Young Adults' Experience of Loneliness in London's Most Deprived Areas

Young adults (16-24 years old) are currently the loneliest group in Western countries. In particular, young adults of lower socio-economic status (SES) living in the most deprived areas are loneliest in the United Kingdom. This mixed-methods study explored the experience of loneliness among this under-explored demographic in London. Using a novel free association technique, the experience of loneliness was found to be characterized by: a sense of isolation, negative emotions and thoughts, coping and a positive orientation to aloneness. An exploration of these themes revealed that: one can feel isolated or excluded even when surrounded by people; the experience of loneliness is accompanied by a set of interrelated feelings and thoughts like rumination; and technological and/or non-technological outlets can be used to cope. Social media play both a positive and negative role in loneliness, and loneliness is not always experienced negatively. The quantitative data indicated that this sample was lonely. By providing insight into young adults' loneliness, the findings indicate what types of interventions are likely to diminish it

How young adults cope with loneliness: a study of London’s most deprived boroughs

There is growing recognition that young adults of low socioeconomic status are among the loneliest in the United Kingdom. However, there has been a dearth of qualitative research exploring how they cope with their loneliness. Using a novel free association technique, this study sought to explore how young adults (n = 48) in London’s most deprived areas cope with feeling lonely. A thematic analysis, informed by an inductive approach, identified six key themes. Seeking connection, avoidance, seeking support and cognitive strategies were most prevalent. Meaning-focused coping and distraction were also identified, albeit less often. Overall, there were diverse ways of coping within and across respondents and important differences were found between the genders. The findings call for the early identification of those at risk of persistent avoidance behaviours and for interventions that provide meaningful leisure activities, with mutual goals in communities, alongside the strengthening of support and authenticity in relationships

Wellbeing in the city: Young adults' sense of loneliness and social connection in deprived urban neighbourhoods

Neighbourhood characteristics can facilitate or hinder the development of social ties, thereby influencing the loneliness of those who live in them. Most research to date has focused upon how either older adults (65+) or youth (under 19 years old) view and experience their neighbourhood, paying little attention to young adults (aged 16–24). Young adults are the loneliest age-group within the UK and other Western countries. Their loneliness is associated with living in deprived communities (e.g., areas experiencing social-economic inequalities), feeling a strong sense of disconnection from their neighbourhoods and having little trust in others within these spaces. Therefore, this study utilises social representations theory to explore how young adults (18–24 years old) from London's four most deprived boroughs view and experience their neighbourhood using a systematic, qualitative methodology. In particular, the concept of dialogical antimonies, known as themata are used. A purposive sample of forty-eight participants was asked to write and/or draw where they felt loneliest and where they felt most socially connected in their neighbourhoods. These associations were then explored via an open-ended, exploratory interview. This revealed that the experience of neighbourhood was structured around four themata: 1) having no one to talk to/being disconnected from others vs. being with family or friends, 2) feeling bored/having nothing to do vs. having shared interests, goals or activities, 3) being in an unfamiliar environment vs. seeing familiar faces/having a sense of community, 4) busy vs. peaceful environment. On this basis, suggestions and implications for the design of wellbeing-enhancing neighbourhoods are discussed

Optimal Restricted Estimation for More Efficient Longitudinal Causal Inference

Efficient semiparametric estimation of longitudinal causal effects is often analytically or computationally intractable. We propose a novel restricted estimation approach for increasing efficiency, which can be used with other techniques, is straightforward to implement, and requires no additional modeling assumptions

What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards.

People with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards

Fracking in the UK press: threat dynamics in an unfolding debate

Shale gas is a novel source of fossil fuel which is extracted by induced hydraulic fracturing, or “fracking”. This article examines the socio-political dimension of fracking as manifested in the UK press at three key temporal points in the debate on the practice. Three newspaper corpora were analysed qualitatively using Thematic Analysis and Social Representations Theory. Three overarching themes are discussed: “April–May 2011: From Optimism to Scepticism”; “November 2011: (De-)Constructing and Re-Constructing Risk and Danger”; “April 2012: Consolidating Social Representations of Fracking”. In this article, we examine the emergence of and inter-relations between competing social representations, discuss the dynamics of threat positioning and show how threat can be re-construed in order to serve particular socio-political ends in the debate on fracking

