Nuffield Foundation Research Articles

Dr. Coluthur Gopalan: Father of Indian Nutrition Science.

Dr. Coluthur Gopalan, a towering figure in nutrition science in India, made seminal contributions that transformed public health and nutrition policy in the country. Born in Salem, Tamil Nadu, in 1918, Dr. Gopalan's illustrious academic journey began at the Christian College High School and Madras Medical College, where he earned his M.D. in General Medicine in 1943. The Bengal Famine of 1942 profoundly influenced his career, steering him towards nutrition research. Awarded the Nuffield Foundation Scholarship, he earned a Ph.D. in nutrition from the University of London in just 30 months. Upon his return to India, he joined the Nutrition Research Laboratories (NRL) in Coonoor in 1949, which later became the National Institute of Nutrition (NIN), where he significantly broadened the scope of nutrition research. Dr. Gopalan's work laid the foundation for pivotal national nutrition programs, such as the Integrated Child Development Services (ICDS) and the midday meal scheme for schoolchildren. His tenure as Director of NIN (1960-1974) and later as Director General of the Indian Council of Medical Research (ICMR) from 1974 to 1979 saw major advancements in addressing malnutrition and emerging issues like overnutrition. His dedication to improving women's and children's nutritional status left a lasting impact on public health in India. Dr. Gopalan's pioneering research on protein-calorie malnutrition, micronutrient deficiencies, and holistic approaches to nutritional problems provided critical insights and guided thenational policies. As an institution builder, he transformed NIN into a premier research center and during his tenure established new research institutes at ICMR, fostering a robust framework for future research. His advocacy ensured that nutrition was prioritized in national development plans, leading to significant health improvements. Internationally recognized, Dr. Gopalan's contributions included efforts to improve global nutrition, earning him numerous accolades. His legacy, encapsulated in the Nutrition Foundation of India, and his several contributionscontinueto be a vital resource for nutritionists and policymakers, ensuring lasting benefits for future generations. Dr. Gopalan's compassionate personality, visionary leadership, and holistic approach have indelibly advanced the nutritional status and health of millions globally.

P116 Effectiveness and safety of biosimilar etanercept GP2015 in patients with rheumatoid arthritis in the UK: results from the COMPACT study

Abstract Background/Aims COMPACT is a non-interventional, multinational cohort study to evaluate effectiveness, safety and quality of life (QoL) outcomes in patients with rheumatic diseases treated with GP2015, an approved etanercept (ETN) biosimilar, under real-world conditions. Here, we present data from patients in the UK with rheumatoid arthritis (RA) enrolled in the COMPACT study, focusing on those who switched to GP2015 from reference ETN or another biosimilar ETN. Methods The COMPACT study included patients (≥18 years of age) with rheumatic diseases treated with GP2015. This analysis includes patients from the UK diagnosed with RA who were in treatment Group A (patients in clinical remission or low disease activity under treatment with reference ETN or other biosimilar ETN, who switched to GP2015 prior to study enrolment). Effectiveness and QoL outcomes were assessed using Disease Activity Score 28-joint count (DAS28) and health assessment questionnaire-disability index (HAQ-DI), respectively, and are presented up to Week 24. Safety outcomes were assessed, including rates of adverse events (AEs) and serious AEs (SAEs). Results A total of 112 patients with RA who switched to GP2015 from reference ETN or another biosimilar ETN (Group A) were enrolled in the UK. The mean ± standard deviation (SD) age was 62.9 ± 11.3 years and 74.1% of patients were female. The mean ± SD DAS28 score remained unchanged from baseline (2.6 ± 1.3) to Week 24 (2.5 ± 1.6). The mean ± SD HAQ-DI score displayed no major difference between baseline (1.2 ± 0.8) and Week 24 (0.9 ± 0.8). Overall, 67.9% (n = 76) of patients experienced ≥1 AE and 9.8% (n = 11) of patients experienced ≥1 SAE (Table). Conclusion Over 24 weeks of treatment with GP2015, disease activity remained low and stable in patients with RA previously switched from reference ETN or from another biosimilar ETN, with no new safety concerns observed. These results from a cohort of patients with RA treated in the UK are consistent with effectiveness, QoL and safety data reported previously for the total population in the COMPACT study. Disclosure A. Askari: None. C. Both: None. A. Martin: None. D.A. Walsh: Consultancies; Consultancy fees paid to University of Nottingham: Contura International A/S, Glaxo SmithKline, AKL Research and Development Ltd, Consultancy fees paid to University of Nottingham: Pfizer Ltd, Abbvie Ltd, Ely Lilly & Co.Ltd, Galapagos Ltd., Reckitt Benckiser Health Ltd. Honoraria; Speaker fees paid to David Walsh: Irish Society of Rheumatology, Speaker fees paid to University of Nottingham: Medscape International, Pfizer Ltd, Abbvie Ltd. Grants/research support; Grants paid to University of Nottingham: Versus Arthritis, UKRI, NIHR, Nuffield Foundation, Pfizer Ltd, Ely Lilly & Co Ltd, UCB Pharma, Grants paid to University of Nottingham: GlaxoSmithKline Research and Development, Orion Corporation. T. Sheeran: None.

