Dawning Dependence: Processes underlying smoking cessation in adolescence

During adolescence young people are known to try out a range of risk behaviours, including smoking. Even though the detrimental health consequences of smoking are well known, the prevalence of smoking among Dutch adolescents remains high. Until today, efforts to control adolescent smoking are mainly focused on the prevention of smoking, whereas fewer efforts are made towards facilitating smoking cessation. Since the chance of a successful attempt to cease smoking diminishes the longer that people smoke, it is important that cessation interventions also focus on adolescents. However, compared to the many reports on predictors of smoking initiation, the literature addressing adolescent smoking cessation is rather limited, and the field is still considered to be underdeveloped. To facilitate the planning and development of programs to promote cessation among adolescents who smoke, the current thesis presents a number of studies that focus on identifying and studying potential determinants of smoking cessation, as well as determinants of important parameters of successful cessation such as readiness to quit smoking and undertaking quit attempts. Multiple levels of influence on the process of adolescent smoking cessation are considered and tested, including addiction, psychological and environmental factors. In addition, predictions and assumptions of several theories that are frequently used in explaining health behaviour, such as the Transtheoretical Model and Social Cognitive Theory, were tested in their applications to adolescent smoking cessation

CLADAG 2021 BOOK OF ABSTRACTS AND SHORT PAPERS

The book collects the short papers presented at the 13th Scientific Meeting of the Classification and Data Analysis Group (CLADAG) of the Italian Statistical Society (SIS). The meeting has been organized by the Department of Statistics, Computer Science and Applications of the University of Florence, under the auspices of the Italian Statistical Society and the International Federation of Classification Societies (IFCS). CLADAG is a member of the IFCS, a federation of national, regional, and linguistically-based classification societies. It is a non-profit, non-political scientific organization, whose aims are to further classification research

Separation of powers in the Kuwaiti criminal justice system

Discussions of the separation of powers tend to be related to the administrative state. By contrast, this research addresses the question of separating powers within the criminal justice system of Kuwait, examining the function of this division and the structures that are designed to protect the rights of citizens. Despite being formally regulated according to democratic principles, the criminal justice system of Kuwait has been described as excessively controlled by executive bodies. Currently, there appears to be a lack of research explaining how numerous criminal justice bodies in Kuwait can effectively promote the principles of freedom, democracy, and equality before the law, and separation of powers is an important factor which can be connected to such outcomes. The research aims to provide insights into the separation of powers between institutions and to assess its effectiveness in addressing the principles stated in the Constitution of Kuwait. The origins of the modern Kuwaiti criminal justice system will also be explored, with a focus on British jurisdiction (as a past influence) and French, Egyptian and Islamic law (as continuing influences). This development history makes Kuwait an excellent example of the fusion and diffusion of law, which, although it has been investigated widely, is still a topic of interest among modern researchers, alongside human rights and their protection through the criminal law system. This is one of the first studies to discuss the separation of powers in the Kuwaiti criminal justice system as a mixed phenomenon that can influence the protection of Kuwaiti citizens’ human rights at each stage of law enforcement and prosecution

Optimising the Investigation of Interventional Treatments in Lateral Elbow Tendinopathy

Background and Aim Lateral Elbow Tendinopathy (LET) is a common, painful condition, predominantly affecting working age people. Although numerous studies have been conducted assessing a multitude of therapeutic interventions, fundamental information regarding outcome measure choice, treatment delivery techniques, and trial feasibility have not been explored. This thesis aims to optimise the investigation of interventional therapies in lateral elbow tendinopathy by furthering the foundational knowledge from which future researchers can inform their study design. Methods A portfolio of studies was undertaken to explore three main themes: the choice of patient-centred outcome measure, the rationale for injection therapy technique and the feasibility and acceptability of a randomised controlled study methodology in Platelet-Rich Plasma (PRP) injection therapy. Seven studies addressing these themes were undertaken: a three-phase systematic review and standardised evaluation of patient-centred clinical rating systems in elbow pathology, a validation study of outcome measures in a UK population of lateral elbow tendinopathy patients, a cadaveric assessment of elbow injection distribution, a Delphi consensus study of PRP injection use and a feasibility randomised controlled trial of PRP versus surgery for chronic LET. Results The systematic review identified 72 clinical rating systems used in elbow pathology, 15 of which had a history of validation in lateral elbow tendinopathy patients. Standardised comparative assessment found that only four reached the minimum threshold for recommendation (QDASH, DASH, OES and PRTEE). The correlation between the frequency of clinical rating systems use and their performance was r = 0.35. Cross-culturally specific validity of these rating systems in a UK population was limited to 20 patients embedded in mixed pathology cohorts. Evaluation of the psychometric properties of the highest performing clinical rating systems was performed in 50 tendinopathy patients recruited across general practice, physiotherapy and secondary care settings, with all instruments achieving adequate internal consistency (Cronbach's alpha >0.87), reliability (intraclass correlation coefficient >0.85) and responsiveness (effect sizes >0.46). The cadaveric evaluation found no statistical difference between the intratendinous distribution of lateral elbow injections between 1ml and 3ml or between single shot or fenestrated injection techniques. The Delphi consensus study on the application of platelet-rich plasma injections found poor levels of agreement amongst experts on the technical preparation and application of this treatment. The feasibility randomised control trial found that a randomised controlled trial is technically feasible (86% recruitment rate, 8% drop-out and 8% cross-over). Qualitative interviews with these patients identified very high levels of procedural injection pain. Conclusion This research improves upon the knowledge base from which future evaluations of interventional treatment in lateral elbow tendinopathy can be constructed. It is the first one to identify the wide choice and disparate utility of patient-centred outcome measures in elbow pathology. It can recommend the QDASH, DASH, OES or PRTEE for use in the English language and provides evidence of the validity and reliability of these instruments in the UK. Injection methodology should be rationalised to low volume single-shot injections, and research priorities should be allied to areas identified as lacking expert consensus. Though feasible and acceptable, future parallel group studies should quantify and report procedural pain.Royal College of SurgeonsStryker UK LtdBritish Elbow & Shoulder Societ

