HIV testing in patients presenting with indicator conditions in outpatient settings: offer and uptake rates, and educational and active interventions

Approximately 13% of people living with HIV in the UK are undiagnosed which has significant implications in terms of onward transmission and late diagnosis. HIV testing guidelines recommend routine screening in anyone presenting to healthcare with an HIV indicator condition (IC); however, this does not occur routinely. This study aimed to assess the feasibility and effectiveness of using case note prompts highlighting the presence of an IC to increase HIV testing. Clinicians in three outpatient departments received case note prompts either before or after a period of clinician-led identification. Test offer and uptake rates were assessed. A parallel anonymous seroprevalence study estimated the prevalence of undiagnosed HIV. A total of 4191 patients had an appointment during the study period; 608 (14.5%) had an IC. HIV test offer was significantly higher when a prompt was inserted into notes (34.3% versus 3.2%, p < 0.001). The prevalence of diagnosed HIV in the cohort was 4.1%. No cases of undiagnosed HIV infection were identified. Despite guidelines, offer of HIV testing is low. Strategies to increase routine screening of patients presenting with an IC are needed. Individual case note prompts significantly increase HIV test offer; however, the effect is lost if the strategy is withdrawn

Letting go, creating meaning : The role of acceptance and commitment therapy in helping people confront existential concerns and lead a vital life

We all must confront existential crises such as sickness, death of loved ones, loss of job, mistreatment from others, and relationship breakdown. These crises can shatter our sense of meaning. How can we face that moment with honesty and courage, embrace the distress, and create new meaning? This chapter provides a theory of how language and self-awareness can lead us into existential crisis and loss of meaning. It then provides an evidence-based account of how the DNA-V model of Acceptance and Commitment Therapy (ACT) can help people to answer “Yes” to Camus’ most important philosophical question, “Is life worth living?”. ACT can help people recreate coherence after a coherence-shattering event, overcome alienation from the body, overcome inertia, overcome a sense of self that is self-destroying or feels “empty,” and bridge the gulf between self and others and create genuine connection

Embracing the complexity of our inner worlds : Understanding the dynamics of self-compassion and self-criticism [Commentary]

Objectives Although research in self-compassion has been rapidly growing, there is still substantial controversy about its meaning and measurement. The controversy centers on Neff’s popular Self- Compassion Scale (SCS) and the argument that compassionate self-responding (CSR) and uncompassionate self-responding (UCS) are a single dimension versus the argument that they are two semi-independent, unipolar dimensions, with UCS not reflective of “true” self-compassion. Methods We review the evidence for both positions and conclude that the data cannot yet resolve the debate. Results Neither position is proven to be right or wrong. We recommend the way forward is to let go of traditional factor analytic approaches and examine self-compassionate behavior as a dynamic network of interacting processes that are influenced by context. This leads us to three classes of testable hypotheses. The link between CS and UCS will depend on the timeframe of measurement, current circumstances, and individual differences. Conclusions We propose a middle ground to the SCS debate; rather than supporting the single total score, 2-factor score (CSR and UCS) or the 6-factor score (the six subscales of the SCS), we argue these constructs interact dynamically, and the decision of which scoring method to use should depend on the three testable contextual hypotheses

Healthcare start-ups are not getting what they need from big pharma

Start-ups are at the forefront of healthcare innovation, developing cutting-edge solutions that address current challenges and pain points in the patient journey. Alex Bedenkov, Ryan Bate, Madeleine Thun, Abhay Kakde, Ankita Deshpande, and Gill Hayes write that partnership with industry can be the catalyst for start‑ups to accelerate their progress in shaping the healthcare ecosystems of tomorrow. But there is room for improvement in how the industry supports and collaborates with innovators

The Compassion Balance: Understanding the Interrelation of Self- and Other-Compassion for Optimal Well-being

Objectives: This study examined the role of self-other harmony in the relations between self-compassion, other-compassion, and well-being. Past research has shown self- and other-compassion to be positively related. But we hypothesised that self-compassion can be perceived as incompatible with other-compassion, and that self-compassion and other-compassion might be uncorrelated or negatively correlated in daily life for some individuals. We termed this pattern lack of self-other harmony in compassion and hypothesised that it would undermine the benefits of compassion. Method: Using an experience sampling method in patients (n=154) with a variety of diagnoses, we measured self-compassion, other-compassion, life-satisfaction, mood, and contextual variables six times per day for 42 time points. Results: For most participants, self-compassion was positively associated with other-compassion. However, there was substantial heterogeneity in this effect. The degree of self-other harmony moderated the link between compassion directed towards self or other and well-being. Higher levels of compassion were associated with higher levels of well-being, but only for those who experienced the harmony. When the two forms of compassion were not in harmony, levels of self/other-compassion were largely unrelated to well-being. Conclusions: The findings emphasise the importance of personalised compassion interventions rather than a one-size-fits-all approach. Increasing self-compassion or other-compassion is likely to improve well-being for most people. However, for a minority lacking the self-other harmony, it may be necessary to assess their interpretation of self- and other-compassion, then work with them to promote the compassion balance optimal for their well-being