Exploring Curriculum Making in Scottish Secondary Schools: Trends and Effects

This article presents the findings from a recent study funded by the Nuffield Foundation, which aimed to provide insights into the experiences of young people and teachers in secondary schools across Scotland under the Curriculum for Excellence (CfE). Our research has uncovered a decrease in the number of National Qualifications entries in S4 under CfE, a phenomenon commonly referred to in Scotland as ‘curriculum narrowing.’ Furthermore, we have identified evidence of social stratification in overall and subject entry patterns in S4, with students from disadvantaged areas experiencing a more significant decline in entries and being limited to a narrower range of subjects. Additionally, our study has revealed signs of curriculum fragmentation during the Broad General Education phase (years S1–S3). The findings from our study also suggest that the curriculum decisions made in schools are primarily driven by the demand for better attainment data, particularly in National Qualifications during the Senior Phase (school years S4–S6), with less emphasis on what it means for an individual to become an educated person in a modern and complex society. Based on our findings, we have concluded that curriculum fragmentation and narrowing under CfE have a detrimental impact on the progression and attainment of young people. Schools that offer a broader curriculum in S4 demonstrate higher enrolment rates for Higher qualifications in S5 and Advanced Higher qualifications in S6. In contrast, schools that offer a narrower curriculum in S4, particularly those in deprived areas, are more likely to experience delays in higher-level qualification entry. A broader curriculum in S4 has been associated with improved performance in National 5 qualifications, higher scores in international tests such as PISA English and Maths, and higher scores on OECD measures of global competences. On the other hand, a narrower curriculum is correlated with less favourable outcomes after leaving school, especially in terms of Higher Education enrolment.

Poor decisions

England's early years spend is below par, explain Carey Oppenheim, early childhood lead, and Dr Claire Sewell, communications manager, at the Nuffield Foundation

Predictors of uncertainty and unwillingness to receive the COVID-19 booster vaccine: An observational study of 22,139 fully vaccinated adults in the UK.

SummaryBackgroundThe continued success of the COVID-19 vaccination programme in the UK will depend on widespread uptake of booster vaccines. However, there is evidence of hesitancy and unwillingness to receive the booster vaccine, even in fully vaccinated adults. Identifying factors associated with COVID-19 booster vaccine intentions specifically in this population is therefore critical.MethodsWe used data from 22,139 fully vaccinated adults who took part in the UCL COVID-19 Social Study. Multinomial logistic regression examined predictors of uncertainty and unwillingness (versus willingness) to receive a COVID-19 booster vaccine (measured 22 November 2021 to 6 December 2021), including (i) socio-demographic factors, (ii) COVID-19 related factors (e.g., having been infected with COVID-19), and (iii) initial intent to receive a COVID-19 vaccine in the four months following the announcement in the UK that the vaccines had been approved (2 December 2020 to 31 March 2021).Findings4% of the sample reported that they were uncertain about receiving a COVID-19 booster vaccine, and a further 4% unwilling. Initial uncertainty and unwillingness to accept the first COVID-19 vaccine in 2020-21 were each associated with over five times the risk of being uncertain about and unwilling to accept a booster vaccine. Healthy adults (those without a pre-existing physical health condition) were also more likely to be uncertain or unwilling to receive a booster vaccine. In addition, low levels of current stress about catching or becoming seriously ill from COVID-19, consistently low compliance with COVID-19 government guidelines during periods of strict restrictions (e.g., lockdowns), lower levels of educational qualification, lower socio-economic position, and age below 45 years were all associated with uncertainty and unwillingness.InterpretationOur findings highlight that there are a range of factors that predict booster intentions, with the strongest predictor being previous uncertainty and unwillingness. Two other concerning patterns also emerged from our results. First, administration of booster vaccinations may increase social inequalities in experiences of COVID-19 as adults from lower socio-economic backgrounds are also most likely to be uncertain or unwilling to accept a booster vaccine as well as most likely to be seriously affected by the virus. Second, some of those most likely to spread COVID-19 (i.e., those with poor compliance with guidelines) are most likely to be uncertain and unwilling. Public health messaging should be tailored specifically to these groups.FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].

