To Follow Up or Not? A new model of supportive care for early breast cancer: Interim Results

To Follow Up or Not? A New Model of Supportive Care for Early Breast Cancer Background: Routine follow-up after curative treatment for early breast cancer exists to monitor for local recurrence and provide support for patients. Hospital visits can be stressful for patients and evidence indicates most recurrences are first identified by the patient. The value of resource-intense clinical follow-up is constantly being questioned. Many believe that time spent seeing essentially well-women is not clinically beneficial or an efficient use of time. Methods: This pilot study tested the feasibility and acceptability of a new supportive model of follow-up using quality-of-life (QOL) questionnaires plus qualitative diary evaluations. All patients attended four half day patient education workshops with course evaluations, followed by randomised to open access (OA) or hospital follow up (HFU). QOL including Hospital Anxiety and Depression Score (HADS), EORTC QLQ-C30 and BR23 were performed at baseline and 6 months, with further results awaited for 12, 18 and 24 months. Results: 106 women were recruited to the pilot study. 53 were randomised to HFU and 53 to OA. Multivariate analyses of covariance (MANCOVA) tests were conducted on all QOL data. Age was included as a covariate. Follow-up ANCOVAs on individual function and symptom outcomes were also conducted. The MANCOVA analyses indicated no statistically significant differences in change scores between HFU and OA groups, or between patients of different ages, on any of the three questionnaires. In all cases the effect of group had a greater effect on change (baseline-6 months) scores than the effect of age. Univariate ANCOVA tests and descriptive analyses showed performance improvement in many of the individual function and symptom scales in the OA group. Conclusions: While open access patients showed greater mean improvements in more scales than patients seen in clinic, follow-up method does not appear to significantly affect overall outcomes on any of the three questionnaires. As an influencing factor, the patients' age is less significant than the assigned group. This new model is feasible and acceptable. It is being adopted as standard across the Yorkshire Cancer Network

Briefing Note : Workshop on Developing a Model Anti-SLAPP Law for Scotland

Workshop reportPublisher PD

The impact of self-efficacy, expectations, and readiness on hearing aid outcomes

Objective: To examine the impact of self-efficacy and expectations for hearing aids, and readiness to improve hearing, on hearing aid outcome measures in first-time adult hearing aid users Design: A prospective, single centre design. Predictor variables measured at the hearing assessment included measures of self-efficacy, expectations and readiness to improve hearing. Outcome measures obtained at sixweek follow-up were the Glasgow Hearing Aid Benefit Profile and Satisfaction with Amplification in Daily Life. Study sample: A sample of 30 first-time adult hearing aid users were recruited through a public-sector funded audiology clinic. Results: When measured prior to hearing aid fitting, self-efficacy for hearing aids predicted satisfaction with hearing aids but was not related to other hearing aid outcomes. Expectations of hearing aids, in particular positive expectations, and readiness to improve hearing predicted outcomes for hearing aid satisfaction and benefit, although not hearing aid use. Hearing sensitivity was not correlated with hearing aid outcomes. Conclusions: These results suggest that assessment of expectations of hearing aids, and readiness to improve hearing, may be useful to help identify individuals attending audiology clinics who would most likely benefit from hearing aid provision

The impact of self-efficacy, expectations, and readiness on hearing aid outcomes

Objective: To examine the impact of self-efficacy and expectations for hearing aids, and readiness to improve hearing, on hearing aid outcome measures in first-time adult hearing aid users Design: A prospective, single centre design. Predictor variables measured at the hearing assessment included measures of self-efficacy, expectations and readiness to improve hearing. Outcome measures obtained at sixweek follow-up were the Glasgow Hearing Aid Benefit Profile and Satisfaction with Amplification in Daily Life. Study sample: A sample of 30 first-time adult hearing aid users were recruited through a public-sector funded audiology clinic. Results: When measured prior to hearing aid fitting, self-efficacy for hearing aids predicted satisfaction with hearing aids but was not related to other hearing aid outcomes. Expectations of hearing aids, in particular positive expectations, and readiness to improve hearing predicted outcomes for hearing aid satisfaction and benefit, although not hearing aid use. Hearing sensitivity was not correlated with hearing aid outcomes. Conclusions: These results suggest that assessment of expectations of hearing aids, and readiness to improve hearing, may be useful to help identify individuals attending audiology clinics who would most likely benefit from hearing aid provision

Seasonality of depressive symptoms in women but not in men: a cross-sectional study in the UK Biobank cohort

