Conversations that count: Advance Care Planning as preventative medicine

Background: Fundamental to the concept of Advance Care Planning (ACP) is empowering individuals and communities to recognise death as an inevitable part of life.Methods: ACP facilitators and clinical champions in the Canterbury region of New Zealand have been very active in engaging the community. This has occurred through consumer presentations, the creation of specific pages on the Canterbury District Health Board (CDHB) consumer information website (HealthInfo) and support of the National ACP awareness campaign ‘Conversations that Count’.Results: ‘Consumer power’ has been invaluable in driving the uptake of ACP in the CDHB. A survey of 49 GPs in 2015 found many were reluctant to start ACP conversations or felt they ‘did not have time’. The turning point was the realisation that patients are not only wanting but are actively asking to have these important conversations and to create Advance Care Plans (ACPlans). 1200 electronic ACPlans have now now been created in Canterbury, with 80% generated in primary care.The ACP pages on HealthInfo are consistently in the top 20 pages viewed each month which indicates that the community is seeking information and wanting to take control. Uptake and demand for consumer presentations and ‘Conversations that Count’ resources also continues to grow year on year.Discussion: Increased awareness and understanding of ACP gives people the opportunity to think and frame their reasoning, so they are better prepared to have well informed discussions with health care professionals. It helps them be clearer in their mind about their own limits and concerns. It is important for people to consider the question - “what is O.K for me and what isn’t?”. In this context, ACP conversations can be seen as preventative medicine.Patients need to be as well equipped as possible to be active participants in healthcare decisions, especially regarding end of life. Through the ACP process, unnecessary suffering, confusion and conflict can be reduced or prevented and unwanted or  burdensome treatment that is not in line with their goals and priorities can be averted.Conclusion: Valuing and honouring a person’s participation in their health care decision-making is important for all healthcare organisations. Prioritising ACP is an effective way of making this happen.

Health-related quality of life in children with perceived and diagnosed food hypersensitivity

The few studies measuring health-related quality of life (HRQL) in food hypersensitivity (FHS) have found significantly reduced HRQL in patients and their families, particularly in the areas of family and social activities, emotional issues and family economy. One aspect that has not been studied is the effect of suspected FHS (food allergy/intolerance) vs. diagnosed FHS [based on a food challenge or a positive skin prick test (SPT) and good clinical history] on HRQL. Therefore, the aim of this study was to investigate the HRQL in children with a proven diagnosis of FHS vs. those with reported FHS.MethodsWe have utilized the 10-yr old follow-up cohort of the Food Allergy and Intolerance Research (FAIR) study from the Isle of Wight and assessed the child's HRQL with the Food Allergy Quality of Life Questionnaire – Parent form (FAQLQ-PF) which measures HRQL using four domains: food anxiety, emotional impact, social and dietary limitation.ResultsWhen comparing the two groups of children (proven FHS vs. perceived FHS), no difference in HRQL was found, although food anxiety showed a p-value of (p = 0.062). This was also the case when correcting for all confounding factors identified.ConclusionWe have found that having a clear diagnosis of FHS is not an independent predictor of HRQL. Future studies are required comparing two more similar groups. We also need to focus more on the effect of continuous input from the multidisciplinary team on HRQL and which particular factors of FHS management affect HRQL

Changing prevalence of wheeze, rhinitis and allergic sensitisation in late childhood:findings from 2 Isle of Wight birth cohorts’ 12-years apart

