Being homeless: The influence of personality and coping styles on health outcomes.

In 2007/2008 there were 56,561 applications to Scottish local authorities by individuals or households seeking assistance under the homeless persons legislation. This thesis examines the legislative background to homelessness and considers issues of definition. The link between homelessness and health outcomes is reviewed and homelessness is identified as a stressor. People react differently to being homeless and the influence of personality, and coping styles on health outcomes, measured by a modified version of the General Health Questionnaire (Goldberg and Hillier, 1979), was examined. Ninety-six people who had applied to a local authority for assistance due to homelessness completed a questionnaire and participated in an interview at a single session. The Ten Item Personality Index (Gosling, et. al, 2003) and the Internal-External scale (Rotter, 1966) were used to measure personality and the Ways of Coping Questionnaire (Folkman and Lazarus, 1988) was used to measure coping styles. The data was analysed using descriptive, correlational and regression analysis for the quantitative data and a reporting framework, which was developed to report on the qualitative data. It was found that emotional stability, planful problem solving, seeking social support and accepting responsibility were significant predictors of both mental and physical symptoms. Conscientiousness, and accepts responsibility were significant predictors of (social) dysfunction. Locus of control was found to have no significant influence on health outcomes. An interesting finding was that seeking social support as a coping style had the result of worsening health outcomes. Further analysis revealed that the outcome of seeking support is important and that to fail to achieve this can have a detrimental effect on health outcomes. The interview data gives an account of what being homeless means from a participant’s perspective and provides useful context to the quantitative data. The interview results were consistent with, and supported the questionnaire results. The implication of these results for an intervention strategy for homeless people assisted by a local authority is discussed, and a possible intervention is suggested which would enhance coping skills and improve access to health care for this group

Analysis of a First Professional Year Student Wellness Program

Objective: To identify wellness-related needs and assess the impact of wellness-related offerings among first professional year pharmacy students. Innovation: A survey tool was developed and offered to P1 students at the beginning and end of their fall and spring semesters. Additional biometric data was also collected to help identify wellness needs. Data from the first academic year (AY1) was used to develop targeted wellness interventions offered to P1 students during the subsequent academic year (AY2). Assessment strategies from AY1 were repeated with minor modifications in AY2 to identify changes in baseline needs and changes in markers across the academic year. Critical Analysis: AY1 survey response rates varied from 20.1% to 47.4% across the semester. Frequent dissatisfaction was reported with diet, weight, and exercise. AY2 survey response rates varied from 15.8% to 58.3% across the semester. The AY2 cohort demonstrated similar dissatisfaction data; however, also demonstrated lower baseline stress scores as compared to the AY1 cohort, higher baseline BMI, and higher systolic and diastolic blood pressure. Individual interventions offered to AY2 students were attended by as many as 16.5% of the academic cohort. Nutrition classes exhibited stronger attendance than fitness classes. Next Steps: The process used in this study was easily implemented and provided understanding of wellness gaps, which helped to identify interventions that were implemented and assessed. The process also demonstrated that wellness needs can vary from one population to another, reinforcing the value of periodic assessment to identify changing needs.   Type: Not

Building governance and energy efficiency: Mapping the interdisciplinary challenge

Improving the energy efficiency of multi-owned properties (MoPs)—commonly known as apartment or condominium buildings—is central to the achievement of European energy targets. However, little work to date has focused on how to facilitate retrofit in this context. Drawing on interdisciplinary Social Sciences and Humanities expertise in academia, policy and practice, this chapter posits that decision-making processes within MoPs might provide a key to the retrofit challenge. Existing theories or models of decision-making, applied in the MoP context, might help to explain how collective retrofit decisions are taken—or overlooked. Insights from case studies and practitioners are also key. Theories of change might then be employed to develop strategies to facilitate positive retrofit decisions. The chapter maps the issues and sets an agenda for further interdisciplinary research in this novel area

Mentoring Residency Candidates: Avoiding Misinformation and Employing Best Practices

Type: Commentar

Presenting signs and patient co-variables in Gaucher disease : outcome of the Gaucher Earlier Diagnosis Consensus (GED-C) Delphi initiative