Genome editing and farmed animal breeding: social and ethical issues

The Nuffield Council on Bioethics has published in December 2021 their most recent report on the social and ethical issues associated with the use of genome editing in farm animal breeding. The Nuffield Council on Bioethics is an independent body based in the United Kingdom that examines and advises on ethical issues arising from developments in bioscience and health. The Council is made up of around 15 members and 12 executive staff. It was established by the trustees of the Nuffield Foundation in 1991, is funded jointly by the Nuffield Foundation, the Medical Research Council and Wellcome. One of their terms of reference is to identify and define ethical questions raised by recent developments in biological and medical research that concern, or are likely to concern, the public interest; and the Council reviews the available evidence with a view to report on these matters and to make recommendations relating to policy and practice.

Variations in the incidence of common mental disorder symptoms in the general population throughout the COVID-19 pandemic: a longitudinal cohort study

BackgroundThe COVID-19 pandemic and nationally mandated restrictions to control the virus were anticipated to increase the incidence of mental health issues. So far, little evidence has been found of increases in the use of mental health services. Heterogeneous mental health has been found in general population cohorts during the first 6 months of the pandemic. This study aimed to explore changes in the likelihood of clinically significant mental health issues during 14 months of the pandemic, and to identify individual risk factors for poor mental health. MethodsA cohort was formed of 33 703 adults in England who provided data between March, 2020, and April, 2021 (11 023 [32·7%] aged 60 years or older; 25 567 [75·9%] women; and 1628 [4·8%] from Black, Asian, and Minority Ethnic groups). Trajectories of meeting criteria for clinically significant depression or anxiety each month were estimated with growth mixture modelling through validated screening measure cutoffs (Patient Health Questionnaire-9 scores ≥10 or Generalised Anxiety Disorder Assessment-7 scores ≥8). Sociodemographic and personality-related (Big Five Inventory) risk factors associated with trajectory class membership were identified in multivariable regression models. The study was approved by the University College London Research Ethics Committee (reference 12467/005). FindingsWe identified five trajectories for depression and five for anxiety. Participants (general population weighted) in the largest trajectory class (depression: n=20 818 [62%]; anxiety: n=21 167 [63%]) had a less than 5% probability of reporting clinically significant symptoms of depression or anxiety throughout the study period. However, other trajectories represented participants with clinically significant mental health issues: high likelihood of distress throughout the study period (depression: n=4444 [13%]; anxiety: n=4214 [13%]); distress early in the pandemic that decreased within the first four months (depression: n=3 052 (9%); anxiety: n=3 050 [9%]); distress that emerged around five months after the pandemic began (depression: n=2157 [6%]; anxiety: n=2 111 [6%]); and a moderate likelihood of such problems throughout the pandemic study period (March, 2020, to April, 2021) (depression: n=3230 [10%]; anxiety: n=3 159 [9%]). Being in younger age groups (compared with being older than 60 years), female, a carer, having an existing mental health diagnosis, socialising daily pre-pandemic, and higher neuroticism scores were all independently associated with poorer mental health outcomes. Participants from Black, Asian, and Minority Ethnic groups or those living alone were more likely to follow trajectories that changed little in relation to the course of the pandemic. InterpretationAlmost four in ten people followed trajectories with a greater than 50% chance of reporting clinically significant levels of depression or anxiety symptoms during the study period. Sociodemographic, health, and personality factors were associated with differential mental health trajectories. These findings might support targeted public health interventions for those in the highlighted at-risk groups, given the likelihood of developing mental health issues during the course of the pandemic. FundingThis work was supported by the Nuffield Foundation (grant number WEL/FR-000022583), UK Research and Innovation (grant number ES/S002588/1), and Wellcome Trust (grant number 221400/Z/20/Z and 201292/Z/16/Z).

