Enhancing positive mood in older adults: implications for vaccine effectiveness

The influenza vaccine is less effective in older adults compared to their younger counterparts. At the same time, this population is more susceptible to contracting influenza, with more severe consequences, including higher rates of complications, hospitalisations, and deaths. There is an abundance of evidence demonstrating how psychological factors, such as stress, can influence and modulate immune function, including response to vaccinations. Recent work has extended this to other psychological factors, suggesting that mood, or affect, may also be linked to vaccine response, however the evidence here is much more limited. This thesis presents three inter-related pieces of research, which sought to build on this evidence base and contribute to our current understanding of the influence of mood on vaccinations. The ultimate aim of this research was to develop an intervention to enhance positive mood, with a view to enhancing the effectiveness of the influenza vaccination in the older adult population. First, the evidence surrounding the effectiveness of using participant-driven choice in interventions compared to ‘no-choice’ interventions was systematically reviewed. This review sought to investigate whether the integration of participant choice within an existing, previously trialled, positive mood intervention would maximise mood enhancement and thus the potential to enhance vaccine-specific antibody levels. The review found that whilst choice-interventions led to less drop-out and greater adherence, evidence for mood-related outcomes was unclear and warranted further investigation. Second, a randomised controlled clinical study (n=654) was conducted to investigate the effectiveness of the previously trialled fixed-content positive mood intervention, a new choice-based intervention, and usual care, in terms of enhancing positive mood. Vaccine response at four-weeks post-vaccination was assessed as a secondary outcome. Results showed that both the fixed-content and choice-based interventions significantly improved mood compared to usual care, however there were no significant differences between the two interventions. There were no significant differences between groups in terms of antibody levels at four weeks post-vaccination. Finally, a qualitative study using a thematic-content hybrid analysis approach was carried out with a selection of participants from the randomised trial, to assess participants’ perceptions of how the intervention may or may not have worked, and to identify ways in which both the intervention and study experience as a whole could be improved for a future trial implementing the optimised intervention. Analysis revealed that both interventions, as well as the overall study experience, were liked by participants, indicating that further optimisation may not be necessary. Additionally, several potential mechanisms underlying the relationship between the interventions and mood were identified. The research presented in this thesis has several important implications. Firstly, that the use of choice should be considered where there is concern regarding drop-out or adherence, but may not be more effective than no-choice interventions in enhancing mood. Secondly, that brief positive mood interventions are effective in enhancing positive mood in older adults in a primary care setting. Future work is required to evaluate their impact on immune outcomes including mechanistic work to understand the relationship between mood and immunity, and a large scale trial, with immune response as the primary outcome

Economic estimates of invasive wild pig damage to crops in 12 US states

We report the results of a survey on invasive wild pig (Sus scrofa L.) damage and control in 12 US states (Alabama, Arkansas, California, Florida, Georgia, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, and Texas). The crops chosen for this study represent the “second-tier” in terms of economic importance after the six crops that were the subject of Anderson et al. (2016). The survey was distributed by the USDA National Agricultural Statistical Service (NASS) in the summer of 2019 to a sample of producers in each of the states (except California) of the following six crops: hay, pecans (Carya illinoinensis (Wangenh.) K.Koch), melons (cantaloupe (Cucumis melo L. var. cantalupensis), honeydew (Cucumis melo L. (Inodorus Group)), and watermelon (Citrullus Schrad.), sugarcane (Saccharum officinarum L.), sweet potatoes (Ipomoea batatas (L.) Lam.), and cotton (Gossypium L.). In California, where there the crops of economic importance differed from the other states in the study, damages were calculated for producers of hay, almonds (Prunus dulcis (Mill.) D.A. Webb), grapes (Vitis vinifera L.), sod, carrots (Daucus L.), lettuce (Lactuca L.), and strawberries (Fragaria L.). In total, 7438 respondents completed the questionnaire. Findings indicate that damage can be substantial. The highest yield loss estimates occurred for hay in Texas. Control efforts were common, but no control method was rated by the majority of producers as very effective. Extrapolating crop damage estimates to the state-level in 12 states with reportable damage yielded an estimated crop loss of $272 million/yr. Though large, this number likely represents only a small fraction of the total damage by wild pigs in these states because it only includes crop damage to six crops. We hope findings from this survey will help guide control efforts and research, as well as serve as a benchmark against which the effectiveness of future control efforts can be measured

