A highly polarized TH2 bladder response to infection promotes epithelial repair at the expense of preventing new infections.

Urinary tract infections (UTIs) typically evoke prompt and vigorous innate bladder immune responses, including extensive exfoliation of the epithelium. To explain the basis for the extraordinarily high recurrence rates of UTIs, we examined adaptive immune responses in mouse bladders. We found that, following each bladder infection, a highly T helper type 2 (TH2)-skewed immune response directed at bladder re-epithelialization is observed, with limited capacity to clear infection. This response is initiated by a distinct subset of CD301b+OX40L+ dendritic cells, which migrate into the bladder epithelium after infection before trafficking to lymph nodes to preferentially activate TH2 cells. The bladder epithelial repair response is cumulative and aberrant as, after multiple infections, the epithelium was markedly thickened and bladder capacity was reduced relative to controls. Thus, recurrence of UTIs and associated bladder dysfunction are the outcome of the preferential focus of the adaptive immune response on epithelial repair at the expense of bacterial clearance.

Organ Transplant Recipients' Experiences of Physical Activity: Health, Self-Care, and Transliminality.

Physical activity (PA) is an important lifestyle component of long-term health management for organ transplant recipients, yet little is known about recipients' experiences of PA. The purpose of this study was to shed light on this experience and to investigate the possible implications of PA in the context of what is a complex patient journey. Phenomenological analysis was used to examine interviews with 13 organ transplant recipients who had taken part in sporting opportunities posttransplantation. Findings illuminate how participants' experiences of PA were commonly shaped by the transliminal nature of being an organ transplant recipient as well as a sense of duty to enact health, self-care, and donor-directed gratitude. This analysis underlines the potential role of PA in supporting organ transplant recipients' attempts to live well following transplantation and makes novel connections between PA and our existing knowledge about challenges related to identity, survivorship, obligation, and patient empowerment.

A day in the life of a Ménière's patient: understanding the lived experiences and mental health impacts of Ménière's disease.

Concepts of social practice are increasingly being used to understand experiences of everyday life, particularly in relation to consumption and healthy lifestyles. This article builds on this in the context of lives disrupted and reshaped by chronic illness. It uses social practice theory to examine the lived experiences of individuals with Ménière's disease; a long-term progressive vestibular disorder, defined by episodes of severe and debilitating vertigo, aural fullness, tinnitus and sensorineural hearing loss. Drawing on the findings of 20 in-depth narrative interviews with Ménière's patients, and eight spousal/partner interviews, we explore the impacts of the condition on sensory, temporal, spatial and social dimensions of the body. In doing so, we highlight the intensely embodied sensory and emotional work required to maintain connections between the 'competences', 'materials' and 'meanings' that constitute and sustain the performance of both mundane and meaningful social practices over time. As connections between these elements of social practice are disrupted during more active phases of the condition, affected individuals may be defected from old practices and recruited to new ones, often requiring both time and social support to find meaning or pleasure in these alternative ways of being in the world.

Male combat veterans' narratives of PTSD, masculinity, and health.

This article uniquely examines the ways a group of male combat veterans talk about masculinity and how, following post-traumatic stress disorder (PTSD), they performed masculinities in the context of a surfing group, and what effects this had upon their health and wellbeing. Participant observations and life history interviews were conducted with a group of combat veterans who belonged to a surfing charity for veterans experiencing PTSD. Data were rigorously explored via narrative analysis. Our findings revealed the ways in which veterans enacted masculinities in accordance with the values that were cultivated during military service. These masculine performances in the surfing group had important effects both on and for the veterans' wellbeing. Significantly, the study highlights how masculine performances can be seen alternately as a danger and as a resource for health and wellbeing in relation to PTSD. The article advances knowledge on combat veterans and mental health with critical implications for the promotion of male veterans' mental health. These include the original suggestion that health-promoting masculine performances might be recognised and supported in PTSD treatment settings. Rather than automatically viewing masculinity as problematic, this article moves the field forward by highlighting how hegemonic masculinities can be reconstructed in positive ways which might improve veterans' health and wellbeing. A video abstract of this article can be found at: https://www.youtube.com/watch?v=BaYzaOP1kAY.

The effects of surfing and the natural environment on the well-being of combat veterans.

Although researchers have identified the benefits of physical activity on well-being, there is little evidence concerning the effects of nature-based physical activity. We investigated the effect of one nature-based activity-surfing-on the well-being of combat veterans experiencing posttraumatic stress disorder (PTSD). We conducted interviews and participant observations with a group of combat veterans belonging to a United Kingdom-based veterans' surfing charity. Our primary analytical approach was dialogical narrative analysis. Based on our rigorous analysis and findings, we suggest that surfing facilitated a sense of respite from PTSD. Respite was a fully embodied feeling of release from suffering that was cultivated through surfing and shaped by the stories veterans told of their experiences. We significantly extend previous knowledge on physical activity, combat veterans, and PTSD by highlighting how nature-based physical activity, encapsulated in the conceptual notion of the "blue gym," can promote well-being among combat veterans.

