Attitudes and perceptions of people with a learning disability, family carers and paid care workers, towards cancer screening programmes in the United Kingdom:A qualitative systematic review and meta-aggregation

Objective: Evidence suggests that people with a learning disability (PwLD) are less likely to attend cancer screening than the general population in the United Kingdom. The aim of this systematic review was to identify and synthesise qualitative studies reporting the attitudes and opinions of PwLD, family carers, and paid care workers towards national cancer screening programmes. Methods: Five electronic and two grey literature databases were searched. Fourteen thousand eight hundred forty-six papers were reviewed against predetermined inclusion criteria. Included papers were critically appraised. Findings were synthesised using meta-aggregation. Results: Eleven papers met the inclusion criteria, all related to cervical and breast screening. No papers were related to colorectal cancer screening. Findings were clustered into four synthesised findings: (1) supporting women with a learning disability (WwLD) to attend screening, (2) WwLD's awareness of screening and their psychophysical experiences, 3) professional practice barriers including the need for multidisciplinary working and an understanding of the needs of WwLD, and (4) approaches to improve the uptake of cervical and breast cancer screening. The synthesis highlights the significance of WwLD having support to understand the importance of screening to be able to make an informed choice about attending. Conclusions: WwLD may not attend cancer screening due to fear, concerns over pain, and the potential influence of family carers and paid care workers. The review identified practical mechanisms which could help WwLD attend screening. Future research should focus on identifying potential barriers and facilitators as a proactive measure to promote colorectal cancer screening

Comparative assessment of phototherapy protocols for reduction of oxidative stress in partially transected spinal cord slices undergoing secondary degeneration

Background: Red/near-infrared light therapy (R/NIR-LT) has been developed as a treatment for a range of conditions, including injury to the central nervous system (CNS). However, clinical trials have reported variable or sub-optimal outcomes, possibly because there are few optimized treatment protocols for the different target tissues. Moreover, the low absolute, and wavelength dependent, transmission of light by tissues overlying the target site make accurate dosing problematic. Results: In order to optimize light therapy treatment parameters, we adapted a mouse spinal cord organotypic culture model to the rat, and characterized myelination and oxidative stress following a partial transection injury. The ex vivo model allows a more accurate assessment of the relative effect of different illumination wavelengths (adjusted for equal quantal intensity) on the target tissue. Using this model, we assessed oxidative stress following treatment with four different wavelengths of light: 450 nm (blue); 510 nm (green); 660 nm (red) or 860 nm (infrared) at three different intensities: 1.93 × 10¹⁶ (low); 3.85 × 10¹⁶ (intermediate) and 7.70 × 10¹⁶ (high) photons/cm²/s. We demonstrate that the most effective of the tested wavelengths to reduce immunoreactivity of the oxidative stress indicator 3-nitrotyrosine (3NT) was 660 nm. 860 nm also provided beneficial effects at all tested intensities, significantly reducing oxidative stress levels relative to control (p ≤ 0.05). Conclusions: Our results indicate that R/NIR-LT is an effective antioxidant therapy, and indicate that effective wavelengths and ranges of intensities of treatment can be adapted for a variety of CNS injuries and conditions, depending upon the transmission properties of the tissue to be treated.12 page(s

Common polygenic variation in coeliac disease and confirmation of ZNF335 and NIFA as disease susceptibility loci

Coeliac disease (CD) is a chronic immune-mediated disease triggered by the ingestion of gluten. It has an estimated prevalence of approximately 1% in European populations. Specific HLA-DQA1 and HLA-DQB1 alleles are established coeliac susceptibility genes and are required for the presentation of gliadin to the immune system resulting in damage to the intestinal mucosa. In the largest association analysis of CD to date, 39 non-HLA risk loci were identified, 13 of which were new, in a sample of 12 014 individuals with CD and 12 228 controls using the Immunochip genotyping platform. Including the HLA, this brings the total number of known CD loci to 40. We have replicated this study in an independent Irish CD case–control population of 425 CD and 453 controls using the Immunochip platform. Using a binomial sign test, we show that the direction of the effects of previously described risk alleles were highly correlated with those reported in the Irish population, (P=2.2 × 10−16). Using the Polygene Risk Score (PRS) approach, we estimated that up to 35% of the genetic variance could be explained by loci present on the Immunochip (P=9 × 10−75). When this is limited to non-HLA loci, we explain a maximum of 4.5% of the genetic variance (P=3.6 × 10−18). Finally, we performed a meta-analysis of our data with the previous reports, identifying two further loci harbouring the ZNF335 and NIFA genes which now exceed genome-wide significance, taking the total number of CD susceptibility loci to 42

Individual differences in susceptibility to online influence: A theoretical review

© 2017 The Authors Scams and other malicious attempts to influence people are continuing to proliferate across the globe, aided by the availability of technology that makes it increasingly easy to create communications that appear to come from legitimate sources. The rise in integrated technologies and the connected nature of social communications means that online scams represent a growing issue across society, with scammers successfully persuading people to click on malicious links, make fraudulent payments, or download malicious attachments. However, current understanding of what makes people particularly susceptible to scams in online contexts, and therefore how we can effectively reduce potential vulnerabilities, is relatively poor. So why are online scams so effective? And what makes people particularly susceptible to them? This paper presents a theoretical review of literature relating to individual differences and contextual factors that may impact susceptibility to such forms of malicious influence in online contexts. A holistic approach is then proposed that provides a theoretical foundation for research in this area, focusing on the interaction between the individual, their current context, and the influence message itself, when considering likely response behaviour

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Attitudes of women with a learning disability and their carers, towards the NHS cervical and breast cancer screening programmes: A qualitative systematic review and meta-aggregation

Background: An effective way to identify cancers and reduce mortality is through screening. However, in the UK people with a learning disability are less likely than the general population, to attend cervical and breast cancer screening. Aim: To undertake a qualitative systematic review to explore the attitudes of people with a learning disability, family carers, and paid care workers towards the UK cervical and breast cancer national screening programmes.Methods: Five electronic databases were searched to identify qualitative papers published from 1988 onwards. Studies which met the inclusion criteria were retained. Additional searches for grey literature, and of citation and reference lists were conducted of included articles. Two reviewers independently appraised the papers using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. The JBI methodology for meta-aggregation was used to synthesis the findings. Results: Six studies were included with 37 findings being extracted. These were clustered together, based on similarity of meanings, into eight categories then into three synthesised findings: 1) Supporting women with a learning disability to attend screening, 2) Psychophysical factors of women with a learning disability towards screening and 3) Professional practice barriers and poor understanding of the needs of women with a learning disability.Conclusion: The findings indicate that family carers, paid care workers and Health Care Professionals, have an influential role in supporting or inhibiting the uptake of cervical and breast cancer screening. But also women with a learning disability experience a range of factors which can inhibit their uptake. <br/