Spending work or leisure time in nature-based settings has positive impacts on health and wellbeing especially for those experiencing stress or those with poorer physical health, mental health or wellbeing. This research examined the impact of participation in a sustainable green infrastructure and landscape management project delivered through Down to Earth at a National Health Service (NHS) hospital site. The three participant groups comprising healthcare staff (n = 27), NHS patients (n = 37) and community participants (n = 22) experienced changes in one or more self-reported measures over time. Patient and community participants showed reductions in self-reported anxiety, boredom and sense of failure. Healthcare staff showed increased resilience, wellbeing, community connection, and connection to nature alongside a reduction in common mental health symptoms. These findings reveal positive impacts of "working in/with nature" on wellbeing and mental health, and provide novel evidence of their potential for improving the health/wellbeing of healthcare workers within their workplace.

On average single individuals commonly report worse mental health outcomes than partnered individuals. With the population of single adults quickly growing it is important the mechanism that relates singlehood to worse mental health outcomes is better understood. We conducted a scoping review to summarise the literature on the relationship between singlehood and mental health, and to evaluate the extent to which ultimate level perspectives are included in the current research. Of the 181 papers, from the PsycINFO databases, included in this review the consistent finding was that single individuals reported worse mental health oucomes. An inductive thematic analysis of these sources was used to identify patterns within the literature, with four clusters of commonly associated data items reflecting different singlehood identities (Widowed & Lonely Women, Never-Partnered & Childless Women, Male Involuntary Singles and Low-Socioeconomic Status Single Parents). Similar mental health outcomes were found for single men and women but the factors influencing this relationship were sexually differentiated in ways consistent with evolutionary theory. Childlessness and age were found to be more important in the outcomes of single women, compared to sexual access and voluntariness of singlehood in the outcomes of single men. With only a small number of exceptions, the literature broadly ignores ultimate levels of analysis and evolutionary explanations for the negative impacts of singlehood and accompanying sex differences. We provide a detailed discussion of how evolutionary theory could be used to shed light on the extant literature and call for future research to consider ultimate as well as proximate perspectives.

This scoping review aimed to identify factors associated with vaccination decisions among pregnant women in the UK, guided by the SAGE matrix on vaccine hesitancy, and explored differences between qualitative and quantitative findings and between vaccine intentions (attitudes) and actual uptake (behaviors). Embase®, MEDLINE®, PsycInfo, Web of Science, and Cochrane were searched; rapid review methodologies were applied. From 2,326 records, 49 primary studies were included (published 2010-2025). We identified 222 qualitative factors from 32 studies, and 114 quantitative factors from 30 studies. Qualitative studies frequently reported individual and group influences, particularly beliefs and attitudes about vaccine effectiveness and safety, and the role of healthcare professionals in decision-making. Quantitative studies highlighted sociodemographic influences, including older age, ethnicity, and lower social/economic deprivation. Factors found to be associated with vaccination intention vs. uptake were inconsistent, though these findings should be interpreted cautiously given the modest number of studies addressing this issue.

ObjectivesMyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term debilitating illness characterised by profound and persistent fatigue (JAMA: The Journal of the American Medical Association, 313, 2015, 1101). The current study aims to explore the experiences of women with ME/CFS living with their partners during the COVID-19 pandemic in the United Kingdom.DesignThe study adopted a qualitative design comprising semi-structured interviews with participants. Interviews were analysed using thematic analysis (TA).MethodsParticipants were women with ME/CFS (n = 21) recruited through ME/CFS support groups in the United Kingdom. All participants were in romantic relationships and lived with their partners.ResultsData were organised into three themes: (1) lockdown disrupting routine, (2) reducing difference and (3) fear of getting COVID-19. People with ME/CFS found that lockdown disrupted their well-established routines. Although routines were disrupted by partners and increased working-from-home practices, participants found having partners at home helpful. People with ME/CFS believed that the changes induced by the pandemic reduced the differences between themselves and the outside world which, prior to lockdown, had felt prominent. They were fearful of getting COVID-19 as they believed this would make their ME/CFS worse. This meant that for people with ME/CFS, the lifting of the lockdown restrictions was an anxiety-provoking time, hence impacting symptoms. People with ME/CFS continued to adhere to government guidelines after national restrictions were eased.ConclusionsThis study outlines the experiences of women with ME/CFS during COVID-19, alongside the long-term impact this has had due to the changes that the pandemic imposed. These findings may have implications for those with long COVID.

Evidence suggests that chronic cortisol excess may precede the development of an allostatic load, and that this association may be influenced by the level of work stress. This study aims to investigate the associations between hair cortisol concentration and the development of systemic allostatic load cross-sectionally and at a lag of four years, stratified by level of effort-reward imbalance.The sample consisted of respondents from the English Longitudinal Study of Ageing (ELSA) who were in employment with hair cortisol measurements at baseline (wave 6), and allostatic load markers at baseline and follow-up (wave 8; n=411; 64% female). Hair cortisol was used as a measure of total cortisol expression over the preceding two months. Allostatic load was modelled as a count-based index using nine markers; three per system, across the immune, metabolic and cardiovascular systems. This model was then grouped by a median-cut effort reward-imbalance scale (0.83) and regression pathways were compared between groups using a series of Chi-Squared tests of difference. Results provide evidence that higher hair cortisol concentrations predict an increase in immune and cardiovascular allostatic load cross-sectionally, and a metabolic allostatic load at a lag of four years. These pathways were found in the high effort-reward imbalance group, but not in the low effort-reward imbalance group. There were also significant differences found between groups for hair cortisol concentration as a predictor of concurrent immune and cardiovascular allostatic load Findings may indicate a novel temporality to the accumulation of an allostatic load, and that the “tipping point” between allostasis and allostatic load may lie within the ability of the HPA axis to regulate the cardiovascular system concurrently, with longitudinal consequences for metabolic syndrome indicators.

The majority of research into the impact of chronic occupational stress on allostatic load lacks insight into the underlying biological mechanisms. This study examines whether hair-derived cortisol mediates the relationship between poor psychosocial job quality and allostatic load in a multivariate mediation model with repeated outcomes over four years. Data from 411 ELSA respondents in employment with hair cortisol measurements at wave 6 and allostatic load markers at waves 6 and 8 (64% female) were analysed. Job quality was modelled as a latent variable using indicators of job content. Hair cortisol represented HPA axis reactivity over the preceding two months. Allostatic load index was grouped by system; immune (insulin-like growth factor 1, c-reactive protein, fibrinogen), metabolic (hba1c, triglycerides, total/HDL cholesterol) and cardiovascular (systolic and diastolic blood pressure, pulse). Poor job quality was associated with immune and metabolic dysregulation, and a blunted cortisol response at wave 6. There were small, significant mediation effects from job quality to levels of systemic allostatic load via cortisol; immune and cardiovascular dysregulation at wave 6, and metabolic dysregulation at wave 8. Cortisol showed the strongest association with cardiovascular measures at baseline, and over the four-year period predicted a switch from an elevated immune response to immunosuppression, and the maintenance of metabolic syndrome symptoms. This study indicates temporality in the accumulation of an allostatic load, providing evidence that hair cortisol partly mediates the mechanism through which poor job quality "gets under the skin" to produce longitudinal differences in systemic dysregulation.

Objective To explore UK public decisions around whether or not to get COVID-19 vaccines, and the facilitators and barriers behind participants’ decisions. Design This qualitative study consisted of six online focus groups conducted between 15 th March and 22 nd April 2021. Data were analysed using a framework approach. Setting Focus groups took place via online videoconferencing (Zoom). Participants Participants (n = 29) were a diverse group (by ethnicity, age and gender) UK residents aged 18 years and older. Results We used the World Health Organization’s vaccine hesitancy continuum model to look for, and explore, three main types of decisions related to COVID-19 vaccines: vaccine acceptance, vaccine refusal and vaccine hesitancy (or vaccine delay). Two reasons for vaccine delay were identified: delay due to a perceived need for more information and delay until vaccine was “required” in the future. Nine themes were identified: three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six main barriers (Preference for “natural immunity”; Concerns over possible side effects; Perceived lack of information; Distrust in government;; Conspiracy theories; “Covid echo chambers”) to vaccine uptake. Conclusion In order to address vaccine uptake and vaccine hesitancy, it is useful to understand the reasons behind people’s decisions to accept or refuse an offer of a vaccine, and to listen to them and engage with, rather than dismiss, these reasons. Those working in public health or health communication around vaccines, including COVID-19 vaccines, in and beyond the UK, might benefit from incorporating the facilitators and barriers found in this study.

