The Age of Cyberchondria

The internet is a source of valuable medical information. However, it has the potential to increase anxiety in people who have no medical training, when it is employed as a diagnostic procedure. While hypochondriasis is a condition that is familiar in the medical literature, there is little research into the effects of technology on health anxiety and hypochondria. The literature supports the view that technology impacts on the management of one’s health and on the traditional doctor-patient relationships. Anxiety induced by health-related online search is an increasingly differentiated activity and is known in the field of cyberpsychology as cyberchondria. This literature review aims to evaluate a broad range of research studies concerning health anxiety, hypochondria, online medical information seeking and the emerging phenomenon of cyberchondria. Themes identified include: technology-facilitated health information seeking; the impact of medical online search on traditional doctor-patient relationships in the consultation process; the need for better health management; and, medical knowledge empowerment of patients. Aspects of health-related information-seeking behaviour relevant for cyberpsychology are also considered. The latest recommendations of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) working party regarding future classification of hypochondria and technology-facilitated symptom seeking are reported. Recommendations for further research include a large-scale study to assess the prevalence and nature of cyberchondria. The findings of the review are relevant for healthcare professionals, as the impact of the internet on patient behaviour and healthcare management is likely to increase steadily over time

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Weak states, Islam and terrorism : examining causal connections in Southeast Asia

Since 9/11, terrorism has become one of the top strategic concerns for the international community. At present, this phenomenon is often attributed to two main factors. First are 'weak' states, whose internal conditions provide an opportune environment for the development and facilitation of terrorist groups. Second is Islam fundamentalism, a religious ideology seen as particularly vulnerable to extremism. It is further assumed that many local militant Islamist groups are part of a larger ideologically congruent network coordinated by Al-Qaeda; in other words, a 'second front' of international terrorism. While there is little doubt that weak states and Islam play some role in the path to terrorism, initial investigation reveals that the assumed bi-causal relationship between either of these factors and terrorism is poorly grounded. The 'weak' state remains conceptually vague, while evidence suggests that Islam in a political context cannot be automatically associated with religious extremism. Using a proposed conceptual framework, this thesis argues that political violence stems from grievance felt within a particular group. This grievance is a result of specific dimensions of weakness found within states. The move from 'standard' political violence to terrorism requires an ideological bridge: a 'higher' justification that permits the use of exceptionally violent or destructive acts as a means to an end. I apply this framework to Southeast Asia and in particular three cases where Islam and terrorism coincide: Aceh, Indonesia, the southern Philippines and southern Thailand. I ask: what are the causal connections between dimensions of weakness, Islam and terrorism in these cases? Is Southeast Asia a 'second front' of international terrorism? Examination of the cases reveals that terrorism is more clearly attributed to grievance felt by a particular Islamic community as a result of concentrated structural weaknesses within the regions they reside. Terrorism also appears less driven by religion than assumed. The motivation for local militant Islamist groups to use terrorist acts is derived predominantly from a need to preserve a particular ethnic identity that also happens to be Islamic. Finally, evidence reveals that these conflicts remain largely local in character, with little or no outside influence from international Islamic terrorist groups, weakening the theory that Southeast Asia is a 'second front' of international terrorism.Arts, Faculty ofPolitical Science, Department ofGraduat

Collaborative Data Governance to Support First Nations-Led Overdose Surveillance and Data Analysis in British Columbia, Canada

First Nations Peoples in the province of British Columbia (BC), Canada, have been disproportionately affected by the overdose crisis. In 2016, a public health emergency was declared by BC’s Provincial Health Officer (PHO) in response to the significant rise in opioid-related overdose deaths reported in BC. New surveillance systems were required to identify trends in overdose events and related deaths in the province as a whole, and for First Nations Peoples. Data sharing and analysis processes that adhered to the principles of OCAP® (ownership, control, access, and possession), and to the Truth and Reconciliation Commission of Canada’s Calls to Action, needed to be developed. The First Nations Health Authority (FNHA), BC Centre for Disease Control, PHO, and the BC Ministry of Health have worked collaboratively to facilitate identification of First Nations persons in surveillance data for appropriate analysis by FNHA. This paper outlines the data stewardship and governance context, principles, and operational considerations for creating overdose surveillance systems to measure overdose events among First Nations Peoples in BC

Assessing Hepatitis C Burden and Treatment Effectiveness through the British Columbia Hepatitis Testers Cohort (BC-HTC): Design and Characteristics of Linked and Unlinked Participants.

BACKGROUND:The British Columbia (BC) Hepatitis Testers Cohort (BC-HTC) was established to assess and monitor hepatitis C (HCV) epidemiology, cost of illness and treatment effectiveness in BC, Canada. In this paper, we describe the cohort construction, data linkage process, linkage yields, and comparison of the characteristics of linked and unlinked individuals. METHODS:The BC-HTC includes all individuals tested for HCV and/or HIV or reported as a case of HCV, hepatitis B (HBV), HIV or active tuberculosis (TB) in BC linked with the provincial health insurance client roster, medical visits, hospitalizations, drug prescriptions, the cancer registry and mortality data using unique personal health numbers. The cohort includes data since inception (1990/1992) of each database until 2012/2013 with plans for annual updates. We computed linkage rates by year and compared the characteristics of linked and unlinked individuals. RESULTS:Of 2,656,323 unique individuals available in the laboratory and surveillance data, 1,427,917(54%) were included in the final linked cohort, including about 1.15 million tested for HCV and about 1.02 million tested for HIV. The linkage rate was 86% for HCV tests, 89% for HCV cases, 95% for active TB cases, 48% for HIV tests and 36% for HIV cases. Linkage rates increased from 40% for HCV negatives and 70% for HCV positives in 1992 to ~90% after 2005. Linkage rates were lower for males, younger age at testing, and those with unknown residence location. Linkage rates for HCV testers co-infected with HIV, HBV or TB were very high (90-100%). CONCLUSION:Linkage rates increased over time related to improvements in completeness of identifiers in laboratory, surveillance, and registry databases. Linkage rates were higher for HCV than HIV testers, those testing positive, older individuals, and females. Data from the cohort provide essential information to support the development of prevention, care and treatment initiatives for those infected with HCV

HCV laboratory data linkage rate by year 1992–2013.

<p>HCV laboratory data linkage rate by year 1992–2013.</p

Comparison of linked and unlinked HCV testers.

<p>Comparison of linked and unlinked HCV testers.</p

Flow diagram showing overall linkage yield.

<p>Flow diagram showing overall linkage yield.</p