The importance of developing care-worker-centered robotic aides in long-term care.

Recent research points to the fact that new medical technological innovations are just as relevant in the context of long-term care or chronic care as they are in the context of acute care. In the spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long-term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two-pronged. First, we delve into a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human-type, that is, organic, consciousness. We support the thesis that the emergence and formation of human-type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long-term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long-term care is one-on-one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch.

Growing Up Under COVID-19: Young People's Agency in Family Dynamics.

The COVID-19 pandemic transformed the nature of family life in countries across the world. School, and workplace closures meant that families spent more time at home and had to confront new economic, social, and psychological challenges as a result of lockdowns and the greater proximity of family members. Policy, research and media coverage of the pandemic’s impact on family life has focused primarily on the economic costs borne by households. This article draws on the findings from an empirical research project funded by the UK Nuffield Foundation on “Politics, Participation and Pandemics: Growing up under COVID-19”, which worked with young people as co-researchers, to present an innovative perspective on the impact of lockdown on family relationships. The research team adopted a longitudinal ethnographic action research approach to document and make sense of the experiences of young people (aged 14–18) in four countries: Italy, Lebanon Singapore and the United Kingdom. The project used digital ethnography and participatory methods to track the responses of 70 young people to the challenges created by the pandemic. The study used the family as a prism for understanding how the lives of children and young people in different family circumstances and relationships were affected by the crisis. This article analyses, firstly, the complex shifting dynamics within households to identify the transformative effects of the pandemic on family life in various socio-cultural contexts. Secondly, it examines how young people’s agency shaped family dynamics. In conclusion, the authors recommend how the findings from the study can be used to inform government interventions designed to minimise the impacts of the pandemic on the social well-being and rights of children and young people, and to recognise them as active participants in family and civic life both during and after the pandemic

Coluthur Gopalan. 28 November 1918—3 October 2019

Gopalan was a brilliant medical student. The Bengal famine of 1942 made him decide to devote his career to ‘the investigation and mitigation of the nutrition-related problems of Indians, especially those of the disadvantaged sections’. He was the first Indian to win a Nuffield Foundation research scholarship to study in England in 1946. In less than three years he had earned a PhD as well as a DSc in nutrition. He returned to India and joined the Nutrition Research Laboratory in Coonoor. His studies over the next decade showed that, contrary to the global belief, both kwashiorkor and marasmus were manifestations of protein energy malnutrition. His research studies on improving the nutritional status of pregnant women and children with food supplementation led to the initiation of India's Integrated Child Development Scheme and Mid-day Meal programmes. India's National Anaemia Prophylaxis Programme and Massive Dose Vitamin A Supplementation Programme were also initiated on the basis of the studies he led. As Director General of the Indian Council of Medical Research he created institutions to undertake research in the areas of neglected tropical diseases and medical statistics. He initiated the National Talent Search Scheme to ensure adequate human resources for medical research. After he retired, he set up the Nutrition Foundation of India, to continue with policy and operational research studies on the triple burden of malnutrition. He initiated the setting up of the Nutrition Society of India and the Federation of Asian Nutrition Societies to improve networking among nutrition scientists. In reply to a query on his major contributions, he said: ‘I helped to get Nutrition Science in India the recognition it deserved, and I built institutions that will serve the people of India long after my lifetime.’

