Qualitative results from a phase II pilot randomised controlled trial of a lymphoma nurse-led model of survivorship care

Purpose: To explore and describe lymphoma survivors’ thoughts and perceptions of the components of a nurse led lymphoma survivorship clinic intervention. Methods: An exploratory, qualitative descriptive study using interviews from 10 participants who had transitioned post-treatment into the survivorship phase via a nurse-led lymphoma survivorship clinic intervention. Results: Thematic analysis revealed three major themes: Reassurance and individualised care; Information and support; and Empowerment. Participants described the reassurance they gained from having contact with a health professional post-treatment who individualised information and support. A survivorship care plan and treatment summary was developed for this study and was believed to be very patient-centred and helpful. This enabled participants to take back control of their health and well-being and to rebuild confidence. Conclusions: In this study, participants expressed a need for patient-centred follow-up care that addressed their concerns and supported them in the survivorship phase to get their life back on track. Nurse-led follow-up may offer a viable model of post-treatment survivorship care to lymphoma cancer survivors

Intake of game birds in the UK:assessment of the contribution to the dietary intake of lead by women of childbearing age and children

AbstractObjectiveConcern has recently been expressed about Pb levels in Pb-shot game meat. Our aim was to determine the consumption of game birds in a representative sample population in the UK, and in children and women of childbearing age in particular.DesignPopulation-based cross-sectional cohort study. Data from 4 d diet diaries from the UK National Diet and Nutrition Survey (NDNS; 2008–2010) were extracted to analyse data on game bird consumption in the sample population, in women of childbearing age (15–45 years old) and in children ≤6 years old.SettingHome-based study in representative areas of the UK.SubjectsParticipants in the NDNS (2008–2010; n 2126, age 1·5 to &gt;65 years).ResultsFifty-eight participants (2·7 %) reported eating game birds. The mean intake was 19·5 (sd 18·1) g/d (median 15·6, range 1·3–92·9 g/d). In women of childbearing age (15–45 years), 11/383 (2·9 %) reported eating game birds, with a mean intake of 22·4 (sd 25·8) g/d (median 15·6, range 2·0–92·9 g/d). In children aged ≤6 years old, 3/342 (0·9 %) were reported as eating game birds, with a mean intake of 6·8 (sd 9·7) g/d (median 2·4, range 1·3–23·2 g/d).ConclusionsThe prevalence of consumption of game birds by women of childbearing age and children ≤6 years old was relatively low and intakes were small. However, any exposure to Pb in these two groups is undesirable. As are uncertainties about the ability of the diet diary method to capture the consumption of food items that are infrequently consumed, alternative methods of capturing these data should be used in future studies.</jats:sec

The long-term impact of folic acid in pregnancy on offspring DNA methylation : follow-up of the Aberdeen folic acid supplementation trial (AFAST)

Funding This work was supported by the NIHR Bristol Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. R.C.R., G.C.S., N.K., T.G., G.D.S. and C.L.R. work in a unit that receives funds from the University of Bristol and the UK Medical Research Council (MC_UU_12013/1, MC_UU_12013/2 and MC_UU_12013/8). This work was also supported by CRUK (grant number C18281/A19169) and the ESRC (grant number ES/N000498/1). C.M.T. is supported by a Wellcome Trust Career Re-entry Fellowship (grant number 104077/Z/14/Z).Peer reviewedPublisher PD

Low level lead exposure and pregnancy outcomes:dose–response relationships

BACKGROUND: National and international guidelines on safe levels for blood Pb in pregnancy focus on a threshold above which exposure is of concern. However, it has recently been suggested that the decrease in birth weight per unit increase in blood Pb is actually greater at lower than at higher concentrations of Pb without evidence of a lower threshold of effect. Our aim was to investigate whether there was evidence for a differential effect of maternal Pb levels on birth outcomes and/or a threshold value for effects. METHODS: Blood samples from pregnant women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Data collected on the infants included anthropometric variables. We fitted adjusted multivariable fractional polynomial models for birth outcomes. RESULTS: Adjusted models that assumed a linear relationship between untransformed blood Pb and the outcomes provided the best fit: an increase of 1 µg/dl was associated with changes in birth weight of −9.93 (95 % CI −20.27, 0.41) g, head circumference −0.03 (95 % CI −0.06, 0.00) cm and crown–heel length −0.05 (95 % CI −0.10, 0.00) cm. CONCLUSION: There was no evidence in this study to suggest a supralinear dose–response relationship or a lower threshold for the effect of maternal blood Pb on birth outcomes. This has implications for consideration of national and international guidelines on levels of concern in pregnancy. Exposure to Pb should be kept as low as possible during pregnancy to minimise adverse outcomes