BACKGROUND: While the prevalence of asthma in children is decreasing or remaining the same, time trends in the prevalence of rhinitis in children are not known. Understanding sensitisation trends may help inform about trends in asthma and rhinitis prevalence.OBJECTIVE: To assess time trends of wheeze, rhinitis and aero-allergen sensitisation prevalence at 10 years of age, we compared two birth cohorts established 12 years apart. To gain insight into differences in disease prevalence, we assessed association of family history, early life exposures and sensitisation with wheeze and rhinitis in each cohort.METHODS: The IoW (Isle of Wight) and FAIR (Food Allergy and Intolerance Research) unselected birth cohorts were established in 1989 and 2001 respectively in IoW. Identical ISAAC questionnaire and skin prick test data were collected and compared at 10 years of age.RESULTS: Over the 12-year period from 2001 to 2012, prevalence of lifetime wheeze, current wheeze and those ever treated for asthma decreased by 15.9% (45.5 vs. 29.6, P < 0.001), 3.9% (18.9 vs. 15, P = 0.020) and 8.2% (31.7 vs. 23.5, P = 0.001), respectively. Conversely, current rhinitis and lifetime rhinitis prevalence increased by 5.5% (22.6 vs. 28.1, P = 0.004) and 13% (18.6 vs. 31.7, P < 0.001), respectively. Atopic status remained stable; however, house dust mite (HDM) sensitisation decreased by 5.6% (19.2 vs. 13.6, P = 0.004) and grass sensitisation increased by 3.5% (12.9 vs. 16.4, P = 0.054). Male sex, parental history of asthma and HDM sensitisation were significantly associated with lifetime wheeze in both cohorts, while maternal smoking during pregnancy was a significant risk factor only in the earlier IoW cohort. Parental history of rhinitis and grass sensitisation was significantly associated with lifetime rhinitis in both cohorts, while HDM sensitisation was significant only for the IoW cohort.CONCLUSION: Contrasting changes were noted with falling wheeze and HDM sensitisation but rising rhinitis and grass sensitisation prevalence. Changing prevalence of aero-allergen sensitisations may explain the different time trends observed in these cohorts

SVM Optimization for Brain Tumor Identification Using Infrared Spectroscopic Samples.

The work presented in this paper is focused on the use of spectroscopy to identify the type of tissue of human brain samples employing support vector machine classifiers. Two different spectrometers were used to acquire infrared spectroscopic signatures in the wavenumber range between 1200⁻3500 cm-1. An extensive analysis was performed to find the optimal configuration for a support vector machine classifier and determine the most relevant regions of the spectra for this particular application. The results demonstrate that the developed algorithm is robust enough to classify the infrared spectroscopic data of human brain tissue at three different discrimination levels.This work has been supported in part by the European Commission through the FP7 FET Open Programme ICT-2011.9.2, European Project HELICoiD “HypErspectral Imaging Cancer Detection” under Grant Agreement 618080. This work has been also supported in part by the Canary Islands Government through the ACIISI (Canarian Agency for Research, Innovation and the Information Society), ITHACA project “Hyperespectral identification of Brain tumors” under Grant Agreement ProID2017010164. Additionally, this work has been supported in part by the 2016 PhD Training Program for Research Staff of the University of Las Palmas de Gran Canaria. Finally, this work was completed while Samuel Ortega was beneficiary of a pre-doctoral grant given by the “Agencia Canaria de Investigacion, Innovacion y Sociedad de la Información (ACIISI)” of the “Conserjería de Economía, Industria, Comercio y Conocimiento” of the “Gobierno de Canarias”, which is part-financed by the European Social Fund (FSE) (POC 2014-2020, Eje 3 Tema Prioritario 74 (85%))

Pathways into living alone in mid-life: diversity and policy implications

This paper adopts a life course approach to investigate the pathways into living alone in mid-life in Britain and how these vary by gender and socio-economic status. The rise in the proportion of people living alone over the past three decades has been well documented. However, much of the focus of the existing literature has been on either people living solo in young adulthood or in later life. Mid-life has received surprising little scholarly attention, despite the fact that living arrangements in mid-life are changing rapidly, and that household composition and socio-economic circumstances in the period immediately prior to retirement are strongly associated with living arrangements and associated sources of support in later life. This paper therefore aims to fill this gap. We begin with a review of previous research on living alone and present a conceptual framework of the pathways into living alone in mid-life. Data from the United Kingdom Household Longitudinal Survey (UKHLS) are used to analyse the partnership and parenthood histories and socio-economic characteristics of those currently living alone in mid-life. The findings indicate that the dissolution of a marriage with children is the dominant pathway into mid-life solo-living, but that there is also a substantial group of never partnered men living alone. These never partnered men are split between those with low and high socio-economic status. Distinguishing between different groups of individuals living alone in mid-life is important for policy as these groups of men and women will have different social and financial resources as they enter later life. Mid-life men living alone who have not had children, have no educational qualifications, are not economically active and who live in rented housing are likely to be most at risk of needing a social and economic ‘safety net’ in old age