Reconceptualising fair access to highly academically selective universities

The higher education regulator for England has set challenging new widening access targets requiring universities to rethink how merit is judged in admissions. Universities are being encouraged to move away from the traditional meritocratic equality of opportunity model of fair access, which holds that university places should go to the most highly qualified candidates irrespective of social background, in accordance with the principles of procedural fairness. Instead, they are being asked to move towards what we term the meritocratic equity of opportunity model, which holds that prospective students’ qualifications should be judged in light of the socioeconomic circumstances in which these were obtained to enhance distributive fairness, a practice known in the UK as contextualised admissions. In this paper, we critically discuss the theoretical underpinnings of these two competing perspectives on fair access and review the existing empirical evidence base, drawing together for the first time insights from our ESRC and Nuffield Foundation funded studies of fair access to highly academically selective universities in England. We argue that reconceptualising fair access in terms of distributive fairness rather than procedural fairness offers a more socially just set of principles on which to allocate valuable but scarce places at the most academically selective universities in England, unless or until such time as the vertical stratification of higher education institutions is reduced or eliminated entirely.

Age specific trends in mortality disparities by socio-economic deprivation in small geographical areas of England, 2002-2018: A retrospective registry study.

SummaryBackgroundDisparities in mortality rates according to socioeconomic position (SEP) have been rising in England. We describe the association between recent changes in socioeconomic inequality and trends in mortality disparities for different age and sex groups at small-area level in England.MethodsVital registration data from the Office for National Statistics on resident population size and number of deaths in each Lower Super Output Area (LSOA) in England from 2002 to 2018 were stratified by sex and 5-year age group. We grouped LSOA into ventiles of the Index of Multiple Deprivation (IMD), our indicator of SEP. We examined time trends in smoothed mortality rates, using 3 year moving averages for the period 2003-2017, by age across the IMD distribution. We measured mortality inequalities using the ratio of mortality rates between different deprivation groups. We calculated mortality rate ratios between the most and the least deprived 10% of areas (Total Inequality) and between the median and least deprived (Lower Inequality) 10% of areas by year, gender and age group, to examine where in the distribution of deprivation trends in mortality inequality arose.FindingsAmong <1 year olds, the inequality in mortality rates between the poorest 10% of LSOAs and the richest 10% of LSOAs fell between 2003 and 2017 by 22•7% for men and 22•8% for women. The largest inequalities were observed among 40 to 54 year olds. This inequality increased over the study period – from 3•2 times higher mortality rates for men in the most as opposed to the least deprived 10% of LSOAs in 2003 to 3•3 times in 2017. The rise was from 2•4 to 2•6 for women. Age groups ≥65 years, who experience the highest mortality risk, had low but rising inequality. Men and women aged 65 to 79 living in the most deprived LSOAs had a mortality rate 1•9 times higher than the least deprived in 2003 but this had increased to 2•2 times higher for women and 2•3 times higher for men by 2017. This was due to rising inequality in both halves of the distribution – between the top 10% of LSOA and the middle, and between the middle and the bottom 10% of LSOA.InterpretationOverall mortality inequality rose in England but there were substantial differences in the trends for specific age and sex groups. Infant and child mortality inequality fell. At older ages, mortality inequality rose across cohorts, although in different ways, as each cohort's exposure to life-course to labour market inequality has differed. Policy goals of reducing mortality inequality will be best met by a focus on the risk factors that are specific to particular age and deprivation groups.FundingEconomic and Social Research Council, through the ESRC Centre for the Microeconomic Analysis of Public Policy at the IFS. We gratefully acknowledge the support of the Nuffield Foundation, grant reference WEL/43603. The project has been funded by the Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre.

Telecare at a crossroads? Finding researchable questions

Purpose This paper aims to report on a structured attempt to develop new directions for research into telecare. Current research evidence suggests that telecare in the UK is not optimally cost-effective and does not deliver better outcomes than more traditional forms of care and support. To address this problem, an analysis of expert opinion about future directions for research is provided. Design/methodology/approach Two electronic surveys of UK based academic experts were conducted. Participants were drawn from a range of professional disciplines, including medicine, social care, occupational therapy and social policy and identified were by their contribution in this, or allied fields. The first survey included nine questions intended to identify at least one new research question that could form the basis of a funding proposal to the Nuffield Foundation, which provided “seedcorn” funding to support this work. Ten themes were identified following thematic analysis. The second survey asked participants to prioritise three of these themes. Findings Key themes emerging as priority areas for future research were as follows: the role of assessment in ensuring technology deployment meets the needs of service users; ethical implications of technology and how these might be addressed in the future; and the use of end user co-production/co-creation approaches in the development of new assistive technologies and digital enabled care. Research limitations/implications The findings are based on academic expert opinion; perspectives of practitioners, service users and family members are unrepresented. Practical implications The findings of this study could contribute to development of new directions for telecare research, and future strategic funding decisions in this rapidly changing field. Originality/value Evidence for sub-optimal outcomes for telecare requires new thinking. The authors are not aware of any other study that offers an analysis of expert opinion of fruitful areas for new research into telecare.