Learning to run from narrative foreclosure: one woman's story of aging and physical activity.

In this article, the authors construct a story of one woman's (Justine's) experience of learning to run within the context of a beginners group. Building on existing scholarship on narrative, aging, and physical activity, this work is part of a larger ethnographic project examining subjective accounts of the physically active aging body across the life course. Concerned with often simplistically linear problems of representation, the authors present a messy text that represents the complex and fluid nature of Justine's embodied tale. The aim is to show the intersection of biographical (storied) identity with health behavior choices and to interrogate the process of challenging narrative foreclosure. By using the emerging genre of messy text as a creative analytic practice, the authors avoid prompting a single, closed, convergent reading of Justine's story. Instead, they provoke interpretation within the reader as witness and expand the ways in which research on aging and physical activity has been represented.

"More than just a walk in the park": A multi-stakeholder qualitative exploration of community-based walking sport programmes for middle-aged and older adults.

In spite of the large-scale growth of walking sport (WS) programmes globally, limited research has explored the experiences of the key stakeholders involved in such programmes (i.e. decision-makers, facilitators, and players). We aimed to explore stakeholder experiences of community-based WS programmes to better understand the appeal of such sport options for middle-aged and older adults, and propose tentative recommendations for the feasibility and sustainability of these types of programmes. We conducted semi-structured interviews with 21 stakeholders who were involved with WS programmes in Australia as decision-makers, facilitators, and/or players. Data were analysed with reflexive thematic analysis. Four key themes pertaining to the WS experience were identified - 'a renewed lease of life', 'navigating ageing stereotypes', 'tension between organisational demands and players' needs', and 'WS facilitators as catalysts of success'. Specifically, we found that WS participation enabled a positive ageing discourse for middle-aged and older adults. WS players had to negotiate stereotypes that, at times, were perceived as participation barriers. We also noted some tensions between the demands of sport organisations and the needs of middle-aged and older adults regarding sport participation. Finally, we also noted the importance of the facilitators' role in increasing accessibility of, and long-term participation in, such programmes. We suggest that to offer feasible and sustainable community-based WS programmes across Australia, incompatibilities across various stakeholders' perspectives need to be addressed.

Relationships between Recreation and Pollution When Striving for Wellbeing in Blue Spaces.

Our aim for this research was to identify and examine how recreation enthusiasts cope with and mitigate the violence of pollution as they strive for wellbeing in polluted "blue spaces" (e.g., seas, oceans). Our methodology to undertake the research was ethnography (online and offline), including autoethnography and informal interviews (40). The study proceeded from a constructivist epistemology which emphasizes that knowledge is situated and perspectival. The study site was a post-industrial area of northeast England where a long-standing but also rapidly growing surfing culture has to live with pollution (legacy and ongoing). We found evidence of what have become quotidian tactics that attach to themes of familiarity, embodiment, resignation, denial, and affect/emotion used by enthusiasts to cope with and mitigate the violence of pollution. We argue that by necessity some surfers are persisting in striving for wellbeing not simply in spite of pollution but rather with pollution. We assert surfers enact a "resigned activism" that influences their persistence. We extend critical scholarship concerning relationships between recreation, blue spaces, and wellbeing by moving beyond a restrictive binary of focusing on either threats and risks or opportunities and benefits of blue space to health and wellbeing, instead showing how striving for wellbeing through recreation in the presence of pollution provides evidence of how such efforts are more negotiated, fluid, situated, uncertain, dissonant, and even political than any such binary structure allows for.

Beyond "Move More": Feeling the Rhythms of physical activity in mid and later-life.

The last two decades have seen growing unease regarding the negative health consequences of increasing levels of physical inactivity, both in the UK and further afield. Public health initiatives and interventions aimed at increasing levels of physical activity have, therefore, become somewhat commonplace. Within the current context of demographic change, with growing numbers of older adults and evidence that inactivity increases with age, these initiatives hold particular relevance to mid and later-life adults. Yet despite their prevalence, the policy gains from such promotional efforts have typically been modest at best, demonstrating the limits to decontextualized health messages that encourage people to 'sit less', 'move more' or 'move faster'. In this paper, we draw on the concept of rhythm, to provide an original contribution in response to recent calls to rethink existing approaches to physical activity in mid-life and beyond. We draw from three qualitative data sets from separate studies exploring health, wellbeing and ageing (two in the context of chronic health conditions and sensory impairments). Inspired by facet methodology, we advance knowledge by providing 'flashes of insight' into the subtle patterns and tempos that frame physical activity in mid and later life. In doing so, we offer alternative insight into how people avail themselves to, and experience motion and stillness during these life stages. That alternative, as we also note, has an important role to play in the development of appropriate, relatable health messages regarding movement that recognises 'expertise by experience'.

