Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: empirical evidence from secondary analysis of multi-national, online cross-sectional surveys

Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level

Namaste Care in nursing care homes with people with advanced dementia: protocol for a feasibility randomised controlled trial

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.Introduction Many people living with advanced dementia live and die in nursing care homes. The quality of life, care and dying experienced by these people is variable. Namaste Care is a multisensory programme of care developed for people with advanced dementia. While there is emerging evidence that Namaste Care may be beneficial for people with dementia, there is a need to conduct a feasibility study to establish the optimum way of delivering this complex intervention and whether benefits can be demonstrated in end-of-life care, for individuals and service delivery. The aim of the study is to ascertain the feasibility of conducting a full trial of the Namaste Care intervention. Methods and analysis A feasibility study, comprising a parallel, two-arm, multicentre cluster controlled randomised trial with embedded process and economic evaluation. Nursing care homes (total of eight) who deliver care to those with advanced dementia will be randomly allocated to intervention (delivered at nursing care home level) or control. Three participant groups will be recruited: residents with advanced dementia, informal carers of a participating resident and nursing care home staff. Data will be collected for 6 months. Feasibility objectives concern the recruitment and sampling of nursing homes, residents, informal carers and staff; the selection and timing of primary (quality of dying and quality of life) and secondary clinical outcome measures (person centredness, symptom presence, agitation, quality of life, resource use and costs and residents' activity monitored using actigraphy). Acceptability, fidelity and sustainability of the intervention will be assessed using semistructured interviews with staff and informal carers. Ethics and dissemination This protocol has been approved by NHS Wales Research Ethics Committee 5 (ref: 17/WA0378). Dissemination plans include working with a public involvement panel, through a website (http://www.namastetrial.org.uk), social media, academic and practice conferences and via peer reviewed publications. Trial registration number ISRCTN14948133; Pre-results.Peer reviewe

An End-to-End Machine Learning Solution for Anxiety and Depressive Disorder Symptom Occurrence During COVID-19: A New York Case Study

Anxiety and depression during the COVID-19 pandemic have heightened as evidenced by the rapidly growing corpus of research articles suggesting a link between the pandemic and mental health. This paper proposes a unique end-to-end user-centric machine learning (ML) architecture, capable of assessing the quality of ML predictions about the occurrence of anxiety and/or depression symptoms. A case study is presented using official New York State COVID-19 data, highlighting the plug-and-play capabilities of this architecture for both external features, and newer ML models. This is demonstrated through the formal design of a custom weighted clustering algorithm which outperforms conventional unsupervised techniques in grouping symptomatic cases. The ability to augment external sentiment data mined from social media platforms like Twitter, increases the predictive power of this architecture. This work serves as a blueprint to build a practical ML solution to better gauge the effect of future pandemic waves on mental health

Interventions to Promote Cancer Awareness and Early Presentation: Systematic Review

Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma

Mining Public Opinion on COVID-19 Vaccines using Unstructured Social Media Data

The emergence of the novel coronavirus (COVID-19), and the necessary separation of populations led to an unprecedented number of new social media users seeking information related to the pandemic. Nowadays, with an estimated 4.5 billion users worldwide, social media data offer an opportunity for near real-time analysis of large bodies of text related to disease outbreaks and vaccination. This study investigated and compared public discourse related to COVID-19 vaccines expressed on two popular social media platforms, Reddit and Twitter. Approximately 9.5 million Tweets and 70 thousand Reddit comments were analyzed from dates January 1, 2020, to March 1, 2022, and analyzed through topic modeling, sentiment analysis, and semantic network analysis. Sentiment analysis through the fine-tuned DistilRoBERTa model revealed that even though Twitter content was overall more negative than content expressed on Reddit, relatively similar changes in sentiment occurred among users of both online platforms. Reversals in sentiment trends typically occurred within relative proximity to events such as vaccine development news, vaccine release, frequent discussion of side-effects, the discovery of new variants, and pandemic fatigue. Topic modeling and semantic network analysis provided insight into how public discourse related to COVID-19 and vaccinations, misinformation, and vaccine hesitancy evolved over 26 months. Though misinformation and mention of conspiracy theories were detected with the analysis, the occurrence of both was less frequent than expected. This work provides a framework that could be scaled and utilized by public health officials to monitor disease outbreaks in near real-time in large communities as well as smaller local groups. Hopefully, the results from this study will help to guide and facilitate the implementation of targeted digital interventions among vaccine-hesitant populations and provide insights to public health officials to inform decision-making and effective policy development

The Symptom Experience of Black Women with Heart Failure Preserved Ejection Fraction

Background: Heart failure (HF) is a prevalent disease with a complex symptom experience. Black women with Heart Failure preserved Ejection Fraction (HFpEF) are especially burdened by symptoms, and their symptom experience is poorly understood. Clustering HF symptoms to understand which symptoms are experienced together is a potential option for helping patients recognize impending exacerbations. Methods: The dissertation\u27s first manuscript is an integrative review to examine the current state of HF symptom cluster literature. The second manuscript explores the feasibility and acceptability of a mixed methods HF symptom cluster study of Black women with HFpEF (N=44) and presents preliminary symptom cluster results. The third manuscript presents symptom experience themes from qualitative interviews (N=15) and integrates those findings with quantitative questionnaire data. Findings: An integrative review of HF symptom cluster literature revealed a need for exploring the symptom experience of Black women with HFpEF using mixed methods. A convergent-parallel mixed methods study protocol met feasibility benchmarks and was deemed acceptable by Black women with HFpEF. Preliminary symptom clusters were identified using quantitative symptom data from symptom questionnaires. Qualitative themes emerged relating to the symptom experience and person, and mixed methods integration provided additional key findings of concordance, discordance, and expansion. Conclusion: This dissertation describes the symptom experience of Black women with HFpEF, provides valuable information on the recruitment of an understudied population and their acceptability of a study protocol, and builds the foundation for conducting a mixed methods HF symptom cluster study with a larger sample in the future

Understanding Disease Heterogeneity and Patient Characteristics in Patients with Amyotrophic Lateral Sclerosis (ALS)

Background: Amytrophic lateral sclerosis (ALS) is a fatal neurologic disease that is projected to double in worldwide incidence in the next 20 years. The heterogenic nature of the disease and relatively limited research data, compared to non-rare diseases, have made it difficult for clinician researchers to alter the course of the disease within the short life expectancy after symptom onset. Method: This was a mixed-method retrospective review and live sampling study using three distinct data sources. Retrospective data was abstracted from the electronic medical record systems for a select group of ALS patients seen at the University of California, Irvine Neuromuscular Center (UCI NMC). Additional retrospective datasets curated by the Pooled Resources Open-Access Clinical Trials (PRO-ACT) database were also analyzed. Observational data was collected using a 9-item survey developed on Google Forms and disseminated through the ALS Association Golden West Chapter. The items measured symptom onset, diagnostic journey, and patient demographics.Results: The analyses confirmed current reports of higher disease incidence in Caucasian populations, usually comprising at least 60% of each dataset. The gender prevalence towards males was only observed in the PRO-ACT dataset. There was also a difference in mean age between PRO-ACT (56 years), UCI (61 years), and Online Questionnaire respondents (66 years). Discussion: Ultimately retrospective data analyses were limited by substantial missing, not at random data. Large data repositories can bridge the gap between non-rare and rare disease research, but only with robust and methodologic data collection across all participating sites

Supporting people with active and advanced disease: a rapid review of the evidence

1.1 Background: the NCSI AAD group The National Cancer Survivorship Initiative (NCSI, 2010) was set up in response to the NHS Cancer Reform Strategy (Department of Health, 2007) as a collaboration between Macmillan Cancer Support, the Department of Health and NHS Improvement, with the goal to achieve a better understanding of the experiences of cancer survivors and to advocate for the provision of services to support them. Within this broad remit, it was recognised that there was a particular group of patients whose needs were commonly neglected; people who were experiencing the ongoing effects of cancer beyond first-line treatment but who were not at end of life. The Active and Advanced Disease (AAD) working group was created to consider issues of relevance to such people. 1.2 Aims of this review This project set out to meet the following aim: To review the literature on selected cancers in order to identify implications for the development of services to support patients experiencing difficulties associated with active and advanced disease