The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study.

BACKGROUND: In the United States, people with relapsing-remitting multiple sclerosis (RRMS) can face difficulty accessing disease-modifying therapies (DMTs) because of insurance, pharmacy, or provider policies. These barriers have been associated with poor adherence and negative health outcomes. OBJECTIVE: The goals of this study were to describe the overall occurrence of difficulties and delays associated with gaining access to DMTs among people with RRMS, to assess DMT adherence during periods of reduced access, and to contextualize the patients\u27 journey from receipt of a prescription for DMT to obtaining and taking their medication when faced with access barriers. METHODS: We recruited US-based adults self-reporting RRMS from a Web-based health data-sharing social network, PatientsLikeMe. Individuals were invited to complete a Web-based survey if they reported a diagnosis of RRMS and were prescribed a DMT for MS. Follow-up phone interviews were conducted with 10 respondents who reported experiencing an MS-related relapse during the time they had experienced challenges accessing DMTs. RESULTS: Among 507 survey completers, nearly half were either currently experiencing an issue related to DMT assess or had difficulty accessing a DMT in the past (233/507, 46.0%). The most frequently reported reasons for access difficulty were authorization requirements by insurance companies (past issues: 78/182, 42.9%; current issues: 9/42, 21%) and high out-of-pocket costs (past issues: 54/182, 29.7%; current issues: 13/42, 31%). About half (20/39, 51%) of participants with current access issues and over a third (68/165, 41.2%) of those with past issues went without their medication until they could access their prescribed DMT. Relapses were reported during periods of reduced DMT access for almost half (56/118, 47.5%) of those with past issues and nearly half (22/45, 49%) of those with current issues. Resolving access issues involved multiple stakeholder agents often coordinated in a patient-led effort. Among those who had resolved issues, about half (57/119, 47.9%) reported that doctors or office staff were involved, under half (48/119, 40.3%) were involved themselves, and about a third (39/119, 32.8%) reported the drug manufacturer was involved in resolving the issue. Follow-up interviews revealed that the financial burden associated with obtaining a prescribed DMT led to nonadherence. Additionally, participants felt that DMT treatment delays and stress associated with obtaining the DMT triggered relapses or worsened their MS. CONCLUSIONS: This study expands current research by using a patient-centered, mixed-methods approach to describe barriers to MS treatment, the process to resolve barriers, and the perceived impact of treatment barriers on outcomes. Issues related to DMT access occur frequently, with individuals often serving as their own agents when navigating access difficulties to obtain their medication(s). Support for resolution of DMT access is needed to prevent undue stress and nonadherence

Aphelenchoides sp. destroying mushroom mycelium

RESP-357

Conserving nature out of fear or knowledge? Using threatening versus connecting messages to generate support for environmental causes

Threatening and connecting messages are two types of appeals commonly used to encourage conservation behaviors, yet little research has examined their psychological impacts and behavioral outcomes. This paper describes two studies contrasting these approaches with a neutral comparison and testing their effects on state levels of negative affect, caring, and openness, psychological states which we expected in turn would encourage conservation behavior. Participants viewed visually identical nature videos with no text, connecting text or negative text. They then reported on their state experiences, and were asked to engage in conservation behaviors, including supporting conservation organizations. Findings showed that connecting messages increased caring and openness, and decreased negative affect, and by doing so elicited more conservation behaviors. On the other hand, threatening messages showed no beneficial effects above a neutral comparison without an appeal. Our findings, which we contextualize in motivational theory, can be used to inform the use of messages to promote conservation.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.jnc.2015.04.00

Detection of an endangered mammalian species using environmental DNA analysis

Poster presented at The Mammal Society 63rd Spring Conference & AGM, 31st March-2nd April, 2017, Cambridge, UK

Environmental DNA analysis – non-invasive detection of endangered species in aquatic and terrestrial environments

Poster presented at Human Identification Solutions (HIDS) 2017, 16th-17th May, 2017, Vienna, Austria

The complete plasmid sequences of Salmonella enterica serovar Typhimurium U288.

