The impact of colorectal cancer, self-efficacy and social support on work ability and employment status : a longitudinal study

Each year approximately 90,000 new cases of cancer are diagnosed in people of working age in the United Kingdom (UK) (Morrell ;Pryce, 2005). The potential impact of cancer and its treatment on working life is substantial, with approximately 40% of all cancer patients taking time off work during treatment and recovery (Short, Vasey ;Tunceli, 2005). However, little information is available on employment outcomes for those managing colorectal cancer. Colorectal cancer is a commonly diagnosed cancer with approximately 36,000 people diagnosed each year in the UK. Although research demonstrates promising return to work outcomes for this group, not enough is known about the factors (variables) impacting their return to work intentions, work ability and employment outcomes. The aims of this research were to: examine the return to work intentions, work ability and employment outcomes of colorectal cancer patients over six months; explore the role of self-efficacy and psychosocial well-being, and explore the role of health professionals in providing work-related support and information to patients. Findings from these studies may help to better inform future interventions to support this cancer group. Fifty participants newly diagnosed with colorectal cancer were recruited from three Acute NHS Trusts (n = 27) across the Midlands and a support group (n = 23) affiliated to a National Cancer Charity. Participants completed questionnaires at three time points: baseline (post surgery or pre-treatment); follow-up time 1 (3 months), and follow-up time 2 (6 months). As well as illness and demographic characteristics, the questionnaires measured job self-efficacy, work ability, cancer self-efficacy, quality of life, fatigue and depression. A sub-sample of participants (n = 10) completed a monthly diary over six months. This captured temporal fluctuations and patterns in cancer management, return to work intentions and work ability and the factors impacting upon these (self-efficacy and social support). Finally, 18 health professionals participated in semi-structured interviews that explored the nature and type of work-related advice currently provided to colorectal cancer patients. Data were analysed using both quantitative (ANOVAs and regression) and qualitative techniques (thematic analysis). The questionnaire study identified varying levels in self-assessed work ability and psychosocial well-being. Most importantly, positive changes in perceptions of cancer self-efficacy F (1.02, 61.12) = 14.70, p = 0.0005, and job self-efficacy F (2, 94) = 10.85, p = 0.0005 were detected over time; however, interactions between treatment type and time did not emerge (p > 0.05). Factors related to perceived work ability outcomes cross-sectionally included type of occupation (β = 0.31, t = 2.65, p = 0.0005) and quality of life (β = 0.42, t = 2.57, p = 0.01) at baseline, treatment type (β = -0.19, t = -1.94, p = 0.05) at follow-up time 1 and job self-efficacy at follow-up time 1 (β = 0.57, t = 4.40, p = 0.0005) and time 2 (β = 0.50, t = 2.92, p = 0.006). In contrast, factors related to employment status (i.e. working, not working) were job self-efficacy (OR = 2.20, 95% CI: 1.17 4.13) at baseline and occupation (OR = 0.03, 95% CI: 0.00 0.86), and perceived work ability (OR = 3.05, 95% CI: 1.00 12.80) at follow-up time 2. Along with self-assessed work ability at baseline (β = 0.67, t = 3.99, p = 0.0005), receiving chemotherapy alone or a combination of treatments (i.e. other than surgery alone) (β = -0.24, t = -1.99, p = 0.05) were the strongest predictors of follow-up work ability (independent of age and occupation). Finally, treatment type (OR = 9.91, 95% CI: 1.57 62.50) was also identified as the strongest predictor of employment status approximately six months after diagnosis. Findings from the diary study suggest that self-efficacy beliefs were important in understanding employment outcomes and return to work intentions. The role of such beliefs was multi-faceted and results infer that several factors seemed to impact return to work intentions and self-efficacy temporally. Treatment, symptoms and decrements in perceived work ability were identified as the most prominent factors that served as barriers preventing resumption of work. Moreover, there was a degree of disparity between return to work intent and work ability. Additionally, the diary study identified variation in work-related advice and guidance provided to colorectal patients. Subsequently, some participants may have been under the impression that they were unable to work, especially during treatment. Results from the interview study found that health professionals attempted to provide guidance to working-aged patients. However, the nature of such guidance varied due to experience, knowledge and time constraints. Furthermore, participants highlighted a lack of knowledge and an insufficient evidence base were barriers to providing more appropriate guidance. The majority of participants stated that this was an aspect of patient care that falls short and to address the issue a concerted multi-disciplinary effort was required. In short, the findings indicate that the factors related to work ability, return to work intentions and employment outcomes of colorectal cancer patients varied over time, whereby certain variables took precedence over others at particular time points. Furthermore, the results suggest that self-efficacy beliefs are important; however, it is crucial to point out that self-efficacy is unlikely to operate as a stand-alone factor. Indeed, it is argued that it may be a construct that is considered in future research endeavours alongside pre-existing findings, which would inevitably help towards gaining a more comprehensive account of the factors related to the work outcomes of individuals affected by cancer.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Impact of the Media Portrayal of Coeliac Disease: A Qualitative Study

