Covid and the common good: In-group out-group dynamics and Covid-19 vaccination in Wales and the United States.

Vaccination is a social act, where benefits spill-over to third parties. How we approach such social decisions is influenced by whether likely beneficiaries share salient social identities with us. This study explores these dynamics using representative survey data from two contexts: national identity groups in Wales (N = 4187) and political partisans in America (N = 4864). In both cases, those in the minority in their local area were less likely to be vaccinated. In Wales, respondents who did not identify as Welsh were less likely to be vaccinated the greater the proportion of residents of their local area identified as Welsh. In America, the vaccination rate of Biden voters fell off more steeply than that of Trump voters as the proportion of Trump voters in their county increased. Results are robust to controlling for likely confounds and sensitivity analyses. In-group out-group dynamics help to shape important health decisions.

Covid and the coalfield: Covid-19 vaccine hesitance in Wales and Appalachia.

BACKGROUND: Vaccine hesitancy is a barrier to Covid-19 vaccine uptake and displays a social gradient, compounding health disparities. While social gradients are a vital concept in health, they flatten distinctions between types of disadvantaged community. This paper focuses on vaccine hesitance in post-industrial and de-industrialising coalfields. The social consequences of the decline of coal mining may present barriers to vaccine uptake. METHODS: We ran parallel surveys in Wales (N = 4187) and US states overlapping with central Appalachia (N = 4864), to examine whether vaccine attitudes and uptake varied between areas with different coal mining histories. These surveys were accompanied by qualitative interviews of 36 residents of these coalfields to explore vaccination decisions and triangulate with survey data. RESULTS: Factor analysis identified four axes of attitudes in the survey data: vaccine confidence, covid scepticism, vaccine individualism, and concerned confusion. These themes were echoed in the interviews. Vaccine confidence was lower; and covid scepticism, vaccine individualism, and concerned confusion higher, in residents of areas of Wales with greater mining extent and where pits closed during certain periods. Residents of former US coal counties had lower vaccine confidence and higher covid scepticism, while those in current coal counties had greater vaccine individualism and concerned confusion. In former US coal counties and Welsh areas where pits closed since 1980, vaccine uptake was lower. Differences could not be explained by respondents' income and education. In the interviews, norms of social solidarity were often invoked by vaccinated respondents, while unvaccinated respondents did not frame decisions in the context of the industrial history of their areas. DISCUSSION: The legacy of coal-mining's decline presents barriers to public health campaigns. We show evidence of this across two historically significant coalfields. Attention is needed to avert negative public health consequences of global energy transition.

Cross-level group density interactions on mental health for cultural, but not economic, components of social class.

BACKGROUND: The ethnic density literature links mental health to ethnic minority status in one's neighbourhood. This design has also been applied to other identities, including sexual and political minorities, but surprisingly little attention has been paid to class-based identities. We use a Bourdieusian framework to examine whether a 'class density' association with mental health can be found for economic capital - people's material assets - and cultural capital - symbolic signifiers of class, such as tastes and interests. METHODS: Multi-level regression with post-stratification was used to make area-level estimates of cultural and economic capital for each middle super output area in Wales, using data from the National Survey for Wales 2017/18 (N = 11,381). These estimates were linked to independent individual-level data from the 2018/19 edition of the same survey (N = 4058) and mixed effects models containing individual-level capital, area-level capital, and their interaction were fitted, predicting whether respondents reported a mental health problem. Models were fitted unadjusted, adjusted for age and gender; for the other form of capital on the individual and area levels; and for the other capital's cross-level interaction. Multiple imputation was used to account for missing data. RESULTS: For cultural capital, a cross-level interaction was found where area-level cultural capital was protective in respondents reporting higher levels of individual-level cultural capital, but a risk factor for mental health problems in those with low individual-level cultural capital (odds ratio = 0.83, CI95% = 0.75-0.93). No such relationship was found for economic capital (odds ratio = 0.96, CI95% = 0.88-1.06). These results remained robust in adjusted models. CONCLUSIONS: The presence of a class density association with mental health for cultural capital but not economic capital suggests that symbolic signifiers of class, more than material aspects, activate class identities and drive group density phenomena. There are implications for planning policy, mental health, and political leadership.

Can hospital episode statistics support appraisal and revalidation? Randomised study of physician attitudes.

Hospital episode statistics were originally designed to monitor activity and allocate resources in the NHS. Recently their uses have widened to include analysis of individuals' activity, to inform appraisal and revalidation, and monitor performance. This study investigated physician attitudes to the validity and usefulness of these data for such purposes, and the effect of supporting individuals in data interpretation. A randomised study was conducted with consultant physicians in England, Wales and Scotland. The intervention group was supported by a clinician and an information analyst in obtaining and analysing their own data. The control group was unsupported. Attitudes to the data and confidence in their ability to reflect clinical practice were examined before and after the intervention. It was concluded that hospital episode statistics are not presently fit for monitoring the performance of individual physicians. A more comprehensive description of activity is required for these purposes. Improvements in the quality of existing data through clinical engagement at a local level, however, are possible.

Laying the foundations for good medical practice: a new educational resource.

Balancing service commitments with educational development is never easy. The European Working Time Directive and the Chief Medical Officer's report on senior house officer training bring new challenges. The Royal College of Physicians has developed 'Laying the Foundations for Good Medical Practice', a resource that enables tutors to teach generic skills to small groups of trainees in a fun and interactive way.

Standards in medical record keeping.

Medical records serve many functions but their primary purpose is to support patient care. The RCP Health Informatics Unit (HIU) has found variability in the quality of records and discharge summaries in England and Wales. There is currently a major drive to computerise medical records across the NHS, but without improvement in the quality of paper records the full benefits of computerisation are unlikely to be realised. The onus for improving records lies with individual health professionals. Structuring the record can bring direct benefits to patients by improving patient outcomes and doctors' performance. The HIU has reviewed the literature and is developing evidence-based standards for record keeping including the structure of the record. The first draft of these standards has been released for consultation purposes. This article is the first of a series that will describe the standards, and the evidence behind them.