64 research outputs found
Cancer-related health behaviours of young people not in education, employment or training ('NEET'): a cross-sectional study
Background: Links between participating in unhealthy behaviours, e.g. smoking, and an increased risk of
developing some cancers are well established. Unemployed adults are more likely to participate in cancer-related
health behaviours than their employed counterparts. However, evidence of whether this is true in young adults not
in education, employment or training (NEET) compared to their ânon-NEETâ peers is either limited or inconclusive.
Using cross-sectional health data from across the UK, this study aims to investigate whether participation in cancerrelated
health behaviours varies by NEET status.
Methods: Data for 16â24 year olds were extracted from the 2010â12 Health Surveys for England (HSE) and Scottish
Health Surveys (SHeS). Information on economic activity in the last week was used to determine NEET status. Data
on whether respondents had been seeking employment within the last four weeks and availability to start within
the next two weeks allowed NEETs to be further identified as unemployed (UE) or economically inactive (EI).
Logistic regression modelled the effect of being NEET on odds of being a current smoker; heavy drinker; not
participating in sport; having eaten less than five portions of fruit or vegetables the day before survey interview and
having an unhealthy body mass index (BMI). Analyses were performed before and after exclusion of EI NEETs.
Results: Data were extracted for 4272 individuals, of which 715 (17%) were defined as NEET with 371 (52%) and
342 (48%) further classified as UE and EI respectively. Two NEETs could not be further defined as UE or EI due to
missing information. Relative to non-NEETs, NEETs were significantly more likely to be current smokers, not
participate in sport and have an âunhealthyâ BMI. These results held after adjustment for socio-demographic
characteristics both before and after exclusion of EI NEETs. Before exclusion of EI NEETs, NEETs were significantly
less likely to be heavy drinkers than non-NEETs. There was no significant difference in likelihood of heavy drinking
between NEETs and non-NEETs when excluding EI NEETs.
Conclusions: NEETs were generally at an increased risk of participating in cancer-related health behaviours than
non-NEETs. As the likelihood of becoming NEET is greater in socioeconomically-disadvantaged groups, interventions
to discourage unhealthy behaviours in NEETs may contribute to a reduction in health inequalities
Acceptability of Computerized Cognitive Behavioral Therapy for Adults : Umbrella Review
Background: Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits. Objective: This study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. Methods: An umbrella review informed by the Joanna Briggs Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalized in terms of uptake of, dropping out from, or completion of cCBT treatment; factors that facilitated or impeded adherence; and reports about user, carer, and health care professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool and undertaken independently by 2 reviewers. Results: The systematic searches of databases identified 234 titles, and 9 reviews (covering 151 unique studies) met the criteria. Most studies were comprised of service users with depression, anxiety, or specifically, panic disorder or phobia. Operationalization of acceptability varied across reviews, thereby making it difficult to synthesize results. There was a similar number of guided and unguided cCBT programs; 34% of guided and 36% of unguided users dropped out; and guidance included email, telephone, face-to-face, and discussion forum support. Guided cCBT was completed in full by 8%-74% of the participants, while 94% completed one module and 67%-84% completed some modules. Unguided cCBT was completed in full by 16%-66% of participants, while 95% completed one module and 54%-93% completed some modules. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), internet or computerized delivery problems, negative perceptions about cCBT, low motivation, too busy or not having enough time, and personal circumstances were stated as reasons for dropping out. Yet, some users favored the anonymous nature of cCBT, and the capacity to undertake cCBT in one's own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between sociodemographic variables, mental health status, and cCBT adherence or dropping out. Users tended to be satisfied with cCBT, reported improvements in mental health, and recommended cCBT. Overall, the results indicated that service users' preferences were important considerations regarding the use of cCBT. Conclusions: The review indicated that "one size did not fit all" regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake, and adherence and therefore, deliver treatment benefits and improve mental health.Peer reviewe
Patient's perspectives of living with a precancerous condition : monoclonal gammopathy of undetermined significance (MGUS)
Funding for this study was provided by a Cancer Translational Research Group Young Investigator Grant. At the time of the study, Dr Charlene McShane was in receipt of a Cancer Research UK Population Sciences Research Fellowship.Peer reviewedPostprin
Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment (Review)