The Association of Lifestyle and Mood with Long-Term Levels of Cortisol: A Systematic Review

Objectives: To critically review evidence for associations between long-term cortisol levels, mood, and lifestyle factors.Method: Systematic searches of electronic databases (MEDLINE, EMBASE, PsycINFO, WoS, and CINAHL) were conducted up to 21/11/2020 to identify observational and interventional studies (n=4971) reporting associations between one or more lifestyle or mood factor with cortisol outcomes measured over ?4 weeks in healthy adults. Quality of included studies were assessed using Downs and Black checklist.Results: The quality of evidence supporting the associations of lifestyle or mood with long-term cortisol levels was assessed as being of moderate-to-poor quality. Observational studies (n=25) indicated positive associations for BMI/body weight (ESr, pooled effect size correlation=0.15, p<.001), physical activity (ESr=0.16, p<.001), perceived stress (ESr=0.114, p=.02), and depression (ESr=0.133, p=.02), but not stressors (ESr=0.06, p=.29), anxiety (ESr=0.08, p=.14), or specific features of stress (ESr=0.25, p=.10). There was insufficient evidence to reliably estimate associations between long-term cortisol levels and sleep, smoking, alcohol consumption, caffeine consumption, and PTSD. Findings from interventional studies (n=27) were mixed and did not always support the relationships found in observational studies.Conclusions: Findings of this review were limited by the quality of the evidence. Current evidence for the associations between mood and lifestyle factors with long-term levels of cortisol is mixed. For many factors, there was considerable uncertainty regarding the size of association with long-term cortisol due to a paucity of evidence. Future research should aim to (1) follow more consistent sampling protocols between studies, and (2) clearly describe the hypothesized mechanisms through which the interventions would affect cortisol levels

The effect of choice interventions on retention-related, behavioural and mood outcomes: a systematic review with meta-analysis

The provision of choice within interventions has been associated with increased motivation, engagement and interest, as well as improved clinical outcomes. Existing reviews are limited by their wide inclusion criteria or by not assessing behaviour change and mood outcomes. This review examines whether participant-driven choice-based interventions specifically are more likely to be enjoyed and accepted by participants compared to no-choice interventions, and whether this impacts on intervention outcomes in terms of behaviour change or mood. Forty-four randomised controlled trials were identified for inclusion. Random effects meta-analyses were performed for retention-related outcomes (drop-out, adherence and satisfaction), and aggregate behaviour change and mood outcomes. Choice-based interventions resulted in significantly less participant drop-out and increased adherence compared to interventions not offering choice. Results for the behaviour change and mood analyses were mixed. This meta-analytic review demonstrates that choice-based interventions may enhance participant retention and adherence, thus researchers and clinicians alike should consider the provision of choice when designing research and interventions. The evidence for the role of choice in behaviour change and mood is less convincing, and there is a need for more, higher quality research in this area

Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review

BACKGROUND: STIs in older adults (adults aged 50 years and older) are on the rise due to variable levels of sex literacy and misperceived susceptibility to infections, among other factors. We systematically reviewed evidence on the effect of non-pharmacological interventions for the primary prevention of sexually transmitted infections (STIs) and high-risk sexual behaviour in older adults. METHODS: We searched EMBASE, MEDLINE, PSYCINFO, Global Health and the Cochrane Library from inception until March 9th, 2022. We included RCTs, cluster-randomised trials, quasi-RCTs, interrupted time series (ITS) and controlled and uncontrolled before-and-after studies of non-pharmacological primary prevention interventions (e.g. educational and behaviour change interventions) in older adults, reporting either qualitative or quantitative findings. At least two review authors independently assessed the eligibility of articles and extracted data on main characteristics, risk of bias and study findings. Narrative synthesis was performed. RESULTS: Ten studies (two RCTs, seven quasi-experiment studies and one qualitative study) were found to be eligible for this review. These interventions were mainly information, education and communication activities (IECs) aimed at fostering participants’ knowledge on STIs and safer sex, mostly focused on HIV. Most studies used self-reported outcomes measuring knowledge and behaviour change related to HIV, STIs and safer sex. Studies generally reported an increase in STI/HIV knowledge. However, risk of bias was high or critical across all studies. CONCLUSIONS: Literature on non-pharmacological interventions for older adults is sparse, particularly outside the US and for STIs other than HIV. There is evidence that IECs may improve short-term knowledge about STIs however, it is not clear this translates into long-term improvement or behaviour change as all studies included in this review had follow-up times of 3 months or less. More robust and higher-quality studies are needed in order to confirm the effectiveness of non-pharmacological primary prevention interventions for reducing STIs in the older adult population

Texas Hunters’ Perceptions Regarding the Acceptability of Toxicants to Control Wild Pig Populations

Wild pigs (Sus scrofa) are an invasive species in the United States. They damage agriculture, degrade water quality and ecological communities, and host a number of viruses, parasites, and bacteria transmissible to humans and animals. In states such as Texas, USA, where wild pigs cause extensive damage to agriculture and property, officials have considered allowing for the use of toxicants to control wild pig populations. To provide decision-makers with information regarding stakeholders’ perceptions of the use of toxicants to control wild pigs, we surveyed Texas hunters in 2019 to assess the level of acceptance of a hypothetical wild pig toxicant, the sociodemographic and other factors most closely associated with acceptability of such a toxicant, and the specific concerns that underlie hunters’ positions on the use of such a toxicant. We received 37,317 completed responses to an online, self-administered survey. Respondents were divided over the use of a toxicant, with 43% finding a toxicant acceptable, 18% neutral, and 39% finding a toxicant unacceptable. The factor most closely associated with acceptance of a wild pig toxicant was respondents’ desired wild pig population size in Texas (χ2 = 3,657.7, P \u3c 0.001, V = 0.26), with 70% of respondents who preferred that wild pigs be completely removed from Texas finding the use of a toxicant to be acceptable, compared to 14% of respondents who preferred that wild pig populations increase or stay the same. The most commonly raised concerns in connection with toxicant usage were potential negative impacts to nontarget animals (33%) and negative impacts to human health (24%). Our research suggests that while achieving a consensus among Texas hunters on toxicant usage is unrealistic, building majority support may be possible if the identified concerns are sufficiently addressed in product development and outreach

A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care

Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps

Impacts of the COVID-19 pandemic and self-isolation on students and staff in higher education: A qualitative study

This qualitative study explored the impact of COVID-19 self-isolation and social restriction measures on university students, through the perspectives of both students and the staff supporting them. The study comprised 11 focus groups (students) and 26 individual interviews (staff) at a higher education institution in England during a period of national lockdown (January–March 2021). Participants were university students (n = 52) with self-isolation experiences and university staff (n = 26) with student-facing support roles. Focus group and interview data were combined and analysed using an inductive thematic approach. Four themes emerged: ‘Adaptation during the pandemic’, ‘Practical, environmental, and emotional challenges of self-isolating’, ‘Social factors and their impact on COVID-19 testing and self-isolation adherence’, and ‘Supporting self-isolation’. Students and staff struggled with the imposed restrictions and shift to online education. Students found it difficult to adapt to new expectations for university life and reported missing out on professional and social experiences. Students and staff noted concerns about the impact of online teaching on educational outcomes. Students endorsed varied emotional responses to self-isolation; some felt unaffected whilst others experienced lowered mood and loneliness. Students were motivated by pro-social attitudes; campaigns targeting these factors may encourage continued engagement in protective behaviours. Staff struggled to manage their increased workloads delivering support for self-isolating students. Universities must consider the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student wellbeing and educational attainment. Greater support should be provided for staff during transitional periods, with ongoing monitoring of workforce stress levels warranted

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo