The relationship between cancer patient's fear of recurrence and radiotherapy : a systematic review and meta-analysis

The authors are also grateful to the Breast Cancer Now for supporting this research (grant reference number 6873).OBJECTIVE: This review aims to provide an overview of the current knowledge available on the nature and extent of the relationship between external-beam radiotherapy (RT) and fear of cancer recurrence (FoR). METHODS: PubMed, MEDLINE and EMBASE databases were searched to identify relevant studies. Systematic review procedures were followed including a quality assessment. Meta-analysis of suitable studies was conducted. RESULTS: Twenty-five eligible studies were included in the systematic review and 15 of them were included in further meta-analysis. Meta-analysis of the available data confirmed a weak relationship between RT and FoR (15 studies, 9567 patients, overall r = 0.053, 95%, CI: 0.021-0.085, P = 0.001). Subgroup analysis based on cancer site (breast cancer versus other types of cancer) revealed that the correlation between RT and FoR was statistically significant in 'other cancer' group (P˂0.001) but was nonsignificant in 'breast cancer' group (P = 0.538). CONCLUSIONS: While meta-analysis reports a statistically significant association between cancer patient's FoR and the receipt of RT, these results should be interpreted with caution due to significant variability between studies. Further longitudinal studies should be conducted to address the trajectory of FoR over RT in greater detail. PostprintPeer reviewe

Prevalence of gestational diabetes mellitus in Europe: A meta-analysis

Aims  Estimates of the prevalence of gestational diabetes vary widely. It is important to have a clear understanding of the prevalence of this condition to be able to plan interventions and health care provision. This paper describes a meta-analysis of primary research data reporting the prevalence of gestational diabetes mellitus in the general pregnant population of developed countries in Europe.  Methods  Four electronic databases were systematically searched in May 2016. English language articles reporting gestational diabetes mellitus prevalence using universal screening in general pregnant population samples from developed countries in Europe were included. All papers identified by the search were screened by one author, and then half screened independently by a second author and half by a third author. Data were extracted by one author. Values for the measures of interest were combined using a random effects model and analysis of the effects of moderator variables was carried out.  Results  A total of 3258 abstracts were screened, with 40 studies included in the review. Overall prevalence of gestational diabetes mellitus was 5.4% (3.8–7.8). Maternal age, year of data collection, country, area of Europe, week of gestation at testing, and diagnostic criteria were found to have a significant univariate effect on GDM prevalence, and area, week of gestation at testing and year of data collection remained statistically significant in multivariate analysis. Quality category was significant in multivariate but not univariate analysis.  Conclusions  This meta-analysis shows prevalence of GDM that is at the upper end of previous estimates in Europe

Patterns of self-monitoring of blood glucose (SMBG) in insulin-treated diabetes: analysis of a Scottish population over time

Analysis of a diabetes clinical information system in Tayside, Scotland, shows that a significant proportion of insulin-treated patients with diabetes are not self-monitoring blood glucose according to current clinical guidance and recommendations, with some not self-monitoring their blood glucose at all. Although there has been an increase in the numbers of reagent strips dispensed over the past decade, this increase is mainly accounted for by increased testing frequency among people with diabetes already testing.Output Type: Research Lette