BACKGROUND: It is estimated that up to 75% of cancer survivors may experience cognitive impairment as a result of cancer treatment and given the increasing size of the cancer survivor population, the number of affected people is set to rise considerably in coming years. There is a need, therefore, to identify effective, nonâpharmacological interventions for maintaining cognitive function or ameliorating cognitive impairment among people with a previous cancer diagnosis. OBJECTIVES: To evaluate the cognitive effects, nonâcognitive effects, duration and safety of nonâpharmacological interventions among cancer patients targeted at maintaining cognitive function or ameliorating cognitive impairment as a result of cancer or receipt of systemic cancer treatment (i.e. chemotherapy or hormonal therapies in isolation or combination with other treatments). SEARCH METHODS: We searched the Cochrane Centre Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PUBMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. We also searched registries of ongoing trials and grey literature including theses, dissertations and conference proceedings. Searches were conducted for articles published from 1980 to 29 September 2015. SELECTION CRITERIA: Randomised controlled trials (RCTs) of nonâpharmacological interventions to improve cognitive impairment or to maintain cognitive functioning among survivors of adultâonset cancers who have completed systemic cancer therapy (in isolation or combination with other treatments) were eligible. Studies among individuals continuing to receive hormonal therapy were included. We excluded interventions targeted at cancer survivors with central nervous system (CNS) tumours or metastases, nonâmelanoma skin cancer or those who had received cranial radiation or, were from nursing or care home settings. Language restrictions were not applied. DATA COLLECTION AND ANALYSIS: Author pairs independently screened, selected, extracted data and rated the risk of bias of studies. We were unable to conduct planned metaâanalyses due to heterogeneity in the type of interventions and outcomes, with the exception of compensatory strategy training interventions for which we pooled data for mental and physical wellâbeing outcomes. We report a narrative synthesis of intervention effectiveness for other outcomes. MAIN RESULTS: Five RCTs describing six interventions (comprising a total of 235 participants) met the eligibility criteria for the review. Two trials of computerâassisted cognitive training interventions (n = 100), two of compensatory strategy training interventions (n = 95), one of meditation (n = 47) and one of physical activity intervention (n = 19) were identified. Each study focused on breast cancer survivors. All five studies were rated as having a high risk of bias. Data for our primary outcome of interest, cognitive function were not amenable to being pooled statistically. Cognitive training demonstrated beneficial effects on objectively assessed cognitive function (including processing speed, executive functions, cognitive flexibility, language, delayedâ and immediateâ memory), subjectively reported cognitive function and mental wellâbeing. Compensatory strategy training demonstrated improvements on objectively assessed delayedâ, immediateâ and verbalâmemory, selfâreported cognitive function and spiritual quality of life (QoL). The metaâanalyses of two RCTs (95 participants) did not show a beneficial effect from compensatory strategy training on physical wellâbeing immediately (standardised mean difference (SMD) 0.12, 95% confidence interval (CI) â0.59 to 0.83; I(2)= 67%) or two months postâintervention (SMD â 0.21, 95% CI â0.89 to 0.47; I(2) = 63%) or on mental wellâbeing two months postâintervention (SMD â0.38, 95% CI â1.10 to 0.34; I(2) = 67%). Lower mental wellâbeing immediately postâintervention appeared to be observed in patients who received compensatory strategy training compared to waitâlist controls (SMD â0.57, 95% CI â0.98 to â0.16; I(2) = 0%). We assessed the assembled studies using GRADE for physical and mental health outcomes and this evidence was rated to be low quality and, therefore findings should be interpreted with caution. Evidence for physical activity and meditation interventions on cognitive outcomes is unclear. AUTHORS' CONCLUSIONS: Overall, the, albeit lowâquality evidence may be interpreted to suggest that nonâpharmacological interventions may have the potential to reduce the risk of, or ameliorate, cognitive impairment following systemic cancer treatment. Larger, multiâsite studies including an appropriate, active attentional control group, as well as consideration of functional outcomes (e.g. activities of daily living) are required in order to come to firmer conclusions about the benefits or otherwise of this intervention approach. There is also a need to conduct research into cognitive impairment among cancer patient groups other than women with breast cancer
Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study
This study formed part of a diagnostic test accuracy study to quantify the ability of three index home monitoring (HM) tests (one paper-based and two digital tests) to identify reactivation in Neovascular age-related macular degeneration (nAMD). The aim of the study was to investigate views about acceptability and explore adherence to weekly HM. Semi-structured interviews were held with 98 patients, family members, and healthcare professionals. A thematic approach was used which was informed by theories of technology acceptance. Various factors influenced acceptability including a patientâs understanding about the purpose of monitoring. Training and ongoing support were regarded as essential for overcoming unfamiliarity with digital technology. Findings have implications for implementation of digital HM in the care of older people with nAMD and other long-term conditions
Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study
Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ℠0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe
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