Very low prevalence of IgE mediated wheat allergy and high levels of cross-sensitisation between grass and wheat in a UK birth cohort

BackgroundPatients often report adverse reactions to wheat. Interpretation of sensitization to wheat pollen and flour with/without sensitization to grass pollen is a clinical problem.AimWe set out to determine the prevalence of wheat allergy in a birth cohort (10/11 year olds) and investigate the usefulness of performing skin prick tests (SPT), specific IgE tests and component resolved diagnostics to wheat pollen and flour.MethodsThe Food Allergy and Intolerance Research (FAIR) birth cohort included babies born on the Isle of Wight (UK) between September 2001–August 2002 (n = 969). Children were followed up at 1, 2, 3 and 10/11 years. 588 children had SPTs to wheat pollen and grass during the 10 year follow-up. 294 children underwent further SPT to wheat flour and 246 had specific IgE testing to wheat and grass.ResultsEight children underwent oral food challenges (OFC). We diagnosed 0.48 % (4/827; 95 % CI 0–1 %) children with wheat allergy based on OFC. 16.3 % (96/588) were sensitized to grass pollen, 13.4 % (79/588) to wheat pollen; 78 % (75/96) sensitized to both. Only one child was sensitized to wheat flour and wheat pollen, but not grass pollen. For specific IgE, 15.0 % (37/246) and 36.2 % (89/246) were sensitized to wheat and grass pollen, with 40.5 % (36/89) sensitized to both. Of the 37 children sensitized to wheat, 3 (8.1 %) were sensitized to omega 5 gliadin, 1 (2.7 %) to wheat lipid transfer protein and 1 to wheat gliadin.ConclusionClinicians should be aware of the high level of cross-sensitization when performing tests to wheat and grass pollen i.e. sensitisation to wheat specific IgE and wheat pollen SPT should be assessed in the presence of grass pollen SPT and/or specific IgE

Validation and acceptability of double-blind, placebo-controlled food challenges in children

The Double Blind Placebo Controlled Food Challenge (DBPCFC) is considered the gold standard for food allergy diagnosis (1, 2). It is recommended that active and placebo challenge foods for DBPCFCs are sufficiently blinded in terms of smell, flavour and texture. Difficulties arise with children undergoing DBPCFCs as they may refuse to eat the challenge food or struggle to eat the large volumes required to adhere to internationally recommended dosages (2). This article is protected by copyright. All rights reserve

What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care

Background: Increasing numbers of older patients with advanced cancer live alone but there is little research on how well health services meet their needs. The aim of this study was to compare the experiences and future preferences for care between two groups of older people with cancer in their last year of life; those who live alone, and those who live with co-resident carers. Methods: In-depth qualitative interviews were conducted with 32 people aged between 70 and 95 years who were living with cancer. They were recruited from general practices and hospice day care, when the responsible health professional answered no to the question, of whether they would be surprised if the patient died within twelve months. Twenty participants lived alone. Interviews were recorded and transcribed and the data analysed using a Framework approach, focussing on the differences and commonalities between the two groups. Results: Many experiences were common to all participants, but had broader consequences for people who lived alone. Five themes are presented from the data: a perception that it is a disadvantage to live alone as a patient, the importance of relational continuity with health professionals, informal appraisal of care, place of care and future plans. People who lived alone perceived emotional and practical barriers to accessing care, and many shared an anxiety that they would have to move into a care home. Participants were concerned with remaining life, and all who lived alone had made plans for death but not for dying. Uncertainty of timescales and a desire to wait until they knew that death was imminent were some of the reasons given for not planning for future care needs. Conclusions: Older people who live alone with cancer have emotional and practical concerns that are overlooked by their professional carers. Discussion and planning for the future, along with continuity in primary care may hold the key to enhancing end-of-life care for this group of patients