This paper explores changes in the commissioning, contracting and provision of NHS-funded cataract surgery in England over the last decade, focusing on the growing role of independent sector providers (ISPs). In recent years, there has been a dramatic rise in NHS-funded cataract surgery (from almost 417,000 cases in 2018/19 to about 650,000 in 2023/24) with the ISP share increasing from 22 to 57 per cent. A mixed-methods approach was employed, combining quantitative analysis of over 4.6 million NHS-funded hospital admissions for cataract surgery (2013–2024) and qualitative interviews with senior NHS and ISP stakeholders. Interviews were analysed using reflexive thematic analysis. The shift to ISPs was largely unplanned, driven by long NHS waiting lists, favourable payment tariffs, and low barriers to entry for new providers. ISPs’ involvement has contributed to reduced waiting times and improved productivity, potentially due to specialised infrastructure and incentive structures. However, concerns exist about contract management, service quality, and value for money. The study highlights the need for improved service commissioning, tariff reform, stronger contractual oversight, and effective monitoring to ensure quality and value. These findings have broader implications for healthcare systems balancing competition, patient choice, and public–private delivery models in elective care.

What can be learned about pandemic preparedness from greater attention to perspectives of people who live in regions labelled as ‘hotspots’ for disease outbreaks? And how might such attention require us to reconfigure science, policy, and practice – as part of a broader shifting of power in pandemics? These are the questions that motivate and are explored through the papers in this special issue on pandemic preparedness, for which this paper serves as Introduction. All the contributions to this special issue present perspectives, experiences, and reflections from African settings, drawing on research co-designed and conducted in close engagement with local communities or in dialogue with African scientists and public health actors. They approach biosocial questions from the concerns of the disciplinary fields of social, medical, and political anthropology, of engaged interdisciplinary social science, and, crucially, of embedded, ‘grassroots’ fieldwork by researchers who have grown up with the communities they are studying. The team bringing these complementary areas of expertise came together for a collaborative programme on ‘Pandemic preparedness: local and global concepts and practices in tackling disease threats in Africa’ supported by a collaborative award from the Wellcome Trust during 2018–2023. This special issue thus forms part of wider advocacy for rethinking pandemic preparedness and for the value of anthropology in informing its meanings and practices, now more than ever.

Multiple myeloma (MM) is one of the most common blood cancers. Despite lengthening survival with modern therapy, it remains largely fatal. Understanding the influence of common modifiable risk factors on MM risk is necessary to inform prevention.

We investigated the association between dietary exposures and MM in a population-based case-control study conducted in Victoria, and NSW, Australia (2010-2016). Incident cases of MM (n=746) were recruited primarily via cancer registries. Controls (n=706) were siblings or spouses of cases.

We estimated odds ratios (OR) and 95% confidence intervals (95%CI) for associations between MM and dietary exposures, including dietary patterns, fish consumption, and a healthy lifestyle index, adjusting for confounders.

Higher scores on a modified version of the Alternative Healthy Eating Index-2010 were associated with reduced risk of MM (mAHEI: OR=0.88, 95%CI=0.78-0.98). There was weaker evidence for reduced risk associated with higher healthful plant-based dietary index score (hPDI: OR=0.91, 95%CI=0.81-1.02). Increased MM risks were observed with higher scores on empirical dietary inflammatory pattern (EDIP: OR=1.20, 95%CI=1.07-1.35), empirical dietary indices for hyperinsulinaemia (EDIH: OR=1.15, 95%CI=1.02-1.31), and insulin resistance (EDIR: OR=1.21, 95%CI=1.08-1.37). There was no clear evidence of association with MM risk for fish consumption or a healthy lifestyle index.

We observed an association between adherence to a healthy diet and lower MM risk. While adherence to dietary patterns with the potential to increase insulin levels, insulin resistance, or promote inflammation was associated with increased MM risk. Results of studies assessing dietary intervention for MM prevention could reveal whether dietary modification directly influences MM risk.

Iron deficiency (ID) is a common nutritional disorder, especially among children, women of reproductive age. Detecting ID before it progresses to iron deficiency anaemia (IDA) is critical for prevention. This study assessed mean corpuscular hemoglobin (MCH) and red cell distribution width (RDW) as complete blood count (CBC) based markers for early non-anaemic iron deficiency (NAID). We retrospectively analysed records of children aged 2 months to 6 years who underwent regular general health checks at Fujian Provincial Maternal and Child Health Hospital between July 2022 and July 2024, ID was defined by serum ferritin < 15 µg/L. Children with thalassemia, inflammatory conditions (CRP > 5 mg/L), or incomplete data were excluded. Logistic regression was used to evaluate associations between CBC indices and ID. Model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve and externally validated using NHANES (August 2021-August 2023, Cycle 12) data. A total of 2,018 children were included (training: n = 1,413, testing: n = 605; external validation: n = 232). MCH (OR = 0.63; 95% CI, 0.52-0.76; p < 0.001) and RDW (OR = 1.44; 95% CI, 1.16-1.79; p = 0.001) were independent predictors of ID. The model showed consistent performance, with AUCs of 0.77 (training), 0.81 (testing), and 0.87 (validation). MCH and RDW are practical markers for early NAID detection in Chinese and US children, offering a valuable tool for any setting with an automated haematology analyser, particularly when access to advanced iron studies is restricted.

A high sodium intake is a major risk factor for raised blood pressure. Consumption of fish fillet is associated with lower blood pressure in humans and other animals, whereas the effects of consuming fish residuals are less explored. To obtain high-quality fishmeal with acceptable sensory properties, the fish residuals may be washed with seawater onboard factory trawlers. This will increase the sodium content in the residuals, and whether this affects blood pressure has not yet been investigated. The primary objective of the present study was to investigate if the increased sodium content in Atlantic cod (Gadus morhua) residuals after washing with saltwater affected the development of high blood pressure in male obese Zucker fa/fa rats which spontaneously develop hypertension. Rats were fed diets containing cod protein powders prepared from unwashed or saltwater-washed backbone or head fractions (n 6/group) as 25% of total protein with the remaining 75% as casein, or casein as the sole protein source (Control group, n 6) for six weeks. Blood pressure was measured on day 0 and 40. The diets containing backbone protein powder, independent of whether this fraction was washed with saltwater or not, attenuated the blood pressure increase compared to the Control group, whereas diets containing washed or unwashed head protein powder did not affect the blood pressure development. To conclude, a diet containing cod backbone protein powder attenuated the blood pressure increase in obese Zucker fa/fa rats, and this effect was not compromised by the higher sodium content in backbones washed with saltwater.

Recent US policy changes, including abortion bans and reductions to social safety nets, have intensified structural pressures on reproductive decision-making. Research has examined interpersonal and clinical forms of reproductive coercion, but legal and policy forces remain undertheorized. This commentary introduces and defines sociolegal reproductive coercion as occurring when individuals feel pressured or constrained in their reproductive choices due to legal and policy landscapes that are reinforced and reified by social and cultural forces. These pressures operate collectively to make certain options, such as long-acting reversible contraception, feel obligatory even when undesired, by amplifying risks associated with pregnancy, abortion, and parenting. Sociolegal coercion interacts with clinical practice, shaping provider counseling and narrowing perceived options, and disproportionately affects marginalized communities already subject to systemic inequities. We situate this construct within existing scholarship on constrained choice and social control, propose a conceptual framework, and outline implications for research, clinical care, and policy. Recognizing sociolegal reproductive coercion is critical for understanding how health policy and sociocultural dynamics jointly constrain autonomy and for informing reforms that advance reproductive justice in a post-Roe landscape.