Background: Coeliac disease (CD) is a topic that has gained momentum in recent years due to an increase in the rates of diagnosis and a rise in the number of people following a gluten-free diet (GFD). Previous studies have shown the ability of the media to influence the behavior of the public, particularly in relation to healthcare. The media portrayal of CD, and its significance, has not yet been explored. Objectives: This study aims to describe and analyze the nature of the media coverage of CD. The implications of the nature of messages should be considered, and any temporal change in content explored. Methods: A document analysis of local and national UK newspaper articles over three weeks, from May 2(nd) to May 22(nd), 2016, was conducted, ensuring coverage of articles from Coeliac Awareness Week (commencing May 9(th)). Articles containing instances of CD-related language were collected by Kantar Media ([London, UK] a media intelligence company) for their client - Coeliac UK (Buckinghamshire, UK), and analyzed using a combination of thematic and content analysis techniques. An inductive approach was used to code articles into themes, with frequency data also presented. Results: Four hundred eighty-eight articles were included in the analysis, with 233, 117, and 138 articles in weeks one, two, and three, respectively. Six overarching themes were identified: events around Awareness Week and food content noted as gluten-free (GF), as well as raising awareness, encouraging people to seek help, and other health implications and perceptions of CD and the GFD, of which a significant proportion consisted of articles by Coeliac UK. The increasing popularity of the GFD emerged as a theme, encompassing the growth of the GF industry and celebrity endorsements. Notably, positively and negatively framed articles were identified, with most instances of negative articles occurring in week three. Conclusions: Coeliac Awareness Week was found to have had an influence on the content of newspaper articles, given the increase in the number of negative articles in week three and the significantly higher number of articles in week one. This mixed messaging was considered to negatively impact the potential and current patients with CD, especially in relation to GFD adherence and diagnosis rates.

Patients' and healthcare professionals' views on a specialist smoking cessation service delivered in a United Kingdom hospital: a qualitative study

BACKGROUND: Hospital admission provides a powerful opportunity to promote smoking cessation. We explored patients' and healthcare professionals' (HCP) views of a specialist smoking cessation service comprising systematic smoking ascertainment, default provision of pharmacotherapy and behavioural counselling at the bedside, and post-discharge follow-up, in a clinical trial in a United Kingdom teaching hospital. METHODS: Semi-structured interviews with 30 patients who were offered the intervention, and 27 HCPs working on intervention wards, were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: The shock of being admitted, and awareness that smoking may have contributed to the need for hospital admission, caused many patients to reassess their quit intentions. Most patients felt the service was too good an opportunity to pass up, because having long-term support and progress monitored was more likely to result in abstinence than trying alone. Had they not been approached, many patients reported that they would have attempted to quit alone, though some would have been discouraged from doing so by pharmacotherapy costs. Service delivery by a specialist advisor was favoured by patients and HCPs, largely because HCPs lacked time and expertise to intervene. HCPs reported that in usual practice, discussions about smoking were usually limited to ascertainment of smoking status. Timing of service delivery and improved co-ordination between service staff and inpatient ward staff were matters to address. CONCLUSIONS: A hospital-based specialist smoking cessation service designed to identify smokers and initiate cessation support at the bedside was deemed appropriate by patients and HCPs. TRIAL REGISTRATION: Trial registration: ISRCTN25441641

‘I Felt Welcomed in Like They’re a Little Family in There, I Felt Like I Was Joining a Team or Something’: Vape Shop Customers’ Experiences of E-Cigarette Use, Vape Shops and the Vaping Community