Barriers and Facilitators of Patient’s Engagement in Musculoskeletal Research

In recent years there has been a growing interest by stakeholders in engaging patients in research where the preferences/ expectations and input of patients are important in the conceptualization and execution of the research projects/medical procedures. Patients are becoming more informed, empowered and active partners in their healthcare, and are seeking to be more engaged in the research engagement continuum The purpose of this thesis was to 1) assess and identify the facilitators and significant barriers of patients\u27 engagement in musculoskeletal research; and document factors that facilitate patient engagement in musculoskeletal research. 2) identify and synthesize evidence that determines the extent to which expectations are predictive of postoperative outcomes in patients undergoing total shoulder, elbow, or radial head replacement and metacarpophalangeal joint arthroplasty. We conducted a literature review on patient engagement in research and a systematic review on patient expectations in musculoskeletal arthroplasty. Although there was a limited but significant association between patients’ preoperative expectations and postoperative outcomes for total shoulder arthroplasty yet we found in both studies that patients’ beliefs/self-efficacy expectations, barriers and potential benefits according to Health Belief Model influenced patients’ engagement in health research and the outcomes on total joint arthroplasty. We also found that lack of awareness of research was a major barrier to patient engagement in research Only a few (10.8%) have ever been involved in the research engagement continuum as team members. This finding was very important because it highlights a major gap in the implementation of patient engagement in the research. Several other barriers were identified in the study such as cost of transportation to the research site, work commitment, and patients’ concerns about the potential effect of research on their health. The participants also expressed their preferences and some factors that could facilitate their engagement in research. One key message from this thesis was that given the fact that patients\u27 knowledge and participation are important for participation in research, future research initiatives should be flexible enough to accommodate patients’ preferences and expectations

Humeral shaft fractures:Epidemiology, management, and outcomes

The dissertation describes the epidemiology, treatment, and outcomes of humeral shaft fractures. Humeral shaft fractures can be treated nonoperatively with functional bracing of operatively with plate osteosynthesis or an intramedullary nail. The research in this dissertation was carried out as the preferred treatment of humeral shaft fractures was subject to scientific debate. This dissertation first describes a systematic literature review and pooled analysis, which suggests that even though all treatment modalities result in satisfactory outcomes, plate osteosynthesis seems to result in the most favorable outcomes. Furthermore, it describes the results of the HUMMER study, a multicenter prospective cohort study with 29 participating centers designed to compare operative and nonoperative treatment of a closed humeral shaft fracture AO type 12A and B. This study shows that Operative treatment is associated with a more than twofold reduced risk of nonunion, earlier functional recovery, and a better range of motion of the shoulder and elbow joint than nonoperative treatment. Besides that, it showed that the rate of complications as well as secondary surgical interventions was higher in the nonoperative group. When comparing outcomes after operative treatment, the study showed that plate osteosynthesis of a humeral shaft fracture in adults results in faster recovery, especially of the shoulder function. Besides that, it was found that plate osteosynthesis was associated with fewer implant-related complications and surgical reinterventions than nailing. Therefore, the authors concluded plate osteosynthesis should be the preferred operative treatment strategy for humeral shaft fractures AO type 12 A and B. As secondary analysis, the consequences of radial nerve palsy at presentation and postoperative radial nerve palsy in patients with a closed humeral shaft fracture were described. This showed that radial nerve palsy in humeral shaft fractures, either at presentation or postoperative, has a low occurrence rate and a high rate of spontaneous functional recovery. Therefore, treatment of humeral shaft fractures should not be guided by the presence of radial nerve palsy at presentation or risk of postoperative radial nerve palsy. Furthermore, the cost-utility and cost-effectiveness of operative versus nonoperative treatment in patients with a humeral shaft fracture were analyzed. It was found that, due to the limited effect of the treatment a humeral shaft fracture on quality of life measured with the EQ-5D, the cost-effectiveness in terms of costs per QALY (€111,860) exceeds the acceptability limit. The incremental costs of €2,880 per meaningful difference in DASH are well below this limit and suggest that operative treatment for a humeral shaft fracture is cost-effective.The last part of the dissertation describes the fracture type, treatment, and outcome of humeral shaft fractures in adult polytraumatized patients. This showed that humeral shaft fractures in adult polytraumatized patients were most often AO-type A and treated operatively. In this population, rates of radial nerve palsy at presentation and nonunion were relatively high. Besides that, patients still reported upper extremity disability at approximately five years post trauma.Finally, the general discussion and future perspectives are discussed in Chapter 8.<br/