Salmonella enterica Serovar Typhimurium U288 is an emerging pathogen of pigs. The strain contains three plasmids of diverse origin that encode traits that are of concern for food security and safety, these include antibiotic resistant determinants, an array of functions that can modify cell physiology and permit genetic mobility. At 148,711 bp, pSTU288-1 appears to be a hybrid plasmid containing a conglomerate of genes found in pSLT of S. Typhimurium LT2, coupled with a mosaic of horizontally-acquired elements. Class I integron containing gene cassettes conferring resistance against clinically important antibiotics and compounds are present in pSTU288-1. A curious feature of the plasmid involves the deletion of two genes encoded in the Salmonella plasmid virulence operon (spvR and spvA) following the insertion of a tnpA IS26-like element coupled to a blaTEM gene. The spv operon is considered to be a major plasmid-encoded Salmonella virulence factor that is essential for the intracellular lifecycle. The loss of the positive regulator SpvR may impact on the pathogenesis of S. Typhimurium U288. A second 11,067 bp plasmid designated pSTU288-2 contains further antibiotic resistance determinants, as well as replication and mobilization genes. Finally, a small 4675 bp plasmid pSTU288-3 was identified containing mobilization genes and a pleD-like G-G-D/E-E-F conserved domain protein that modulate intracellular levels of cyclic di-GMP, and are associated with motile to sessile transitions in growth

Exploring the feasibility of using Participatory Action Research (PAR) as a mechanism for school culture change to improve mental health

Adolescence is a key time to prevent or reduce poor mental health outcomes. Supportive school environments play an important role in this, and the concept of health-promoting schools have been supported globally. Participatory action research (PAR) combines theory, practice, action, and reflection by developing practical solutions to address concerns and issues within communities. Running four PAR groups across three secondary schools, we explored the feasibility of using the approach as a mechanism for bringing about culture change and improving mental health. We undertook interviews and focus groups with students (n = 24), school staff (n = 11), facilitators (n = 3), and parents/carers (n = 2). Findings are organised under five key headings: 1) Establishing PAR groups, and the PAR cycle; 2) PAR group impact; 3) Facilitators of PAR success; 4) Barriers to PAR success; 5) Future recommendations. This study demonstrated the feasibility of PAR as a tool to improve school culture. Students participating in PAR were engaged, passionate, and motivated to influence and transform school culture to improve mental health. Future research should aim to trial the PAR approach on a larger scale, to determine whether the barriers and facilitators of PAR success identified here are relevant and transferable to schools in other contexts, and to measure the impact of such initiatives on mental health outcomes

Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial

Objectives: The aim was to evaluate an Acceptance Commitment Therapy (ACT) intervention for people with knee or hip osteoarthritis; a related aim was to compare treatment effects from Rasch-transformed and standard scales. Methods: Participants were recruited from a research database and outpatient rheumatology and orthopaedic clinics at two hospitals. Eligible participants were randomly allocated to either intervention or usual care. Intervention comprised six-sessions of group ACT. Outcomes were assessed two and four months after randomisation. Rasch-transformed and standard self-report measures were compared. Qualitative interviews also explored the acceptability of the intervention. Results: Of 8 people assessed for eligibility, 31 (36%) were randomised. The main reason for non-randomisation was that participants received surgery. Of the 16 participants randomised to intervention, 64% completed ≥50% of the scheduled group sessions. Follow-up data was complete for 84% participants at two months and 68% at four months. Outcome analysis demonstrated important differences between the Rasch-transformed and standard scales. There were significant differences between the groups in pain. Qualitative interviews with 7 participants suggested the intervention was acceptable. Conclusions: ACT for osteoarthritis is likely to be an acceptable treatment option for people with osteoarthritis. Progress to a definitive trial is warranted. Rasch-transformed outcome scales are preferable in clinical trials where possible