Background: Specialist electronic cigarette (e-cigarette) shops, known as vape shops, provide access to a less harmful alternative to smoking. This study aimed to understand customers’ experiences of vaping and vape shops, and the extent to which smoking cessation advice is and should be provided in these shops. Methods: We conducted telephone interviews with 22 customers recruited in vapeshops in the East Midlands region of England. Interviews explored participants’ smoking histories, reasons for using e-cigarettes, the role of vape shops in their e-cigarette use, and whether smoking cessation was discussed in vape shops. Interviews were analysed following framework approach principles. Results: Most respondents regarded e-cigarettes as a quitting tool and reported very positive experiences of vaping. Vape shops were central to participants’ positive experiences, in that they provided access to a wide variety of high-quality products and reliable product information and advice. The shop staff engendered a sense of loyalty in customers which, together with the community of other vapers, created a network that helped to support e-cigarette use. Vape shops were not regarded as a setting in which cessation advice was generally provided but were acknowledged as potentially appropriate places to provide quitting support. Conclusions: Vape shops have the potential to play an important role in tobacco harm reduction, which could be increased if their service model were to extend to help smokers to quit

Portrayal of tobacco smoking in popular women's magazines: a content analysis

Background: Whilst many countries have introduced legislation prohibiting tobacco advertising and sponsorship, references to tobacco continue to appear in the media. This study quantified and characterized tobacco smoking content in popular women's magazines. Methods: The 10 top weekly and 5 monthly women's magazines most popular among 15–34 year olds in Britain published over a 3-month period were included. A content analysis was conducted for both written and visual content. Results: In 146 magazines, there were 310 instances of tobacco content, the majority of which were positive towards smoking. Instances of celebrities smoking were most common (171, 55%), often in holiday or party settings that could be perceived to be luxurious, glamorous or fun. In all, 55 (18%) tobacco references related to fashion, which generally created an impression of smoking as a norm within the industry; and 34 (11%) text and image references to tobacco in TV and film. There were 50 (16%) reader-initiated mentions of smoking, typically in real-life stories or readers writing in to seek advice about smoking. Anti-smoking references including the hazards of smoking were infrequent (49; 16%). Conclusions: Although tobacco advertising is prohibited in Britain, women's magazines still appear to be promoting positive messages about tobacco and smoking

Ayurveda for managing non-communicable diseases in Organisation for Economic Co-operation and Development: a qualitative systematic review protocol on experiences, perceptions, and perspectives of Ayurvedic practitioners and patients

Background and Aims: Ayurveda is a traditional medicine that originated in the Indian subcontinent, and its use remains widespread in the Indian subcontinent, especially for managing non-communicable diseases (NCDs). It is also becoming increasingly popular in the Organization for Economic Co-operation and Development (OECD) countries as complementary and alternative medicine. Qualitative research studies have been conducted in various OECD countries to explore the experiences, perceptions, and perspectives of Ayurvedic practitioners and patients with NCDs regarding the usage of Ayurveda for managing these conditions. However, to date, no systematic review on this topic has been published. Therefore, this systematic review aims to synthesize the experiences, perceptions, and perspectives of Ayurvedic practitioners and patients with NCDs on the usage of Ayurveda for managing these conditions in OECD countries. Methods: The systematic review will be conducted in accordance with the JBI systematic review guideline on qualitative evidence. We will include qualitative research studies conducted among Ayurvedic practitioners or adult patients with NCDs in any OECD member country to explore experiences, perceptions, or perspectives regarding the usage of Ayurveda for managing NCDs. MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), AMED, and Web of Science will be searched to identify published studies. EthOS and ProQuest Dissertations and Theses will be searched to identify unpublished studies. No date or language restrictions will be applied. Initially, a narrative synthesis will be conducted. Where possible, study findings will be pooled using the meta-aggregation approach. PROSPERO registration CRD4202339795

Nature of events and alcohol-related content in marketing materials at a university freshers’ fair: a summative content analysis

Introduction:The transition to university is a potentially influential time upon students’ drinking behaviour. This study explored the nature of activities and alcohol-related content in marketing materials from student-led societies and local businesses provided to students, at a university freshers’ fair in the UK. Methods: All marketing materials handed out at the fair were collected across the 5-day event in September 2015. Written and visual content was analysed using a summative qualitative content analysis. Results: Most student-led societies promoted social events they were hosting (n=530), most of which took place in a drinking venue or referred to drinking (n=335). Only four explicitly alcohol-free events were promoted. Student-led societies also promoted activities relating to their interest e.g. sports training (n=519), a small proportion of which had references to drinking and drinking venues (n=54). Three societies provided promotional handouts from local bars or nightclubs. Local bars, pubs and nightclubs promoted events they hosted (n=81) as well as alcoholic drink promotions (n=79) and alcohol branded advertising (n=22), albeit infrequently for the latter. Conclusions: In the first week of university, students are exposed to alcohol-related events, promotions, and advertising, which may act as an incentive to participate in drinking