Surrogate Markers for Time-Varying Treatments and Outcomes

BACKGROUND: A surrogate marker is a variable commonly used in clinical trials to guide treatment decisions when the outcome of ultimate interest is not available. A good surrogate marker is one where the treatment effect on the surrogate is a strong predictor of the effect of treatment on the outcome. We review the situation when there is one treatment delivered at baseline, one surrogate measured at one later time point, and one ultimate outcome of interest and discuss new issues arising when variables are time-varying. METHODS: Most of the literature on surrogate markers has only considered simple settings with one treatment, one surrogate, and one outcome of interest at a fixed time point. However, more complicated time-varying settings are common in practice. In this article, we describe the unique challenges in two settings, time-varying treatments and time-varying surrogates, while relating the ideas back to the causal-effects and causal-association paradigms. CONCLUSION: In addition to discussing and extending popular notions of surrogacy to time-varying settings, we give examples illustrating that one can be misled by not taking into account time-varying information about the surrogate or treatment. We hope this article has provided some motivation for future work on estimation and inference in such settings

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review & revise’ experience

Background: We aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review & revise’ which is a key strategy to minimise antibiotic overuse in hospitals. Methods: In this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study. Results: Participants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions. Conclusions: This study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review & revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received

Dental side effects of long-term obstructive sleep apnea therapy:a 10-year follow-up study

OBJECTIVES: Patients with obstructive sleep apnea (OSA) are usually treated with either mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) therapy. The objective of this study is to evaluate changes in dental occlusion associated with long-term MAD and CPAP therapy. MATERIALS AND METHODS: Data from 14 OSA patients using MAD and 17 OSA patients using CPAP therapy were evaluated at baseline, 2-year and 10-year follow-up. Changes in dental occlusion were analyzed from dental plaster casts with a digital sliding caliper. RESULTS: At 2-year follow-up, MAD therapy resulted in significant dental changes when compared with baseline values. In MAD therapy, overjet and overbite decreased with 1.1 ± 1.8 mm and 1.1 ± 1.2 mm respectively. With CPAP therapy overjet and overbite decreased significantly with 0.2 ± 0.5 mm and 0.3 ± 0.5 mm, respectively. Both groups also showed significant changes in molar occlusion. After a 10-year follow-up, significant and more pronounced changes were seen in overjet and overbite. In MAD therapy, overjet and overbite decreased with 3.5 ± 1.5 mm and 2.9 ± 1.5 mm respectively when compared with baseline values. In CPAP therapy, overjet and overbite decreased with 0.7 ± 1.5 mm and 0.8 ± 1.4 mm respectively when compared with baseline values. CONCLUSIONS: This study demonstrates that MAD and CPAP therapy result in significant changes in dental occlusion. These changes appear progressive and more pronounced with MAD compared to CPAP therapy. CLINICAL RELEVANCE: Long-term OSA treatment results in significant dental side effects that may progress over time. Informed consent is fundamental before starting MAD treatment and individualized long-term follow-up is of eminent importance

Early responses to H7N9 in southern mainland China

This article is made available through the Brunel Open Access Publishing Fund. © 2014 Goodwin and Sun; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: H7N9 posed potentially serious health challenges for Chinese society. The previous SARS outbreak in this country was accompanied by contradictory information, while worries about wide-spread influenza led to discrimination worldwide. Early understanding of public threat perceptions is therefore important for effective public health communication and intervention. Methods: We interviewed 1011 respondents by phone two weeks after the first case. Questions examined risk awareness and media use, beliefs about the emergence of the threat and those most at risk, anxiety about infection and preventive and avoidant behaviours. Results: Results demonstrate moderate levels of anxiety but relatively high levels of trust towards government officials. Threat emergence was associated with hygiene levels, temperature change, floating pigs in the Huangpu River and migration to the city. Anxiety predicted both recommended and non-recommended behavioural changes. Conclusions: Comparatively high levels of trust in Chinese government advice about H7N9 contrast positively with previous pandemic communications in China. Anxiety helped drive both recommended and non-recommended behaviours, with potentially important economic and social implications. This included evidence of 'othering’ of those associated with the threat (e.g. migrants). Findings emphasise the need to manage public communications early during new influenza outbreaks.Fudan Tydall Centre and Fudan Media and Public Opinion Center