Ménière's disease and biographical disruption: Where family transitions collide.

People's lived experiences of chronic illness have garnered increasing research interest over the last 30-40 years, with studies recognising the disruptive influence of illness onset and progression, both to people's everyday lives and to their biographical selves. We extend this body of work, drawing on the experiences of people living with Ménière's disease; a long-term progressive vestibular disorder characterised by unpredictable episodes of debilitating vertigo, tinnitus and permanent sensorineural hearing loss. In response to calls for more critical examination of the wider biographical contexts in which chronic illnesses are encountered, we draw on 28 in-depth narrative interviews with Ménière's patients and their family members to discuss how personal chronic illness experiences may be closely entwined with, and deeply shaped by, the life transitions (illness-related and otherwise) of 'linked others'. Interviews were conducted in south west England from January to June 2015. Focusing on intersecting transitions of parenthood, caregiving and retirement, we explore how and why familial relationships can both facilitate and hinder adaptation to a lifetime of chronically disrupted normalities, contributing to fluctuating experiences of 'cherished time', 'anomalous time' and 'turbulent time'. In so doing, we suggest that the onset and progression of chronic illness could usefully be re-conceptualised as one of many 'biographical oscillations' encountered during the life course that serve to re-route us between continually shifting life trajectories. In recognising life's dynamism and challenging the identity-limiting and self-damaging nature of entrenched cultural life course constructions, we suggest value in recognising alternative ways of 'living well' when negotiating the wide-ranging biographical maps that life can follow.

Collective stories and well-being: using a dialogical narrative approach to understand peer relationships among combat veterans experiencing post-traumatic stress disorder.

Using a dialogical narrative approach, this original research explored how combat veterans experiencing post-traumatic stress disorder made sense of peer relationships with other veterans and what effects these relationships had on their well-being. Interviews and participant observations were conducted with 15 male combat veterans (aged 27-60 years) and one member of the civilian emergency services, the majority of whom were diagnosed with post-traumatic stress disorder following traumatic exposure in a range of armed conflicts. All participants were part of a surfing charity for veterans experiencing post-traumatic stress disorder. Data were rigorously analysed using a dialogical narrative analysis (DNA). Findings revealed the collective story that veterans used to make sense of peer relationships within the group. This collective story worked for the veterans to shape their experiences of well-being by fostering camaraderie, stimulating deeper connections and countering the negative effects of post-traumatic stress disorder. Potential therapeutic effects of the collective story were also identified. This article extends previous knowledge on combat veterans and social relationships and advances the field of narrative health psychology through the empirical application of a sophisticated dialogical narrative approach.

Seeking everyday wellbeing: The coast as a therapeutic landscape.

Recent research suggests coastal environments may promote human health and wellbeing. This article explores the diverse coastal experiences sought out by residents of two towns in south west England to promote and preserve their personal wellbeing in the context of their everyday lives. It draws on the findings of an in-depth interpretive study conducted from May to November 2013 that examined the relative contribution of varied green and blue space experiences to individual wellbeing through the life course. Personalised activity maps produced using accelerometer and Global Positioning System (GPS) data were used to guide in-depth geo-narrative interviews with a purposive sample of 33 participants. This was combined with a subset of nine case study go-along interviews in places deemed therapeutic by the participants themselves, offering deeper insight into the lived experiences and relationships playing out within such places. Situated in a novel adaptation of the therapeutic landscapes framework, this article explores how symbolic, achievement-oriented, immersive and social experiences contributed to participants' sense of wellbeing in their local coastal areas. Participants expressed particularly strong and often enduring connections to the local coastline, with different coastal stretches perceived to cater for varied therapeutic needs and interests, at multiple scales and intensities. The findings suggest the need for greater acknowledgement of people's emotional, deeply embodied and often shared connections to the coast within coastal management policy and practice, both nationally and internationally. Importantly, such efforts should recognise the fluid, dynamic nature of this land-sea boundary, and the valued therapeutic experiences linked to this fluidity.

Mental Health and Subjective Well-being of Individuals With Ménière's: Cross-sectional Analysis in the UK Biobank.