Moderate prenatal cadmium exposure and adverse birth outcomes:a role for sex-specific differences?

BACKGROUND/AIM: Studies on the effects of moderate prenatal exposure to cadmium (Cd) on birth outcomes have been contradictory and it has been suggested that effects may be partly masked by sex‐specific effects. Our aim was to examine the association of Cd exposure in a large group of pregnant women with birth outcomes in the whole group of participants and by sex. METHODS: Pregnant women were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Whole blood samples for singleton pregnancies with a live birth were analysed for Cd (n = 4191). Data collected on the infants included anthropometric variables and gestational age at delivery. Data were analysed using SPSS v18. RESULTS: There were adverse associations of maternal blood Cd level with birthweight (unstandardized B coefficient −62.7 g, 95% CI −107.0, −18.4) and crown–heel length (−0.28 cm, 95% CI −0.48, −0.07) in adjusted regression models. On stratification by sex, maternal blood Cd level was adversely associated with birthweight (−87.1 g, 95% CI −144.8, −29.4), head circumference (−0.22 cm, 95% CI −0.39, −0.04), and crown–heel length (−0.44 cm, 95% CI −0.71, −0.18) in girls but not in boys in adjusted regression models. CONCLUSION: In these pregnant women with moderate prenatal Cd exposure there evidence of adverse associations with birth anthropometry variables in the whole group. However, there was evidence of associations with anthropometric variables in girls that were not evident in boys. Sex‐specific effects require further investigation in large cohorts as a possible contributor to the lack of associations generally found in mixed‐sex studies

The mental health of newly graduate doctors in Malta

Several studies have shown high rates of psychiatric morbidity in young doctors at various stages of their training (Paice, et al. 2002, Levine et al. 2006). Migration is also known to have an impact on emotional wellbeing (Bhugra 2004). Foreign doctors in Malta now make up over 30% of the junior doctor cohort. This is a new situation for trainers here.This study was carried out in part fulfillment of the requirements for the completion of Specialist Training in Psychiatry in Malta. This article focuses on the first part of the study: the quantitative analysis aimed to answer the following questions: 1. What are the rates of mental health problems amongst recently qualified doctors? 2. What are the factors associated with the increased rates of mental distress? Subjects and methods: A quantitative cross-sectional analysis was carried out by means of self-report questionnaire including demographic details and the General Health Questionnaire-28 (GHQ-28) (Goldberg 1972). This study was approved by the Health Ethics Committee (HEC23/12). Results: 117 (78.5%) of junior doctors participated in this study. 70.9% were Maltese. 49.4% were found to have GHQ-28 scores of more than 6, indicating significant psychological distress. Further analyses revealed that lack of leisure time (p<0.001), uncertainty (p=0.009), migration (p=0.03) and being female (p=0.04) were significantly related to caseness. Conclusion: As trainers and supervisors in medical education, it is important to be aware of the difficulties that young doctors face. These may include psychological distress, significant enough to reach caseness. Lack of leisure time seems to be an important factor which is possibly an area that can be easily tackled.peer-reviewe

Folic acid in pregnancy and mortality from cancer and cardiovascular disease : further follow-up of the Aberdeen folic acid supplementation trial

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. Acknowledgements The authors wish to acknowledge Professor Marion Hall, who set up the original randomised trial of folic acid supplementation. The authors also thank Ms Katie Wilde and the Data Management Team, University of Aberdeen, for their help with the extraction and linking of data and the data analysts from ISD Scotland.Peer reviewedPublisher PD