Learning from theCOVIDcrisis for educating children and young people with SEN/disabilities.

Learning from theCOVIDcrisis for educating children and young people with SEN/disabilities.

Self-help for learned journals: Scientific societies and the commerce of publishing in the 1950s.

In the decades after the Second World War, learned society publishers struggled to cope with the expanding output of scientific research and the increased involvement of commercial publishers in the business of publishing research journals. Could learned society journals survive economically in the postwar world, against this competition? Or was the emergence of a sales-based commercial model of publishing – in contrast to the traditional model of subsidized journal publishing – an opportunity to transform the often-fragile finances of learned societies? But there was also an existential threat: if commercial firms could successfully publish scientific journals, were learned society publishers no longer needed? This paper investigates how British learned society publishers adjusted to the new economic realities of the postwar world, through an investigation of the activities organized by the Royal Society of London and the Nuffield Foundation, culminating in the 1963 report Self-Help for Learned Journals. It reveals the postwar decades as the time when scientific research became something to be commodified and sold to libraries, rather than circulated as part of a scholarly mission. It will be essential reading for all those campaigning to transition academic publishing – including learned society publishing – away from the sales-based model once again.

Maurice Pierre Crosland (1931-2020): an appreciation.

Following some years of declining health, Professor Maurice Crosland passed away on 30 August 2020 at the age of eighty-nine. Author of four influential scholarly monographs, Maurice played major roles in the British Society for the History of Science during the 1960s and 1970s as an active Member of Council, Honorary Editor of the British Journal for the History of Science (1965-71) and Honorary President of the society (1974-6). His academic career began in 1963 with his appointment to a lectureship in the History & Philosophy of Science at the University of Leeds. In 1974 the by-then Reader in History of Science secured a £100,000 Nuffield Foundation Grant with which to establish, for the first time, a dedicated history-of-science group at the University of Kent at Canterbury. Appointed Professor of the History of Science and Director of the Unit for the History, Philosophy and Social Relations of Science (known as the 'History of Science Unit' or simply 'the Unit'), his objectives during the five-year Nuffield-funded period were to focus on promoting the research activities of the new group, build up much-needed library resources in a university which was barely ten years old, and effect a transition to a research and teaching Unit that would offer modules to undergraduates in each of the three principal faculties (Humanities, Natural Sciences and Social Sciences). His own research centred on French science during and after the Napoleonic period, with particular emphasis on the history of chemistry and the formal institutions and informal networks of Parisian science. In 1984 his work was recognized with the American Chemical Society's award of the Dexter Prize, a rare achievement for a British scholar.

Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications.

BackgroundNegative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards vaccines and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine in a large sample of UK adults.MethodsData were cross-sectional and from 32,361 adults in the UCL COVID-19 Social Study. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial regression examined the impact of socio-demographic and COVID-19 related factors, negative vaccine attitudes, and prior vaccine behaviour on uncertainty and unwillingness to be vaccinated for COVID-19.Findings16% of respondents displayed high levels of mistrust about vaccines across one or more domains. Distrustful attitudes towards vaccination were higher amongst individuals from ethnic minority backgrounds, with lower levels of education, lower annual income, poor knowledge of COVID-19, and poor compliance with government COVID-19 guidelines. Overall, 14% of respondents reported unwillingness to receive a vaccine for COVID-19, whilst 23% were unsure. The largest predictors of both COVID-19 vaccine uncertainty and refusal were low-income groups (< £16,000, a year), having not received a flu vaccine last year, poor adherence to COVID-19 government guidelines, female gender, and living with children. Amongst vaccine attitudes, intermediate to high levels of mistrust of vaccine benefit and concerns about future unforeseen side effects were the most important determinants of both uncertainty and unwillingness to vaccinate against COVID-19.InterpretationNegative attitudes towards vaccines are a major public health concern in the UK. General mistrust in vaccines and concerns about future side effects in particular will be barriers to achieving population immunity to COVID-19 through vaccination. Public health messaging should be tailored to address these concerns and specifically to women, ethnic minorities, and people with lower levels of education and incomes.FundingThe Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].