Exploring parents’ experiences, attitudes and understanding of gastro-oesophageal reflux in infants

Background: Gastro-oesophageal reflux (GOR) affects nearly half of infants. Parents play a crucial role in management but more understanding of their attitudes and experiences is needed to inform future education, support and research. This study aims to explore parental experiences, attitudes and understanding of the symptoms, diagnosis and management of infant GOR.Methods: Qualitative semi-structured interviews with 9 parents of infants with GOR in the UK, analysed by thematic analysis.Results: 8 participants were mothers and median age was 34 years. Over half identified as White ethnicity. Parents described that GOR can affect all aspects of life, including mental wellbeing and bonding with their baby. Medications are time-consuming to prepare and can cause challenging side effects such as constipation. It is crucial that health professionals manage parental expectations in that treatments are not curative and symptoms do not last forever. Attitudes about healthcare professionals varied: some were perceived as dismissive,whilst some showed understanding. There were differences depending on whether the child was a first or second born child, with more understanding shown where the child was not the parents’ first born. Parents felt more education could be beneficial for parents and clinicians.Conclusions: Infant GOR can affect infants and parents in a variety of ways, impacting both physical and mental health. Parents play a vital role in the management of infant reflux, but there is lack of consistency of information and levels of knowledge among healthcare professionals vary. More education could be beneficial, and further research is needed into health professionals’ perceptions and fathers’ experiences

Vape shops: Who uses them and what do they do?

BACKGROUND: 'Vape shops' are a popular source for buying electronic cigarettes (e-cigarettes) and related products. The products that vape shops sell, their marketing techniques and the extent to which they provide information or encouragement to smokers to quit tobacco use, as well as the patterns of tobacco and e-cigarette use of their customers are not well understood. METHODS: We conducted cross-sectional surveys in vape shops in the East Midlands region of the United Kingdom, one with shop staff (n = 41), and one with customers (n = 197). RESULTS: The majority of customers (84%) currently used e-cigarettes. Among current vapers, 19% were dual users and 78% had quit smoking. Over half of vapers reported using a lower level of nicotine in their current e-liquid than when they started using e-cigarettes. There was a wide variety in products and price ranges between the shops. Many staff reported that customers ask for information about quitting smoking (90%). Less than half reported providing smoking cessation advice, although 76% of staff reported feeling confident about delivering cessation advice to customers who ask for it. Just under half of customers and shop staff said they thought it was appropriate to deliver formal in-store smoking cessation support. CONCLUSIONS: The majority of vape shop customers are vapers who have quit smoking. Shop staff play a central role in providing customers with product information, and many provide smoking cessation advice. Further research is needed to investigate the potential for smoking cessation interventions in vape shops, including the extent to which these would appeal to non-vapers

Association between polycystic ovarian syndrome and adverse pregnancy and neonatal outcomes among women in Oman

Objectives: To examine the association between PCOS and selected metabolic, pregnancy and neonatal outcomes among pregnant women and their newborns. Methods: Cohort study using electronic hospital records from two tertiary hospitals in Oman. Data were collected from 922 women, contributing 1,939 pregnancies and 1,721 live born infants, in the period from 1 January 2006 to 31 May 2017. Metabolic, pregnancy and neonatal outcomes in the 305 women with a diagnosis of PCOS were compared to outcomes in 617 women without PCOS using multivariable multilevel regression models. Results: Women with PCOS were more likely to develop adverse metabolic outcomes during pregnancy compared to women without PCOS, including developing gestational diabetes mellitus (odds ratio (OR) 3.79, 95% CI 2.22, 6.48) and pregnancy induced hypertension (OR 2.81, 95% CI 1.26, 6.24). The odds of adverse birth outcomes of miscarriage (OR 4.43, 95% CI 2.92, 6.71) and preterm delivery (OR 3.46, 95% CI 1.94, 6.16) were also higher, as was the risk of undergoing emergency caesarean section (OR 3.51, 95% CI 1.80, 6.86). Infants born to mothers with PCOS were not at increased risk of macrosomia, low weight for gestational age or low APGAR score, but they were more likely to require admission to a neonatal unit (OR 2.41, 95% CI 1.10, 5.27). Conclusions: Pregnant women in Oman with PCOS are at a significantly increased risk of metabolic disorders during pregnancy and several adverse birth and neonatal outcomes. Close antenatal monitoring will help early detection and control of metabolic disorders and timely intervention