Respiratory infections place a significant burden on individuals, healthcare systems and society. This short report discusses early findings from an ongoing longitudinal survey study as part of the wider Community Action on Respiratory Infections Cymru (CARI) study. An initial baseline survey was sent to a large sample of predominately older adults in Wales in December 2022 and January 2023 (n=3476) (f = 63%; white = 98%; age, M=62.94 (SD=12.83)). Follow-up ‘symptom surveys’ are being sent to random sub-samples of the overall sample at regular intervals throughout winter 2022/3. Results find that intentions to get future COVID-19 vaccinations are high, but that prevalence of infection-reducing behaviours was generally low. Additionally, although overall worry about respiratory infections was relatively low, there was greater worry about COVID-19 relative to flu and other viruses. Amongst those experiencing symptoms, flu was perceived as the most common cause, and a high temperature, continuous cough and fever were most likely to lead people to take specific precautions like taking a COVID-19 test or seeking medical advice. Findings have implications for public health, including the need to provide nuanced but clear public health information and guidance on what actions to take when people are experiencing symptoms of a respiratory illness.

Health communication has relevance for virtually every aspect of health and well-being, including disease prevention. This review explored the effectiveness of communications in enhancing the adoption of or adherence to behavioural interventions (non-pharmaceutical interventions (NPIs)) related to COVID-19. The review takes the UK as a case study and focuses on self-reported behaviours (e.g. social distancing). It also reviews the psychosocial determinants of adherence. Searches were conducted using PubMed, Scopus, CINAL, ASSIA and iCite databases. Eleven thousand five hundred records were identified and 13 were included in the final sample. Included studies suggest that NPI adoption or adherence was generally high, and communication had significant impacts, with key themes including clarity and consistency, trust and control. Based on the evidence in this review, features of effective communication in the context of NPI adoption or adherence are (i) information should be conveyed clearly and conflicting (mixed) messages should be avoided; (ii) information should be conveyed by trusted sources (e.g. health authorities) and (iii) communication should strike a balance between being authoritative but avoiding language seen as controlling (e.g. 'you must'). Future research should prioritize quantitative, experimental and longitudinal study designs, that focus specifically on communication as an intervention, and which measure behaviour. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Objective. Desmoid-type fibromatosis (DF), a rare benign tumour with similar treatment options to cancer, can adversely impact people’s lives, yet little qualitative research addressing patients’ experiences of DF exists. The present study aimed to understand the day-to-day experiences of individuals with DF and their experiences of healthcare. Methods. Semistructured, qualitative interviews were conducted by phone or email with 20 participants. Inductive thematic analysis was performed, structured with the Framework approach. Results. Many participants reported delays in diagnosis. This was attributed to them ignoring their symptoms or to healthcare professionals lacking awareness of DF. Healthcare experiences varied, with some participants expressing good support. Others felt unsupported, viewing staff as dismissive of difficulties. Comparisons between DF and cancer were commonly discussed. Some participants felt relieved that they did not have cancer; others perceived that their needs were secondary to cancer patients and believed they were treated as less important. Participants discussed negative impact of DF on psychosocial well-being. Chronic pain and activity limitations seemed to impact mood and relationships. Conclusion. Greater awareness and understanding of DF by health professionals may help to reduce diagnostic delay and improve support. Individuals may benefit from being treated by specialist DF teams.

This report summarises the findings of the public views during the Covid pandemic (PVCOVID) study, conducted between March 2020 and November 2022. PVCOVID included a longitudinal qualitative study of a cohort of members of the UK public, documenting in real-time their attitudes and experiences of the pandemic. The report documents people's experiences of, and compliance with, non- pharmaceutical interventions (NPIs) including lockdowns and social distancing, testing, contact tracing and self-isolation, facemask use, as well as their attitudes towards vaccines. Key lessons for the future include: Build trust in government and use trusted messengers; Tackle misinformation; Ensure rules and guidance are clear and consistent; Balance providing too much with too little information; and Provide greater support for social distancing and isolation, including emotional and mental health support.