Anti-Vaccine Attitudes and Risk Factors for Not Agreeing to Vaccination Against COVID-19 Amongst 32,361 UK Adults: Implications for Public Health Communications

Background: Negative attitudes towards vaccines and an uncertainty or unwillingness to receive vaccinations are major barriers to managing the COVID-19 pandemic in the long-term. We estimate predictors of four domains of negative attitudes towards vaccines and identify groups most at risk of uncertainty and unwillingness to receive a COVID-19 vaccine in a large sample of UK adults.Methods: Data were from 32,361 adults in the UCL COVID-19 Social Study. Ordinary least squares regression analyses examined the impact of socio-demographic and COVID-19 related factors on four types of negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial logistic regression examined the impact of socio-demographic and COVID-19 related factors, negative vaccine attitudes, and prior vaccine behaviour on uncertainty and unwillingness to be vaccinated for COVID-19.Findings: 16% of respondents displayed high levels of mistrust or misinformation about vaccines across one or more domains. Distrustful attitudes towards vaccination were higher amongst individuals from ethnic minority backgrounds, with lower levels of education, lower annual income, poor knowledge of COVID-19, and poor compliance with government COVID-19 guidelines. Overall, 14% of respondents reported unwillingness to receive a vaccine for COVID-19, whilst 22% were unsure. The largest predictors of both COVID-19 vaccine uncertainty and refusal were low income (Interpretation: Negative attitudes towards vaccines are major public health concerns in the UK. General mistrust in vaccines and concerns about future side effects in particular will be barriers to achieving population immunity to COVID-19 through vaccination. Public health messaging should be tailored to address these concerns.Funding: The Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].Declaration of Interests: All authors declare no conflicts of interest.Ethics Approval Statement: Ethical approval for the COVID-19 Social Study was granted by the UCL Ethics Committee. All participants provided fully informed consent and the study is GDPR compliant.

Programming Emotional Care: The Nuffield Study of the Children’s Hospital, 1963

ABSTRACT The essay examines the integration of psychological expertise into the planning of the post-war children’s hospital in England. Its main objects of analysis are the Platt Report (1959), which conceptualized the child’s emotional needs and fears as distinct from those of adults, and the Nuffield Foundation’s study Children in Hospital (1963), one of the earliest attempts to develop a scientific methodology for integrating subjective experience into an architectural brief. The children’s hospital was conceptualized in relation to the familiar environments of the home and the school, to maintain their emotional stability in an unfamiliar social and technological environment. In the ways in which it sequenced admittance, treatment, recovery and discharge, the spatial organization of the children’s hospital not only reflected new ways of thinking about children and their emotions, but also promoted new desires, expectations, and truths regarding the relationship between children, parents, medical personnel and the state.

Data citizenship: rethinking data literacy in the age of disinformation, misinformation, and malinformation

In this paper we examine what ‘data literacy’ – under various definitions – means at a time of persistent distribution of ‘dis-/mis-/mal-information’ via digital media. The paper first explores the definition of literacies (written, media, information, digital and data literacies) considering the various parameters and considerations they have gone through. We then examine the intersection of dis-/mis-/mal-information and ‘fake-news’ and these literacies. The paper explores what types of literacies are needed today and the important role of variations in citizens' social context. We highlight three main gaps in current data literacy frameworks – 1. going beyond the individual; 2. critical thinking of the online ecosystem; and 3. designing skills for proactive citizens. We discuss these gaps while highlighting how we integrated these into our survey of UK citizens' data literacies as part of our Nuffield Foundation funded project - Me and My Big Data. By discussing our theoretical and methodological challenges we aim to shed light on not only how the definition of data literacy changes but also how we can develop education programmes that take into account information distortions and put proactive citizens at the centre.