'First, do no harm': are disability assessments associated with adverse trends in mental health? A longitudinal ecological study.

In England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist-the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies. METHOD: We used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health. RESULTS: Each additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities. CONCLUSIONS: The programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits

Fit-for-work or fit-for-unemployment? Does the reassessment of disability benefit claimants using a tougher work capability assessment help people into work?

Background Many governments have introduced tougher eligibility assessments for out-of-work disability benefits, to reduce rising benefit caseloads. The UK government initiated a programme in 2010 to reassess all existing disability benefit claimants using a new functional checklist. We investigated whether this policy led to more people out-of-work with long-standing health problems entering employment. Method We use longitudinal data from the Labour Force Survey linked to data indicating the proportion of the population experiencing a reassessment in each of 149 upper tier local authorities in England between 2010 and 2013. Regression models were used to investigate whether the proportion of the population undergoing reassessment in each area was independently associated with the chances that people out-of-work with a long-standing health problem entered employment and transitions between inactivity and unemployment. We analysed whether any effects differed between people whose main health problem was mental rather than physical. Results There was no significant association between the reassessment process and the chances that people out-of-work with a long-standing illness entered employment. The process was significantly associated with an increase in the chances that people with mental illnesses moved from inactivity into unemployment (HR=1.22, 95% CI 1.03 to 1.45). Conclusions The reassessment policy appears to have shifted people with mental health problems from inactivity into unemployment, but there was no evidence that it had increased their chances of employment. There is an urgent need for services that can support the increasing number of people with mental health problems on unemployment benefits

Food bank operational characteristics and rates of food bank use across Britain

Background Food banks are a common community-based response to household food insecurity in high-income countries. While the profile of their users and nature of the quality of food they provide have been researched, few studies have examined their operational characteristics to explore the accessibility of their services for people at risk of food insecurity. This study describes the nature of operations in a food bank network operating in Britain and explores how operations are associated with volume of use. Methods Data from The Trussell Trust Foodbank’s network of 1145 distribution centres in 2015/16 on hours of operation, locations, and usage were combined with national statistics on Working Tax Credit claimants, disability and unemployment. Descriptive statistics focused on how often and when food banks were open within local authorities. The relationships between operational characteristics and volume of use were examined using regression analyses. Interaction terms tested how relationships between indicators of need with food bank usage changed with operational characteristics. Results Weekday operating hours were primarily between the hours of 10 a.m. and 2 p.m., but at any given hour no more than 20% of distribution centres were open, with fewer than 3% open after 4 pm. Where food banks had fewer distribution centres and operating hours, the volume of food bank usage was lower. In-work poverty, disability, and unemployment rates were all associated with higher volume of usage; however, the relationship between disability and food bank use was modified by the density of food banks and number of operating hours. Where food banks were less accessible, the relationship between disability and food bank use was diminished. Conclusions These findings suggest operational characteristics are an important part of access to food banks and raise questions about the ability of food banks to meet the needs of people at risk of food insecurity in Britain

Health professionals’ experiences and perspectives on food insecurity and long‐term conditions : A qualitative investigation

© 2019 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.Peer reviewedPublisher PD

Determination of the high-pressure crystal structure of BaWO4 and PbWO4

We report the results of both angle-dispersive x-ray diffraction and x-ray absorption near-edge structure studies in BaWO4 and PbWO4 at pressures of up to 56 GPa and 24 GPa, respectively. BaWO4 is found to undergo a pressure-driven phase transition at 7.1 GPa from the tetragonal scheelite structure (which is stable under normal conditions) to the monoclinic fergusonite structure whereas the same transition takes place in PbWO4 at 9 GPa. We observe a second transition to another monoclinic structure which we identify as that of the isostructural phases BaWO4-II and PbWO4-III (space group P21/n). We have also performed ab initio total energy calculations which support the stability of this structure at high pressures in both compounds. The theoretical calculations further find that upon increase of pressure the scheelite phases become locally unstable and transform displacively into the fergusonite structure. The fergusonite structure is however metastable and can only occur if the transition to the P21/n phases were kinetically inhibited. Our experiments in BaWO4 indicate that it becomes amorphous beyond 47 GPa.Comment: 46 pages, 11 figures, 3 table

Angular and energy dependence of ion bombardment of Mo/Si multilayers

The process of ion bombardment is investigated for the fabrication of Mo/Si multilayer x-ray mirrors using e-beam evaporation. The ion treatment is applied immediately after deposition of each of the Si layers to smoothen the layers by removing an additional thickness of the Si layer. In this study the parameters of Kr+ ion bombardment have been optimized within the energy range 300 eV-2 keV and an angular range between 20 degrees and 50 degrees. The optical performance of the Mo/Si multilayers is determined by absolute measurements of the near-normal-incidence reflectivity at 14.4 nm wavelength. The multilayer structures are analyzed further with small-angle reflectivity measurements using both specular reflectivity and diffuse x-ray scattering. The optimal smoothening parameters are obtained by determining the effect of ion bombardment on the interface roughness of the Si layer. The optimal conditions are found to be 2 keV at 50 degrees angle of incidence with respect to the surface. These settings result in 47% reflectivity at 85 degrees (lambda = 14.4 nm) for a 16-period Mo/Si multilayer mirror, corresponding to an interface roughness of 0.21 nm rms. Analysis shows that the interface roughness is determined by ion induced viscous flow, an effect which increases with ion energy as well as angle of incidence. In order to determine the effect of intermixing of the Si and Mo atoms, the penetration depth of the Kr+ ions is calculated as a function of ion energy and angle of incidence. Furthermore, the angular dependence of the etch yield, obtained from the in situ reflectivity measurements, is investigated in order o determine the optimal ion beam parameters for the production of multilayer mirrors on curved substrates. (C) 1997 American Institute of Physics

The benefit sanction: a correctional device or a weapon of disgust?

The benefit sanction is a dominant activation policy in Britain’s ‘welfare-to-work’ regime. While policymakers believe in their necessity to correct behaviour, research shows benefit sanctions cause additional harm to Britain’s marginalised groups. Drawing upon a small-scale qualitative study, this article first navigates new territory, mapping the ways stigma emerges from the state – channelled through the benefit sanction – and manifests in the lives of sanctioned claimants. Acknowledging wider evidence, the sanction is then argued to have failed as a correctional device. Rather, taking into account Britain’s current politico-economic climate, the sanction appears as a weapon used to incite negative emotion in an attempt to police the boundaries of the labour market, while frequently abandoning some of the UK’s most vulnerable citizens

Living on the edge: precariousness and why it matters for health

The post-war period in Europe, between the late 1940s and the 1970s, was characterised by an expansion of the role of by the state, protecting its citizens from risks of unemployment, poverty, homelessness, and food insecurity. This security began to erode in the 1980s as a result of privatisation and deregulation. The withdrawal of the state further accelerated after the 2008 financial crisis, as countries began pursuing deep austerity. The result has been a rise in what has been termed ‘precariousness’. Here we review the development of the concept of precariousness and related phenomena of vulnerability and resilience, before reviewing evidence of growing precariousness in European countries. It describes a series of studies of the impact on precariousness on health in domains of employment, housing, and food, as well as natural experiments of policies that either alleviate or worsen these impacts. It concludes with a warning, drawn from the history of the 1930s, of the political consequences of increasing precariousness in Europe and North America