Tracking the State and Behavior of People in Response to COVID-1 19 Through the Fusion of Multiple Longitudinal Data Streams

The changing nature of the COVID-19 pandemic has highlighted the importance of comprehensively considering its impacts and considering changes over time. Most COVID-19 related research addresses narrowly focused research questions and is therefore limited in addressing the complexities created by the interrelated impacts of the pandemic. Such research generally makes use of only one of either 1) actively collected data such as surveys, or 2) passively collected data. While a few studies make use of both actively and passively collected data, only one other study collects it longitudinally. Here we describe a rich panel dataset of active and passive data from U.S. residents collected between August 2020 and July 2021. Active data includes a repeated survey measuring travel behavior, compliance with COVID-19 mandates, physical health, economic well-being, vaccination status, and other factors. Passively collected data consists of all locations visited by study participants, taken from smartphone GPS data. We also closely tracked COVID-19 policies across counties of residence throughout the study period. Such a dataset allows important research questions to be answered; for example, to determine the factors underlying the heterogeneous behavioral responses to COVID-19 restrictions imposed by local governments. Better information about such responses is critical to our ability to understand the societal and economic impacts of this and future pandemics. The development of this data infrastructure can also help researchers explore new frontiers in behavioral science. The article explains how this approach fills gaps in COVID-19 related data collection; describes the study design and data collection procedures; presents key demographic characteristics of study participants; and shows how fusing different data streams helps uncover behavioral insights

"Obesity" and "Clinical Obesity" Men's understandings of obesity and its relation to the risk of diabetes: A qualitative study

<p>Abstract</p> <p>Background</p> <p>The 2007 Wanless report highlights the ever increasing problem of obesity and the consequent health problems. Obesity is a significant cause of diabetes. An increasing evidence base suggests that in terms of reducing diabetes and CVD risk, it is better to be "fit and fat" than unfit and of normal weight. There has been very little previous research into the understandings that men in the general population hold about the issues of weight, exercise and health; we therefore undertook this study in order to inform the process of health promotion and diabetes prevention in this group.</p> <p>Methods</p> <p>A qualitative study in North East England General Practice using a purposive sample of men aged 25 and 45 years (selection process designed to include 'normal', 'overweight' and 'obese' men). One to one audio-recorded semi structured interviews focused on: overweight and obesity, diet, physical activity and diabetes. Transcripts were initially analysed using framework analysis. Emerging themes interlinked.</p> <p>Results</p> <p>The men in this study (n = 17) understand the word obesity differently from the clinical definition; "obesity" was used as a description of those with fat in a central distribution, and understandings of the term commonly take into account fitness as well as weight. Men in their late 30s and early 40s described becoming more aware of health issues. Knowledge of what constitutes a 'healthy lifestyle' was generally good, but men described difficulty acting upon this knowledge for various reasons e.g. increasing responsibilities at home and at work. Knowledge of diabetes and the link between obesity and diabetes was poor.</p> <p>Conclusion</p> <p>Men in this study had a complex understanding of the interlinked importance of weight and fitness in relation to health. Obesity is understood as a description of people with centrally distributed fat, in association with low fitness levels. There is a need to increase understanding of the causes and consequences of diabetes. Discussion of increased health awareness by men round the age of 40 may indicate a window of opportunity to intervene at this time.</p

External validation and adaptation of a dynamic prediction model for patients with high‐grade extremity soft tissue sarcoma

Background and Objectives: A dynamic prediction model for patients with soft tissue sarcoma of the extremities was previously developed to predict updated overall survival probabilities throughout patient follow‐up. This study updates and externally validates the dynamic model. Methods: Data from 3826 patients with high‐grade extremity soft tissue sarcoma, treated surgically with curative intent were used to update the dynamic PERsonalised SARcoma Care (PERSARC) model. Patients were added to the model development cohort and grade was included in the model. External validation was performed with data from 1111 patients treated at a single tertiary center. Results: Calibration plots show good model calibration. Dynamic C‐indices suggest that the model can discriminate between high‐ and low‐risk patients. The dynamic C‐indices at 0, 1, 2, 3, 4, and 5 years after surgery were equal to 0.697, 0.790, 0.822, 0.818, 0.812, and 0.827, respectively. Conclusion: Results from the external validation show that the dynamic PERSARC model is reliable in predicting the probability of surviving an additional 5 years from a specific prediction time point during follow‐up. The model combines patient‐, treatment‐specific and time‐dependent variables such as local recurrence and distant metastasis to provide accurate survival predictions throughout follow‐up and is available through the PERSARC app.Peer reviewe