Self-monitoring of blood glucose in insulin-treated diabetes: a multicase study

Objective To explore how and why self-monitoring of blood glucose (SMBG) is carried out in a real-world context. Research design and methods We conducted a multicase study among ten people with type 1 and insulin-treated type 2 diabetes mellitus in Scotland, alongside seven nominated support people and four healthcare professionals. All participants were interviewed in depth and six participants provided SMBG diaries. Stones' version of structuration theory informed the analysis. Results People with diabetes were able to provide immediate motives for SMBG at particular times, often having different motives on different occasions. We identified six such motives, including routine, in response to symptoms, associated with a diabetes review, to facilitate lifestyle, when a 'good' result was expected, and higher level motives for longer term glycemic control. These motives were influenced by underlying attitudes toward diabetes that included level of engagement and responsibility for diabetes, a desire not to be controlled by diabetes, resistance to diabetes, diabetes education and relationship with the health service, fear of hypoglycemia, and prevention of diabetes complications. Five responses to test results were identified, depending on the immediate motive and underlying attitudes. Conclusions People with insulin-treated diabetes do not necessarily self-monitor with an explicit goal of improving long-term glycemic control, but may have other motives that are important to them. An individualized understanding is therefore needed to advise people with diabetes how SMBG can be optimized for them

Health and health behaviours among a cohort of first year nursing students in Scotland: A self-report survey

The study aim was to collect data on the health and health-related behaviours of undergraduate nursing students at a Higher Education Institution in Scotland, to identify the need for potential health behaviour change interventions as part of their undergraduate course. An anonymous self-report questionnaire (with questions about physical activity, diet, sleep, alcohol, smoking, mental health) was administered to first year nursing students at a Scottish university. The response rate was 88%, with 207 respondents (26 male, 178 female, 3 other). Age ranged from 16 to 45 years (mean 24.5 years). Overall, 48 (23.1%) students rated their physical health as excellent/very good, and 100 (48.3%) their mental health as such. 157 (76.2%) students were achieving 150 min of physical activity per week. There were 48 (29%) and 30 (18.2%) overweight and obese students respectively. 129 (62.6%) students viewed a mobile device for > 30 min before sleep. 176 (86.3%) students consumed alcohol, with 32 (15.4%) reporting binge drinking. The prevalence of current smoking was 24.8%. The students’ health behaviour profile was therefore broadly similar to that of the general population in Scotland, but smoking, diet, sleep practices and binge-drinking were identified as priority areas for health education and intervention

The development of an intervention for diabetes prevention among people with impaired glucose regulation:feasibility and acceptability of an intervention component

Background As part of the design process of a low-cost minimal-contact diabetes prevention intervention, we issued a blood glucose meter to people with impaired glucose regulation (who are at high risk of type 2 diabetes). We conducted a feasibility study to assess the acceptability of this intervention component and whether and how recipients engaged with it. Methods A blood glucose meter was given to 19 people identified through primary care, who were asked to use the meter in an exploratory way during a 4-week trial period, to try to understand the effect of different foods on the body. They were advised that they could test as often or as little as they liked and were also asked to keep a food/exercise diary for at least 1 week. They were interviewed about their experiences afterwards. Results There was a high level of engagement with testing, with the total number of tests recorded ranging from 11 to 114 (median 74) among 18 participants. Fifteen participants tested almost every day during the 4-week period. The cognitive engagement was more limited. All participants commented on their own results, and most were able to relate high or low results to foods eaten and exercise taken, usually in response to prompting. However, there was limited thought or understanding beyond this in terms of longer-term patterns of diet and exercise, and testing was routine rather than experimental. Some participants were confused by conflicting or unexpected results. A few minor problems were reported by participants, such as soreness, inconvenience, and difficulty in getting blood, but never enough to discontinue testing. Several participants stated that the meter was a useful aid as a reminder that they were at high risk of diabetes and served as a prompt that needed to make and/or maintain behaviour changes. Conclusions The study suggests that blood glucose monitoring is acceptable to people with impaired glucose regulation and that they would engage with it as part of an intervention to improve their diet. The study has also uncovered potential mechanisms of action for behaviour change

Fear of cancer recurrence trajectory during radiation treatment and follow-up into survivorship of patients with breast cancer

