Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

How and when we use health services or healthcare provision has dominated exploration of and debates around healthcare access. Levels of utilisation are assumed as a proxy for access. Yet, focusing on utilisation conceals an important aspect of the access conundrum: the relationships that patients and potential patients have with the healthcare system and the professionals within those systems. Candidacy has been proposed as an antidote to traditional utilisation models. The Candidacy construct offers the ability to include patient-professional aspects alongside utilisation and thus promotes a deeper understanding of access. Originally applied to healthcare access for vulnerable populations, additional socio-demographic factors, including age and ethnicity, have also been shown to influence the Candidacy process. Here we propose a further extension of the Candidacy construct and illustrate the importance of illness identities when accessing healthcare. Drawing on a secondary data analysis of three data sets of qualitative interviews from colorectal cancer and heart failure patients we found that though similar access issues are apparent pre-diagnosis, diagnosis marks a critical juncture in the experience of access. Cancer patients describe a person-centred responsive healthcare system where their patienthood requires only modest assertion. Cancer speaks for itself. In marked contrast heart failure patients, describe struggling within a seemingly impermeable system to understand their illness, its implications and their own legitimacy as patients. Our work highlights the pressing need for healthcare professionals, systems and policies to promote a person centred approach, which is responsive and timely, regardless of illness category. To achieve this, attitudes regarding the importance or priority afforded to different categories of illness need to be tackled as they directly influence ideas of Candidacy and consequently access and experiences of care

Colchicine may decrease cardiovascular events in patients with coronary artery disease

This oral anti-inflammatory agent may offer a low-cost option for prevention of cardiovascular events in this patient population.Leslie Griffin, MD; Julia Groce, MD; Sara Conway, MD (University of Tennessee, College of Medicine, Chattanooga). Deputy Editor: Corey Lyon, DO (University of Colorado, Denver)Includes bibliographical reference

Content analysis of on-package formula labelling in Great Britain: use of marketing messages on first infant, follow-on, growing-up and specialist formula

OBJECTIVE: To explore on-package formula messaging with reference to legislation and government issued guidance in Great Britain (GB). DESIGN: Formula products were identified, pictures of all sides of packs collated, and on-package text and images were coded. Compliance with both GB legislation and guidance issued by the Department of Health and Social Care (DHSC) was assessed. SETTING: All formula packs available for sale over the counter in GB between April and October 2020. PARTICIPANTS: Formula packs (n71) including infant formula, follow-on formula, growing-up formula and specialist formula were identified, coded and analysed. RESULTS: In total, 41% of formula packs included nutrition claims and 18% included health claims that may be considered non-permitted according to DHSC guidance. Additionally, 72% of products showed images considered 'non-permitted'. BMS legislation states infant and follow-on formula packs should be clearly distinguishable but does not provide criteria to assess similarity. Based on DHSC guidance, 72% of infant and follow-on formula packs were categorised as showing a high degree of similarity. Marketing practices not covered by current legislation were widespread, such as 94% of infant formula packs including advertisements for follow-on formula or growing-up formula. CONCLUSIONS: Text and images considered non-permitted according to DHSC guidance for implementing Breast Milk Substitute (BMS) legislation were widespread on formula products available in GB. As terms such as 'similarity' are not defined in BMS legislation it was unclear if breaches had occurred. Findings support the WHO call for loopholes in domestic legislation to be closed as a matter of urgency

Online Extremism and Terrorism Researchers’ Security, Safety, and Resilience:: Findings from the Field

This report presents findings from the REASSURE (Researcher, Security, Safety, and Resilience) project’s in-depth interviews with 39 online extremism and terrorism researchers. Based at universities, research institutes, and think tanks in Europe and North America, the interviewees studied mainly, albeit not exclusively, far-right and violent jihadist online activity. The report catalogues for the first time the range of harms they have experienced, the lack of formalised systems of care or training, and their reliance therefore on informal support networks to mitigate those harms

Psychometric Network Analysis of the Hungarian WAIS

The positive manifold—the finding that cognitive ability measures demonstrate positive correlations with one another—has led to models of intelligence that include a general cognitive ability or general intelligence (g). This view has been reinforced using factor analysis and reflective, higher-order latent variable models. However, a new theory of intelligence, Process Overlap Theory (POT), posits that g is not a psychological attribute but an index of cognitive abilities that results from an interconnected network of cognitive processes. These competing theories of intelligence are compared using two different statistical modeling techniques: (a) latent variable modeling and (b) psychometric network analysis. Network models display partial correlations between pairs of observed variables that demonstrate direct relationships among observations. Secondary data analysis was conducted using the Hungarian Wechsler Adult Intelligence Scale Fourth Edition (H-WAIS-IV). The underlying structure of the H-WAIS-IV was first assessed using confirmatory factor analysis assuming a reflective, higher-order model and then reanalyzed using psychometric network analysis. The compatibility (or lack thereof) of these theoretical accounts of intelligence with the data are discussed

Cardiovascular disease biomarkers are associated with declining renal function in type 2 diabetes

