sensitive searches of 18 electronic databases from 1997 to February 2010 supplemented by grey literature searches. STUDY SELECTION: Studies produced since 1997 using qualitative methods to collect perspectives of people aged 12-18 years in the UK, reporting methods for data collection or analysis. Studies of people with eating disorders and those rated low in reliability and usefulness were excluded. RESULTS: Searches identified 30 studies involving over 1400 young people from a range of contexts. Young people of all sizes placed considerable emphasis on personal responsibility, and on the social, rather than health implications of being overweight. Young people with experience of obesity described severe, unrelenting, size-related abuse and isolation. Regardless of their own size, young people were judgemental of individuals who were overweight, but those with experience of obesity described an environment that contained multiple barriers to weight loss. Only one study asked young people directly what might support them to have a healthy body size. Study findings were configured under three main themes, labelled with quotes from included studies: general perceptions of size and society's responses ('It's on your conscience all the time'); the experiences of young people who were overweight ('If I had the choice I wouldn't be this size') and these larger young people's experiences of trying to loose weight and suggestions for action ('Make sure, even when it's hard, you've got people there'). CONCLUSIONS: The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world. Research and policy need to engage young people actively so as to address the social implications of obesity

Human well-being impacts of terrestrial protected areas

© 2013 Pullin et al.; licensee BioMed Central Ltd. Background: Establishing Protected Areas (PAs) is among the most common conservation interventions. Protecting areas from the threats posed by human activity will by definition inhibit some human actions. However, adverse impacts could be balanced by maintaining ecosystem services or introducing new livelihood options. Consequently there is an ongoing debate on whether the net impact of PAs on human well-being at local or regional scales is positive or negative. We report here on a systematic review of evidence for impacts on human well-being arising from the establishment and maintenance of terrestrial PAs. Methods: Following an a priori protocol, systematic searches were conducted for evidence of impacts of PAs post 1992. After article title screening, the review was divided into two separate processes; a qualitative synthesis of explanations and meaning of impact and a review of quantitative evidence of impact. Abstracts and full texts were assessed using inclusion criteria and conceptual models of potential impacts. Relevant studies were critically appraised and data extracted and sorted according to type of impact reported. No quantitative synthesis was possible with the evidence available. Two narrative syntheses were produced and their outputs compared in a metasynthesis. Results: The qualitative evidence review mapped 306 articles and synthesised 34 that were scored as high quality. The quantitative evidence review critically appraised 79 studies and included 14 of low/medium susceptibility to bias. The meta-synthesis reveals that a range of factors can lead to reports of positive and negative impacts of PA establishment, and therefore might enable hypothesis generation regarding cause and effect relationships, but resulting hypotheses cannot be tested with the current available evidence. Conclusions: The evidence base provides a range of possible pathways of impact, both positive and negative, of PAs on human well-being but provides very little support for decision making on how to maximise positive impacts. The nature of the research reported to date forms a diverse and fragmented body of evidence unsuitable for the purpose of informing policy formation on how to achieve win-win outcomes for biodiversity and human well-being. To better assess the impacts of PAs on human well-being we make recommendations for improving research study design and reporting

Mindful networks? Navigating and negotiating life and work in academia.

In this chapter I unpack my use of social networks (and social media) as a means of being more mindful about the role of research and scholarship in the construction of my academic identity. I have found it to be a restless, shifting identity that has to be carefully and continually navigated and negotiated. On the one hand, I explain how participation in social networks has actively shaped my sense of academic community and also the scholarly relationships that contribute strongly to my academic health and wellbeing. On the other hand, I question the extent to which social networking and the use of social media in academia allow truly mindful practices to be enacted. For example, I sometimes worry that social networking for academic purposes through social media contributes to the acceleration of higher education practice – never switching off, always being connected – potentially further exacerbating academics’ levels of labour, stress and pressure. By reflecting upon and analysing my scholarly use of Twitter and Instagram I explore how this practice (usually) keeps me acting mindfully as an academic and evaluate the extent to which it enables me to engage better in the complex cognitive and emotional demands of working in higher education. Finally, I reflect upon my recent change of both role and institution, which saw me unexpectedly and temporarily suspend my regular use of social media for academic purposes.N/

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Police Pre-Arrest Diversion of People with Mental Health Issues: A Systematic Review of the Impacts on Crime and Mental Health

Mental health is recognised as a part of the ‘core business of policing’ (Adebowale, 2013; Butler, 2014). Changes in community mental health services mean that the police constitute the ‘first emergency service’ for people experiencing a mental health crisis (Lamb et al, 2002). The nature of policing and mental health in England and Wales, however, is complex and challenging. Officers do not have sufficient resources to deal with people with mental health issues (PMHI) or assist individuals in crisis (Home Affairs Select Committee, 2015). PMHI who are suspected of an offence can be cautioned, arrested and/ or taken into police custody. Typically involving low level offences, anti-social behaviour or ‘survival crimes’ (Hiday, 1999), such arrests are considered to be unnecessary or contributing to the ‘criminalisation of mental illness’ (Butler, 2014; Reuland et al., 2009; Teplin, 1985). Alternatively, an individual in need of ‘immediate care or control’ can be detained under section 136 of the Mental Health Act (1983). Such individuals are often taken to police custody cells, rather than NHS Mental Health Section 136 suites, due to lack of capacity in the health system (HMIC, 2013; NHS Confederation, 2015)