Funding: Generous support received from Breast Cancer Now (Grant No. 6873).Background:  Fear of cancer recurrence (FCR) has been shown to be higher in patients treated with external beam radiotherapy (RT) compared to those untreated. However, little is known about the dynamics of patient’s FCR during and after RT. The aim of this study was to examine FCR levels in a longitudinal panel design with breast cancer patients receiving RT. Methods:  Consecutive newly-diagnosed breast cancer patients (n = 94) attending a single cancer centre were invited to complete a 7-item FCR scale (FCR7) that was collected weekly by paper instrument and at a follow-up phone call 6–8 weeks after completion of RT. Descriptive statistics, and Latent Growth Curve Modelling (LGCM) were utilised to analyse the data. Results:  Women who were younger, single/separated, had chemotherapy, had extra boost radiation treatment, taking Herceptin and treated by 4-field technique reported higher recurrence fear at baseline. There was strong evidence of substantial variation in the trajectory of FCR (z = − 3.54, p < .0001). The average trajectory of FCR over RT was negative (unstandardized estimate = − 0.59) and associated with FCR follow-up level (standardised estimate = 0.36, z = 3.05, p < .002), independent of baseline recurrence fears. Conclusion:  Patients vary in their trajectory of recurrence fears over RT which predicts FCR approximately 2 months following treatment. Review appointments by therapy radiographers presents an opportunity to intervene in FCR trajectories. Trial registration:  ClinicalTrials.gov: NCT02599506. Prospectively registered on 11th March 2015Publisher PDFPeer reviewe

Young children’s lives during the pandemic: Families in Tower Hamlets survey and panel findings

One of a series of briefings about the findings of the UKRI funded Families in Tower Hamlets study of families lives during the Covid-19 pandemic in relation to children's live

How does the self-reported health of undergraduate nursing students change during their degree programme? Survey results from a Scottish University

Background The lifestyle behaviours, and the physical and mental health of nurses, are poorer than those of other allied health professionals, and of the general population. However, these were no less favourable among first year undergraduate nursing students at a Scottish Higher Education Institution (HEI) than among similar people of the same age. We compared health and health behaviours among the same cohort of undergraduate nursing students over the course of their degree. Methods An anonymous self-complete repeat cross-sectional survey was administered during a timetabled teaching session at three time-points to undergraduate nursing students at the start of Years 1, 2 and 3 of their programme. They had received written information about the study previously. Results Self-reported health did not change significantly over time, but there was a clear decline over the 3 years in the proportions of students rating their mental health as excellent/very good/good and a concomitant increase in those rating their mental health as fair/poor. Correspondingly, the mean WEMWBS wellbeing score declined over the 3 years, with the proportion of students with a score of less than 46 (indicating either high risk of major depression, or in high risk of psychological distress and increased risk of depression) increasing from one quarter to one half. This effect was captured and described using a Bayesian regression analysis. The most noticeable change in health behaviours was a decline in physical activity levels over the study period. The proportion of students managing 150 min of weekly physical activity decreased from three quarters to two thirds. This was reflected in higher self-reported sedentary time, although there were no observable trends over time in mean BMI, or proportions of students categorised as overweight or obese. Conclusions: This paper suggests that there may be a decline in mental health and in participation in physical activity among nursing students over the course of their degree. We recommend the incorporation of an intervention into the undergraduate nursing curriculum that promotes and encourages regular physical activity, offering students the opportunity to learn about health promotion and lifestyle change in practice, to improve their own physical health, and to address mental wellbeing

The contribution of a complex systems-based approach to progressive social resilience

The use of resilience in social practice has evolved from a theoretical framework at the intersection between individuals and their social ecology. Critics argue this theory still results in policies and practices that are too individualised, with the potential for negative social consequences. This paper further critiques contemporary understanding of resilience theory and its application. It juxtaposes complex systems theory with a social inequalities oriented resilience practice. This provides a paradoxical approach. It is acknowledged that state and public policy decisions and actions can be anti-resilient, undermining community and social resilience that already exists in the form of social relationships, self-organisation and co-production. Nevertheless, collective social resilience also illustrates the potential of local and service user organisations to contribute to an overall transformational change process