HYPOTHESIS: Ménière's disease significantly impacts on an individual's mental health and subjective well-being (SWB). BACKGROUND: Ménière's disease is an unpredictable illness that impacts on mental health. The symptom triad of vertigo, tinnitus, and hearing loss all contribute to the disabling nature of the condition. To date, limited research has investigated the mental health and SWB impact of Ménière's disease. METHODS: We investigated the mental health and SWB of 1,376 Ménière's sufferers in the UK Biobank and compared this to over 500,000 controls. Participants in the Biobank were asked 38 questions pertaining to mental health and SWB. We utilized crude and adjusted linear and logistic regression to investigate the association between Ménière's and mental health and SWB. We also investigated how mental health and SWB might be related to length of diagnosis to see whether people might adapt to Ménière's over time. RESULTS: Ménière's was associated with increased frequency of depression, tiredness, tenseness, and unenthusiasm in the 2 weeks before recruitment. Ménière's was associated with longer periods of depression than controls (10.2 wk [95% CI: 5.2-15.2 wk]). Reduced health satisfaction was associated with Ménière's, but in other aspects of life (general happiness, work, family, friends, financial), individuals with Ménière's were as happy as controls. Mental health and SWB in individuals diagnosed for longer was better than in those who were recently diagnosed suggesting at least partial adaptation. DISCUSSION: This is the largest population study investigating the mental health impact of Ménière's. Our findings suggest that Ménière's adversely impacts on mental health, an individual's emotional state, and their life satisfaction. However, our findings raise the importance of supporting social relations for people with Ménière's and that although a cure is not currently available, we can still learn much about the adaptation strategies developed by long-term sufferers to help individuals with new diagnoses.

Pleasure: a forgotten dimension of physical activity in older age.

Pleasure is an under-researched and under theorized concept within health and health-related areas, particularly in relation to physical activity in older age. This gap is addressed here. The paper forms part of a larger qualitative project conducted between March 2011 and July 2013 within which fifty-one physically active older adults (age sixty to ninety-two years) were interviewed about their experiences of physical activity. Twenty-seven of these participants were also involved in a photo elicitation exercise whereby they responded to photographic images of themselves doing their activity. The paper reports in-depth on one of the themes - pleasure - that was initially identified through a rigorous categorical-content analysis of this data. An original typology of pleasure for physical activity in older age is developed, which details four significant ideal types of pleasure: sensual pleasure; documented pleasure; the pleasure of habitual action; and the pleasure of immersion. The implications of this typology for debates around embodiment, affect, and narratives of ageing are discussed in relation to health promotion and future research in this underserved area.

Green space, health and wellbeing: making space for individual agency.

This essay examines the assumptions of green space use underpinning much existing green space and health research. It considers opportunities to move the field forward through exploring two often overlooked aspects of individual agency: the influence of shifting life circumstances on personal wellbeing priorities and place practices, and the role of personal orientations to nature in shaping how green space wellbeing opportunities are perceived and experienced. It suggests such efforts could provide more nuanced insights into the complex, personal factors that define and drive individual choices regarding the use of green spaces for wellbeing over time, thereby strengthening our understanding of the salutogenic potential (and limits) of green spaces.

Telling a (good?) counterstory of aging: natural bodybuilding meets the narrative of decline.

OBJECTIVES: In Western society, the narrative of decline dominates the aging process. We know very little about the complexities of how people resist this narrative. The purpose of this article is to understand how a group of mature natural bodybuilders resisted the narrative of decline. METHODS: In-depth life story interviews were conducted with 13 natural bodybuilders aged between 50 and 73 years. Verbatim transcripts were produced and the data analyzed using a structural narrative analysis. A dialogical analysis was also utilized. RESULTS: The participants' experiences did not fit with stereotypical assumptions about decline and deterioration in older age. They all told counterstories to "natural" aging, yet what differed was how the participants' counterstories resisted the narrative of decline and the level of resistance that they provided. DISCUSSION: We advance knowledge in the fields of aging and narrative inquiry by revealing the multidimensionality of resistance. We demonstrated how participants storied resistance in different ways and the important implications this had for the way aging was understood and acted upon-by themselves and potentially by others. In addition to advancing theoretical knowledge, in this article, we also significantly contribute to understandings of the potential of narrative for changing human lives and behavior across the life course in more positive and nuanced ways.

Expanding the agenda for research on the physically active aging body.

In this article, the authors consider the different approaches that can be used to examine the relationship between physical activity and aging. They propose that much is to be gained in our awareness of this dynamic relationship by drawing on multiple forms of knowledge that can generate diverse understandings regarding the impact of physical activity on physiological, psychological, and social aspects of aging. Accordingly, 3 different approaches to understanding the older physically (in)active body are presented. These are categorized as (a) the objective truth about the aging, physically active body; (b) the subjective truth about the aging, physically active body; and (c) "tales" about the aging, physically active body. The key underpinnings, strengths, and weaknesses of each approach are outlined. A number of examples from the literature are also offered to demonstrate where and how each approach has been used to contribute to our understanding about older people and physical activity. The more thorough, multidisciplinary, and wide spanning our knowledge of the aging, active body is, the more informed we might become in every dimension of its existence.