This review summarises the extant literature investigating the relation between traffic-related air pollution levels in and around schools and executive functioning in primary-school-aged children. An electronic search was conducted using Web of Science, Scopus, and Education Literature Datasets databases (February 2020). Review articles were also searched, and forwards and backwards searches of identified studies were performed. Included papers were assessed for quality. We included 9 separate studies (published in 13 papers). Findings suggest that indoor and outdoor particulate matter with a diameter of 2.5 μm or less (PM2.5) negatively influences executive function and academic achievement and that indoor and outdoor nitrogen dioxide (NO2) adversely affects working memory. Evidence for the effects of particulate matter with a diameter of 10 μm or less (PM10) is limited but suggests potential wide-ranging negative effects on attention, reasoning, and academic test scores. Air pollution in and around schools influences executive function and appears to impede the developmental trajectory of working memory. Further research is required to establish the extent of these effects, reproducibility, consequences for future attainment, and place within the wider context of cognitive development.

Objectives The study explored public attitudes and behaviours in relation to COVID-19 two years into the pandemic. Design This Qualitative study consisted of online focus groups carried out between 15th-30th June 2022. Data were analysed using a framework approachSetting Focus groups took place via online videoconferencingParticipants Participants (n= 28) were all UK residents aged 18 years or older, representing a range of gender and ethnic backgrounds, invited from the Public Views during the Covid Pandemic (PVCOVID) study.Results Most participants reported feeling ‘back to normal’, not having thought much about COVID-19 recently, and were not wearing masks or socially distancing. Lack of media coverage was a big factor cited, as was the perception that new variants were ‘milder.’ A minority of participants were still wearing masks or socially distancing and some argued they felt ‘reconditioned’ to be more cautious or less socially active. Identifying COVID-19 symptoms, and distinguishing them from flu was challenging, with some suggesting they would test on ‘instinct’ or if they felt very unwell. Intention to take a COVID-19 test and to socially distance if unwell was generally high. There was a modest appetite for future boosters, with those already triple-jabbed suggesting they would receive another dose in future, particularly if it was officially recommended. Some participants argued they would only change their behaviour if the situation was ‘serious’ (e.g. if the death rate increased significantly). Most participants said they would adopt more caution if there was a future wave, although many argued that the lack of trust caused by UK political figures breaking rules (‘Partygate’) would harm future compliance. Conclusions. The study suggests that the ‘Living with COVID’ strategy and the relative lack of media coverage have contributed to a sense of things being ‘back to normal’. If future developments in the pandemic require behavioural change, public health policy and communication will need to overcome this perception and barriers such as a lack of trust in government and the perception of the virus as milder.

OBJECTIVE The study explored the impacts of an economic crisis – the UK’s ‘cost of living crisis’ – on mental and physical health from the perspectives of people themselves. It also explored how people coping with this crisis, and as a secondary objective, explored if, and if so how, the COVID-19 pandemic was shaping, their experiences or views of the cost of living crisis.DESIGN This qualitative study consisted of online focus groups carried out between September 14th- 29th 2022. Data were analysed using a thematic approach.SETTING Focus groups took place via (Zoom) videoconferencing.PARTICIPANTS Participants (n= 28) were all UK adults, recruited as part of the Public Views during the Covid Pandemic (PVCOVID) study.RESULTS Most participants, and particularly those on low or insecure income or living in deprived communities, felt that the cost of living crisis was having negative impact on their mental and emotional health and wellbeing. Analysis generated five main themes, three related to why the cost of living crisis was affecting their health: (1) Anxiety over an uncertain future; (2) Worry about others; (3) A loss of control and two related to the ways in which people were coping, or trying to cope, with the crisis: (1) Resilience and Family and community support. CONCLUSIONS. This study found that the cost of living crisis is having significant impacts on health, particularly on the mental health of those on low- or insecure-incomes or from deprived communities. Further research and policy investment is needed to explore ways to provide emotional as well as practical/financial support for those most vulnerable to economic crises.