© 2018 The Authors. Internal Medicine Journal by Wiley Publishing Asia Pty Ltd on behalf of Royal Australasian College of Physicians.Background: Gaucher disease (GD) presents with a range of signs and symptoms. Physicians can fail to recognise the early stages of GD owing to a lack of disease awareness, which can lead to significant diagnostic delays and sometimes irreversible but avoidable morbidities. Aim: The Gaucher Earlier Diagnosis Consensus (GED-C) initiative aimed to identify signs and co-variables considered most indicative of early type 1 and type 3 GD, to help non-specialists identify ‘at-risk’ patients who may benefit from diagnostic testing. Methods: An anonymous, three-round Delphi consensus process was deployed among a global panel of 22 specialists in GD (median experience 17.5 years, collectively managing almost 3000 patients). The rounds entailed data gathering, then importance ranking and establishment of consensus, using 5-point Likert scales and scoring thresholds defined a priori. Results: For type 1 disease, seven major signs (splenomegaly, thrombocytopenia, bone-related manifestations, anaemia, hyperferritinaemia, hepatomegaly and gammopathy) and two major co-variables (family history of GD and Ashkenazi-Jewish ancestry) were identified. For type 3 disease, nine major signs (splenomegaly, oculomotor disturbances, thrombocytopenia, epilepsy, anaemia, hepatomegaly, bone pain, motor disturbances and kyphosis) and one major co-variable (family history of GD) were identified. Lack of disease awareness, overlooking mild early signs and failure to consider GD as a diagnostic differential were considered major barriers to early diagnosis. Conclusion: The signs and co-variables identified in the GED-C initiative as potentially indicative of early GD will help to guide non-specialists and raise their index of suspicion in identifying patients potentially suitable for diagnostic testing for GD.Peer reviewedFinal Published versio

Exogenous sex steroid hormones and asthma in females:protocol for a population-based retrospective cohort study using a UK primary care database

This work was supported by Asthma UK, grant number: AUK-IG-2016-346. BIN, INS, CRS and AS were in addition support by the Farr Institute and Asthma UK Centre for Applied Research. BIN acknowledges the support of Knut and Alice Wallenberg Foundation and the Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden.Peer reviewedPublisher PD

Risk of cerebrovascular disease among 13,457 five‐year survivors of childhood cancer: a population based cohort study

Survivors of childhood cancer treated with cranial irradiation are at risk of cerebrovascular disease (CVD), but the risks beyond age 50 are unknown. In all, 13457 survivors of childhood cancer included in the population‐based British Childhood Cancer Survivor Study cohort were linked to Hospital Episode Statistics data for England. Risk of CVD related hospitalisation was quantified by standardised hospitalisation ratios (SHRs), absolute excess risks and cumulative incidence. Overall, 315 (2.3%) survivors had been hospitalised at least once for CVD with a 4‐fold risk compared to that expected (95% confidence interval [CI]: 3.7‐4.3). Survivors of a central nervous system (CNS) tumour and leukaemia treated with cranial irradiation were at greatest risk of CVD (SHR = 15.6, 95% CI: 14.0‐17.4; SHR = 5.4; 95% CI: 4.5‐6.5, respectively). Beyond age 60, on average, 3.1% of CNS tumour survivors treated with cranial irradiation were hospitalised annually for CVD (0.4% general population). Cumulative incidence of CVD increased from 16.0% at age 50 to 26.0% at age 65 (general population: 1.4‐4.2%). In conclusion, among CNS tumour survivors treated with cranial irradiation, the risk of CVD continues to increase substantially beyond age 50 up to at least age 65. Such survivors should be: counselled regarding this risk; regularly monitored for hypertension, dyslipidaemia and diabetes; advised on life‐style risk behaviours. Future research should include the recall for counselling and brain MRI to identify subgroups that could benefit from pharmacological or surgical intervention and establishment of a case‐control study to comprehensively determine risk‐factors for CVD

MicroRNA-196a & microRNA-101 expression in Barrett's oesophagus in patients with medically and surgically treated gastro-oesophageal reflux

<p>Abstract</p> <p>Background</p> <p>Proton pump inhibitor (PPI) medication and surgical fundoplication are used for the control of gastro-oesophageal reflux in patients with Barrett's oesophagus, but differ in their effectiveness for both acid and bile reflux. This might impact on the inflammatory processes that are associated with progression of Barrett's oesophagus to cancer, and this may be evident in the gene expression profile and microRNA expression pattern in Barrett's oesophagus mucosa. We hypothesised that two miRNAs with inflammatory and oncogenic roles, miR-101 and miR-196a, are differentially expressed in Barrett's oesophagus epithelium in patients with reflux treated medically vs. surgically.</p> <p>Findings</p> <p>Mucosal tissue was obtained at endoscopy from patients with Barrett's oesophagus whose reflux was controlled by proton pump inhibitor (PPI) therapy (n = 20) or by fundoplication (n = 19). RNA was extracted and the expression of miR-101 and miR-196a was measured using real-time reverse transcription - polymerase chain reaction. There were no significant differences in miR-101 and miR-196a expression in Barrett's oesophagus epithelium in patients treated by PPI vs. fundoplication (p = 0.768 and 0.211 respectively). Secondary analysis showed a correlation between miR-196a expression and Barrett's oesophagus segment length (p = 0.014).</p> <p>Conclusion</p> <p>The method of reflux treatment did not influence the expression of miR-101 and miR-196a in Barrett's oesophagus. This data does not provide support to the hypothesis that surgical treatment of reflux better prevents cancer development in Barrett's oesophagus. The association between miR-196a expression and Barrett's oesophagus length is consistent with a tumour promoting role for miR-196a in Barrett's oesophagus.</p