Background: We examined whether seasonal variations in depressive symptoms occurred independently of demographic and lifestyle factors, and were related to change in day length and/or outdoor temperature. Methods: In a cross-sectional analysis of >150,000 participants of the UK Biobank cohort, we used the cosinor method to assess evidence of seasonality of a total depressive symptoms score and of low mood, anhedonia, tenseness and tiredness scores in women and men. Associations of depressive symptoms with day length and mean outdoor temperature were then examined. Results: Seasonality of total depressive symptom scores, anhedonia and tiredness scores was observed in women but not men, with peaks in winter. In women, increased day length was associated with reduced low mood and anhedonia scores, independent of demographic and lifestyle factors. For women, longer day length was associated with increased tiredness. Associations with day length were not independent of the average outdoor temperature preceding assessment. Limitations: This was a cross-sectional investigation – longitudinal studies of within-subject seasonal variation in mood are necessary. Outcome measures relied on self-report and measured only a subset of depressive symptoms. Conclusion: This large, population-based study provides evidence of seasonal variation in depressive symptoms in women. Shorter days were associated with increased feelings of low mood and anhedonia in women. Clinicians should be aware of these population-level sex differences in seasonal mood variations in order to aid recognition and treatment of depression and subclinical depressive symptoms

Being warm being happy: understanding factors influencing adults with learning disabilities being warm and well at home with inclusive research

The aim of the Being Warm Being Happy project was to understand and characterise fuel poverty and energy vulnerability from the perspective of adults with learning disabilities. Undertaken in community settings in South Yorkshire, UK, the study adopted an inclusive research approach, with three members of a self-advocacy organisation who have learning disabilities and/or autism working alongside academics as co-researchers. The study incorporated home temperature and humidity measurements and qualitative individual interviews. Ten households, all of which included an adult with learning disabilities participated in the research. Framework analysis identified four interrelated themes influencing decisions about energy use and payment method. First, energy need varied according to health status. Energy need was also influenced by the size, tenure and age of the participant’s home. Second, emotions, attitudes and values, in particular a sense of control impacted upon energy use. Third, knowledge and previous experience could help or hinder participants keeping warm. Factors included prior first-hand experiences of support from self-advocacy organisations, energy companies and local authorities and the influence of parents’ views and practices. Finally, concerns about affordability and challenges accessing the energy market also had an important impact on experiences and decisions. The research contributes to the limited evidence base about the nature and experience of fuel poverty amongst adults with learning disabilities highlighting the extent to which the existing energy system puts them at a disadvantage and the resourcefulness and resilience of many adults with learning disabilities when facing these challenges

Does involvement in a cohort study improve health and affect health inequalities? A natural experiment

Abstract Background Evidence suggests that the process of taking part in health research can improve participants\u2019 health, independent of any intended intervention. However, no research has yet explored whether these effects differ across socioeconomic groups. If the effect of mere participation in health research also has a social gradient this could increase health inequalities and bias research results. This study used the Born in Bradford family cohort (BIB) to explore whether simply taking part in BIB had improved participants\u2019 health and, if so, whether this effect was mediated by socioeconomic status. Methods Survey data on self-reported health behaviours were collected between 2007 and 2010 as part of BIB. These were augmented by clinical data on birth weight. Pregnant women on their second pregnancy, joining BIB for the first time formed the control group. Their health was compared to women on their second pregnancy who had both pregnancies within the study, who formed the exposed group. In order to limit the inherent bias in a non-randomised study, propensity score analysis was used, matching on age, ethnicity, education and date of questionnaire. The results were then compared according to mothers' education. Results Of six outcomes tested, only alcohol consumption showed a statistically significant reduction with exposure to BIB (OR: 0.35, 95% CIs 0.13, 0.92). Although effect estimates were larger for women with higher education compared to lower education, these effects were not statistically significant. Conclusions Despite one significant finding, these results overall are insufficient to conclude that simply taking part in BIB affected participants\u2019 health. We recommend that socioeconomic status is considered in future studies testing effects of research participation, and that randomised studies with larger sample sizes are conducted

High Level of Soluble HLA-G in the Female Genital Tract of Beninese Commercial Sex Workers Is Associated with HIV-1 Infection

Most HIV infections are transmitted across mucosal epithelium. Understanding the role of innate and specific mucosal immunity in susceptibility or protection against HIV infection, as well as the effect of HIV infection on mucosal immunity, are of fundamental importance. HLA-G is a powerful modulator of the immune response. The aim of this study was to investigate whether soluble HLA-G (sHLA-G) expression in the female genital tract is associated with HIV-1 infection.Genital levels of sHLA-G were determined in 52 HIV-1-uninfected and 44 antiretroviral naïve HIV-1-infected female commercial sex workers (CSWs), as well as 71 HIV-1-uninfected non-CSW women at low risk of exposure, recruited in Cotonou, Benin. HIV-1-infected CSWs had higher genital levels of sHLA-G compared with those in both the HIV-1-uninfected CSW (P = 0.009) and non-CSW groups (P = 0.0006). The presence of bacterial vaginosis (P = 0.008), and HLA-G*01:01:02 genotype (P = 0.002) were associated with higher genital levels of sHLA-G in the HIV-1-infected CSWs, whereas the HLA-G*01:04:04 genotype was also associated with higher genital level of sHLA-G in the overall population (P = 0.038). When adjustment was made for all significant variables, the increased expression of sHLA-G in the genital mucosa remained significantly associated with both HIV-1 infection (P = 0.02) and bacterial vaginosis (P = 0.03).This study demonstrates that high level of sHLA-G in the genital mucosa is independently associated with both HIV-1 infection and bacterial vaginosis