Perspectives on an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a qualitative study.

BACKGROUND: A new Health and Wellbeing pathway was introduced into the Improving Access to Psychological Therapies (IAPT) service in one geographical area of the UK in 2021 to address the wider determinants of mental health problems. It comprised assisted signposting to wider services and physical health promotion. This qualitative study aimed to understand stakeholders' experiences of implementing and receiving this new support and the barriers and facilitators to its delivery. METHODS: Forty-seven interviews were conducted, with service developers (n = 6), service deliverers (n = 12), service users (n = 22) and community and clinical partners (n = 7), as part of a larger mixed-methods evaluation. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis. RESULTS: Three themes spanned all participant groups and represented key aspects of the service: (1) identifying suitability, (2) a holistic service, and (3) moving forward. The sub-themes represent the barriers and facilitators to processes working in practice, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment, tailoring the support and delivery mode, and increasing transparency around continued care to drive sustained benefits. LIMITATIONS: Service users may have been selected due to their positive experiences of IAPT and were not demographically representative of the population, although participants' experiences of the service did suggest variation in our sample. CONCLUSIONS: The Health and Wellbeing pathway was perceived as having a positive impact on mental health and could reduce the burden on therapeutic services. However, service- and individual-level barriers need to be addressed to enhance statutory and community support links, manage service users' expectations, and improve accessibility for certain groups.

Interpretation of Timetrends (1996-2017) of the Incidence of Selected Cancers in England in Relation to Mobile Phone Use as a Possible Risk Factor.

Radiofrequency (RF) radiation from mobile phones has been classified as possibly carcinogenic to humans (2b) by IARC. However, to date, the discussion on whether mobile phone use is a cancer risk factor has not been solved. In this context of continuing uncertainty, it is important to continue to monitor cancer incidence trends. Annual incidence rates and directly age-standardized rates of selected cancers by sex and 5-year age groups for 1996 to 2017 for England were obtained from the UK Office for National Statistics. Interpretation in light of mobile phone use as a contributing risk factor was conducted for cancers of the brain, parotid gland, thyroid, and colorectal cancer, which have all been hypothesized to be associated with RF exposure. Brain and parotid gland cancers were updated by an additional 10 years following a previous publication, and continue to provide little evidence of an association with mobile phone use. Although mobile phone use as a potential risk factor contributing to increased incidence of colorectal or thyroid cancer could not be excluded based on these ecological data, it is implausible that it is an important risk factor for either. In the absence of clarity from epidemiological studies, it remains important to continue to monitor trends. However, for the time being, and in agreement with data from other countries, there is little evidence of an association between mobile phone use and brain or parotid gland cancer, while the hypotheses of associations with thyroid or colorectal cancer are similarly weak. © 2021 Bioelectromagnetics Society.

Ischemic Heart Disease Mortality and Occupational Radiation Exposure in a Nested Matched Case-Control Study of British Nuclear Fuel Cycle Workers: Investigation of Confounding by Lifestyle, Physiological Traits and Occupational Exposures.

Epidemiological studies have suggested a link between low-level radiation exposure and an increased risk of cardiovascular disease, but the possibility of bias or confounding must be considered. We analyzed data from a matched case-control study nested in a cohort of British male industrial (i.e., blue-collar) nuclear fuel cycle workers using paired conditional logistic regression. The cases were comprised of workers from two nuclear sites who had died from ischemic heart disease (IHD) and were matched to controls on nuclear site, date of birth and first year of employment (1,220 pairs). Radiation doses from external sources and to the liver from internally deposited plutonium and uranium were obtained. Models were adjusted for age at start of employment at either site, decade of start, age at exit from study (death or censoring), process/other worker and socio-economic status. Included potential confounding factors of interest were occupational noise, shift work, pre-employment blood pressure, body mass index and tobacco smoking. Cumulative external doses ranged from 0-1,656 mSv and cumulative internal doses for those monitored for radioactive intakes ranged from 0.004-5,732 mSv. In a categorical analysis, additionally adjusted for whether or not a worker was monitored for internal exposure, IHD mortality risk was associated with cumulative external unlagged dose with a 42% excess risk (95% CI: 4%, 95%) at >103 mSv (highest quartile relative to lowest quartile), and 35% (95% CI: -1%, 84%) at >109 mSv 15-year lagged dose. The log-linear increase in risk per 100 mSv was 2% (95% CI: -4%, 8%) for unlagged external dose and 5% (95% CI: -2%, 11%) for 15-year lagged dose. Associations with external dose for workers monitored only for exposure to external radiation reflected those previously reported for the cohort from which the cases and controls were drawn. There was little evidence of excess risk associated with cumulative doses from internal sources, which had not been assessed in the cohort study. The impact of the included potential confounding variables was minimal, with the possible exception of occupational noise exposure. Subgroup analyses indicated evidence of heterogeneity between sites, occupational groups and employment duration, and an important factor was whether workers were monitored for the potential presence of internal emitters, which was not explained by other factors included in the study. In summary, we found evidence for an increased IHD mortality risk associated with external radiation dose, but little evidence of an association with internal dose. External dose associations were minimally affected by important confounders. However, the considerable heterogeneity in the associations with external doses observed between subgroups of workers is difficult to explain and requires further work.

The future of exposure assessment: perspectives from the X2012 Conference.

The British Occupational Hygiene Society, in collaboration with the Institute of Occupational Medicine, the University of Manchester, the UK Health and Safety Executive, and the University of Aberdeen hosted the 7th International Conference on the Science of Exposure Assessment (X2012) on 2 July-5 July 2012 in Edinburgh, UK. The conference ended with a special session at which invited speakers from government, industry, independent research institutes, and academia were asked to reflect on the conference and discuss what may now constitute the important highlights or drivers of future exposure assessment research. This article summarizes these discussions with respect to current and future technical and methodological developments. For the exposure science community to continue to have an impact in protecting public health, additional efforts need to be made to improve partnerships and cross-disciplinary collaborations, although it is equally important to ensure that the traditional occupational exposure themes are still covered as these issues are becoming increasingly important in the developing world. To facilitate this the 'X' conferences should continue to retain a holistic approach to occupational and non-occupational exposures and should actively pursue collaborations with other disciplines and professional organizations to increase the presence of consumer and environmental exposure scientists.