Aims/hypothesis: We investigated whether biochemical cardiovascular risk factors and/or markers of subclinical cardiovascular disease were associated with the development of reduced renal function in people with type 2 diabetes. Methods: A cohort of 1066 Scottish men and women aged 60–74 years with type 2 diabetes from the Edinburgh Type 2 Diabetes Study were followed up for a median of 6.7 years. New-onset reduced renal function was defined as two eGFRs <60 ml−1 min−1 (1.73 m)−2 at least 3 months apart with a > 25% decline from baseline eGFR. Ankle brachial pressure index (ABI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT) were measured at baseline. Pulse wave velocity (PWV) and carotid intima media thickness were measured 1 year into follow-up. Data were analysed using Cox proportional hazards models. Results: A total of 119 participants developed reduced renal function during follow-up. ABI, PWV, NT-proBNP and hsTnT were all associated with onset of decline in renal function following adjustment for age and sex. These associations were attenuated after adjustment for additional diabetes renal disease risk factors (systolic BP, baseline eGFR, albumin:creatinine ratio and smoking pack-years), with the exception of hsTnT which remained independently associated (HR 1.51 [95% CI 1.22, 1.87]). Inclusion of hsTnT in a predictive model improved the continuous net reclassification index by 0.165 (0.008, 0.286). Conclusions/interpretation: Our findings demonstrate an association between hsTnT, a marker of subclinical cardiac ischaemia, and subsequent renal function decline. Further research is required to establish the predictive value of hsTnT and response to intervention

Adolescent brain cognitive development (ABCD) study: Overview of substance use assessment methods.

One of the objectives of the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org/) is to establish a national longitudinal cohort of 9 and 10 year olds that will be followed for 10 years in order to prospectively study the risk and protective factors influencing substance use and its consequences, examine the impact of substance use on neurocognitive, health and psychosocial outcomes, and to understand the relationship between substance use and psychopathology. This article provides an overview of the ABCD Study Substance Use Workgroup, provides the goals for the workgroup, rationale for the substance use battery, and includes details on the substance use module methods and measurement tools used during baseline, 6-month and 1-year follow-up assessment time-points. Prospective, longitudinal assessment of these substance use domains over a period of ten years in a nationwide sample of youth presents an unprecedented opportunity to further understand the timing and interactive relationships between substance use and neurocognitive, health, and psychopathology outcomes in youth living in the United States

Perceived influence of commercial milk formula labelling on mothers’ feeding choices in Great Britain: a qualitative study

OBJECTIVE: To understand how mothers use commercial milk formula (CMF) labels to inform their feeding choices and explore mothers' understanding of differences between CMF products. DESIGN: Qualitative study with recruitment via social media. Online semistructured interviews, including a product mapping exercise and thematic analysis. PARTICIPANTS: Mothers (n=25) using CMF for children <3 years living in Great Britain (GB). RESULTS: Mothers were drawn to brands they recognised from years of exposure to CMF advertising. CMF products were assumed to vary according to brand and stage, but participants found on-pack information did not explain how. This added to anxiety about choosing 'the best one' and mothers would have liked guidance from healthcare professionals (HCPs). Wide availability of CMF for older infants and children, and on-pack messaging suggesting progression from one product to the next, led many to believe these products were necessary. There was confusion over the appropriate use of specialist products. While mothers rarely mentioned on-pack health and nutrition claims, they were attracted to the overall appearance of packs and messaging relating to science, research and nature. References to breast milk and a logo perceived to represent a breastfeeding mother were taken as indicators of closer similarity to breast milk. CONCLUSIONS: CMF legislation in GB should be updated to restrict brand advertising and the use of on-pack text and images that mothers perceive as indicating products have a closer similarity to breast milk. Greater input from HCPs was desired by new mothers and would support them to make more informed choices about CMF

Reducing Poverty in California…Permanently

If California were to seriously commit to equalizing opportunity and reducing poverty, how might that commitment best be realized? This is of course a hypothetical question, as there is no evidence that California is poised to make such a serious commitment, nor have many other states gone much beyond the usual lip-service proclamations. There are many reasons for California’s complacency, but an important one is that most people think that poverty is intractable and that viable solutions to it simply don’t exist. When Californians know what needs to be done, they tend to go forward and get it done. When, for example, the state’s roads are in disrepair, there are rarely paralyzing debates about exactly how to go about fixing them; instead we proceed with the needed repairs as soon as the funds to do so are appropriated. The same type of sure and certain prescription might appear to be unavailable when it comes to reducing poverty. It is hard not to be overwhelmed by the cacophony of voices yielding a thick stream of narrow-gauge interventions, new evaluations, and piecemeal proposals.1 Although the research literature on poverty is indeed large and may seem confusing, recent advances have in fact been so fundamental that it is now possible to develop a science-based response to poverty. In the past, the causes of poverty were not well understood, and major interventions, such as the War on Poverty, had to be built more on hunch than science. It is an altogether different matter now. The causes of poverty are well established, and the effects of many possible policy responses to poverty are likewise well established. The simple purpose of this essay is to assemble these advances into a coherent plan that would, if implemented, reduce poverty in California substantially